Out-of-hospital cardiac arrest: Factors associated with survival

Roth, Ronald N.; Stewart, Ronald D.; Rogers, Kenneth D.; Cannon, Glenn M.

doi:10.1016/s0196-0644(84)80470-9

Cited by 241 publications

(49 citation statements)

References 9 publications

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“…Electrical defibrillation remains the mainstay of therapy, but the efficacy of electrical defibrillation decreases with increasing duration of ischemia. [1][2][3] Decreasing the delay to defibrillation by introduction of automated external defibrillators (AED) or other modifications improves survival from cardiac arrest in certain subsets of patients. 4,5 However, overall recovery from cardiac arrest outside the hospital remains low, perhaps because many applications of AEDs still occur beyond the time during which defibrillation is likely to be successful.…”

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confidence: 99%

Scaling Exponent Predicts Defibrillation Success for Out-of-Hospital Ventricular Fibrillation Cardiac Arrest

et al. 2001

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Background-Defibrillator shocks often fail to terminate ventricular fibrillation (VF) in out-of-hospital cardiac arrest (OOHCA), and repeated failed shocks can worsen the subsequent response to therapy. Because the VF waveform changes with increasing duration of VF, it is possible that ECG analyses could estimate the preshock likelihood of defibrillation success. This study examined whether an amplitude-independent measure of preshock VF waveform morphology predicts outcome after defibrillation. Methods and Results-Clinical data and ECG recordings from an automated external defibrillator were obtained for 75 subjects with OOHCA in a suburban community with police first responders and a paramedic-based emergency medical system. An estimate of the fractal self-similarity dimension, the scaling exponent, was calculated off-line for the VF waveform preceding shocks. Success of the first shock was determined from the recordings. Return of pulses and survival were determined by chart review. The first shock resulted in an organized rhythm in 43% of cases, and 17% of cases survived to hospital discharge. A lower mean value of the scaling exponent was observed for cases in which the first defibrillation resulted in an organized rhythm (Pϭ0.004), for cases with return of pulses (Pϭ0.049), and for cases surviving to hospital discharge (PϽ0.001). Receiver operator curves revealed the utility of the scaling exponent for predicting the probability of restoring an organized rhythm (area under the curveϭ0.70) and of survival (area under the curveϭ0.84). Conclusions-The VF waveform in OOHCA can be quantified with the scaling exponent, which predicts the probability of first-shock defibrillation and survival to hospital discharge.

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confidence: 99%

Scaling Exponent Predicts Defibrillation Success for Out-of-Hospital Ventricular Fibrillation Cardiac Arrest

et al. 2001

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“…Studies have analyzed a multitude of factors influencing the outcome of resuscitation. 11,12 For obvious reasons, the outcome after cardiac arrest as shown in our data does not adhere to the Utstein template. Therefore it should not be compared uncritically with other published data.…”

Section: Discussionmentioning

confidence: 76%

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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“…[11][12][13][14] The overwhelming majority of eventual survivors come from this group. [15][16][17][18] If the definitive treatment for these arrhythmias-defibrillation-can be implemented promptly a perfusing cardiac rhythm may be restored and lead to long term survival. The only interventions that have been shown unequivocally to improve long term survival are basic life support and defibrillation.…”

Section: Defibrillationmentioning

confidence: 99%