title: Pulseless electrical activity and unsuccessful out-of-hospital resuscitation: what is the cause of death?
abstract: OBJECTIVE
  To study the cause of deaths after witnessed cardiac arrest followed by pulseless electrical activity and unsuccessful of out-of-hospital resuscitation; and to detect any differences between causes of death determined at autopsy and those inferred from clinical history.
  
  
  METHODS
  In this prospective observational study, data were collected from 91 individuals treated by the emergency medical services in three urban communities in southern Finland.
  
  
  RESULTS
  Cause of death was determined at autopsy in 59 cases and without autopsy in 32 cases. There were significantly more diagnoses of acute myocardial infarction and fewer of pulmonary embolism and aortic dissection and rupture among cases without autopsy compared with those followed by autopsy.
  
  
  CONCLUSIONS
  In unsuccessful resuscitation from out-of-hospital cardiac arrest with pulseless electrical activity as initial rhythm, an autopsy should be performed to determine the correct cause of death.
authors.affiliation: Tampere University Hospital, Department of Surgery and Anaesthesiology, PO Box 2000, FIN-33521 Tampere, Finland. ilkka.virkkunen@uta.fi
authors.forename: Ilkka
authors.initials: I
authors.lastname: Virkkunen
authors.forename: Laura
authors.initials: L
authors.lastname: Paasio
authors.forename: Sanna
authors.initials: S
authors.lastname: Ryynänen
authors.forename: Arno
authors.initials: A
authors.lastname: Vuori
authors.forename: Antti
authors.initials: A
authors.lastname: Sajantila
authors.forename: Arvi
authors.initials: A
authors.lastname: Yli-Hankala
authors.forename: Tom
authors.initials: T
authors.lastname: Silfvast
mesh_terms: D000368:Aged; D001344:Autopsy; D016887:Cardiopulmonary Resuscitation; D002423:Cause of Death; D022062:Electrophysiologic Techniques, Cardiac / Q000401:mortality*; D004632:Emergency Medical Services; D005260:Female; D005387:Finland / Q000453:epidemiology; D006323:Heart Arrest / Q000401:mortality* / Q000628:therapy*; D006801:Humans; D008297:Male; D011674:Pulse / Q000401:mortality*; D017211:Treatment Failure