Prehospital Ventricular Defibrillation

The subsequent course of 301 subjects with prehospital ventricular fibrillation detected by rescue units was analyzed. Defibrillation was successful in 199. Of these patients, 98 died before admission; of 101 who were hospitalized, 59 died in the hospital, and 42 were discharged alive. Initially rapid post-defibrillation heart rates and atrial fibrillation or sinus tachycardia were associated with good survival in contrast to slow rates and idioventricular or junctional rhythms. Among hospitalized patients ventricular fibrillation or ventricular tachycardia recurred in 57 per cent and in most within 24 hours. Acute myocardial infarction was diagnosed in 35 per cent, and ischemia alone (predominantly of the anterior wall) in 32 per cent. In 17 per cent no acute myocardial changes evolved. Congestive heart failure occurred in 63 per cent, cardiogenic shock in 25 per cent, and pulmonary complications in 42 per cent. Of the 42 who were discharged, 60 per cent returned to pre-arrest status; 28 per cent had mild, and 12 per cent had severe neurologic deficit. Of hospital deaths, 40 per cent were within one day, and 75 per cent within one week. Mean survival for discharged patients was 12.7 months. Regardless of arrhythmia prophylaxis, 28 per cent died suddenly after discharge. (N Engl J Med 291:317–321, 1974)