CPR-only survivors of out-of-hospital cardiac arrest: Implications for out-of-hospital care and cardiac arrest research methodology

Study objective: There is little evidence that cardiopulmonary resuscitation (CPR) alone may lead to the resuscitation of cardiac arrest victims with other than respiratory causes (eg, pediatric arrest, drowning, drug overdose). The objective of this study was to identify out-of-hospital cardiac arr...

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Bibliographic Details
Published in:Annals of emergency medicine 2001-06, Vol.37 (6), p.602-608
Main Authors: De Maio, Valerie J., Stiell, Ian G., Spaite, Daniel W., Ward, Roxanne E., Lyver, Marion B., Field, Brian J., Munkley, Douglas P., Wells, George A.
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Biological and medical sciences
Cardiopulmonary Resuscitation - methods
Cardiopulmonary Resuscitation - standards
Cohort Studies
Electric Countershock
Electrocardiography
Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care
Emergency Medical Services - methods
Emergency Medical Services - standards
Female
Health Services Research - methods
Health Services Research - standards
Heart Arrest - diagnosis
Heart Arrest - mortality
Heart Arrest - therapy
Humans
Intensive care medicine
Male
Medical sciences
Middle Aged
Ontario - epidemiology
Palpation
Survival Analysis
Survivors - statistics & numerical data
Time Factors
Treatment Outcome
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Summary:Study objective: There is little evidence that cardiopulmonary resuscitation (CPR) alone may lead to the resuscitation of cardiac arrest victims with other than respiratory causes (eg, pediatric arrest, drowning, drug overdose). The objective of this study was to identify out-of-hospital cardiac arrest survivors resuscitated without defibrillation or advanced cardiac life support. Methods: This observational cohort included all adult survivors of out-of-hospital cardiac arrest of a cardiac cause from phases I and II of the Ontario Prehospital Advanced Life Support Study. During the study period, the system provided a basic life support/defibrillation level of care but no advanced life support. CPR-only patients were patients determined to be without vital signs by EMS personnel who regained a palpable pulse in the field with precordial thump or CPR only and then were admitted alive to the hospital. Six members of a 7-member expert review panel had to rate the patient as either probably or definitely having an out-of-hospital cardiac arrest, and a rhythm strip consistent with a cardiac arrest rhythm had to be present to be considered a patient. Criteria considered were witness status, citizen or first responder CPR, CPR duration, arrest rhythm and rate, and performance of precordial thump. Results: From January 1, 1991, to June 30, 1997, 9,667 patients with out-of-hospital cardiac arrest were treated. The overall survival rate to hospital discharge was 4.6%. There were 97 apparent CPR-only patients admitted to the hospital. Application of the inclusion criteria yielded 24 CPR-only patients who had true out-of-hospital cardiac arrest and 73 patients judged not to have cardiac arrest. Of the 24 true CPR-only patients admitted to the hospital, 15 patients were discharged alive, 10 patients were witnessed by bystanders, and 7 patients were witnessed by EMS personnel. The initial arrest rhythm was pulseless electrical activity in 9 patients, asystole in 12 patients, and ventricular tachycardia in 3 patients. One patient with ventricular tachycardia converted to sinus tachycardia with a single precordial thump. Conclusion: CPR-only survivors of true out-of-hospital cardiac arrest do exist; some victims of out-of-hospital cardiac arrest of primary cardiac cause can survive after provision of out-of-hospital basic life support care only. However, many patients found to be pulseless by means of out-of-hospital evaluation likely did not have a true cardiac arrest. Th
ISSN:0196-0644
1097-6760
DOI:10.1067/mem.2001.114302