Does appropriate treatment of the primary underlying cause of PEA during resuscitation improve patients' survival?
OBJECTIVE
We aimed to document how often patients received appropriate treatment of the primary cause underlying pulseless electrical activity (PEA) during cardiopulmonary resuscitation (CPR) and how it affected their outcome.


METHODS
Data were collected between 2003 and 2010 in Finland and Sweden. All adult patients who underwent in-hospital cardiac arrest (IHCA) with PEA as the initial rhythm were included, if CPR was attempted. Patients were divided into two groups: those who received appropriate treatment of the primary cause during CPR (treatment of the primary cause group) and those who received conventional CPR (non-specific treatment group). Survival between groups was compared and a multivariable logistic regression analysis was performed to exclude the effect of possible confounders.


RESULTS
Of 104 study patients, 19 (18%) received treatment of the primary cause and 85 (82%) received non-specific treatment. 30-Days survival of patients in treatment of primary cause group was superior compared to patients in the non-specific treatment group: 6 (32%) vs. 9 (11%) were alive 30 days after IHCA, p=0.03. Multivariable analysis suggested that treatment of the primary cause improves the odds of survival 2.5-fold, but this was not statistically significant. Age was the only significant independent prognostic factor for 30-days survival.


CONCLUSIONS
During CPR, only a fifth of patients received appropriate treatment of the primary cause underlying PEA. Those patients were more likely to be alive 30 days after IHCA, but age turned out to be the only significant individual factor for better survival.
Department of Anaesthesia and Intensive Care, Helsinki University Central Hospital, Hyvinkää Hospital, Sairaalankatu 1, 05850 Hyvinkää, Finland. sini.saarinen@hus.fi
Sini
S
Saarinen
Jouni
J
Nurmi
Tuukka
T
Toivio
David
D
Fredman
Ilkka
I
Virkkunen
Maaret
M
Castrén
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016887:Cardiopulmonary Resuscitation / Q000379:methods* / Q000401:mortality; D004554:Electric Countershock; D004632:Emergency Medical Services; D005260:Female; D005387:Finland; D006323:Heart Arrest / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016019:Survival Analysis; D013548:Sweden; D016896:Treatment Outcome; D014693:Ventricular Fibrillation / Q000150:complications / Q000401:mortality / Q000628:therapy*