title: Outcomes following out-of-hospital cardiac arrest with an initial cardiac rhythm of asystole or pulseless electrical activity in Victoria, Australia.
abstract: BACKGROUND
  While internationally reported survival from out-of-hospital cardiac arrest (OHCA) is improving, much of the increase is being observed in patients presenting to emergency medical services (EMS) in shockable rhythms. The purpose of this study was to assess survival and 12-month functional recovery in patients presenting to EMS in asystole or pulseless electrical activity (PEA).
  
  
  METHODS
  The Victorian Ambulance Cardiac Arrest Registry was searched for adult OHCA patients presenting in non-shockable rhythms in Victoria, Australia between 1st July 2003 and 30th June 2013. We excluded patients defibrillated prior to EMS arrival and arrests witnessed by EMS. Twelve-month quality-of-life interviews were conducted on survivors who arrested between 1st January 2010 and 31st December 2012. The main outcome measures were survival to hospital discharge and 12-month functional recovery measured by the Extended Glasgow Outcome Scale (GOSE).
  
  
  RESULTS
  A total of 38,378 non-shockable OHCA attended by EMS were included, of which 88.0% were asystole and 11.6% were PEA. Of the patients receiving resuscitation, survival to hospital discharge was 1.1% for asystole and 5.9% for PEA (p<0.001), with no significant improvement observed over the 10 year study period. In survivors with 12-month follow-up data, the combined rate of death, vegetative state or lower severe disability was 66.7% (95% CI 41.0-80.0%) for asystole and 44.7% (95% CI 30.2-59.9%) for PEA.
  
  
  CONCLUSIONS
  Survival outcomes following OHCA with initial rhythms of asystole or PEA did not improve over the 10-year study period. Our findings indicate high rates of death within 12 months, and unfavourable functional recovery for survivors.
authors.affiliation: Department of Research and Evaluation, Ambulance Victoria, Doncaster, Melbourne, VIC, Australia; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Prahran, Melbourne, VIC, Australia. Electronic address: Emily.Andrew@ambulance.vic.gov.au.
authors.forename: E
authors.initials: E
authors.lastname: Andrew
authors.affiliation: Department of Research and Evaluation, Ambulance Victoria, Doncaster, Melbourne, VIC, Australia; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Prahran, Melbourne, VIC, Australia.
authors.forename: Z
authors.initials: Z
authors.lastname: Nehme
authors.affiliation: Department of Research and Evaluation, Ambulance Victoria, Doncaster, Melbourne, VIC, Australia; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Prahran, Melbourne, VIC, Australia.
authors.forename: M
authors.initials: M
authors.lastname: Lijovic
authors.affiliation: Department of Research and Evaluation, Ambulance Victoria, Doncaster, Melbourne, VIC, Australia; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Prahran, Melbourne, VIC, Australia; Intensive Care Unit, Alfred Hospital, Prahran, Melbourne, VIC, Australia.
authors.forename: S
authors.initials: S
authors.lastname: Bernard
authors.affiliation: Department of Research and Evaluation, Ambulance Victoria, Doncaster, Melbourne, VIC, Australia; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Prahran, Melbourne, VIC, Australia; Discipline of Emergency Medicine, School of Primary, Aboriginal and Rural Health Care, University of Western Australia, Crawley, Perth, WA, Australia.
authors.forename: K
authors.initials: K
authors.lastname: Smith
mesh_terms: D000328:Adult; D000368:Aged; D016887:Cardiopulmonary Resuscitation / Q000379:methods* / Q000401:mortality; D015331:Cohort Studies; D004554:Electric Countershock / Q000379:methods / Q000401:mortality; D004562:Electrocardiography / Q000379:methods*; D004632:Emergency Medical Services / Q000379:methods; D005260:Female; D015600:Glasgow Coma Scale; D006323:Heart Arrest / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D058687:Out-of-Hospital Cardiac Arrest / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D017063:Outcome Assessment, Health Care; D011788:Quality of Life; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D017741:Survivors / Q000523:psychology / Q000706:statistics & numerical data*; D014693:Ventricular Fibrillation / Q000175:diagnosis / Q000453:epidemiology; D014739:Victoria
keywords: Cardiopulmonary resuscitation; Emergency medical services; Heart arrest; Outcome studies