Many patients with out-of-hospital
cardia
c arrest present with pulseless ele
ctri
c a
ctivity (PEA) rather than sho
ckable rhythm. Despite improvements in resus
citation
care, survival of PEA patients remains dismal. Our main obje
ctive was to
chara
cterize out-of-hospital
cardia
c arrest patients by initial presenting rhythm and to evaluate independent determinants of PEA.
c_2">Methods
A population-based study was conducted using the Toronto Rescu Epistry database with linkage to administrative data in Ontario, Canada. We included patients older than 20 years who had nontraumatic cardiac arrests from 2005 to 2010. Multivariable logistic regression models were constructed to determine factors predicting the occurrence of PEA vs shockable rhythm vs asystole.
c_3">Results
Of the 9,882 included patients who received treatment, 24.5% had PEA, 26.3% had shockable rhythm, and 49.2% had asystole. Patients with PEA had a mean age of 72 years, 41.2% were female and had multiple comorbidities, and 53.4% were hospitalized in the past year. As compared with shockable rhythm, PEA patients were older, were more likely to be women, and had more comorbidities. As compared with asystole, PEA patients had similar baseline and clinical characteristics, but were substantially more likely to have an arrest witnessed by emergency medical services (odds ratio 13) or by bystander (odds ratio 3.24). Mortality at 30 days was 95.5%, 77.9%, and 98.9% for patients with PEA, shockable rhythm, asystole, respectively.
c_4">Conclusions
Patient characteristics differed substantially in those presenting with PEA and shockable rhythm. In contrast, the main distinguishing factor between PEA and asystole cardiac arrest related mainly to factors at the time of the cardiac arrest.