Rhythms and outcomes of adult in-hospital cardiac arrest.
OBJECTIVE
To determine the relationship of electrocardiographic rhythm during cardiac arrest with survival outcomes.


METHODS
Prospective, observational study.


METHODS
Total of 411 hospitals in the National Registry of Cardiopulmonary Resuscitation.


METHODS
Total of 51,919 adult patients with pulseless cardiac arrests from April 1999 to July 2005.


RESULTS
Registry data collected included first documented rhythm, patient demographics, pre-event data, event data, and survival and neurologic outcome data. Of 51,919 indexed cardiac arrests, first documented pulseless rhythm was ventricular tachycardia (VT) in 3810 (7%), ventricular fibrillation (VF) in 8718 (17%), pulseless electrical activity (PEA) in 19,262 (37%) and asystole 20,129 (39%). Subsequent VT/VF (that is, VT or VF occurring during resuscitation for PEA or asystole) occurred in 5154 (27%), with first documented rhythm of PEA and 4988 (25%) with asystole. Survival to hospital discharge rate was not different between those with first documented VF and VT (37% each, adjusted odds ratio [OR]) 1.08; 95% confidence interval [CI] 0.95-1.23). Survival to hospital discharge was slightly more likely after PEA than asystole (12% vs. 11%, adjusted OR 1.1; 95% CI 1.00-1.18), Survival to discharge was substantially more likely after first documented VT/VF than PEA/asystole (adjusted OR 1.68; 95% CI 1.55-1.82). Survival to discharge was also more likely after PEA/asystole without subsequent VT/VF compared with PEA/asystole with subsequent VT/VF (14% vs. 7% for PEA without vs. with subsequent VT/VF; 12% vs. 8% for asystole without vs. with subsequent VT/VF; adjusted OR 1.60; 95% CI, 1.44-1.80).


CONCLUSIONS
Survival to hospital discharge was substantially more likely when the first documented rhythm was shockable rather than nonshockable, and slightly more likely after PEA than asystole. Survival to hospital discharge was less likely following PEA/asystole with subsequent VT/VF compared to PEA/asystole without subsequent VT/VF.
Meaney
Peter A
PA
American Heart Association National Registry for Cardiopulmonary Resuscitation Investigators. Meaney@email.chop.edu
Nadkarni
Vinay M
VM
Kern
Karl B
KB
Indik
Julia H
JH
Halperin
Henry R
HR
Berg
Robert A
RA
D000368:Aged; D016887:Cardiopulmonary Resuscitation / Q000379:methods / Q000401:mortality; D004554:Electric Countershock / Q000379:methods / Q000401:mortality; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006323:Heart Arrest / Q000175:diagnosis* / Q000401:mortality* / Q000628:therapy; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data; D011446:Prospective Studies; D012042:Registries; D018570:Risk Assessment; D012720:Severity of Illness Index; D016019:Survival Analysis; D017741:Survivors; D017180:Tachycardia, Ventricular / Q000175:diagnosis* / Q000401:mortality; D016896:Treatment Outcome; D014693:Ventricular Fibrillation / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy