SURVIVAL AMONG PATIENTS WITH OUT-OF-HOSPITAL CARDIAC-ARREST FOUND IN ELECTROMECHANICAL DISSOCIATION

Background: Many patients who suffer an out-of-hospital cardiac arrest are found in electromechanical dissociation at the time the Emergency Medical Service (EMS) arrives. Since they have a poor prognosis, less attention has been paid to them. Aim: To describe a consecutive popul ation of patients with out-of-hospital cardiac arrest found in electro mechanical dissociation and to try to define indicators for an increas ed chance of survival in this patient population. Setting: The municip ality of Goteborg. Patients: All the patients who suffered an out-of-h ospital cardiac arrest between 1981-1992 and were reached by our EMS s ystem and in whom cardiopulmonary resuscitation (CPR) was attempted. R esults: In all, there were 3434 patients with cardiac arrest of whom 7 48 (22%) were found in electromechanical dissociation. They differed f rom patients found in ventricular fibrillation as there were more wome n, a higher frequency of cardiac arrest during the night, a lower freq uency of witnessed cardiac arrest and consequently a lower frequency o f bystander-initiated CPR. In all, 96 patients (13%) were hospitalized alive and only 16(2%) could be discharged from hospital. In a multiva riate analysis relating to age, sex, time of cardiac arrest, interval between collapse and the arrival of the first ambulance, bystander-ini tiated CPR and treatment with adrenaline, atropine and tribonate, no i ndependent predictor of survival was found. Conclusion: Of all the pat ients with out-of-hospital cardiac arrest in whom CPR was attempted by our EMS, 22% were found in electromechanical dissociation. Of these, 13% were hospitalized alive and 2% could be discharged from hospital. No independent predictor of an increased chance of survival was found.