Outcome of resuscitation from bradyarrhythmic or asystolic prehospital cardiac arrest

Abstract

Previous studies of outcome as a function of the initial electrophysiologic mechanisms recorded at the scene of prehospital cardiac arrest have demonstrated that bradyarrhythmias and asystole have the worst prognosis. In this report, our observations in bradyarrhythmic and asystolic arrests occurring from 1980 to 1982 are compared with those from 1975 to 1978. From 1980 to 1982, 61 (27%) of 225 cardiac arrest events meeting entry criteria for the study were bradyarrhythmic or asystolic. Only 2 (8%) of 24 patients with asystole and 1 (20%) of 5 patients with sinus bradycardia survived prehospital intervention. Only 1 of these 29 patients was discharged from the hospital alive. In contrast, 15 (47%) of 32 patients who presented with idioventricular rhythm at initial contact survived prehospital intervention and were hospitalized, and 8 (25%) of these 32 were ultimately discharged alive. When compared with the 1975 to 1978 patients with bradyarrhythmia and asystole, both prehospital survival (8 versus 30%, p less than 0.001) and survival after hospitalization (0 versus 15%, p less than 0.05) significantly improved, but the improvement occurred predominantly in the subgroup with idioventricular rhythm. Survivors within this subgroup tended to have a prompt response to prehospital pharmacologic interventions that were not available to the 1975 to 1978 group. The response was manifested by return to a sinus mechanism or increase in the rate of idioventricular rhythm. In conclusion, outcome has improved for a specific subgroup of victims of prehospital cardiac arrest with bradyarrhythmia or asystole; the improved outcome may relate to field interventions by rescue personnel at the scene of arrest but the mortality rate is still high.

Cardiopulmonary resuscitation of older, inhospital patients: Immediate efficacy and long-term outcome

“…In comparison with younger patients, our elderly subjects were more frequently affected by pulseless electrical activity, which is commonly recognized to cause a poorer outcome (5,6,11,18). In the setting of acute myocardial infarction, which was the more common admission diagnosis, pulseless electrical activity is generally caused by rupture of the infarcted left ventricular free wall leading to cardiac tamponade, an event that is almost invariably fatal at any age (19) and is particularly frequent in the elderly (20).…”

“…I mmediate survival of inhospital and out-of-hospital victims of cardiocirculatory arrest (CA) receiving cardiopulmonary resuscitation (CPR) (1) is deemed satisfactory (2)(3)(4)(5)(6)(7)(8), and reasonably high longterm survival rates, with acceptable quality of life, have also been demonstrated (2,9).…”

Sudden Cardiac Death: Epidemiology, Causes, and Mechanisms

“…Only 9% of such patients were admitted to the hospi tal alive in the earlier study from Miami, Fla., and none were discharged [12]. These percentages improved in a later study, but the improvement was limited to patients who had idioventricular rhythm identified initially and chronotropic agents given at the scene [13]. The largest group of prehospital cardiac arrest victims (65-85%) have ven tricular fibrillation identified at initial con tact, and their outcome is intermediate between the ventricular tachycardia and bradyarrhythmic subgroups.…”

É Imperiosa a Indicação de Estudo Eletrofisiológico Invasivo em Pacientes Sobreviventes de Parada Cardíaca?

“…Em um levantamento de 225 casos de morte súbita publicado por Myerburg e cols. 13 , envolvendo indivíduos que receberam atendimento médico por ocasião da ocorrência do evento, foram observadas bradiarritmias, definidas por assistolia, bradicardia sinusal ou ritmo idioventricular, em 27% dos pacientes. Em portadores de insuficiência cardíaca congestiva severa esses índices são mais elevados.…”

“…Tais observações são relevantes quando se analisam os achados eletrocardiográficos em vítimas de morte súbita, considerados de acordo com o tempo de atendimento médico; quando o tempo decorrido entre a ocorrência do evento e a assistên-cia médica é inferior a 4min, a assistolia é encontrada em apenas 5% dos casos, atingindo 25% quando esse tempo é superior a 16min 5 . Essa constatação, em tese, contribui para justificar os baixos índices de sobrevida, quando a assistolia é o achado eletrocardiográfico em vítimas de morte súbi-ta, que não ultrapassam 15% 12,13 .…”