Cardiovascular medicine
Circadian variation in witnessed out of hospital cardiac arrest
L H Sooa, D Graya, T Youngb, J R Hamptona
a Department of
Cardiovascular Medicine, University Hospital, Queens Medical Centre,
University Hospital, Nottingham NG7 2UH, UK, b Health
Economics Research Group, Brunel University, Uxbridge, Middlesex, UK
Correspondence to: Dr Soo lin.soo{at}akgateway.net
Accepted 4 July 2000
OBJECTIVES
To examine the effect on
circadian variation of out of hospital cardiac arrest according to the
underlying aetiology and presenting rhythm of arrest, and to explore
strategies that might help to improve survival outcome using circadian variation.
DESIGNPopulation based retrospective study.
SETTINGCounty of Nottinghamshire
with a total population of 993 914 and an area of
2183 km2.
SUBJECTSBetween 1 January 1991 and 3 December 1994, all witnessed cardiac arrests attended by the
Nottinghamshire Ambulance Service, of which 1196 patients had a cardiac
cause for their arrest (ICD, 9th revision, codes 390-414 and 420-429)
and 339 had a non-cardiac cause.
RESULTSThe circadian variation of
the cardiac cases was not significantly different from that of
non-cardiac cases (p = 0.587), even when adjusted for age, sex, or
presenting rhythm of arrest. For cardiac cases, the circadian variation
of those who presented with ventricular fibrillation was significantly
different from those presenting with a rhythm other than ventricular
fibrillation (p = 0.005), but was similar to the circadian variation
of bystander cardiopulmonary resuscitation (p = 0.306) and survivors
(p = 0.542). Ambulance response time was also found to have a
circadian variation.
CONCLUSIONSThere is a common
circadian variation of out of hospital cardiac arrest, irrespective of
underlying aetiology, where the presenting rhythm is other than
ventricular fibrillation. This is different from the circadian
variation of cases of cardiac aetiology presenting with ventricular
fibrillation. The circadian variation of ventricular fibrillation, and
consequently survival, may be affected by the availability of bystander
cardiopulmonary resuscitation and the speed of ambulance response.
Keywords: out of hospital; cardiac arrest; circadian variation
© 2000 by Heart
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