Skip to main content Accessibility help
×
Home
Hostname: page-component-544b6db54f-dkqnh Total loading time: 0.196 Render date: 2021-10-17T19:59:18.288Z Has data issue: true Feature Flags: { "shouldUseShareProductTool": true, "shouldUseHypothesis": true, "isUnsiloEnabled": true, "metricsAbstractViews": false, "figures": true, "newCiteModal": false, "newCitedByModal": true, "newEcommerce": true, "newUsageEvents": true }

Factors affecting survival after prehospital asystolic cardiac arrest in a Basic Life Support-Defibrillation system

Published online by Cambridge University Press:  21 May 2015

David A. Petrie*
Affiliation:
alifax Regional Municipality EMS Medical Control Physician Department of Emergency Medicine, Division of EMS, Dalhousie University, Halifax
Valerie De Maio
Affiliation:
Clinical Epidemiology Unit, Ottawa Health Research Institute, Ottawa
Ian G. Stiell
Affiliation:
Division of Emergency Medicine, Ottawa Health Research Institute, University of Ottawa, Ottawa
Jonathan Dreyer
Affiliation:
Division of Emergency Medicine, University of Western Ontario, London, Ont
Michael Martin
Affiliation:
Clinical Epidemiology Unit, Ottawa Health Research Institute, Ottawa
Jo-Anne O’Brien
Affiliation:
Clinical Epidemiology Unit, Ottawa Health Research Institute, Ottawa
*
Department of Emergency Medicine, 351 Bethune, VG Site, QEII Health Sciences Centre, 1278 Tower Rd., Halifax NS B3H 2Y9; fax 902 494-1625, dapetrie@is.dal.ca

Abstract

HTML view is not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Objectives:

Previous studies have shown a low but meaningful survival rate in cases of prehospital cardiac arrest with an initial rhythm of asystole. There may be, however, an identifiable subgroup in which resuscitation efforts are futile. This study identified potential field criteria for predicting 100% nonsurvival when the presenting rhythm is asystole in a Basic Life Support-Defibrillation (BLS-D) system.

Methods:

This prospective cohort study, a component of Phases I and II of the Ontario Prehospital Advanced Life Support (OPALS) Study, was conducted in 21 Ontario communities with BLS-D level of care, and included all adult arrests of presumed cardiac etiology according to the Utstein Style Guidelines. Analyses included descriptive and appropriate univariate tests, as well as multivariate stepwise logistic regression to determine predictors of survival.

Results:

From 1991 to 1997, 9899 consecutive cardiac arrest cases with the following characteristics: male (67.2%), bystander-witnessed (44.7%), bystander CPR (14.2%), call–response interval (CRI) ≤ 8 minutes (82%) and overall survival (4.3%) were enrolled. Of 9529 cases with available rhythm strip recordings, initial arrest rhythms were asystole in 40.8%, pulseless electrical activity in 21.2% and ventricular fibrillation or ventricular tachycardia in 38%. Of 3888 asystolic patients, 9 (0.2%) survived to discharge; 3 of these cases were unwitnessed arrests with no bystander CPR. There were no survivors if the CRI exceeded 8 minutes. Logistic regression analysis demonstrated that independent predictors of survival to admission were “CRI in minutes” (odds ratio [OR] = 0.87; 95% confidence interval [CI], 0.77–0.98) and “bystander-witnessed” (OR = 2.6; 95% CI, 1.5–4.4).

Conclusions:

In a BLS-D system, there is a very low but measurable survival rate for prehospital asystolic cardiac arrest. CRIs of over 8 minutes were associated with 100% nonsurvival, whereas unwitnessed arrests with no bystander CPR were not. These data add to the growing literature that will help guide ethical decision-making for protocol development in emergency medical services systems.

Type
EM Advances • Progrès de la MU
Copyright
Copyright © Canadian Association of Emergency Physicians 2001

References

1.Becker, LB.The epidemiology of sudden death. In: Paradis, NA, Halperin, HR, Nowack, RM, editors. Cardiac arrest: the science and practice of resuscitation medicine. Baltimore: Williams & Wilkins; 1996. p. 2847.Google Scholar
2.Gray, AJ, Redmond, AD, Martin, MA.Use of the automatic external defibrillator-pacemaker by ambulance personnel: the Stockport experience. BMJ 1987;294:11335.CrossRefGoogle ScholarPubMed
3.Eisenberg, M, Bergner, L, Hallstrom, A.Evaluation of paramedic programs using outcomes of pre-hospital resuscitation for cardiac arrest. J Am Coll Emerg Physicians 1979;8:45861.CrossRefGoogle Scholar
4.Nichol, G, Stiell, IG, Laupacis, A, Pham, B, De Maio, VJ, Wells, GA. A cumulative meta-analysis of the effectiveness of defibrillator-capable emergency medical services for victims of out-of-hospital cardiac arrest. Ann Emerg Med 1999;34:51725.CrossRefGoogle ScholarPubMed
5.Kuisma, M, Jaara, K.Unwitnessed out-of-hospital cardiac arrest: Is resuscitation worthwhile? Ann Emerg Med 1997;30:6975.CrossRefGoogle Scholar
6.Cummins, RO, Hazinski, MF.Resuscitations from pulseless electrical activity and asystole: How big a piece of the survivors’ pie? Ann Emerg Med 1998;32:4902.CrossRefGoogle ScholarPubMed
7.Gray, WA, Capone, RJ, Most, AS.Unsuccessful emergency medical resuscitation — Are continued efforts in the emergency department justified? N Engl J Med 1991;325:13938.CrossRefGoogle ScholarPubMed
8.van der Hoeven, JG, Waanders, H, Compier, EA, van der Weyden, PK, Meinders, AE.Prolonged resuscitation efforts for cardiac arrest patients who cannot be resuscitated at the scene: Who is likely to benefit? Ann Emerg Med 1993;22:165963.CrossRefGoogle Scholar
9.Kellerman, AL, Stoves, DR, Hackman, BB.In-hospital resuscitation following unsuccessful prehospital advanced cardiac life support: “heroic efforts” or an exercise in futility? Ann Emerg Med 1988;17:58994.CrossRefGoogle Scholar
10.Gray, WA.Prehospital resuscitation: the good, the bad, and the futile [editorial]. JAMA 1993;270:14712.CrossRefGoogle Scholar
11.Kellerman, AL, Hackman, BB, Somes, G.Predicting outcome of unsuccessful prehospital advanced cardiac life support. JAMA 1993;270:14336.CrossRefGoogle Scholar
12.Bonnin, MJ, Swor, RA.Outcomes in unsuccessful field resuscitation attempts. Ann Emerg Med 1989;18:50712.CrossRefGoogle ScholarPubMed
13.Saunders, CE, Heye, CJ.Ambulance collisions in an urban environment. Prehosp Disaster Med 1994;9:11824.CrossRefGoogle Scholar
14.Clawson, JJ, Martin, RL, Cady, GA, Maio, RF.The wake-effect — emergency vehicle-related collisions. Prehosp Disaster Med 1997;12:2747.CrossRefGoogle ScholarPubMed
15.Bonnin, MJ, Pepe, PE, Kimball, KT, Clark, PS Jr.Distinct criteria for termination of resuscitation in out-of-hospital setting. JAMA 1993;270:145762.CrossRefGoogle ScholarPubMed
16.Suchard, JR, Fenton, FR, Powers, RD.Medicare expenditures on unsuccessful out-of-hospital resuscitations. J Emerg Med 1999; 17:8015.CrossRefGoogle ScholarPubMed
17.Jaslow, D, Barbera, JA, Johnson, E, Moore, W.Termination of nontraumatic cardiac arrest resuscitative efforts in the field: a national survey. Acad Emerg Med 1997;4:9047.CrossRefGoogle ScholarPubMed
18.Sanders, AB.When are resuscitation attempts futile? Acad Emerg Med 1997;4:8523.CrossRefGoogle ScholarPubMed
19.Bailey, ED, Wydro, GC, Cone, DC.Termination of resuscitation in the prehospital setting for adult patients suffering nontraumatic cardiac arrest. National Association of EMS Physicians Standards and Clinical Practice Committee. Prehosp Emerg Care 2000;4:1905.Google Scholar
20.Stratton, SJ, Niemann, JT.Outcome from out-of-hospital cardiac arrest caused by nonventricular arrhythmias: contribution of successful resuscitation to overall survivorship supports the current practice of initiating out-of-hospital ACLS. Ann Emerg Med 1998;32:44853.CrossRefGoogle ScholarPubMed
21.Pepe, PE, Levine, RL, Fromm, RE Jr, Curka, PA, Clark, PS, Zachariah, BS.Cardiac arrest presenting with rhythms other than ventricular fibrillation: contribution of resuscitative efforts toward total survivorship. Crit Care Med 1993;21:183843.CrossRefGoogle ScholarPubMed
22.Ornato, JP, Peberdy, MA.The mystery of bradyasystole during cardiac arrest. Ann Emerg Med 1996;27:57687.CrossRefGoogle ScholarPubMed
23.Stiell, IG, Wells, GA, Spaite, DW, Lyver, MB, Munkley, DP, Field, BJ, et al. The Ontario Prehospital Advanced Life Support (OPALS) Study: rationale and methodology for cardiac arrest patients. Ann Emerg Med 1998;32:18090.CrossRefGoogle ScholarPubMed
24.Stiell, IG, Wells, GA, De Maio, VJ, Spaite, DW, Field, BJ III, Munkley, DP, et al. Modifiable factors associated with improved cardiac arrest survival in a multicenter basic life support/defibrillation system: OPALS Phase 1 results. Ann Emerg Med 1999; 33:4450.Google Scholar
25.Stiell, IG, Wells, GA, Field, BJ III, Spaite, DW, De Miao, VJ, Ward, R, et al. Improved out-of hospital cardiac arrest survival through the inexpensive optimization of an existing defibrillation program, OPALS Study Phase II. JAMA 1999;281:117581.CrossRefGoogle ScholarPubMed
26.Schneiderman, LJ, Jecker, NS, Jonsen, AR.Medical futility: its meaning and ethical implications. Ann Intern Med 1990; 112:2818.CrossRefGoogle ScholarPubMed
27.Youngner, SJ.Medical futility. Crit Care Clin 1996;12:16578.CrossRefGoogle ScholarPubMed
28.Marco, CA, Larkin, GL, Moskop, JC, Derse, AR.Determination of “futility” in emergency medicine. Ann Emerg Med 2000;35: 60412.CrossRefGoogle Scholar
29.Marco, CA, Bessman, ES, Schoenfeld, CN, Kelen, GD.Ethical issues of cardiopulmonary resuscitation: current practice among emergency physicians. Acad Emerg Med 1997;4:898903.CrossRefGoogle ScholarPubMed
30.Nichol, G, Stiell, IG, Hebert, P, Wells, GA, Vandemheen, K, Laupacis, A.What is the quality of life of survivors of out-of-hospital cardiac arrest? A prospective study. Acad Emerg Med 1999; 6:95102.CrossRefGoogle ScholarPubMed
31.Diem, SJ, Lantos, JD, Tulsky, JA.Cardiopulmonary resuscitation on television: miracles and misinformation. N Engl J Med 1996; 334:157882.CrossRefGoogle ScholarPubMed
32.Jones, GK, Brewer, KL, Garrison, HG.Public expectations of survival following cardiopulmonary resuscitation. Acad Emerg Med 2000; 7:4853.CrossRefGoogle ScholarPubMed
33.Delbridge, TR, Fosnocht, DE, Garrison, HG, Auble, TE.Field termination of unsuccessful out-of-hospital cardiac arrest resuscitation: acceptance by family members. Ann Emerg Med 1996; 27:64954.CrossRefGoogle ScholarPubMed
You have Access

Send article to Kindle

To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Factors affecting survival after prehospital asystolic cardiac arrest in a Basic Life Support-Defibrillation system
Available formats
×

Send article to Dropbox

To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

Factors affecting survival after prehospital asystolic cardiac arrest in a Basic Life Support-Defibrillation system
Available formats
×

Send article to Google Drive

To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

Factors affecting survival after prehospital asystolic cardiac arrest in a Basic Life Support-Defibrillation system
Available formats
×
×

Reply to: Submit a response

Please enter your response.

Your details

Please enter a valid email address.

Conflicting interests

Do you have any conflicting interests? *