Arrhythmic causes accounted for 69.1% of resuscitated sudden cardiac arrests and strongly predicted survival to discharge, being present in 91.5% of survivors.
Observational (n=734)
No
Arrhythmic causes strongly predict survival in resuscitated sudden cardiac arrest, whereas nonarrhythmic causes (like neurologic emergencies) have poor outcomes, indicating SCA survivors differ etiologically from sudden cardiac deaths.
p-value: p=<0.004
BACKGROUND In the POST SCD study, the authors autopsied all World Health Organization (WHO)-defined sudden cardiac deaths (SCDs) and found that only 56% had an arrhythmic cause; resuscitated sudden cardiac arrests (SCAs) were excluded because they did not die suddenly. They hypothesized that causes underlying resuscitated SCAs would be similarly heterogeneous. OBJECTIVES The aim of this study was to determine the causes and outcomes of resuscitated SCAs. METHODS The authors identified all out-of-hospital cardiac arrests (OHCAs) from February 1, 2011, to January 1, 2015, of patients aged 18 to 90 years in San Francisco County. Resuscitated SCAs were OHCAs surviving to hospitalization and meeting WHO criteria for suddenness. Underlying cause was determined by comprehensive record review. RESULTS The authors identified 734 OHCAs over 48 months; 239 met SCA criteria, 133 (55.6%) were resuscitated to hospitalization, and 47 (19.7%) survived to discharge. Arrhythmic causes accounted for significantly more resuscitated SCAs overall (92 of 133, 69.1%), particularly among survivors (43 of 47, 91.5%), than WHO-defined SCDs in POST SCD (293 of 525, 55.8%; p < 0.004 for both). Among resuscitated SCAs, arrhythmic cause, ventricular tachycardia/fibrillation initial rhythm, and white race were independent predictors of survival. None of the resuscitated SCAs due to neurologic causes survived. CONCLUSIONS In this 4-year countywide study of OHCAs, only one-third were sudden, of which one-half were resuscitated to hospitalization and 1 in 5 survived to discharge. Arrhythmic cause predicted survival and nearly one-half of nonsurvivors had nonarrhythmic causes, suggesting that SCA survivors are not equivalent to SCDs. Early identification of nonarrhythmic SCAs, such as neurologic emergencies, may be a target to improve OHCA survival.
“The more of those features you have, the worse the outcome is, and those features have different weights—not all of them have the same significance.”
Ricceri et al. (Sat,) conducted a observational in Out-of-hospital cardiac arrest (n=734). Arrhythmic causes accounted for 69.1% of resuscitated sudden cardiac arrests and strongly predicted survival to discharge, being present in 91.5% of survivors.