Evaluation of the outcome of patients hospitalised after pre-hospital cardiac arrest

The aim of this study was to assess management of patients resuscitated aft er pre-hospital cardiac arrest, initially indicated to preserve neurologica l status, the aetiological investigation only being undertaken when the out come is favourable. Eighty-nine pre-hospital cardiac arrests were analysed retrospectively. The hospital survival was 16%, death being due to neurological lesions (55% ), uncontrollable haemodynamic instability -39%) or other causes (7%). One year after the initial episode, none of the survivors had died, all living autonomously without (8 patients) or with minimal neurological sequellae (5 patients). These results are concordant with reports in the literature. The 11 cases of cardiac arrest with a favourable outcome of presumed cardia c origin underwent coronary angiography (6 cases) or endocavitary electroph ysiological investigation (8 cases). These investigations showed or suggest ed an ischaemic process in 4 cases, an arrhythmia in 6 cases and severe val vular heart disease in I case. The independant predictive factors of survival were a Glasgow score of 6 or more on admission, the persistence of a light reflex and benign EEG appear ances according to Synek's classification. The authors conclude that these results are comparable to those reported in the literature with aetiological investigations reserved for cases of favo urable neurological outcome. The investigations including coronary angiogra phy and electrophysiological investigation are essential as shown by the di versity of the cardiac pathologies identified.