Predictors of early and late survival after out-of-hospital cardiac arrest in which asystole was the first recorded arrhythmia on scene.

BACKGROUND

A large proportion of patients who suffer out-of-hospital cardiac arrest have asystole as the initial recorded arrhythmia. Since they have a poor prognosis, less attention has been paid to this group of patients.

AIM

To describe a consecutive population of patients with out-of-hospital cardiac arrest with asystole as the first recorded arrhythmia and to try to define indicators for an increased chance of survival in this population.

SETTING

The community of Gothenburg.

PATIENTS

All patients who suffered out-of-hospital cardiac arrest during 1981 to 1992 and were reached by our emergency medical service (EMS) system and where cardiopulmonary resuscitation (CPR) was attempted.

RESULTS

In all there were 3434 cardiac arrests of which 1222 (35%) showed asystole as the first recorded arrhythmia. They differed from patients with ventricular fibrillation by being younger, including more women and having a longer interval between collapse and arrival of the first ambulance. In all 90 patients (7%) were hospitalized alive and 20 (2%) could be discharged from hospital. Independent predictors for an increased chance of survival were: (a) a short interval between the collapse and arrival of the first ambulance (P < 0.001) and the time the collapse occurred (P < 0.05). Initial treatment given in some cases with adrenaline, atropine and tribonate were not associated with an increased survival.

CONCLUSIONS

Of all the patients with out-of-hospital cardiac arrest, 35% were found in asystole. Of these, 7% were hospitalized alive and 2% could be discharged from hospital. Efforts should be made to improve still further the interval between collapse and arrival of the first ambulance.