title: Aetiology of unsuccessful prehospital witnessed cardiac arrest of unclear origin.
abstract: OBJECTIVE
  To determine, by means of autopsy, the cause of death following unsuccessful cardiopulmonary resuscitation of patients with a witnessed prehospital cardiac arrest of unclear origin.
  
  
  METHODS
  Observational study of all prehospital-witnessed cardiac arrest of unclear origin over a period of 19 months in the emergency medical service region of a tertiary care hospital.
  
  
  RESULTS
  During the study period, 211 prehospital cardiopulmonary resuscitation attempts were recorded. In 144 study participants, cardiopulmonary resuscitation was not successful: there was no return of spontaneous circulation. Cardiac arrest of traumatic or other clear origin was not considered, nor were paediatric cases. Thirty out of the 114 remaining patients underwent an autopsy (26.3%). The main aetiology of cardiac arrest in this selected population was ischaemic heart disease in 16 out of 30 patients (53.3%) followed by pulmonary embolism in four patients (13.3%) and vascular disease other than coronary disease in two patients (6.7%). Other causes consisted of hypertrophic obstructive cardiomyopathy (one patient) (3.3%) and poisoning (one patient) (3.3%). The cause of death could not be identified in six cardiac arrest victims (20%).
  
  
  CONCLUSIONS
  Ischaemic heart disease and pulmonary embolism account for 66.6% of all witnessed cardiac arrest with no return of spontaneous circulation.
authors: Emergency Department, University Hospital Leuven, Leuven, Belgium. peter.vanbrabant@uz.kuleuven.ac.be
authors: Peter
authors: P
authors: Vanbrabant
authors: Erwin
authors: E
authors: Dhondt
authors: Petra
authors: P
authors: Billen
authors: Marc
authors: M
authors: Sabbe