Electromechanical dissociation: Diagnosis, pathophysiology, and management

Charlap, Shlomo; Kahlam, Sam; Lichstein, Edgar; Frishman, W.

doi:10.1016/0002-8703(89)90197-x

Cited by 18 publications

(2 citation statements)

References 45 publications

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“…It is known that ventricular fibrillation is the most common rhythm in cardiac arrest of cardiac origin, 9 whereas EMD/ PEA is associated with pulmonary embolism 10 and ruptured or dissecting aortic aneurysm with cardiac tamponade. 2 When looking for other factors influencing resuscitation such as age, sex, absence or presence of basic life support, location (in-hospital versus out-of-hospital) of cardiac arrest, as well as the times of no flow and low flow, we did not find significant differences between the two groups of patients when the presumed cause was later confirmed as being correct and patients with undetermined and erroneous presumed first diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Accuracy and Impact of Presumed Cause in Patients With Cardiac Arrest

et al. 1998

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Background-International guidelines recommend differentiation between cardiac and noncardiac causes of cardiac arrest.The aim of this study was to find the rate of agreement between primarily postulated and definitive causes of cardiac arrest. Methods and Results-We retrospectively analyzed the primarily presumed cause of cardiac arrest as determined by the emergency room physician on admission in all patients admitted to the emergency department of one urban tertiary care hospital. This was compared with the definitive cause as established by clinical evidence or autopsy. Within 4 years, the initially presumed cause was unclear in 24 (4%) of 593 patients. In the remaining 569 patients, the presumed cause was correct in 509 (89%) and wrong in 60 (11%) cases. Cardiac origin was presumed in 421 (71%) and the definitive cause in 408 (69%) cases. Noncardiac origin was presumed in 148 (25%) and the definitive cause in 185 (31%) patients. Presumed cardiac cause was sensitive (96%) but less specific (77%). Noncardiac causes such as pulmonary embolism, cerebral disorders, or exsanguination were those most frequently overlooked. Asystole occurred significantly more often in patients in whom presumed cause remained undetermined or differed from the definitive cause. Conclusions-Cause of cardiac arrest is not as easily recognized as anticipated, especially when the initial rhythm is different from ventricular fibrillation. This might affect comparability of study results, therapeutic strategies, prognosis, and outcome. Patients in whom the presumed cause was confirmed as being correct had significantly better survival and neurological outcome. (Circulation. 1998;98:766-771.)

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Section: Discussionmentioning

confidence: 99%

Accuracy and Impact of Presumed Cause in Patients With Cardiac Arrest

et al. 1998

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“… 7 Massive pulmonary embolism can lead to cardiac arrest in 41 % of patients, 1 , 2 with most patients presenting in the context of asystole or pulseless electrical activity (PEA). 1 , 8 – 10 Intriguingly, 4–10 % of all out-of-hospital cardiac arrests are due to subarachnoid hemorrhage; however, the pathophysiological mechanism remains unclear. 11 – 14 …”

Section: Introductionmentioning

confidence: 99%

Tissue Plasminogen Activator in Acute Cardiac Arrest

Acharya,

DeBoer,

Haas

2024

Journal of Community Hospital Internal Medicine Perspectives

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Tissue plasminogen activator (TPA) is indicated as an empiric therapy for refractory out-of-the-hospital cardiac arrest for suspected pulmonary embolism and myocardial infarction. Intracranial hemorrhage following TPA administration is a rare complication resulting in increased morbidity and mortality. A history of intracranial bleed, oral anticoagulant use prior to hospital admission, low body weight, and unstable hypertension with blood pressure above 180/110 mmHg at the time of presentation are associated with intracranial bleeding following tPA administration. Dedicated imaging including a Computed Tomography of the head without contrast, while feasible for patients presenting with acute stroke, is impractical in the setting of cardiac arrest. Here we report a case of 66 years old patient who presented in context of refractory cardiac arrest with recurrent PEAs with interval return of spontaneous circulation (ROSC) and was given tPA with eventual ROSC. He was subsequently found to have both a subarachnoid and intraventricular hemorrhage.

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