Prearrest signs of shock and respiratory insufficiency in out-of-hospital cardiac arrests witnessed by crew of the emergency medical service

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• 作者：Markus B. Skrifvars ; James Boyd ; Markku Kuisma
• 刊名：The American Journal of Emergency Medicine
• 出版年：2009
• 出版时间：May 2009
• 年：2009
• 卷：27
• 期：4
• 页码：440-448
• 全文大小：371 K

文摘

Aim

The objective of this study is to determine whether prearrest shock and respiratory insufficiency influence outcome in patients with emergency medical service–witnessed out-of-hospital cardiac arrest.

Methods

Analysis of data from a cardiac arrest database and data from the ambulance charts was performed. For the purpose of the study, shock was defined as prearrest heart rate below 40 or above 140/min, systolic blood pressure as below 90 mm Hg, and respiratory insufficiency as respiratory rate above 36 or oxygen saturation below 90 % . Adjusted odds ratios (ORs) with 95 % confidence intervals (CIs) were calculated.

Results

Of a total of 303 patients, 81 % had prearrest shock or respiratory insufficiency. Mortality was higher in these patients indicated by fewer with return of spontaneous circulation (43 % vs 75 % , P < .001), and lower survival to hospital admission (31 % vs 71 % , P < .001) and to discharge (13 % vs 59 % , P < .001). Independent predictors of mortality were age (OR, 1.04; CI, 1.0-1.06), initial rhythm other than ventricular fibrillation or ventricular tachycardia (OR, 32.9; CI, 10.9-99.0), and respiratory insufficiency (OR, 4.2; CI, 1.4-12.5).

Conclusions

Shock and respiratory depression are common among patients with out-of-hospital cardiac arrest witnessed by the emergency medical service, and these patients have a high mortality when compared with patients without shock or respiratory failure.