Center for Cardiac Arrest Prevention, Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles, California, USA; Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland.
Center for Cardiac Arrest Prevention, Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles, California, USA.
JACC Clin Electrophysiol. 2022 Oct;8(10):1260-1270. doi: 10.1016/j.jacep.2022.06.022. Epub 2022 Aug 31.
The proportion of sudden cardiac arrest (SCA) presenting as pulseless electrical activity (PEA) is rising, and survival remains low. The pathophysiology of PEA-SCA is poorly understood, and current clinical practice lacks specific options for the management of survivors.
In this study, the authors sought to investigate clinical profile, triggers, and long-term prognosis in survivors of SCA presenting with PEA.
The community-based Oregon SUDS (Sudden Unexpected Death Study) (since 2002) and Ventura PRESTO (Prediction of Sudden Death in Multi-ethnic Communities) (since 2015) studies prospectively ascertain all out-of-hospital SCAs of likely cardiac etiology. Lifetime clinical history and detailed evaluation of SCA events is available. We evaluated all SCA survivors with PEA as the presenting rhythm.
The study population included 201 PEA-SCA survivors. Of these, 97 could be contacted for access to their clinical records. Among the latter, the mean age was 67 ± 17 years and 58 (60%) were male. After in-hospital examinations, 29 events (30%) were associated with acute myocardial infarction, and 5 (5%) had bradyarrhythmias. Among the remaining 63 patients (65%), specific triggers remained undetermined, although 31 (49%) had a previous history of heart failure. Of the 201 overall survivors, 91 (45%) were deceased after a mean follow-up of 4.2 ± 4.0 years. Survivors under the age of 40 years had an excellent long-term prognosis.
Survivors of PEA-SCA are a heterogeneous group with high prevalence of multiple comorbidities, especially heart failure. Surprisingly good long-term survival was observed in young individuals. Acute myocardial infarction as the precipitating event was common, but triggers remained undetermined in the majority. Provision of individualized care to PEA survivors requires a renewed investigative focus on PEA-SCA.
心搏骤停（SCA）中无脉电活动（PEA）的比例正在上升，存活率仍然较低。PEA-SCA 的病理生理学尚未被充分理解，目前的临床实践缺乏对幸存者的具体管理选项。
本研究旨在调查表现为 PEA 的 SCA 幸存者的临床特征、诱因和长期预后。
这项基于社区的俄勒冈州 SUDS（突发意外死亡研究）（自 2002 年以来）和文图拉 PRESTO（多民族社区中猝死预测）（自 2015 年以来）前瞻性地确定了所有可能由心脏原因引起的院外 SCA。可获得终生临床病史和详细的 SCA 事件评估。我们评估了所有表现为 PEA 的 SCA 幸存者。
研究人群包括 201 例 PEA-SCA 幸存者。其中 97 例可以联系到他们的临床记录。在后者中，平均年龄为 67 ± 17 岁，58 例（60%）为男性。住院检查后，29 例（30%）与急性心肌梗死相关，5 例（5%）有心动过缓。在其余 63 例患者（65%）中，尽管 31 例（49%）有心力衰竭史，但特定诱因仍未确定。在 201 例总体幸存者中，91 例（45%）在平均 4.2 ± 4.0 年的随访后死亡。年龄在 40 岁以下的幸存者具有极好的长期预后。
PEA-SCA 的幸存者是一个异质群体，合并多种疾病的患病率较高，特别是心力衰竭。令人惊讶的是，年轻个体的长期生存率较高。急性心肌梗死是常见的诱发事件，但大多数情况下诱因仍未确定。为 PEA 幸存者提供个体化护理需要重新关注 PEA-SCA。
