Abstract P34: Rate of Occurrence and Predictors of Re-arrest for Out-of-hospital Cardiac Arrest Patients
Introduction: Pre-hospital cardiac arrest victims for whom stable return of spontaneous circulation (ROSC) is achieved will as a matter of course be transported to a hospital for further post-resuscitative care treatment. Some portion of these patients will re-arrest. The characteristics of these patients who re-arrest have not been described previously. The purpose of this study was to determine the frequency with which cardiac arrest patients re-arrest and to determine the patient characteristics and short-term clinical outcome for these patients.
Methods: A retrospective analysis was conducted of 617 consecutive out-of-hospital cardiac arrest patients treated and transported by Charleston County Emergency Medical Services (EMS) between January 2004 and January 2007.
Results: A total of 148 patients (24%) achieved ROSC during the study period. Of these, 52 patients (35%) re-arrested at some point prior to arrival at the emergency department. There were no statistically significant differences between patients that re-arrested and patients that sustained ROSC in mean age (64±12yrs for patients that re-arrested vs. 65±15 for patients that sustained ROSC, p=0.7), gender (62% male vs. 55% male, p=0.6), incidence of witnessed arrest (69% witnessed vs. 61%, p=0.9), incidence of bystander CPR (33% vs. 23%, p=0.2), location of arrest (65% residence vs. 70%, p=0.6), or EMS response time (9.4±3.2min vs. 9.1±3.4min, p=0.6). Patients that re-arrested were significantly more likely to present with a shockable rhythm (49% ventricular fibrillation/ventricular tachycardia) compared with patients that sustained ROSC (31% ventricular fibrillation/ventricular tachycardia, p=0.03). Forty-eight percent of patients that re-arrested had pulses upon arrival at the emergency department.
Conclusions: Over one-third of out-of-hospital cardiac arrest patients re-arrest in the pre-hospital setting and nearly half of these patients regain pulses prior to arrival at the emergency department. Patients presenting in ventricular fibrillation or ventricular tachycardia are more likely to re-arrest than patients presenting with non-shockable rhythms.