CARDIAC-ARREST PRESENTING WITH RHYTHMS OTHER THAN VENTRICULAR-FIBRILLATION - CONTRIBUTION OF RESUSCITATIVE EFFORTS TOWARD TOTAL SURVIVORSHIP

Objective: The medical Literature portrays a bleak prognosis for out-o f-hospital cardiac arrest cases presenting with asystole, idioventricu lar rhythms with pulselessness, or primary electromechanical dissociat ion. In view of evolving philosophies to waive resuscitation attempts in such cases, we sought to delineate the actual contribution toward o verall survivorship that is provided by resuscitation efforts for pati ents who have these electrocardiographic presentations. Design: A pros pective outcome study which analyzed all out-of-hospital cardiac arres t cases in a large city for a 2-yr period in terms of presenting elect rocardiogram, age, sex, presence and status of witnesses, performance of bystander cardiopulmonary resuscitation, and survival to successful hospital discharge. Setting: A large urban municipality (population, two million) served by a single, centralized emergency medical service s program. Patients: Excluding cases associated with trauma, drugs, ai rway obstruction, submersion or primary respiratory illness, 2,404 con secutive adult out-of-hospital cardiac arrest patients were studied. I nterventions: Standard advanced cardiac Life support. Measurements and Main Results: Although survival ''rates'' of patients with asystole, idioventricular rhythms with pulselessness, and electromechanical diss ociation were low (1.6%, 4.7% and 6.9%, respectively), 22.2% of the 19 3 total survivors (confidence interval: +5.9%) initially presented wit h one of these electrocardiographic rhythms (14 asystole, 18 idioventr icular rhythms with pulselessness, 10 electromechanical dissociation, plus one other). Conclusions: Despite poor survival ''rates,'' resusci tative efforts for patients presenting with asystole, electromechanica l dissociation, and idioventricular rhythms with pulselessness all con tribute significantly toward a community's total survivorship from out -of-hospital cardiac arrest. Initial, aggressive attempts at resuscita tion still should be emphasized in such patients.