Seizure-like presentation in OHCA creates barriers to dispatch recognition of cardiac arrest

Abstract

Purpose: Early recognition of out-of-hospital cardiac arrest (OHCA) by 9-1-1 dispatchers is a critical first step along the resuscitation pathway. Barriers to recognition may lead to adverse outcomes among patients. This study aims to determine the impact of seizure-like activity among OHCA patients during 9-1-1 calls. Methods: We evaluated a retrospective cohort study of all adult, non-traumatic OHCAs that occurred prior to emergency medical services (EMS) arrival on scene in a major metropolitan area from 2014À2018. Dispatch recordings were reviewed to determine if seizure-like activity was reported by the caller using key descriptor phrases such as "seizing," "shaking," or "convulsing." We compared patient demographics, arrest factors, and hospital outcomes using a regional OHCA quality improvement database. Results: Among 3502 OHCAs meeting our inclusion criteria, 149 (4.3%) contained seizure-like activity. When compared to patients without seizure-like activity (3353; 95.7%), patients presenting with seizure-like activity were younger (54 vs. 66 years old; p < 0.05), had a witnessed arrest (88% vs 45%; p < 0.05), presented with an initial shockable rhythm (52% vs. 24%; p < 0.05), and survived to hospital discharge (44% vs. 16%; p < 0.05). The seizurelike activity group also had a longer median time to dispatcher identification of the cardiac arrest [130 s (72,193) vs 62 s (43,102); p < 0.05]. Conclusions: Reported seizure-like activity among patients in cardiac arrest poses a barrier to recognition of cardiac arrests by dispatchers leading to delays in resuscitation instructions.

European Resuscitation Council Guidelines 2021: Basic Life Support

“…25,27 A recent observational study including 3502 OHCAs identified 149 (4.3%) victims with seizure-like activity. 28 Patients presenting with seizurelike activity were younger (54 vs. 66 years old; p < 0.05), were more likely to have a witnessed arrest (88% vs. 45%; p < 0.05), more likely to present with an initial shockable rhythm (52% vs. 24%; p < 0.05), and more likely to survive to hospital discharge (44% vs. 16%; p < 0.05). Similar to agonal respiration, seizures complicate the recognition of cardiac arrest for both lay people and professionals (median time to dispatcher identification of the cardiac arrest; 130 s vs. 62 s; p < 0.05).…”

“…Similar to agonal respiration, seizures complicate the recognition of cardiac arrest for both lay people and professionals (median time to dispatcher identification of the cardiac arrest; 130 s vs. 62 s; p < 0.05). 28 Recognising cardiac arrest after a seizure episode when the victim remains unresponsive with abnormal breathing is important to prevent delayed CPR. The risk of delaying CPR for a cardiac arrest victim far outweighs any risk from performing CPR on a person not in cardiac arrest.…”

Unrecognized Out of Hospital Cardiac Arrest Symptoms during Thailand’s Emergency Medical Services

“…The main obstacle of recognizing OHCA was the difficulty of determining the patient's respiratory status for bystanders [12]. Another important reported symptom of cardiac arrest in our study was seizure-like activity, which may mislead the call handler from recognizing cardiac arrest to epilepsy as in the study of Vaillancourt et al [5], [13].…”

Basismaßnahmen zur Wiederbelebung Erwachsener (Basic Life Support)

“…In einer jüngeren Beobachtungsstudie konnten 3502 Patienten registriert werden, die außerhalb eines Krankenhauses/präklinisch einen Kreislaufstillstand erlitten hatten und krampfähnliche Bewegungen gezeigt hatten (OHCA). 4,3 % ( n = 149) zeigten krampfähnliche Aktivitäten [ 31 ]. Diese Patienten waren jünger (54 vs. 66 Jahre, p < 0,05), hatten häufiger einen beobachteten Kreislaufstillstand (88 vs. 45 %, p < 0,005), wurden eher in einem defibrillierbaren Rhythmus angetroffen (52 vs. 24 %, p > 0,05 und überlebten öfter bis zur Entlassung aus dem Krankenhaus (44 vs. 16 %).…”

“…Ähnlich wie bei der Schnappatmung führten krampfähnliche Episoden bei einem nicht reagierenden, nicht normal atmenden Patienten zu Problemen beim Erkennen des Kreislaufstillstands durch Laien/Notfallzeugen und Leitstellendisponenten. (Mittlere Zeit bis zur Wahrnehmung des Kreislaufstillstands durch den Leitstellendisponenten (130 s vs. 62 s, p > 0,05) [ 31 ].…”