Prognosis Among Survivors of Prehospital Cardiac Arrest☆,☆☆,★
Section snippets
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.
Characteristics Mortality* Odds Ratio 95% CI P† Median age (yr) 68 or younger 16/113 (14) Older than 68 31/102 (30 2.6 1.3-5.2 <.01 Sex Male 37/173 (21) Female 10/42 (24) 1.1 0.5-2.6 History Myocardial infarction Yes 35/102 (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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Cited by (0)
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From the Division of Cardiology, Sahlgrenska University Hospital, Göteborg, Sweden.
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Address for reprints: Johan Herlitz, Division of Cardiology, Sahlgrenska Hospital, S-413 45 Göteborg, Sweden, 46-31-601000
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Reprint no. 47/1/60939