Abstract
This study attempted to correlate the initial cardiac rhythm and survival from prehospital cardiac arrest, as a secondary end-point. Prospective, randomized, double-blinded clinical intervention trial where bicarbonate was administered to 874 prehospital cardiopulmonary arrest patients in prehospital urban, suburban, and rural emergency medical service environments. This group's manifested an overall survival rate of 13.9% (110 of 793) of prehospital cardiac arrest patients. The most common presenting arrhythmia was ventricular fibrillation (VF) (45.0%), asystole (ASY) (34.4%), and pulseless electrical activity (PEA) (15.7%). Less commonly found were normal sinus rhythm (NSR) (1.8%), other (1.8%), ventricular tachycardia (VT) (0.6%), and atrioventricular block (AVB) (0.5%) as prearrest rhythms. The best survival was noted in those with a presenting rhythm of AVB (57.1%), VT (33.3%), VF (15.7%), NSR (14.3%), PEA (11.2%), and ASY (11.1%) (p = 0.02). However, there was no correlation between the final cardiac rhythm and outcome, other than an obvious end-of-life rhythm. The most common presenting arrhythmia was VF (45%), while survival is greatest in those presenting with AVB (57.1%).
Highlights
The US emergency medicine services (EMS) experience was reported by Crampton in 1975 noting a 26% decline in prehospital and 62% in-hospital mortality involving those who underwent ambulance transport, who were Ͻ70 years of age, noting a 66% success rate in prehospital cardiopulmonary resuscitation (CPR) measured as long-term survival under optimal circumstances.[1]Iseri reported experience with 26 primary cardiac arrest patients and rapid response paramedic units demonstrating optimal resuscitation in the ventricular fibrillation (VF) group (14) which was amenable to successful countershock therapy in 86% (12) resulting in survival in 43% (6).[2]
The best survival was noted in those with a presenting rhythm of atrioventricular block (AVB) (57.1%), ventricular tachycardia (VT) (33.3%), VF (15.7%), normal sinus rhythm (NSR) (14.3%), pulseless electrical activity (PEA) (11.2%), and ASY (11.1%) (p = 0.02)
The most common presenting arrhythmia was VF (45%), while survival is greatest in those presenting with AVB (57.1%)
Summary
Iseri reported experience with 26 primary cardiac arrest patients and rapid response paramedic units demonstrating optimal resuscitation in the ventricular fibrillation (VF) group (14) which was amenable to successful countershock therapy in 86% (12) resulting in survival in 43% (6).[2] They defined a poor outcome cohort, the brady-systolic cardiac arrest group, which was associated with autopsy proven coronary artery disease in 50% (7) of patients and was found to be universally fatal. They concluded that a more aggressive approach to prehospital management of brady-systolic arrests was warranted. This study attempted to correlate the initial cardiac rhythm and survival from prehospital cardiac arrest, as a secondary end-point
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