Who survives from out-of-hospital pulseless electrical activity?

Väyrynen, Taneli; Kuisma, Markku; Määttä, Teuvo; Boyd, James

doi:10.1016/j.resuscitation.2007.07.023

Cited by 45 publications

(39 citation statements)

References 9 publications

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“…Compared with epinephrine alone, they observed those who received atropine in addition to epinephrine were less likely to survive to 30 days; they found no difference in ROSC and 30-day favourable neurological outcomes. Our findings are also comparable to a 2008 study of OHCA with PEA by Väyrynen et al 18. Among all epidemiological and clinical characteristics, they found that cardiac cause of arrest and defibrillation had positive correlations with survival, while epinephrine use had a negative correlation.…”

Section: Discussionsupporting

confidence: 91%

Utility of prehospital electrocardiogram characteristics as prognostic markers in out-of-hospital pulseless electrical activity arrests

Gatien

Vaillancourt

et al. 2017

Emerg Med J

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Section: Discussionsupporting

confidence: 91%

Utility of prehospital electrocardiogram characteristics as prognostic markers in out-of-hospital pulseless electrical activity arrests

Gatien

Vaillancourt

et al. 2017

Emerg Med J

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“…Animal models indicate that adrenaline administration significantly increases the probability of return of spontaneous circulation (ROSC) [8-11]. However, evidence in humans is limited, with most studies being observational studies with inconsistent results on short term outcomes including ROSC [5,12-18] and hospital admission [5,13,14,16,18-21]. In addition, inconsistent results were also found in long-term outcomes such as one-month survival with good cerebral performance [14,18] and survival to hospital discharge [5,14,16,18-20].…”

Section: Introductionmentioning

confidence: 99%

Effects of prehospital adrenaline administration on out-of-hospital cardiac arrest outcomes: a systematic review and meta-analysis

et al. 2014

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IntroductionThe aim of this study was to conduct a systematic review and meta-analysis for determining the effects of prehospital adrenaline administration on return of spontaneous circulation, hospital admission, survival to discharge and discharge with cerebral performance category 1 or 2 in out-of-hospital cardiac arrest patients.MethodsMEDLINE and Scopus databases were searched to identify studies reported to March 2014. Study selection and data extraction were independently completed by two reviewers (PA and SR). The baseline characteristics of each study and number of events were extracted. Risk ratios (RR) and 95% confidence interval (CI) were estimated. Heterogeneity and publication bias were also explored.ResultsIn total 15 studies were eligible and included in the study. Of 13 adult observational studies, four to eight studies were pooled for each outcome. These yielded a total sample size that ranged from 2,381 to 421,459. A random effects model suggested that patients receiving prehospital adrenaline were 2.89 times (95% CI: 2.36, 3.54) more likely to achieve prehospital return of spontaneous circulation than those not administered adrenaline. However, there were no significant effects on overall return of spontaneous circulation (RR = 0.93, 95% CI: 0.5, 1.74), admission (RR = 1.05, 95% CI: 0.80, 1.38) and survival to discharge (RR = 0.69, 95% CI: 0.48, 1.00).ConclusionsPrehospital adrenaline administration may increase prehospital return of spontaneous circulation, but it does not improve overall rates of return of spontaneous circulation, hospital admission and survival to discharge.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-014-0463-7) contains supplementary material, which is available to authorized users.

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“…18, 19, 20, 21 The comorbidities associated with non-shockable cardiac arrest, the lower treatment-responsiveness of the rhythms themselves, as well as the circumstances under which the OHCA occurs may all contribute to this poor outcome. For example, compared to patients presenting with an initial VF/VT rhythm in the main study, 8 patients in the current study were older, less likely to present with OHCA in a public setting, to be bystander-witnessed or receive bystander CPR, and had a longer interval from the incident call to EMS arrival, all factors associated with poor survival.…”

Section: Discussionmentioning

confidence: 99%

Antiarrhythmic Drugs for Nonshockable-Turned-Shockable Out-of-Hospital Cardiac Arrest

et al. 2017

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Background Out-of-hospital cardiac arrest (OHCA) commonly presents with non-shockable rhythms (asystole and pulseless electrical activity (PEA)). Whether antiarrhythmic drugs are safe and effective when these evolve to shockable rhythms (ventricular fibrillation/pulseless ventricular tachycardia (VF/VT)) during resuscitation is not known. Methods Adults with non-traumatic OHCA, vascular access and VF/VT anytime after ≥1 shock(s) were prospectively randomized, double-blind, to receive amiodarone, lidocaine or placebo by paramedics. Patients presenting with initial shock-refractory VF/VT were previously reported. The current study was a pre-specified analysis in a separate cohort who initially presented with non-shockable OHCA and were randomized upon subsequently developing shock-refractory VF/VT. The primary outcome was survival to hospital discharge; secondary outcomes included discharge functional status and adverse drug-related effects. Results Of 37,889 patients with OHCA, 3,026 with initial VF/VT and 1,063 with initial non-shockable-turned-shockable rhythms were treatment-eligible, randomized and received their assigned drug. Baseline characteristics among non-shockable-turned-shockable patients were balanced across treatment arms except that placebo recipients included fewer men and were less likely to receive bystander-CPR. Active-drug recipients in this cohort required fewer shocks, supplemental doses of their assigned drug and ancillary antiarrhythmic drugs than placebo-recipients (p<0.05). In all, 16 (4.1%) amiodarone, 11 (3.1%) lidocaine and 6 (1.9%) placebo-treated patients survived to hospital discharge (p=0.24). There was no significant interaction of treatment assignment and discharge survival with the initiating OHCA rhythm (asystole, PEA, or VF/VT); survival in each of these categories was consistently higher with active-drugs, though the trends were not statistically significant. Adjusted absolute differences (95% confidence interval) in survival from non-shockable-turned-shockable arrhythmias with amiodarone vs placebo were 2.3% (−0.3, 4.8), p=0.08 and for lidocaine vs placebo 1.2% (−1.1, 3.6), p=0.30. Over one-half of these survivors were functionally independent or required minimal assistance. Drug-related adverse effects were infrequent. Conclusions Outcome from non-shockable-turned-shockable OHCA is poor, but not invariably fatal. Though not statistically significant, point estimates for survival were greater after amiodarone or lidocaine than placebo, without increased risk of adverse effects or disability, and consistent with previously observed favorable trends from treatment of initial shock-refractory VF/VT with these drugs. Together the findings may signal a clinical benefit that invites further investigation.

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Who survives from out-of-hospital pulseless electrical activity?

Cited by 45 publications

References 9 publications

Utility of prehospital electrocardiogram characteristics as prognostic markers in out-of-hospital pulseless electrical activity arrests

Utility of prehospital electrocardiogram characteristics as prognostic markers in out-of-hospital pulseless electrical activity arrests

Effects of prehospital adrenaline administration on out-of-hospital cardiac arrest outcomes: a systematic review and meta-analysis

Antiarrhythmic Drugs for Nonshockable-Turned-Shockable Out-of-Hospital Cardiac Arrest

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