Determinants of survival in sudden cardiac arrest manifesting with pulseless electrical activity

• Published in: Resuscitation Vol. 187; p. 109798
• Main Authors: Holmstrom, L., Chugh, H., Uy-Evanado, A., Salvucci, A., Jui, J., Reinier, K., Chugh, SS
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01.06.2023
• Subjects: Asthma; Asthma: copd; Cardiopulmonary Resuscitation; Death, Sudden, Cardiac - epidemiology; Death, Sudden, Cardiac - etiology; Death, Sudden, Cardiac - prevention & control; Emergency Medical Services; General population; Humans; Hypoxia; Out-of-Hospital Cardiac Arrest - etiology; Out-of-Hospital Cardiac Arrest - therapy; Prospective Studies; Pulmonary Disease, Chronic Obstructive; Pulseless Electrical Activity; Sudden Cardiac Arrest; Survival; Survival Rate; General population; Hypoxia; Asthma: copd; Sudden Cardiac Arrest; Pulseless Electrical Activity; Survival
• ISSN: 0300-9572; 1873-1570
• DOI: 10.1016/j.resuscitation.2023.109798

The proportion of sudden cardiac arrests (SCA) manifesting with pulseless electrical activity (PEA) has increased significantly, and the survival rate remains lower than ventricular fibrillation (VF). However, a subgroup of PEA-SCA cases does survive and may yield key predictors of improved outcomes when compared to non-survivors. We aimed to identify key predictors of survival from PEA-SCA. Our study sample is drawn from two ongoing community-based, prospective studies of out-of-hospital SCA: Oregon SUDS from the Portland, OR metro area (Pop. approx. 1 million; 2002–2017) and Ventura PRESTO from Ventura County, CA (Pop. approx. 850,000, 2015–2021). For the present sub-study, we included SCA cases with PEA as the presenting rhythm where emergency medical services (EMS) personnel attempted resuscitation. We identified 1,704 PEA-SCA cases, of which 173 (10.2%) were survivors and 1,531 (89.8%) non-survivors. Patients whose PEA-SCA occurred in a healthcare unit (16.9%) or public location (18.1%) had higher survival than those whose PEA-SCA occurred at home (9.3%) or in a care facility (5.7%). Young age, witness status, PEA-SCA location and pre-existing COPD/asthma were independent predictors of survival. Among witnessed cases the survival rate was 10% even if EMS response time was >10 minutes. Key determinants for survival from PEA-SCA were young age, witnessed status, public location and pre-existing COPD/asthma. Survival outcomes in witnessed PEA cases were better than expected, even with delayed EMS response.