Initial cardiac rhythm correlated to emergency department survival.
BACKGROUND
This study attempted to correlate the initial cardiac rhythm and survival from prehospital cardiac arrest, as a secondary end-point.


METHODS
Prospective, randomized, double-blinded clinical intervention trial where bicarbonate was administered to 874 prehospital cardiopulmonary arrest patients in prehospital urban, suburban, and rural emergency medical service environments.


RESULTS
This group's manifested an overall survival rate of 13.9% (110 of 793) of prehospital cardiac arrest patients. The most common presenting arrhythmia was ventricular fibrillation (VF) (45.0%), asystole (ASY) (34.4%), and pulseless electrical activity (PEA) (15.7%). Less commonly found were normal sinus rhythm (NSR) (1.8%), other (1.8%), ventricular tachycardia (VT) (0.6%), and atrioventricular block (AVB) (0.5%) as prearrest rhythms. The best survival was noted in those with a presenting rhythm of AVB (57.1%), VT (33.3%), VF (15.7%), NSR (14.3%), PEA (11.2%), and ASY (11.1%) (p = 0.02). However, there was no correlation between the final cardiac rhythm and outcome, other than an obvious end-of-life rhythm.


CONCLUSIONS
The most common presenting arrhythmia was VF (45%), while survival is greatest in those presenting with AVB (57.1%).
Critical Care Medicine Associates, Sewicley, PA 15143, U.S.A. Department of Emergency Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, U.S.A.
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