Factors associated with out-of-hospital cardiac arrest with pulseless electric activity: A population-based study.
BACKGROUND
Many patients with out-of-hospital cardiac arrest present with pulseless electric activity (PEA) rather than shockable rhythm. Despite improvements in resuscitation care, survival of PEA patients remains dismal. Our main objective was to characterize out-of-hospital cardiac arrest patients by initial presenting rhythm and to evaluate independent determinants of PEA.


METHODS
A population-based study was conducted using the Toronto Rescu Epistry database with linkage to administrative data in Ontario, Canada. We included patients older than 20 years who had nontraumatic cardiac arrests from 2005 to 2010. Multivariable logistic regression models were constructed to determine factors predicting the occurrence of PEA vs shockable rhythm vs asystole.


RESULTS
Of the 9,882 included patients who received treatment, 24.5% had PEA, 26.3% had shockable rhythm, and 49.2% had asystole. Patients with PEA had a mean age of 72 years, 41.2% were female and had multiple comorbidities, and 53.4% were hospitalized in the past year. As compared with shockable rhythm, PEA patients were older, were more likely to be women, and had more comorbidities. As compared with asystole, PEA patients had similar baseline and clinical characteristics, but were substantially more likely to have an arrest witnessed by emergency medical services (odds ratio 13) or by bystander (odds ratio 3.24). Mortality at 30 days was 95.5%, 77.9%, and 98.9% for patients with PEA, shockable rhythm, asystole, respectively.


CONCLUSIONS
Patient characteristics differed substantially in those presenting with PEA and shockable rhythm. In contrast, the main distinguishing factor between PEA and asystole cardiac arrest related mainly to factors at the time of the cardiac arrest.
Institute of Clinical Evaluative Sciences, Toronto, ON, Canada; Schulich Heart Centre, Toronto, ON, Canada; Department of Medicine, University of Toronto, Toronto, ON, Canada. Electronic address: dennis.ko@ices.on.ca.
Dennis T
DT
Ko
Institute of Clinical Evaluative Sciences, Toronto, ON, Canada.
Feng
F
Qiu
Institute of Clinical Evaluative Sciences, Toronto, ON, Canada.
Maria
M
Koh
Department of Medicine, University of Toronto, Toronto, ON, Canada; Sunnybrook Health Sciences Centre; Rescu Keenan Research Centre, Li Ka Shing Knowledge Institute at St Michael's Hospital, Toronto, ON, Canada.
Paul
P
Dorian
Department of Medicine, University of Toronto, Toronto, ON, Canada; Sunnybrook Health Sciences Centre; Rescu Keenan Research Centre, Li Ka Shing Knowledge Institute at St Michael's Hospital, Toronto, ON, Canada; Sunnybrook Centre for Prehospital Medicine, Toronto, ON, Canada.
Sheldon
S
Cheskes
Institute of Clinical Evaluative Sciences, Toronto, ON, Canada.
Peter C
PC
Austin
Institute of Clinical Evaluative Sciences, Toronto, ON, Canada; Department of Medicine, University of Toronto, Toronto, ON, Canada; Department of Critical Care Medicine, Toronto, ON, Canada.
Damon C
DC
Scales
Institute of Clinical Evaluative Sciences, Toronto, ON, Canada; Schulich Heart Centre, Toronto, ON, Canada; Department of Medicine, University of Toronto, Toronto, ON, Canada.
Harindra C
HC
Wijeysundera
Sunnybrook Centre for Prehospital Medicine, Toronto, ON, Canada; Sunnybrook Health Sciences Centre; Rescu Keenan Research Centre, Li Ka Shing Knowledge Institute at St Michael's Hospital, Toronto, ON, Canada.
P Richard
PR
Verbeek
Sunnybrook Health Sciences Centre; Rescu Keenan Research Centre, Li Ka Shing Knowledge Institute at St Michael's Hospital, Toronto, ON, Canada.
Ian
I
Drennan
Institute of Clinical Evaluative Sciences, Toronto, ON, Canada.
Tiffany
T
Ng
Institute of Clinical Evaluative Sciences, Toronto, ON, Canada; Schulich Heart Centre, Toronto, ON, Canada; Department of Medicine, University of Toronto, Toronto, ON, Canada.
Jack V
JV
Tu
Sunnybrook Health Sciences Centre; Rescu Keenan Research Centre, Li Ka Shing Knowledge Institute at St Michael's Hospital, Toronto, ON, Canada.
Laurie J
LJ
Morrison
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001145:Arrhythmias, Cardiac / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy; D016887:Cardiopulmonary Resuscitation; D016022:Case-Control Studies; D016208:Databases, Factual; D004554:Electric Countershock; D004632:Emergency Medical Services; D005260:Female; D006323:Heart Arrest / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D009864:Ontario / Q000453:epidemiology; D058687:Out-of-Hospital Cardiac Arrest / Q000453:epidemiology / Q000503:physiopathology* / Q000628:therapy; D012737:Sex Factors; D017180:Tachycardia, Ventricular / Q000453:epidemiology / Q000503:physiopathology* / Q000628:therapy; D016896:Treatment Outcome; D014693:Ventricular Fibrillation / Q000453:epidemiology / Q000503:physiopathology* / Q000628:therapy