title: Prearrest signs of shock and respiratory insufficiency in out-of-hospital cardiac arrests witnessed by crew of the emergency medical service.
abstract: OBJECTIVE
  The objective of this study is to determine whether prearrest shock and respiratory insufficiency influence outcome in patients with emergency medical service-witnessed out-of-hospital cardiac arrest.
  
  
  METHODS
  Analysis of data from a cardiac arrest database and data from the ambulance charts was performed. For the purpose of the study, shock was defined as prearrest heart rate below 40 or above 140/min, systolic blood pressure as below 90 mm Hg, and respiratory insufficiency as respiratory rate above 36 or oxygen saturation below 90%. Adjusted odds ratios (ORs) with 95% confidence intervals (CIs) were calculated.
  
  
  RESULTS
  Of a total of 303 patients, 81% had prearrest shock or respiratory insufficiency. Mortality was higher in these patients indicated by fewer with return of spontaneous circulation (43% vs 75%, P < .001), and lower survival to hospital admission (31% vs 71%, P < .001) and to discharge (13% vs 59%, P < .001). Independent predictors of mortality were age (OR, 1.04; CI, 1.0-1.06), initial rhythm other than ventricular fibrillation or ventricular tachycardia (OR, 32.9; CI, 10.9-99.0), and respiratory insufficiency (OR, 4.2; CI, 1.4-12.5).
  
  
  CONCLUSIONS
  Shock and respiratory depression are common among patients with out-of-hospital cardiac arrest witnessed by the emergency medical service, and these patients have a high mortality when compared with patients without shock or respiratory failure.
authors: Department of Anaesthesiology and Intensive Care Medicine, Helsinki University Central Hospital, PO Box 340, FIN-00029 HUS, Finland. markus.skrifvars@helsinki.fi
authors: Markus B
authors: MB
authors: Skrifvars
authors: James
authors: J
authors: Boyd
authors: Markku
authors: M
authors: Kuisma
mesh_terms: D000368:Aged; D016887:Cardiopulmonary Resuscitation; D042241:Early Diagnosis; D004632:Emergency Medical Services; D005260:Female; D005387:Finland / Q000453:epidemiology; D006323:Heart Arrest / Q000175:diagnosis / Q000401:mortality*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012131:Respiratory Insufficiency / Q000453:epidemiology*; D012769:Shock / Q000453:epidemiology*; D015996:Survival Rate