Abstract 250: Characterization of Events Surrounding Re-Arrest After Return of Spontaneous Circulation During Prehospital Treatment of Cardiac Arrest
Introduction: It has been recently reported that over a third of out-of-hospital cardiac arrest patients with return of spontaneous circulation (ROSC) re-arrest in the pre-hospital environment after regaining pulses; however, the events surrounding re-arrest have not been well characterized. The purpose of this study was to describe the timing and cardiac rhythms associated with re-arrest.
Methods: A retrospective analysis was conducted of patient care reports and electronic defibrillator files collected by a county-wide EMS system from the treatment of adult non-traumatic cardiac arrest patients between January 2004 and January 2007. Patients that achieved ROSC (n=148) and re-arrested (n=52) were included in the analysis.
Results: Fifty-two patients re-arrested after ROSC (32 re-arrested once, 12 twice, 6 three times, and 2 four times) for a total of 82 re-arrest events. The most common rhythms upon re-arrest were PEA and VF (41% events PEA, 34% VF, 15% VT, 10% asystole). Likelihood of regaining pulses was affected by re-arrest rhythm (82% VF, 83% VT, 63% asystole, 50% PEA, p=0.03). Forty-eight (59%) re-arrest events occurred at the scene and 34 (41%) occurred during transit. Patients were more likely to regain pulses if the re-arrest event occurred at the scene (81% scene vs. 47% transport, p=0.001). Half of patients re-arresting at the scene did so in the 5 min prior to departure although patients were treated for 25.9±8.8 min at the scene. Nearly half of patients (48%) that re-arrested during transport experienced re-arrest within 3 min of departing the scene although transport time was 11.3±7.2 min. Five (10%) of patients re-arrested during the minute of intubation; however, re-arrest occurred on average 14.0±9.8 min after intubation.
Conclusions: The initial rhythm upon re-arrest is commonly PEA or VF; however patients are most likely to regain pulses following re-arrest if the re-arrest rhythm is shockable. Re-arrest events occur frequently in the minutes preceding and following the initiation of pre-hospital transport, suggesting that the process of preparing a patient for transport may be related to re-arrest. Patients are less likely to regain pulses when re-arresting during transport, perhaps due to suboptimal CPR quality during transport.
- © 2010 by American Heart Association, Inc.