Prognosis Among Survivors of Prehospital Cardiac Arrest,☆☆,

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Abstract

Study objective: To describe the prognosis in consecutive patients discharged from hospital after prehospital cardiac arrest.

Patients: All patients in the community of Göteborg who were discharged from hospital after out-of-hospital cardiac arrest between 1981 and 1991. Results: Two hundred forty-three patients were discharged from hospital during the observation period, of whom 80% initially experienced ventricular fibrillation. Among patients discharged, 21% died during the first year; after 10 years, 82% had died. Age, sex, previous history of cardiovascular disease, circumstances at the time of cardiac arrest, complications during hospitalization, and discharge medications were assessed as predictors of 1-year mortality. Independent predictors of death during follow-up were history of myocardial infarction (P<.001), no prescription of β-blockers at discharge (P<.01), age (P<.05), and cerebral performance category (CPC) at discharge (P<.05). Conclusion: Among patients who survived out-of-hospital cardiac arrest, one of five died during the first year and one of five survived 10 years after discharge. Prognosis was associated with a history of myocardial infarction, prescription of β-blockers at discharge, age, and CPC at discharge. [Herlitz J, Ekström L, Wennerblom B, Axelsson Å, Bång A, Holmberg S. Prognosis among survivors of prehospital cardiac arrest. Ann Emerg Med January 1995;25:5863.]

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INTRODUCTION

Increasing numbers of victims of out-of-hospital cardiac arrest are successfully resuscitated and discharged from hospital.1, 2 Whereas factors associated with immediate survival after cardiac arrest have been carefully described,3, 4, 5 information on long-term prognosis and factors associated with prognosis after discharge from hospital is limited.

This study describes the mortality during as much as 10 years of follow-up in consecutive survivors of prehospital cardiac arrest in the community

MATERIALS AND METHODS

The city of Göteborg has an area of 449 km2 and 434,000 inhabitants. Of these, 48% are men. Nine percent of the population are below poverty level (ie, requiring financial support from the community). Sixty-five percent of the population continues their education past the compulsory level.In 1990 there were 5,108 deaths in Göteborg. Of these, 1,360 were attributable to ischemic or coronary heart disease. (International Classification of Diseases codes 410-414). There were 1,177 deaths per

RESULTS

There were 3,158 cardiac arrests during the observation period in which CPR was attempted. Of these, 40% of patients were initially found to have ventricular fibrillation, 36% had asystole and 22% had pulseless electrical activity. Six hundred forty-one patients were hospitalized alive, and 245 were discharged from hospital. Two patients were hospitalized and discharged twice; only the first episodes were included in the analyses. In Table 1,the remaining 243 patients discharged alive are

ONE-YEAR MORTALITY AFTER CARDIAC ARREST

Table 3 shows length of survival by age, sex, and clinical history. A significant increase in mortality was observed among the elderly and in patients with history of myocardial infarction and congestive heart failure.

. One-year mortality among survivors by age, sex, and clinical history.

CharacteristicsMortality*Odds Ratio95% CIP†
Median age (yr)
 68 or younger16/113 (14)
 Older than 6831/102 (302.61.3-5.2<.01
Sex
 Male37/173 (21)
 Female10/42 (24)1.10.5-2.6
History
Myocardial infarction
 Yes35/102 (34)4.4

DISCUSSION

This study describes the survival of consecutive patients successfully resuscitated from prehospital cardiac arrest.

In the community of Göteborg, there were 243 such cases during a 12-year period. Information on survival after discharge was available in all but two patients. The low number of patients followed up for 10 years is explained by the fact that only patients resuscitated before December 31, 1982, could be included in such an analysis.

This study is limited by its retrospective design.

CONCLUSION

In 243 consecutive patients discharged from hospital after out-of-hospital cardiac arrest, about 1 of 5 were dead after 1 year and 1 of 5 survived 10 years. The prognosis was associated with history of myocardial infarction, prescription of β-blockers at discharge, age, and CPC at discharge.

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From the Division of Cardiology, Sahlgrenska University Hospital, Göteborg, Sweden.

☆☆

Address for reprints: Johan Herlitz, Division of Cardiology, Sahlgrenska Hospital, S-413 45 Göteborg, Sweden, 46-31-601000

Reprint no. 47/1/60939

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