Mattias Bergström1, Simon Schmidbauer2, Johan Herlitz3, Araz Rawshani4, Hans Friberg2. 1. Lund University, Skåne University Hospital, Department of Clinical Sciences, Intensive and Perioperative Care, Malmö, Sweden. Electronic address: matti_swe@hotmail.com. 2. Lund University, Skåne University Hospital, Department of Clinical Sciences, Intensive and Perioperative Care, Malmö, Sweden. 3. Faculty of Caring Science, Work Life and Social Welfare, Centre for Prehospital Research, University of Borås, Borås, Sweden. 4. Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
Abstract
OBJECTIVE: To describe the prevalence, baseline characteristics and factors associated with survival in out-of-hospital cardiac arrest (OHCA) with initial non-shockable rhythm sub-grouped into pulseless electrical activity (PEA) and asystole as presenting rhythm. METHODS: The Swedish Registry of Cardiopulmonary Resuscitation is a prospectively recorded nationwide registry of modified Utstein parameters, including all patients with attempted resuscitation after OHCA. Data between 1990-2016 were analyzed. RESULTS: After exclusions, the study population consisted of 48,707 patients presenting with either PEA or asystole. The proportion of PEA increased from 12% to 22% during the study period with a fivefold increase in 30-day survival reaching 4.9%. Survival in asystole showed a modest increase from 0.6% to 1.3%. In the multivariable analysis, PEA was independently associated with survival at 30 days (OR 1.54, 95% CI 1.26-1.88). CONCLUSION: Between 1990 and 2016, the proportion of PEA as the first recorded rhythm doubled with a five-fold increase in 30-day survival, while survival among patients with asystole remained at low levels. PEA and asystole should be considered separate entities in clinical decision-making and be reported separately in observational studies and clinical trials.
OBJECTIVE: To describe the prevalence, baseline characteristics and factors associated with survival in out-of-hospital cardiac arrest (OHCA) with initial non-shockable rhythm sub-grouped into pulseless electrical activity (PEA) and asystole as presenting rhythm. METHODS: The Swedish Registry of Cardiopulmonary Resuscitation is a prospectively recorded nationwide registry of modified Utstein parameters, including all patients with attempted resuscitation after OHCA. Data between 1990-2016 were analyzed. RESULTS: After exclusions, the study population consisted of 48,707 patients presenting with either PEA or asystole. The proportion of PEA increased from 12% to 22% during the study period with a fivefold increase in 30-day survival reaching 4.9%. Survival in asystole showed a modest increase from 0.6% to 1.3%. In the multivariable analysis, PEA was independently associated with survival at 30 days (OR 1.54, 95% CI 1.26-1.88). CONCLUSION: Between 1990 and 2016, the proportion of PEA as the first recorded rhythm doubled with a five-fold increase in 30-day survival, while survival among patients with asystole remained at low levels. PEA and asystole should be considered separate entities in clinical decision-making and be reported separately in observational studies and clinical trials.
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