Can we define patients with no and those with some chance of survival whenfound in asystole out of hospital?

We describe the epidemiology, prognosis, and circumstances at resuscitation among a consecutive population of patients with our-of-hospital cardiac ar rest (OHCA) with asystole as the arrhythmia first recorded by the Emergency Medical Service (EMS), and identify factors associated with survival. We i ncluded all patients in the municipality of Goteborg, regardless of age and etiology, who experienced on OHCA between 1981 and 1997. There were a tota l of 4,662 cardiac arrests attended by the EMS during the study period. Of these, 1,635 (35%) were judged as having asystole as the first-recorded arr hythmia: 156 of these patients (10%) were admitted olive to hospital, and 3 2 (2%) were discharged olive. Survivors were younger (median age 58 vs 68 y ears) and held a witnessed cardiac arrest more often than nonsurvivors (78% vs 50%). Survivors also had shorter intervals from collapse to arrival of ambulance (3.5 vs 6 minutes) and the mobile coronary care unit (MCCU) (5 vs 10 min), and they received atropine less often on scene. There were also a greater proportion of survivors with noncardiac etiologies of cardiac arre st (48% vs 27%). Survivors to discharge also displayed higher degrees of co nsciousness on arrival to the emergency department in comparison to nonsurv ivors. Multivariate analysis among oil patients with asystole indicated age (p = 0.01) and witnessed arrest (p = 0.03) as independent predictors of an increased chance of survival, Multivariate analysis among witnessed arrest s indicated short time to arrival of the MCCU (p <0.001) and no treatment w ith atropine (p = 0.05) as independent predictors of survival, Fifty-five p ercent of patients discharged olive had none or smell neurologic deficits ( cerebral performance categories 1 or 2). No patients >70 years old with unw itnessed arrests (n = 211) survived to discharge, (C) 2000 by Excerpta Medi ca, Inc.