Taneli Väyrynen1, Markku Kuisma, Teuvo Määttä, James Boyd. 1. Helsinki Emergency Medical Services (EMS), Department of Anaesthesiology and Intensive Care Medicine, Helsinki University Central Hospital, P.O. Box 112, FIN-00099 Helsingin Kaupunki, Finland. Taneli.vayrynen@hus.fi
Abstract
AIM OF THE STUDY: To study factors associated with short-term and long-term survival after out-of-hospital cardiac arrest presenting with pulseless electrical activity (PEA). MATERIALS AND METHODS: This was a retrospective observational study. All out-of-hospital cardiac arrests in Helsinki, Finland during 1 January 1997-31 December 2005 were prospectively registered in the cardiac arrest database. Of 3291 arrests 984 had PEA as the first registered rhythm. RESULTS: The use of adrenaline was the only factor associated with long-term survival, by increasing mortality. Increasing delay to the return of spontaneous circulation (ROSC) was the only factor associated with survival among patients that survived to admission, also by increasing mortality. There were no survivors that were discharged in overall performance category (OPC) 1-2 after a bystander-witnessed arrest (excluding cases of hypothermia and/or near-drowning) with first responding unit (FRU)-delay over 14 min, or that were resuscitated for more than 20 min. There were no survivors who were discharged in OPC 1-2 after an unwitnessed arrest with the duration of advanced life support (ALS) exceeding 5.5 min. CONCLUSIONS: The use of adrenaline during resuscitation was the only significant factor which was found to decrease the long-term survival. Among admitted patients, short delay to ROSC was the only factor associated with increased survival. Bystander-CPR and delays to the arrival of the FRU or to the initiation of ALS were not associated with survival. Therefore, it seems difficult to increase survival rates of PEA by improving the chain of survival. More effort should be put to education of the public to call for an ambulance before the cardiac arrest occurs.
AIM OF THE STUDY: To study factors associated with short-term and long-term survival after out-of-hospital cardiac arrest presenting with pulseless electrical activity (PEA). MATERIALS AND METHODS: This was a retrospective observational study. All out-of-hospital cardiac arrests in Helsinki, Finland during 1 January 1997-31 December 2005 were prospectively registered in the cardiac arrest database. Of 3291 arrests 984 had PEA as the first registered rhythm. RESULTS: The use of adrenaline was the only factor associated with long-term survival, by increasing mortality. Increasing delay to the return of spontaneous circulation (ROSC) was the only factor associated with survival among patients that survived to admission, also by increasing mortality. There were no survivors that were discharged in overall performance category (OPC) 1-2 after a bystander-witnessed arrest (excluding cases of hypothermia and/or near-drowning) with first responding unit (FRU)-delay over 14 min, or that were resuscitated for more than 20 min. There were no survivors who were discharged in OPC 1-2 after an unwitnessed arrest with the duration of advanced life support (ALS) exceeding 5.5 min. CONCLUSIONS: The use of adrenaline during resuscitation was the only significant factor which was found to decrease the long-term survival. Among admitted patients, short delay to ROSC was the only factor associated with increased survival. Bystander-CPR and delays to the arrival of the FRU or to the initiation of ALS were not associated with survival. Therefore, it seems difficult to increase survival rates of PEA by improving the chain of survival. More effort should be put to education of the public to call for an ambulance before the cardiac arrest occurs.
Authors: Jukka Vaahersalo; Pamela Hiltunen; Marjaana Tiainen; Tuomas Oksanen; Kirsi-Maija Kaukonen; Jouni Kurola; Esko Ruokonen; Jyrki Tenhunen; Tero Ala-Kokko; Vesa Lund; Matti Reinikainen; Outi Kiviniemi; Tom Silfvast; Markku Kuisma; Tero Varpula; Ville Pettilä Journal: Intensive Care Med Date: 2013-02-16 Impact factor: 17.440
Authors: Peter J Kudenchuk; Brian G Leroux; Mohamud Daya; Thomas Rea; Christian Vaillancourt; Laurie J Morrison; Clifton W Callaway; James Christenson; Joseph P Ornato; James V Dunford; Lynn Wittwer; Myron L Weisfeldt; Tom P Aufderheide; Gary M Vilke; Ahamed H Idris; Ian G Stiell; M Riccardo Colella; Tami Kayea; Debra Egan; Patrice Desvigne-Nickens; Pamela Gray; Randal Gray; Ron Straight; Paul Dorian Journal: Circulation Date: 2017-09-13 Impact factor: 29.690
Authors: Pamela Hiltunen; Markku Kuisma; Tom Silfvast; Juha Rutanen; Jukka Vaahersalo; Jouni Kurola Journal: Scand J Trauma Resusc Emerg Med Date: 2012-12-17 Impact factor: 2.953