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Prehospital cardiac arrest—Rhythm changes in the initial phase of care

2010; Elsevier BV; Volume: 81; Issue: 2 Linguagem: Inglês

10.1016/j.resuscitation.2010.09.116

1873-1570

Mary Headon, Brian Carlin, Gerard Bury, Mairéad Egan,

Healthcare Technology and Patient Monitoring

Introduction: Ireland's MERIT Project was established to support GPs in managing cardiac arrest; it now works with approximately 50% of all practices.1Bury G. Prunty H. Egan M. Sharpe B. Experience of prehospital emergency care among general practitioners in Ireland.EMJ. 2008; 25: 450-454Crossref PubMed Scopus (7) Google Scholar, 2Bury G. Headon M. Dixon M. Egan M. Cardiac arrest in Irish general practice: an observational study from 426 Irish general practices.Resuscitation. 2009; 80: 1244-1247Abstract Full Text Full Text PDF PubMed Scopus (15) Google Scholar Since April 2006 data has been collected on 200 cases of Cardiac Arrest with Resuscitation Attempt (CARA), involving participating GPs. Little information is published on the dynamics of intra-arrest management, particularly in the pre-hospital phase. This study uses MERIT electronic data on CARAs to describe the initial phase of care. Method: Electronic downloads from MERIT defibrillators are collected centrally. Of 200 CARA events, 70 involved MERIT defibrillators; 57 electronic downloads with accompanying clinical data are available. Results: Of 57 patients, 61% were male and the mean age was 61 years. Ten (17.5%) survived to hospital discharge, seven (12.3%) had ROSC but did not survive and 40 (70.2%) did not develop ROSC; 44 (77%) were witnessed arrests (all similar to the full group of 200 CARAs). VF was the first recorded rhythm in 26 (45.6%), asystole in 22 (38.6%) and PEA in 9 (15.8%) cases. Twenty-six (45.6%) patients developed at least one other rhythm during the cardiac arrest. Mean number of shocks delivered was 1.4 (0–9), with a mean period of 19.5 s (9–33) from analysis to shock.Tabled 1Initial rhythmVF/VT = 26Asystole = 22PEA = 9No. of other rhythms observed None34.6%81.8%44.4% One46.2%18.2%44.4% Two19.3%4.4%11.1%Other rhythm observed VF/VT–18.2%11.1% Asystole50%–55.6% PEA34.6%0%– Open table in a new tab Conclusion: Pre-hospital cardiac arrest management involves frequent rhythm changes. Numbers of patients initially observed to be in asystole (18.2%) or PEA (11.1%) converted to a shockable rhythm at some point during the arrest period. These characteristics must be addressed in training, skills and equipment terms.