Clinical paperEpidemiology, trends, and outcome of out-of-hospital cardiac arrest of non-cardiac origin☆
Introduction
The majority of victims who experience out-of-hospital cardiac arrest (OHCA) have ventricular fibrillation (VF) as the presenting rhythm and are thought to have a cardiac etiology for their arrest.1, 2 Over the past decade, the incidence of VF OHCA treated by emergency medical services (EMS) personnel has declined.3, 4, 5, 6 The cause of this decline is not clear. It has been suggested that increasing rates of implantable cardiac defibrillator (ICD) placement with ICD termination of ventricular tachycardia or VF may in part account for the decline in VF OHCA.3 It is also likely that primary prevention of coronary artery disease by more aggressive treatment of cardiac risk factors has contributed to the decline.6 Another possibility is that multisystem organ failure is becoming increasingly more common and presenting frequently as non-VF OHCA. Two epidemiological studies of OHCA of non-cardiac etiology have been published.7, 8 This study was designed to provide a description of the epidemiology of OHCA of non-cardiac etiology and to determine the trends that have occurred over time in a city and county in which outcomes from VF OHCA previously have been published.9, 10, 11, 12
Section snippets
Materials and methods
This study was approved by the Mayo Clinic Institutional Review Board for Human Subject Research. All patients with an OHCA between January 1995 and December 2005 who were identified and treated by EMS personnel (police officers/firefighters/paramedics) in our public service area (population in 2004, 133,283) were included. In this EMS system a single advanced life support (ALS) ambulance service responds to all OHCAs, and patients with return of spontaneous circulation (ROSC) are transported
Results
During the study period, 796 OHCAs were considered for resuscitation. In 414 (52%) resuscitation was attempted. Ninety (21.7%) were determined to be of non-cardiac etiology. The non-cardiac etiology was confirmed by autopsy data in 43 (47.8%) cases. In 28 (31.1%), the final diagnosis was determined from both EMS reports and the electronic medical record, and in 19 (21.1%) the diagnosis was determined solely from the EMS record. Forty (44.4%) were bystander witnessed, 17 (18.9%) received BCPR,
Discussion
The majority of victims of OHCA have VF as the presenting rhythm and a cardiac etiology as the cause of their arrest.1, 2 They also are the most frequent survivors. Less attention has been directed to patients who suffer OHCA from a non-cardiac cause. As the incidence of VF arrest continues to decline more and more of these patients are likely to be encountered by EMS.3, 4, 5, 6, 16, 17, 18 The etiologies of non-cardiac arrest are diverse and include respiratory failure, pulmonary embolism,
Conclusions
The incidence of VF as the presenting rhythm in OHCA has been declining over the past decade. Simultaneously, the incidence of non-cardiac cause OHCA has been increasing. Non-cardiac cause OHCA currently constitutes over one-third of all arrests. Respiratory failure, unknown, pulmonary embolism, and drug overdose were the most common etiologies in our community. 8.9% of patients survived to hospital discharge. The decreasing number of VF arrests may be a contributing factor to the increasing
References (20)
- et al.
Trends in treated ventricular fibrillation out-of-hospital cardiac arrest: a 17-year population-based study
Heart Rhythm
(2004) Have increasing rates of defibrillator implantation reduced the incidence of out-of-hospital cardiac arrest?
Heart Rhythm
(2004)- et al.
Characteristics and outcome among patients suffering from out of hospital cardiac arrest of non-cardiac aetiology
Resuscitation
(2003) - et al.
Outcomes after ventricular fibrillation out-of-hospital cardiac arrest: expanding the chain of survival
Mayo Clin Proc
(2005) - et al.
Evolution of a community-wide early defibrillation programme experience over 13 years using police/fire personnel and paramedics as responders
Resuscitation
(2005) - et al.
Assessment of outcome after severe brain damage
Lancet
(1975) - et al.
Decrease in the occurrence of ventricular fibrillation as the initially observed arrhythmia after out-of-hospital cardiac arrest during 11 years in Sweden
Resuscitation
(2004) - et al.
Success changes the problem: why ventricular fibrillation is declining, why pulseless electrical activity is emerging, and what to do about it
Resuscitation
(2003) - et al.
One-year survival after out-of-hospital cardiac arrest in Bonn city: outcome report according to the ‘Utstein style’
Resuscitation
(1997) - et al.
A comparison of death-certificate out-of-hospital coronary heart disease death with physician-adjucated sudden cardiac death
Am J Cardiol
(2005)
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A Spanish translated version of the summary of this article appears as Appendix in the final online version at 10.1016/j.resuscitation.2006.06.040.