Factors affecting short- and long-term prognosis among 1069 patients with out-of-hospital cardiac arrest and pulseless electrical activity

Aims: To describe the epidemiology, resuscitation factors and prognosis amo ng a consecutive population of patients suffering from out-of-hospital card iac arrest (OHCA) where pulseless electrical activity (PEA) was the first a rrhythmia recorded on emergency medical services (EMS) arrival. Methods: An alysis of data collected prospectively on all patients regardless of age su ccumbing to OHCA during 1980 1997 in the community of Gothenburg where EMS initiated resuscitative measures. Results: 4662 patients with OHCA were att ended by the EMS during the study period. Of these, 1069 (23%) were judged as having PEA as the first recorded arrhythmia; 158 (15%) of these were adm itted alive to hospital and 26 (2.4%) were discharged alive. Survivors to d ischarge had a significantly larger share of bystander cardiopulmonary resu scitation (CPR) (28 vs. P = 0.008), significantly higher levels of consciou sness (8%. awake vs. 0%, P < 0.001) and higher median systolic blood pressu re (145 vs. 106 mmHg, P < 0.001) on arrival at hospital. No patient with un witnessed cardiac arrest and PEA over 80 years old survived. Conclusion: Su rvival among patients suffering from OHCA and PEA is poor, especially among the elderly unwitnessed cases and those who do not receive bystander CPR. The latter seems to be of utmost importance among these patients. (C) 2001 Elsevier Science Ireland Ltd. All rights reserved.