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. 2000 Oct;84(4):370–376. doi: 10.1136/heart.84.4.370

Circadian variation in witnessed out of hospital cardiac arrest

L Soo 1, D Gray 1, T Young 1, J Hampton 1
PMCID: PMC1729451  PMID: 10995402

Abstract

OBJECTIVES—To examine the effect on circadian variation of out of hospital cardiac arrest according to the underlying aetiology and presenting rhythm of arrest, and to explore strategies that might help to improve survival outcome using circadian variation.
DESIGN—Population based retrospective study.
SETTING—County of Nottinghamshire with a total population of 993 914 and an area of 2183 km2.
SUBJECTS—Between 1 January 1991 and 3 December 1994, all witnessed cardiac arrests attended by the Nottinghamshire Ambulance Service, of which 1196 patients had a cardiac cause for their arrest (ICD, 9th revision, codes 390-414 and 420-429) and 339 had a non-cardiac cause.
RESULTS—The circadian variation of the cardiac cases was not significantly different from that of non-cardiac cases (p = 0.587), even when adjusted for age, sex, or presenting rhythm of arrest. For cardiac cases, the circadian variation of those who presented with ventricular fibrillation was significantly different from those presenting with a rhythm other than ventricular fibrillation (p = 0.005), but was similar to the circadian variation of bystander cardiopulmonary resuscitation (p = 0.306) and survivors (p = 0.542). Ambulance response time was also found to have a circadian variation.
CONCLUSIONS—There is a common circadian variation of out of hospital cardiac arrest, irrespective of underlying aetiology, where the presenting rhythm is other than ventricular fibrillation. This is different from the circadian variation of cases of cardiac aetiology presenting with ventricular fibrillation. The circadian variation of ventricular fibrillation, and consequently survival, may be affected by the availability of bystander cardiopulmonary resuscitation and the speed of ambulance response.


Keywords: out of hospital; cardiac arrest; circadian variation

Full Text

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Figure 1  .

Figure 1  

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Witnessed arrests of non-cardiac aetiology in the community.

Figure 2  .

Figure 2  

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Circadian variation of all witnessed cardiac arrects in Nottinghamshire.

Figure 3  .

Figure 3  

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Harmonic regression analysis of cardiac and non-cardiac cases of out of hospital cardiac arrest.

Figure 4  .

Figure 4  

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Harmonic regression analysis of presenting rhythm of arrest in cardiac and non-cardiac cases.

Figure 5  .

Figure 5  

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Harmonic regression analysis of survivors from out of hospital cardiac arrests of cardiac aetiology.

Selected References

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

  1. Argentino C., Toni D., Rasura M., Violi F., Sacchetti M. L., Allegretta A., Balsano F., Fieschi C. Circadian variation in the frequency of ischemic stroke. Stroke. 1990 Mar;21(3):387–389. doi: 10.1161/01.str.21.3.387. [DOI] [PubMed] [Google Scholar]
  2. Arntz H. R., Willich S. N., Oeff M., Brüggemann T., Stern R., Heinzmann A., Matenaer B., Schröder R. Circadian variation of sudden cardiac death reflects age-related variability in ventricular fibrillation. Circulation. 1993 Nov;88(5 Pt 1):2284–2289. doi: 10.1161/01.cir.88.5.2284. [DOI] [PubMed] [Google Scholar]
  3. Bayés de Luna A., Coumel P., Leclercq J. F. Ambulatory sudden cardiac death: mechanisms of production of fatal arrhythmia on the basis of data from 157 cases. Am Heart J. 1989 Jan;117(1):151–159. doi: 10.1016/0002-8703(89)90670-4. [DOI] [PubMed] [Google Scholar]
  4. Cannon C. P., McCabe C. H., Stone P. H., Schactman M., Thompson B., Theroux P., Gibson R. S., Feldman T., Kleiman N. S., Tofler G. H. Circadian variation in the onset of unstable angina and non-Q-wave acute myocardial infarction (the TIMI III Registry and TIMI IIIB). Am J Cardiol. 1997 Feb 1;79(3):253–258. doi: 10.1016/s0002-9149(97)00743-1. [DOI] [PubMed] [Google Scholar]
  5. Cobb L. A., Weaver W. D., Fahrenbruch C. E., Hallstrom A. P., Copass M. K. Community-based interventions for sudden cardiac death. Impact, limitations, and changes. Circulation. 1992 Jan;85(1 Suppl):I98–102. [PubMed] [Google Scholar]
  6. Cobb L. A., Weaver W. D., Hallstrom A. P., Copass M. K. Cardiac resuscitation in the community. The Seattle experience. Cardiologia. 1990 Jan;35(1 Suppl):85–90. [PubMed] [Google Scholar]
  7. Cummins R. O., Eisenberg M. S., Hallstrom A. P., Litwin P. E. Survival of out-of-hospital cardiac arrest with early initiation of cardiopulmonary resuscitation. Am J Emerg Med. 1985 Mar;3(2):114–119. doi: 10.1016/0735-6757(85)90032-4. [DOI] [PubMed] [Google Scholar]
  8. Eisenberg M. S., Bergner L., Hallstrom A. Cardiac resuscitation in the community. Importance of rapid provision and implications for program planning. JAMA. 1979 May 4;241(18):1905–1907. doi: 10.1001/jama.241.18.1905. [DOI] [PubMed] [Google Scholar]
  9. Eisenberg M. S., Horwood B. T., Cummins R. O., Reynolds-Haertle R., Hearne T. R. Cardiac arrest and resuscitation: a tale of 29 cities. Ann Emerg Med. 1990 Feb;19(2):179–186. doi: 10.1016/s0196-0644(05)81805-0. [DOI] [PubMed] [Google Scholar]
  10. Gallagher E. J., Lombardi G., Gennis P., Treiber M. Methodology-dependent variation in documentation of outcome predictors in out-of-hospital cardiac arrest. Acad Emerg Med. 1994 Sep-Oct;1(5):423–429. doi: 10.1111/j.1553-2712.1994.tb02521.x. [DOI] [PubMed] [Google Scholar]
  11. Gallerani M., Portaluppi F., Maida G., Chieregato A., Calzolari F., Trapella G., Manfredini R. Circadian and circannual rhythmicity in the occurrence of subarachnoid hemorrhage. Stroke. 1996 Oct;27(10):1793–1797. doi: 10.1161/01.str.27.10.1793. [DOI] [PubMed] [Google Scholar]
  12. Gordon R. D., Wolfe L. K., Island D. P., Liddle G. W. A diurnal rhythm in plasma renin activity in man. J Clin Invest. 1966 Oct;45(10):1587–1592. doi: 10.1172/JCI105464. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Herlitz J., Ekström L., Wennerblom B., Axelsson A., Bång A., Holmberg S. Effect of bystander initiated cardiopulmonary resuscitation on ventricular fibrillation and survival after witnessed cardiac arrest outside hospital. Br Heart J. 1994 Nov;72(5):408–412. doi: 10.1136/hrt.72.5.408. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Herlitz J., Ekström L., Wennerblom B., Axelsson A., Bång A., Holmberg S. Predictors of early and late survival after out-of-hospital cardiac arrest in which asystole was the first recorded arrhythmia on scene. Resuscitation. 1994 Jul;28(1):27–36. doi: 10.1016/0300-9572(94)90051-5. [DOI] [PubMed] [Google Scholar]
  15. Kleinpeter G., Schatzer R., Böck F. Is blood pressure really a trigger for the circadian rhythm of subarachnoid hemorrhage? Stroke. 1995 Oct;26(10):1805–1810. doi: 10.1161/01.str.26.10.1805. [DOI] [PubMed] [Google Scholar]
  16. Kürkciyan I., Meron G., Behringer W., Sterz F., Berzlanovich A., Domanovits H., Müllner M., Bankl H. C., Laggner A. N. Accuracy and impact of presumed cause in patients with cardiac arrest. Circulation. 1998 Aug 25;98(8):766–771. doi: 10.1161/01.cir.98.8.766. [DOI] [PubMed] [Google Scholar]
  17. Lampert R., Rosenfeld L., Batsford W., Lee F., McPherson C. Circadian variation of sustained ventricular tachycardia in patients with coronary artery disease and implantable cardioverter-defibrillators. Circulation. 1994 Jul;90(1):241–247. doi: 10.1161/01.cir.90.1.241. [DOI] [PubMed] [Google Scholar]
  18. Liberthson R. R., Nagel E. L., Hirschman J. C., Nussenfeld S. R., Blackbourne B. D., Davis J. H. Pathophysiologic observations in prehospital ventricular fibrillation and sudden cardiac death. Circulation. 1974 May;49(5):790–798. doi: 10.1161/01.cir.49.5.790. [DOI] [PubMed] [Google Scholar]
  19. Manfredini R., Portaluppi F., Zamboni P., Salmi R., Gallerani M. Circadian variation in spontaneous rupture of abdominal aorta. Lancet. 1999 Feb 20;353(9153):643–644. doi: 10.1016/S0140-6736(98)05653-0. [DOI] [PubMed] [Google Scholar]
  20. Marler J. R., Price T. R., Clark G. L., Muller J. E., Robertson T., Mohr J. P., Hier D. B., Wolf P. A., Caplan L. R., Foulkes M. A. Morning increase in onset of ischemic stroke. Stroke. 1989 Apr;20(4):473–476. doi: 10.1161/01.str.20.4.473. [DOI] [PubMed] [Google Scholar]
  21. Millar-Craig M. W., Bishop C. N., Raftery E. B. Circadian variation of blood-pressure. Lancet. 1978 Apr 15;1(8068):795–797. doi: 10.1016/s0140-6736(78)92998-7. [DOI] [PubMed] [Google Scholar]
  22. Muller J. E., Ludmer P. L., Willich S. N., Tofler G. H., Aylmer G., Klangos I., Stone P. H. Circadian variation in the frequency of sudden cardiac death. Circulation. 1987 Jan;75(1):131–138. doi: 10.1161/01.cir.75.1.131. [DOI] [PubMed] [Google Scholar]
  23. Myers A., Dewar H. A. Circumstances attending 100 sudden deaths from coronary artery disease with coroner's necropsies. Br Heart J. 1975 Nov;37(11):1133–1143. doi: 10.1136/hrt.37.11.1133. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Norris R. M. Fatality outside hospital from acute coronary events in three British health districts, 1994-5. United Kingdom Heart Attack Study Collaborative Group. BMJ. 1998 Apr 4;316(7137):1065–1070. [PMC free article] [PubMed] [Google Scholar]
  25. Panza J. A., Epstein S. E., Quyyumi A. A. Circadian variation in vascular tone and its relation to alpha-sympathetic vasoconstrictor activity. N Engl J Med. 1991 Oct 3;325(14):986–990. doi: 10.1056/NEJM199110033251402. [DOI] [PubMed] [Google Scholar]
  26. Peckova M., Fahrenbruch C. E., Cobb L. A., Hallstrom A. P. Circadian variations in the occurrence of cardiac arrests: initial and repeat episodes. Circulation. 1998 Jul 7;98(1):31–39. doi: 10.1161/01.cir.98.1.31. [DOI] [PubMed] [Google Scholar]
  27. 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]
  28. Sedgwick M. L., Dalziel K., Watson J., Carrington D. J., Cobbe S. M. Performance of an established system of first responder out-of-hospital defibrillation. The results of the second year of the Heartstart Scotland Project in the 'Utstein Style'. Resuscitation. 1993 Aug;26(1):75–88. doi: 10.1016/0300-9572(93)90166-n. [DOI] [PubMed] [Google Scholar]
  29. Siscovick D. S., Weiss N. S., Fletcher R. H., Lasky T. The incidence of primary cardiac arrest during vigorous exercise. N Engl J Med. 1984 Oct 4;311(14):874–877. doi: 10.1056/NEJM198410043111402. [DOI] [PubMed] [Google Scholar]
  30. Soo L. H., Gray D., Young T., Huff N., Skene A., Hampton J. R. Resuscitation from out-of-hospital cardiac arrest: is survival dependent on who is available at the scene? Heart. 1999 Jan;81(1):47–52. doi: 10.1136/hrt.81.1.47. [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Swor R. A., Jackson R. E., Cynar M., Sadler E., Basse E., Boji B., Rivera-Rivera E. J., Maher A., Grubb W., Jacobson R. Bystander CPR, ventricular fibrillation, and survival in witnessed, unmonitored out-of-hospital cardiac arrest. Ann Emerg Med. 1995 Jun;25(6):780–784. doi: 10.1016/s0196-0644(95)70207-5. [DOI] [PubMed] [Google Scholar]
  32. Tofler G. H., Brezinski D., Schafer A. I., Czeisler C. A., Rutherford J. D., Willich S. N., Gleason R. E., Williams G. H., Muller J. E. Concurrent morning increase in platelet aggregability and the risk of myocardial infarction and sudden cardiac death. N Engl J Med. 1987 Jun 11;316(24):1514–1518. doi: 10.1056/NEJM198706113162405. [DOI] [PubMed] [Google Scholar]
  33. 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]
  34. Weitzman E. D., Fukushima D., Nogeire C., Roffwarg H., Gallagher T. F., Hellman L. Twenty-four hour pattern of the episodic secretion of cortisol in normal subjects. J Clin Endocrinol Metab. 1971 Jul;33(1):14–22. doi: 10.1210/jcem-33-1-14. [DOI] [PubMed] [Google Scholar]
  35. Weston C. F., Stephens M. R. An audit of cardiac arrest management by extended trained ambulance crew. Resuscitation. 1992 Jun-Jul;23(3):207–216. doi: 10.1016/0300-9572(92)90004-v. [DOI] [PubMed] [Google Scholar]
  36. White R. D., Vukov L. F., Bugliosi T. F. Early defibrillation by police: initial experience with measurement of critical time intervals and patient outcome. Ann Emerg Med. 1994 May;23(5):1009–1013. doi: 10.1016/s0196-0644(94)70095-8. [DOI] [PubMed] [Google Scholar]
  37. Willich S. N., Levy D., Rocco M. B., Tofler G. H., Stone P. H., Muller J. E. Circadian variation in the incidence of sudden cardiac death in the Framingham Heart Study population. Am J Cardiol. 1987 Oct 1;60(10):801–806. doi: 10.1016/0002-9149(87)91027-7. [DOI] [PubMed] [Google Scholar]
  38. Wright D., Bannister J., Ryder M., Mackintosh A. F. Resuscitation of patients with cardiac arrest by ambulance staff with extended training in West Yorkshire. BMJ. 1990 Sep 22;301(6752):600–602. doi: 10.1136/bmj.301.6752.600. [DOI] [PMC free article] [PubMed] [Google Scholar]
  39. de Vreede-Swagemakers J. J., Gorgels A. P., Dubois-Arbouw W. I., van Ree J. W., Daemen M. J., Houben L. G., Wellens H. J. Out-of-hospital cardiac arrest in the 1990's: a population-based study in the Maastricht area on incidence, characteristics and survival. J Am Coll Cardiol. 1997 Nov 15;30(6):1500–1505. doi: 10.1016/s0735-1097(97)00355-0. [DOI] [PubMed] [Google Scholar]
  40. el Fawal M. A., Berg G. A., Wheatley D. J., Harland W. A. Sudden coronary death in Glasgow: nature and frequency of acute coronary lesions. Br Heart J. 1987 Apr;57(4):329–335. doi: 10.1136/hrt.57.4.329. [DOI] [PMC free article] [PubMed] [Google Scholar]
  41. van der Hoeven J. G., Waanders H., Compier E. A., van der Weyden P. K., Meinders A. E. Prolonged resuscitation efforts for cardiac arrest patients who cannot be resuscitated at the scene: who is likely to benefit? Ann Emerg Med. 1993 Nov;22(11):1659–1663. doi: 10.1016/s0196-0644(05)81303-4. [DOI] [PubMed] [Google Scholar]

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