Pulseless electrical activity is associated with improved survival in out-of-hospital cardiac arrest with initial non-shockable rhythm

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Pulseless electrical activity is associated with improved survival in out-of-hospital cardiac arrest with initial non-shockable rhythm. / Bergström, Mattias; Schmidbauer, Simon; Herlitz, Johan; Rawshani, Araz; Friberg, Hans.

I: Resuscitation, Vol. 133, 2018, s. 147-152.

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T1 - Pulseless electrical activity is associated with improved survival in out-of-hospital cardiac arrest with initial non-shockable rhythm

AU - Bergström, Mattias

AU - Schmidbauer, Simon

AU - Herlitz, Johan

AU - Rawshani, Araz

AU - Friberg, Hans

PY - 2018

Y1 - 2018

N2 - Objective: To describe the prevalence, baseline characteristics and factors associated with survival in out-of-hospital cardiac arrest (OHCA) with initial non-shockable rhythm sub-grouped into pulseless electrical activity (PEA) and asystole as presenting rhythm. Methods: The Swedish Registry of Cardiopulmonary Resuscitation is a prospectively recorded nationwide registry of modified Utstein parameters, including all patients with attempted resuscitation after OHCA. Data between 1990–2016 were analyzed. Results: After exclusions, the study population consisted of 48,707 patients presenting with either PEA or asystole. The proportion of PEA increased from 12% to 22% during the study period with a fivefold increase in 30-day survival reaching 4.9%. Survival in asystole showed a modest increase from 0.6% to 1.3%. In the multivariable analysis, PEA was independently associated with survival at 30 days (OR 1.54, 95% CI 1.26–1.88). Conclusion: Between 1990 and 2016, the proportion of PEA as the first recorded rhythm doubled with a five-fold increase in 30-day survival, while survival among patients with asystole remained at low levels. PEA and asystole should be considered separate entities in clinical decision-making and be reported separately in observational studies and clinical trials.

AB - Objective: To describe the prevalence, baseline characteristics and factors associated with survival in out-of-hospital cardiac arrest (OHCA) with initial non-shockable rhythm sub-grouped into pulseless electrical activity (PEA) and asystole as presenting rhythm. Methods: The Swedish Registry of Cardiopulmonary Resuscitation is a prospectively recorded nationwide registry of modified Utstein parameters, including all patients with attempted resuscitation after OHCA. Data between 1990–2016 were analyzed. Results: After exclusions, the study population consisted of 48,707 patients presenting with either PEA or asystole. The proportion of PEA increased from 12% to 22% during the study period with a fivefold increase in 30-day survival reaching 4.9%. Survival in asystole showed a modest increase from 0.6% to 1.3%. In the multivariable analysis, PEA was independently associated with survival at 30 days (OR 1.54, 95% CI 1.26–1.88). Conclusion: Between 1990 and 2016, the proportion of PEA as the first recorded rhythm doubled with a five-fold increase in 30-day survival, while survival among patients with asystole remained at low levels. PEA and asystole should be considered separate entities in clinical decision-making and be reported separately in observational studies and clinical trials.

KW - Asystole

KW - Cardiac arrest

KW - Non-shockable rhythm

KW - Out-of-hospital cardiac arrest

KW - Outcome

KW - Pulseless electrical activity

U2 - 10.1016/j.resuscitation.2018.10.018

DO - 10.1016/j.resuscitation.2018.10.018

M3 - Article

VL - 133

SP - 147

EP - 152

JO - Resuscitation

T2 - Resuscitation

JF - Resuscitation

SN - 1873-1570

ER -