Skip to main content
NCBI home page
British Heart Journal logoLink to British Heart Journal
. 1992 Apr;67(4):334–338. doi: 10.1136/hrt.67.4.334

Mortality within hospital after resuscitation from ventricular fibrillation outside hospital.

W Dickey 1, A A Adgey 1
PMCID: PMC1024846  PMID: 1389711

Abstract

OBJECTIVE--To determine factors related to mortality within hospital after successful resuscitation from ventricular fibrillation outside hospital by a mobile coronary care unit manned by a physician. DESIGN--Retrospective review of records of patients resuscitated and admitted to hospital between 1 January 1966 and 31 December 1987. SETTING--Mobile coronary care unit, coronary care unit, and cardiology department. PATIENTS--281 patients (227 male), aged 14-82 (mean 58) successfully resuscitated from ventricular fibrillation outside hospital of whom 182 (65%) developed ventricular fibrillation before the arrival of the mobile coronary care unit. The aetiology of ventricular fibrillation was acute myocardial infarction in 194 patients (69%), ischaemic heart disease without infarction in 71 (25%), and other or unknown in 16 (6%). MAIN OUTCOME MEASURES--Death within hospital. RESULTS--There were 91 deaths in hospital (32%). Factors on univariate analysis significantly associated with increased mortality were patient age > or = 60 years, previous myocardial infarction or cerebrovascular disease, prior digoxin or diuretic treatment, collapse without prior chest pain or with pain lasting 30 minutes or less, defibrillation delayed by > or = 5 min, > or = four shocks required to correct ventricular fibrillation, left ventricular failure or pulmonary oedema and cardiogenic shock after successful defibrillation, and coma on admission to hospital. On multivariate analysis the most important factors (in rank order) were cardiogenic shock after defibrillation, coma on admission to hospital, age > or = 60 years and the requirement for four or more shocks to correct ventricular fibrillation. CONCLUSIONS--The in-hospital mortality of patients resuscitated from ventricular fibrillation outside hospital was related to patient characteristics before the cardiac arrest and to the immediate haemodynamic and neurological status after correction of ventricular fibrillation as well as to factors at the resuscitation itself. The in-hospital mortality of this study compares favourably with the results obtained by units staffed by paramedical workers and emergency medical technicians, although 35% (99/281) of the patients had ventricular fibrillation after the arrival of the mobile unit and defibrillation was thus rapid.

Full text

PDF
334

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Adgey A. A., Scott M. E., Allen J. D., Nelson P. G., Geddes J. S., Zaidi S. A. Management of ventricular fibrillation outside hospital. Lancet. 1969 Jun 14;1(7607):1169–1171. doi: 10.1016/s0140-6736(69)92161-8. [DOI] [PubMed] [Google Scholar]
  2. Aprahamian C., Thompson B. M., Gruchow H. W., Mateer J. R., Tucker J. F., Stueven H. A., Darin J. C. Decision making in prehospital sudden cardiac arrest. Ann Emerg Med. 1986 Apr;15(4):445–449. doi: 10.1016/s0196-0644(86)80185-8. [DOI] [PubMed] [Google Scholar]
  3. Baum R. S., Alvarez H., 3rd, Cobb L. A. Survival after resuscitation from out-of-hospital ventricular fibrillation. Circulation. 1974 Dec;50(6):1231–1235. doi: 10.1161/01.cir.50.6.1231. [DOI] [PubMed] [Google Scholar]
  4. Cummins R. O., Eisenberg M. S., Litwin P. E., Graves J. R., Hearne T. R., Hallstrom A. P. Automatic external defibrillators used by emergency medical technicians. A controlled clinical trial. JAMA. 1987 Mar 27;257(12):1605–1610. [PubMed] [Google Scholar]
  5. Dubois C., Smeets J. P., Demoulin J. C., Piérard L., Foidart G., Henrard L., Tulippe C., Preston L., Carlier J., Kulbertus H. E. Incidence, clinical significance and prognosis of ventricular fibrillation in the early phase of myocardial infarction. Eur Heart J. 1986 Nov;7(11):945–951. doi: 10.1093/oxfordjournals.eurheartj.a061999. [DOI] [PubMed] [Google Scholar]
  6. Dunn H. M., McComb J. M., MacKenzie G., Adgey A. A. Survival to leave hospital from ventricular fibrillation. Am Heart J. 1986 Oct;112(4):745–751. doi: 10.1016/0002-8703(86)90469-2. [DOI] [PubMed] [Google Scholar]
  7. Einarsson O., Jakobsson F., Sigurdsson G. Advanced cardiac life support in the prehospital setting: the Reykjavik experience. J Intern Med. 1989 Feb;225(2):129–135. doi: 10.1111/j.1365-2796.1989.tb00052.x. [DOI] [PubMed] [Google Scholar]
  8. Eisenberg M. S., Bergner L., Hearne T. Out-of-hospital cardiac arrest: a review of major studies and a proposed uniform reporting system. Am J Public Health. 1980 Mar;70(3):236–240. doi: 10.2105/ajph.70.3.236. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Eisenberg M. S., Hallstrom A. P., Copass M. K., Bergner L., Short F., Pierce J. Treatment of ventricular fibrillation. Emergency medical technician defibrillation and paramedic services. JAMA. 1984 Apr 6;251(13):1723–1726. doi: 10.1001/jama.251.13.1723. [DOI] [PubMed] [Google Scholar]
  10. Goldstein S., Landis J. R., Leighton R., Ritter G., Vasu C. M., Wolfe R. A., Acheson A., VanderBrug Medendorp S. Predictive survival models for resuscitated victims of out-of-hospital cardiac arrest with coronary heart disease. Circulation. 1985 May;71(5):873–880. doi: 10.1161/01.cir.71.5.873. [DOI] [PubMed] [Google Scholar]
  11. Hallstrom A. P., Cobb L. A., Swain M., Mensinger K. Predictors of hospital mortality after out-of-hospital cardiopulmonary resuscitation. Crit Care Med. 1985 Nov;13(11):927–929. doi: 10.1097/00003246-198511000-00019. [DOI] [PubMed] [Google Scholar]
  12. Hargarten K. M., Stueven H. A., Waite E. M., Olson D. W., Mateer J. R., Aufderheide T. P., Darin J. C. Prehospital experience with defibrillation of coarse ventricular fibrillation: a ten-year review. Ann Emerg Med. 1990 Feb;19(2):157–162. doi: 10.1016/s0196-0644(05)81801-3. [DOI] [PubMed] [Google Scholar]
  13. Lawrie D. M., Higgins M. R., Godman M. J., Oliver M. F., Julian D. G., Donald K. W. Ventricular fibrillation complicating acute myocardial infarction. Lancet. 1968 Sep 7;2(7567):523–528. doi: 10.1016/s0140-6736(68)92403-3. [DOI] [PubMed] [Google Scholar]
  14. Liberthson R. R., Nagel E. L., Hirschman J. C., Nussenfeld S. R. Prehospital ventricular defibrillation. Prognosis and follow-up course. N Engl J Med. 1974 Aug 15;291(7):317–321. doi: 10.1056/NEJM197408152910701. [DOI] [PubMed] [Google Scholar]
  15. Longstreth W. T., Jr, Inui T. S., Cobb L. A., Copass M. K. Neurologic recovery after out-of-hospital cardiac arrest. Ann Intern Med. 1983 May;98(5 Pt 1):588–592. doi: 10.7326/0003-4819-98-5-588. [DOI] [PubMed] [Google Scholar]
  16. Myerburg R. J., Conde C. A., Sung R. J., Mayorga-Cortes A., Mallon S. M., Sheps D. S., Appel R. A., Castellanos A. Clinical, electrophysiologic and hemodynamic profile of patients resuscitated from prehospital cardiac arrest. Am J Med. 1980 Apr;68(4):568–576. doi: 10.1016/0002-9343(80)90307-1. [DOI] [PubMed] [Google Scholar]
  17. Pantridge J. F., Geddes J. S. A mobile intensive-care unit in the management of myocardial infarction. Lancet. 1967 Aug 5;2(7510):271–273. doi: 10.1016/s0140-6736(67)90110-9. [DOI] [PubMed] [Google Scholar]
  18. Ritter G., Wolfe R. A., Goldstein S., Landis J. R., Vasu C. M., Acheson A., Leighton R., Medendrop S. V. The effect of bystander CPR on survival of out-of-hospital cardiac arrest victims. Am Heart J. 1985 Nov;110(5):932–937. doi: 10.1016/0002-8703(85)90187-5. [DOI] [PubMed] [Google Scholar]
  19. Stults K. R., Brown D. D., Kerber R. E. Efficacy of an automated external defibrillator in the management of out-of-hospital cardiac arrest: validation of the diagnostic algorithm and initial clinical experience in a rural environment. Circulation. 1986 Apr;73(4):701–709. doi: 10.1161/01.cir.73.4.701. [DOI] [PubMed] [Google Scholar]
  20. Tresch D. D., Thakur R. K., Hoffmann R. G., Olson D., Brooks H. L. Should the elderly be resuscitated following out-of-hospital cardiac arrest? Am J Med. 1989 Feb;86(2):145–150. doi: 10.1016/0002-9343(89)90259-3. [DOI] [PubMed] [Google Scholar]
  21. Weaver W. D., Cobb L. A., Hallstrom A. P., Fahrenbruch C., Copass M. K., Ray R. Factors influencing survival after out-of-hospital cardiac arrest. J Am Coll Cardiol. 1986 Apr;7(4):752–757. doi: 10.1016/s0735-1097(86)80332-1. [DOI] [PubMed] [Google Scholar]
  22. Weaver W. D., Copass M. K., Bufi D., Ray R., Hallstrom A. P., Cobb L. A. Improved neurologic recovery and survival after early defibrillation. Circulation. 1984 May;69(5):943–948. doi: 10.1161/01.cir.69.5.943. [DOI] [PubMed] [Google Scholar]
  23. Weaver W. D., Hill D., Fahrenbruch C. E., Copass M. K., Martin J. S., Cobb L. A., Hallstrom A. P. Use of the automatic external defibrillator in the management of out-of-hospital cardiac arrest. N Engl J Med. 1988 Sep 15;319(11):661–666. doi: 10.1056/NEJM198809153191101. [DOI] [PubMed] [Google Scholar]
  24. Webb S. W., Adgey A. A., Pantridge J. F. Autonomic disturbance at onset of acute myocardial infarction. Br Med J. 1972 Jul 8;3(5818):89–92. doi: 10.1136/bmj.3.5818.89. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from British Heart Journal are provided here courtesy of BMJ Publishing Group

RESOURCES