J Korean Soc Emerg Med.  2014 Dec;25(6):737-746. 10.0000/jksem.2014.25.6.737.

Clinical Analysis of Prehospital Heartsavers Surviving Out-of-hospital Cardiac Arrest of Cardiac Origin

• Park KI
• Kim GM
• Jang TC

• KMID: 2101252
• DOI: http://doi.org/10.0000/jksem.2014.25.6.737

Abstract

PURPOSE
Sudden cardiac death is still a major cause of death and a burden to national public health. Out-of-hospital cardiac arrest (OHCA) patients achieving field Return of spontaneous circulation (ROSC) have better survival rates and good neurological outcomes. The study was designed for analysis of prehospital and hospital clinical characteristics of Heartsaver patients surviving OHCA of cardiac origin.
METHODS
A retrospective study was conducted on 31 Heartsaver patients surviving OHCA by Emergency Medical Service (EMS) from March, 2011 to May, 2014; 24 cardiogenic-Heartsaver patients were enrolled in this study. They were divided into the myocardial infarction group (MI group) and the non-myocardial infarction group (Non-MI group) by final diagnosis for comparison of prehospital and in-hospital characteristics.
RESULTS
The etiology of cardiac arrest cause of cardiogenic-Heartsaver was categorized according to five groups, including myocardial infarction (29.2%), Brugada syndrome (25.0%), idiopathic ventricular fibrillation (25.0%), idiopathic ventricular tachycardia (8.3%), and coronary spasm (12.5%). Most patients had good neurological outcomes, Cerebral Performance Categories scale (CPC) median was 1.0(1.0-1.0). The MI group showed higher average age (57.1+/-6.49 vs 52.3+/-13.0, p=0.036), high incidence of ST-segment elevation (42.9%), and nonspecific-ST or T-wave change (24.9%) in electrocardiogram (ECG) after ROSC, higher incidence of regional wall motion abnormality in Echocardiography (85.7% vs 23.5%, p=0.009), and higher peak level of CK-MB, troponin I within 12 hours (p=0.005, p=0.014). Some Non-MI patients had undergone an electrophysiologic study and received an implantable cardioverter defibrillator.
CONCLUSION
Cardiogenic OHCA patients should be examined by cardiac enzyme, ECG, echocardiography, and coronary angiography in order to differentiate etiology. Besides, to prevent sudden cardiac death from fatal arrhythmia, electrophysiologic study and implantable cardioverter defibrillator insertion therapy must be considered.

Keyword

Sudden cardiac death; Implantable cardioverter defibrillator; Out-of-Hospital cardiac arrest; Emergency medical service

MeSH Terms

Arrhythmias, Cardiac
Brugada Syndrome
Cause of Death
Coronary Angiography
Death, Sudden, Cardiac
Defibrillators
Diagnosis
Echocardiography
Electrocardiography
Emergency Medical Services
Heart Arrest
Humans
Incidence
Infarction
Myocardial Infarction
Out-of-Hospital Cardiac Arrest*
Public Health
Retrospective Studies
Spasm
Survival Rate
Tachycardia, Ventricular
Troponin I
Ventricular Fibrillation
Troponin I