Abstract 2702: Prodromal Symptoms of Out-of-hospital Cardiac Arrest: Report From a Large-scaled Population-based Study
Introduction: Little is known about symptoms preceding sudden cardiac arrest.
Objectives: The aim of this study was to describe a frequency of prodromal symptoms of out-of-hospital cardiac arrest (OHCA) and their association with outcomes.
Designs: Population-based cohort study.
Participants: We enrolled all persons aged 18 years or more who suffered OHCA of presumed cardiac etiology, were witnessed by bystanders, and treated by emergency medical service (EMS) in Osaka Prefecture, Japan from Jan 2003 through Dec 2004.
Data collection and analyses: Data were prospectively collected by EMS personnel using an original report form based on the Utstein-style. The primary outcome was one-month survival with favorable neurological outcome. Multiple logistic regression evaluated the factors associated with better neurological outcome.
Results: There were 1,066 witnessed OHCA cases of presumed cardiac etiology and 651 (61.1%) of them had prodromal symptoms. Among them, 389 (59.8%) had prodromal symptoms a few minutes before arrest and 162 (24.9%) had an hour before arrest. Shortness of breath (27.5%) was the most frequent prodromal symptom followed by chest pain (20.6%) and syncope (12.9%). Atypical symptoms were observed in 34.7% cases. Patients with prodromal symptoms were more likely to receive early CPR by EMS and have better outcome (Table⇓). VF as initial rhythm, time from collapse to call, arrest after EMS arrival (OR, 20.8; 95% CI, 1.5–280.7), VF as initial rhythm (OR, 3.9; 95% CI, 1.8 – 8.3), and earlier call (OR per minute, 0.78; 95% CI, 0.66 – 0.92) were associated with better neurological outcome.
Conclusions: Some relevant clinical symptoms frequently preceded OHCA. It is important to exploit the symptoms for early activation of EMS system and better outcome.