Factors Predisposing to Survival After Resuscitation for Sudden Cardiac Arrest |
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Authors: | Santo Ricceri James W Salazar Andrew A Vu Eric Vittinghoff Ellen Moffatt Zian H Tseng |
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Institution: | 1. Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA;2. Department of Medicine, University of California-San Francisco, San Francisco, California, USA;3. Division of Cardiology, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA;4. Department of Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, California, USA;5. Office of Chief Medical Examiner, City and County of San Francisco, San Francisco, California, USA;6. Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California-San Francisco, San Francisco, California, USA |
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Abstract: | BackgroundIn the POST SCD study, the authors autopsied all World Health Organization (WHO)–defined sudden cardiac deaths (SCDs) and found that only 56% had an arrhythmic cause; resuscitated sudden cardiac arrests (SCAs) were excluded because they did not die suddenly. They hypothesized that causes underlying resuscitated SCAs would be similarly heterogeneous.ObjectivesThe aim of this study was to determine the causes and outcomes of resuscitated SCAs.MethodsThe authors identified all out-of-hospital cardiac arrests (OHCAs) from February 1, 2011, to January 1, 2015, of patients aged 18 to 90 years in San Francisco County. Resuscitated SCAs were OHCAs surviving to hospitalization and meeting WHO criteria for suddenness. Underlying cause was determined by comprehensive record review.ResultsThe authors identified 734 OHCAs over 48 months; 239 met SCA criteria, 133 (55.6%) were resuscitated to hospitalization, and 47 (19.7%) survived to discharge. Arrhythmic causes accounted for significantly more resuscitated SCAs overall (92 of 133, 69.1%), particularly among survivors (43 of 47, 91.5%), than WHO-defined SCDs in POST SCD (293 of 525, 55.8%; p < 0.004 for both). Among resuscitated SCAs, arrhythmic cause, ventricular tachycardia/fibrillation initial rhythm, and white race were independent predictors of survival. None of the resuscitated SCAs due to neurologic causes survived.ConclusionsIn this 4-year countywide study of OHCAs, only one-third were sudden, of which one-half were resuscitated to hospitalization and 1 in 5 survived to discharge. Arrhythmic cause predicted survival and nearly one-half of nonsurvivors had nonarrhythmic causes, suggesting that SCA survivors are not equivalent to SCDs. Early identification of nonarrhythmic SCAs, such as neurologic emergencies, may be a target to improve OHCA survival. |
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Keywords: | out of hospital cardiac arrest resuscitation sudden cardiac death CARES"} {"#name":"keyword" "$":{"id":"kwrd0030"} "$$":[{"#name":"text" "_":"Cardiac Arrest Registry to Enhance Survival EMS"} {"#name":"keyword" "$":{"id":"kwrd0040"} "$$":[{"#name":"text" "_":"emergency medical service OHCA"} {"#name":"keyword" "$":{"id":"kwrd0050"} "$$":[{"#name":"text" "_":"out-of-hospital cardiac arrest SCA"} {"#name":"keyword" "$":{"id":"kwrd0070"} "$$":[{"#name":"text" "_":"sudden cardiac arrest SCD"} {"#name":"keyword" "$":{"id":"kwrd0080"} "$$":[{"#name":"text" "_":"sudden cardiac death SSRI"} {"#name":"keyword" "$":{"id":"kwrd0090"} "$$":[{"#name":"text" "_":"selective serotonin reuptake inhibitor VT/VF"} {"#name":"keyword" "$":{"id":"kwrd0100"} "$$":[{"#name":"text" "_":"ventricular tachycardia/ventricular fibrillation WHO"} {"#name":"keyword" "$":{"id":"kwrd0110"} "$$":[{"#name":"text" "_":"World Health Organization |
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