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PubMed2004

Histopathological and behavioral characterization of a novel model of cardiac arrest and cardiopulmonary resuscitation in mice.

Cardiac arrest is associated with high mortality and poor neurological outcome. We characterized functional and histological outcome in a novel mouse model of cardiac arrest and cardiopulmonary resuscitation (CPR) in order to study neuroprotective mechanisms. Cardiac arrest was induced in male C57Bl/6 and 129SVEV mice by i.v. injection of KCl. After 10 min cardiac standstill, CPR was initiated by administration of epinephrine, ventilation with 100% oxygen and chest compressions. Twenty-four hours before and 3 or 7 days after CPR, mice were subjected to behavioral testing using a passive avoidance task, locomotor activity in an open field, and spontaneous alternation in a T-maze. Hippocampal and caudoputamen injury was quantified 3 or 7 days after CPR. At both time points, caudoputamen injury was worse in 129SVEV mice. Post-ischemic mice of both strains showed a reduced number of correct choices in the T-maze up to 7 days after CPR, and were temporarily impaired in learning the passive avoidance task with a retention deficit on day 3 but not on day 7. Locomotor activity showed strain differences with C57Bl/6 mice being more active, but little ischemia-related effects. A dissociation between functional and histological outcome was found emphasizing the importance of combining both outcome measures for evaluation of neuroprotective strategies.

Animals↗
PubMed2006

Cardiocerebral resuscitation for cardiac arrest.

Survival rates from out-of-hospital cardiac arrest continue to be low despite periodic updates in the Guidelines for Emergency Medical Services and periodic improvements such as the addition of automatic external defibrillators (AEDs). The low incidence of bystander cardiopulmonary resuscitation (CPR), substantial time without chest compressions throughout the resuscitation effort, and a lack of response to initial defibrillation after prolonged ventricular fibrillation contribute to these unacceptably poor results. Resuscitation guidelines are only revised every 5 to 7 years and can be difficult to change because of the lack of randomized controlled trials in humans. Such trials are rare because of a number of logistical difficulties, including the problem of obtaining informed consent. An alternative approach to advancing resuscitation science is for evidence-based demonstration projects in areas that have adequate records, so that one may determine whether the new approach improves survival. This is reasonable because the current guidelines make provisions for deviations under certain local circumstances or as directed by the emergency medical services medical director. A wealth of experimental evidence indicates that interruption of chest compressions for any reason in patients with cardiac arrest is deleterious. Accordingly, a new approach to out-of-hospital cardiac arrest called cardiocerebral resuscitation (CCR) was developed that places more emphasis on chest compressions for witnessed cardiac arrest in adults and de-emphasizes ventilation. There is also emphasis on chest compressions before defibrillation in circulatory phase of cardiac arrest. CCR was initiated in Tucson, Arizona, in November 2003, and in two rural Wisconsin counties in early 2004.

Cardiopulmonary Resuscitation↗
PubMed1992

Significance of aborted cardiac arrest and sustained ventricular tachycardia in patients referred for treatment therapy of advanced heart failure.

Cardiac arrest in patients with heart failure may be the result of remediable factors such as pulmonary edema, drug toxicity, or electrolyte abnormalities, or it may be due to primary arrhythmias. The relation of prior aborted cardiac arrest or sustained ventricular tachycardia to subsequent prognosis was assessed in 458 consecutive patients referred for management of advanced heart failure (left ventricular ejection fraction 0.2 +/- 0.07). All patients received tailored vasodilator and diuretic therapy and were then followed as outpatients. Patients were divided into four groups: 388 patients (85%) with no prior cardiac arrest or sustained ventricular tachycardia, 31 patients (7%) with a primary arrhythmia cardiac arrest, 22 patients (5%) with a secondary cardiac arrest, and 17 patients (4%) with sustained ventricular tachycardia without cardiac arrest. Patients with cardiac arrest resulting from a primary arrhythmia were usually treated with antiarrhythmic drugs (25 patients), and five patients received an implantable defibrillator. After hospital discharge actuarial 1-year sudden death risk (17%) and total mortality (24%) rates for the group with primary arrhythmia were similar to corresponding values in patients with no history of cardiac arrest or sustained ventricular tachycardia (17% and 30%, respectively). In patients with a secondary cardiac arrest as a result of exacerbation of heart failure (11 patients), torsade de pointes (10 patients), or hypokalemia (one patient), therapy focused on removal of aggravating factors. Actuarial 1-year sudden death (39%) and total mortality (54%) rates for the group with secondary arrest were higher than for patients without a history of cardiac arrest (p = 0.003 and 0.005, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗
PubMed2003

End tidal CO2 is a quantitative measure of cardiac arrest.

PURPOSE OF THE STUDY: Predictors of severity of cardiac arrest or efficacy of cardiopulmonary resuscitation are few. Respiratory end tidal CO2 (ETCO) is a marker of pulmonary blood flow and, possibly, cardiac arrest. The purpose of this study was to evaluate ETCO as a quantitative marker of cardiac arrest in a human model of ventricular fibrillation (VF). METHODS: Thirty-one cardiac arrest/VF episodes (mean BP < 40 mmHg) in 8 men and 3 women mean age = 42 +/- 24 years, mean left ventricular ejection fraction = 39%) undergoing defibrillator (ICD) implant for ventricular tachycardia or previous cardiac arrest were evaluated with continuous ETCO monitoring during defibrillation threshold testing. All patients but one were intubated. RESULTS: Significant differences (P < 0.001) were noted between ETCO values prior (mean 37.2 +/- 6.8 mmHg) versus during VF (mean 27.1 +/- 5.9 mmHg), and during VF versus return of spontaneous circulation (mean 36.6 +/- 6.6 mmHg). ETCO decreased by 23% +/- 8% from pre-VF to during VF. It increased by 37% +/- 16% during VF to return of spontaneous circulation. These changes were significantly different (P < 0.001). CONCLUSION: Significant changes in ETCO were measured during VF arrest. ETCO can predict acute cardiac arrest in a quantitative manner.

Adult↗
PubMed1998

Use of rapid-deployment extracorporeal membrane oxygenation for the resuscitation of pediatric patients with heart disease after cardiac arrest.

INTRODUCTION: We have recently used extracorporeal membrane oxygenation as a means of rapidly resuscitating pediatric patients with heart disease after cardiopulmonary arrest, in whom conventional resuscitation measures have failed. METHODS: We developed a fully portable extracorporeal membrane oxygenation circuit that is maintained vacuum and carbon dioxide-primed at all times. When needed, the circuit is crystalloid-primed and can be ready for use within 15 minutes. Since February 1996, we have used this rapid-deployment circuit to resuscitate 11 pediatric patients in full cardiopulmonary arrest. RESULTS: The median age of the 11 patients was 120 days (2 days to 4.6 years). Nine patients had a cardiac arrest after cardiac surgery. One patient had a cardiac arrest during cardiac catheterization and one patient had a cardiac arrest before cardiac surgery. Median duration of cardiopulmonary resuscitation was 55 minutes (range 20 to 103 minutes), with no difference in the duration of cardiopulmonary resuscitation between survivors and nonsurvivors. Ten of 11 patients (91%) were weaned from extracorporeal membrane oxygenation and seven (64%) survived to hospital discharge. Six patients are long-term survivors, five of whom are in New York Heart Association class I; one survivor is in class II. Seven patients resuscitated with extracorporeal membrane oxygenation before the use of this rapid-deployment circuit had a median duration of cardiopulmonary resuscitation of 90 minutes, with two (28.6%) survivors. CONCLUSIONS: The use of rapid-deployment extracorporeal membrane oxygenation results in shorter resuscitation times and improved survival in pediatric patients with heart disease after cardiopulmonary arrest.

Cardiac Surgical Procedures↗
PubMed2006

Characteristics and outcome of false cardiac arrests in hospital.

BACKGROUND: Not all hospitalised patients with symptoms of a presumed or threatened cardiac arrest, for whom the rescue team is alerted, eventually suffer a cardiac arrest. This article aims to describe the characteristics and outcome of "false cardiac arrests". METHODS: All patients hospitalised at Sahlgrenska University Hospital for whom the rescue team was alerted between 1 November 1994 and 15 October 2002 were included. RESULTS: In all, there were 1538 calls for the rescue team, of which 70% were caused by cardiac arrest, 9% by respiratory arrest and 21% by "other causes". Survival to discharge was 36% among patients with cardiac arrest, 64% among patients with respiratory arrest and 77% among patients with "other reasons for calling" (p<0.0001 for trend). Among survivors, a cerebral performance categories (CPC) score of 1 at hospital discharge was found in 83% of those with a cardiac arrest, 59% with respiratory arrest and 82% with other reasons for calling (NS for trend). CONCLUSION: Among patients at a Swedish university hospital for whom the rescue team was alerted, about one-third have a "false cardiac arrest". These patients had a survival rate which was about twice that of patients with a "true cardiac arrest". However, among survivors, cerebral function at discharge was similar, regardless of "false" or "true" cardiac arrest.

Aged↗
PubMed2004

Can we define patients with no chance of survival after out-of-hospital cardiac arrest?

OBJECTIVE: To evaluate whether subgroups of patients with no chance of survival can be defined among patients with out-of-hospital cardiac arrest. PATIENTS: Patients in the Swedish cardiac arrest registry who fulfilled the following criteria were surveyed: cardiopulmonary resuscitation (CPR) was attempted; the arrest was not crew witnessed; and patients were found in a non-shockable rhythm. SETTING: Various ambulance organisations in Sweden. DESIGN: Prospective observational study. RESULTS: Among the 16,712 patients who fulfilled the inclusion criteria, the following factors were independently associated with a lower chance of survival one month after cardiac arrest: no bystander CPR; non-witnessed cardiac arrest; cardiac arrest occurring at home; increasing interval between call for and arrival of the ambulance; and increasing age. When these factors were considered simultaneously two groups with no survivors were defined. In both groups patients were found in a non-shockable rhythm, no bystander CPR was attempted, the arrest was non-witnessed, the arrest took place at home. In one group the interval between call for and arrival of ambulance exceeded 12 minutes. In the other group patients were older than 80 years and the interval between call for and arrival of the ambulance exceeded eight minutes. CONCLUSION: Among patients who had an out-of-hospital cardiac arrest and were found in a non-shockable rhythm the following factors were associated with a low chance of survival: no bystander CPR, non-witnessed cardiac arrest, the arrest took place at home, increasing interval between call for and arrival of ambulance, and increasing age. When these factors were considered simultaneously, groups with no survivors could be defined. In such groups the ambulance crew may refrain from starting CPR.

Advanced Cardiac Life Support↗
PubMed1997

Unwitnessed out-of-hospital cardiac arrest: is resuscitation worthwhile?

STUDY OBJECTIVE: To determine the epidemiology of unwitnessed out-of-hospital cardiac arrest and the factors associated with survival after resuscitation using the Utstein style data collection. METHODS: We conducted a prospective cohort study in a 525,000-population city served by a single EMS system comprising a tiered response with physicians in the field. We studied consecutive unwitnessed out-of-hospital cardiac arrests that occurred between January 1, 1994, and December 31, 1995. We determined survival from cardiac arrest to discharge from hospital and the factors associated with survival. RESULTS: Of the 809 patients for whom resuscitation was considered, 205 (25.3%) had sustained unwitnessed arrests. Cardiac origin of arrest was verified in 52% of cases. The most common noncardiac causes of arrest were trauma, intoxication, near-drowning, and hanging. In 150 patients (73.2%) the presenting rhythm was asystole, in 28 (13.6%) it was pulseless electrical activity, and in 27 (13.2%) it was ventricular fibrillation. Resuscitation was attempted in 162 cases, 59 (36.4%) of whom demonstrated return of spontaneous circulation; 45 (27.8%) were hospitalized alive, and 8 (4.9%) were discharged. The survivors represented 6.7% of all out-of-hospital cardiac arrest survivors during the study period. Survival was most likely if patients presented with pulseless electrical activity; none of the patients with asystole of cardiac origin survived. Sex (P = .032), age (inverse relationship, P = .0004), scene of collapse (P = .042), and interval from call receipt to arrival of first responders (P = .004) were associated with survival. In a logistic-regression model, near-drowning remained an independent factor of survival (odds ratio, 15.5; 95% confidence interval, 1.2 to 200). A routine priority dispatching protocol differentiated cardiac arrest patients with survival potential from those who already had irreversible signs of death. CONCLUSION: This survey shows that survival after unwitnessed out-of-hospital cardiac arrest is unlikely with an initial response of basic life support alone. Withdrawal of resuscitation should be considered if an adult victim of unwitnessed cardiac arrest is found in asystole and the arrest is of obvious cardiac origin.

Adolescent↗
PubMed1997

Cerebrovascular reactivity in comatose patients resuscitated from a cardiac arrest.

BACKGROUND AND PURPOSE: Cerebral blood flow after cardiac arrest is reduced during the delayed hypoperfusion phase, while cerebral metabolic rate of oxygen returns to baseline values. Hypocapnia can induce cerebral ischemia in neurosurgical patients who already have reduced cerebral blood flow. The purpose of the present study was to determine whether comatose patients resuscitated from a cardiac arrest have a normal cerebrovascular reactivity to changes in PaCO2 and whether hypocapnia causes cerebral ischemia. METHODS: We measured mean flow velocity (MFV) and pulsatility index (PI) in the middle cerebral artery, jugular bulb oxygen saturation (SjbO2), and arterial-jugular lactate difference (AJLD) during normo-, hypo-, and hyperventilation in 10 comatose patients resuscitated from a cardiac arrest. The first measurements were made within 6 hours after cardiac arrest and repeated 6, 12, and 24 hours later. RESULTS: During hypoventilation we observed a significant decrease in PI and an increase in MFV and SjbO2. During hyperventilation PI and MFV did not change, but SjbO2 showed a significant decrease. This was accompanied by an increase in AJLD, suggesting cerebral ischemia. In four patients the SjbO2 decreased below the ischemic threshold of 55%. CONCLUSIONS: The cerebrovascular reactivity to changes in arterial carbon dioxide tension is preserved in comatose patients resuscitated from a cardiac arrest. Hyperventilation may induce cerebral ischemia in the postresuscitation period.

Adult↗
PubMed1991

[Survey of cardiac arrests during and following anesthesia and surgery for the past seven years].

Cardiac arrests, excluding those associated with cardiac surgery, occurred in eleven out of 13,278 patients who had general anesthesia in our hospital for seven years from 1983 to 1989. Four of them were successfully resuscitated, while the remaining seven patients were lost. The causes of these cardiac arrests were as follows: massive bleeding in four; cardiac compression by surgeons in two; possible coronary artery spasm in one; hyperpotassemia in one; severe metabolic acidosis in one; myocardial ischemia in one; and unknown cardiogenic origin in one. There is no case in which anesthesia was the primary cause of cardiac arrest. Although we can not be absolutely free from cardiac arrest during anesthesia and surgery, we should do our best to detect and correct any factors leading to perioperative cardiac arrests.

Anesthesia, General↗
PubMed1999

Weekly and seasonal variation in the incidence of cardiac arrests.

BACKGROUND: Patterns of temporal variation of cardiac arrests may be important for understanding mechanisms leading to the onset of acute cardiovascular disorders. Previous studies have reported diurnal variation of the onset of cardiac arrests, with high incidence in the morning and in the evening, lack of daily variation during the week, and some seasonal variation. METHODS AND RESULTS: We explored weekly and yearly (seasonal) temporal variation in 6603 out-of-hospital cardiac arrests attended by the Seattle Fire Department. We observed daily variation that peaks on Monday and seasonal variation that peaks in the winter. CONCLUSIONS: Cardiac arrests do not occur randomly during the week or year but follow certain periodic patterns. These patterns are probably associated with patterns of activities.

Adolescent↗
PubMed1993

Characteristics of patients with nonfatal cardiac arrest 3 to 180 days after acute myocardial infarction.

Patients who survive a tachyarrhythmic cardiac arrest in the first 6 months after acute myocardial infarction (AMI) are at risk for recurrent arrests, but the magnitude, timing and characteristics of this phenomenon are unknown. This study characterizes the nature of recurrent tachyarrhythmic cardiac arrests in the absence of reversible factors or new myocardial necrosis in patients between 3 and 180 days after AMI. We retrospectively assessed 28 patients (mean age 61 +/- 12 years) who survived an initial cardiac arrest a median of 10 days after AMI. Mean left ventricular ejection fraction was 36 +/- 9%. Fourteen patients (50%) had at least 1 recurrence of cardiac arrest, and 10 had > 2 arrests. Almost all (92%) recurrent cardiac arrests occurred within 5 days of the preceding arrest, and the high-risk periods were similar after the first, second or third cardiac arrest. Very fast ventricular tachycardia (mean cycle length 212 +/- 30 ms) was the documented responsible arrhythmia in 44 of 51 cardiac arrests. The morphology was either polymorphic, monomorphic or sinusoidal. No clinical or laboratory values could be found that predicted whether a patient would have a recurrent arrest. Nineteen patients (68%) survived to leave the hospital and have been followed for up to 96 months. For these, actuarial 5-year overall survival was 76% and actuarial 5-year arrhythmia-free probability was 80%. Thus, patients who survive a cardiac arrest in the first 6 months after AMI are at high risk of recurrent cardiac arrest for a further 5 days, and the arrests are due to characteristically fast ventricular tachycardias.(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗
PubMed1994

Neurologic outcome and heart resuscitability with closed-chest cardiopulmonary bypass after prolonged cardiac arrest times in rabbits.

OBJECTIVES: To observe the influence of prolonged cardiac arrest times on neurologic outcome and heart resuscitability, using a resuscitation model with cardiopulmonary bypass in the rabbit, and to determine whether the changes in the plasma concentrations of lactate and lipoperoxide correlate with the severity of global brain ischemia. DESIGN: Randomized, prospective, controlled animal trial. SETTING: University research laboratory. SUBJECTS: Forty-three New Zealand white rabbits. INTERVENTIONS: Rabbits were randomly assigned to one of five groups: control, and four groups with cardiac arrest times of 8, 10, 12, and 15 mins. A bolus of 4 to 6 mL of 0.5-M potassium chloride was injected into the right atrium to induce cardiac arrest within 5 secs. Resuscitation was performed using closed-chest cardiopulmonary bypass, and mechanical ventilation with pure oxygen. When necessary, a DC shock of 10 joules/kg was used to terminate ventricular fibrillation. MEASUREMENTS AND MAIN RESULTS: Hemodynamics, electroencephalogram, electrocardiogram, and return times of various cranial reflexes were observed throughout the experiment. Plasma concentrations of lactate and lipoperoxide were determined before cardiac arrest and 5, 30, 90, and 150 mins after resuscitation. The neurologic outcome, measured by Neurologic Deficit Score, was determined at 150 mins postresuscitation. Values for the Neurologic Deficit Score were: 8 +/- 8 in the control group; 31 +/- 13; 37 +/- 19; 69 +/- 22; and 62 +/- 26 in the cardiac arrest groups of 8, 10, 12, and 15 mins, respectively. No significant differences in cardiac resuscitability were found among the four cardiac arrest groups. The plasma concentrations of lactate and lipoperoxide were significantly higher than the prearrest levels; however, there were no significant differences among the four cardiac arrest groups. CONCLUSIONS: Cardiopulmonary bypass can be used to establish a resuscitation model in rabbits. Neurologic outcome worsens progressively in proportion to the prolonged cardiac times, especially when it exceeds 10 mins. Cardiac resuscitability is still possible, even when arrest time exceeds 15 mins. Changes in plasma concentrations of lactate and lipoperoxide do not correlate with the neurologic outcome and heart resuscitability following cardiac arrest.

Analysis of Variance↗
PubMedDate not supplied

The value of moderate hypothermia during anoxic cardiac arrest for coronary artery surgery.

Anoxic cardiac arrest, as opposed to induced ventricular fibrillation, greatly facilitates accurate distal anastomosis in aortocoronary bypass surgery. In order to diminish the anoxic insult, general and topical hypothermia may be used. In an attempt to establish the value of moderate hypothermia during anoxic cardiac arrest two groups of patients were compared. In group I coronary artery bypass procedures were performed under normothermic conditions with anoxic cardiac arrest. Patients in group II underwent similar procedures but under hypothermic conditions. General body hypothermia to an esophageal temperature of 30 degrees C and topical hypothermia with iced saline lavage were used. Using these techniques, the average intramyocardial temperature was 26 degrees C. Nonfatal cardiac complications did not occur more frequently in the hypothermic group. Operative mortality was decreased from 6.3% in the normothermic group to 1.5% in the hypothermic group. However, in group II, in addition to hypothermia, a second factor in the reduction of mortality was the completeness of the revascularization procedure: 58.5% of the patients had three or more bypass grafts in the hypothermic group. The mean anoxic arrest time was over 50 min for all patients--those who survived as well as those who died with postoperative low cardiac output or myocardial infarction. Therefore, anoxic arrest time should be kept as short as possible and certainly less than 50 min. Intermittent aortic occlusion and performance of the proximal anastomoses using a partial occluding clamp on the aorta are currently being used and, together with moderate hypothermia, provide a further reduction in postoperative myocardial complications.

Arrhythmias, Cardiac↗
PubMed2006

Serum neuron-specific enolase as early predictor of outcome after in-hospital cardiac arrest: a cohort study.

INTRODUCTION: Outcome after cardiac arrest is mostly determined by the degree of hypoxic brain damage. Patients recovering from cardiopulmonary resuscitation are at great risk of subsequent death or severe neurological damage, including persistent vegetative state. The early definition of prognosis for these patients has ethical and economic implications. The main purpose of this study was to investigate the prognostic value of serum neuron-specific enolase (NSE) in predicting outcomes in patients early after in-hospital cardiac arrest. METHODS: Forty-five patients resuscitated from in-hospital cardiac arrest were prospectively studied from June 2003 to January 2005. Blood samples were collected, at any time between 12 and 36 hours after the arrest, for NSE measurement. Outcome was evaluated 6 months later with the Glasgow outcome scale (GOS). Patients were divided into two groups: group 1 (unfavorable outcome) included GOS 1 and 2 patients; group 2 (favorable outcome) included GOS 3, 4 and 5 patients. The Mann-Whitney U test, Student's t test and Fisher's exact test were used to compare the groups. RESULTS: The Glasgow coma scale scores were 6.1 +/- 3 in group 1 and 12.1 +/- 3 in group 2 (means +/- SD; p < 0.001). The mean time to NSE sampling was 20.2 +/- 8.3 hours in group 1 and 28.4 +/- 8.7 hours in group 2 (p = 0.013). Two patients were excluded from the analysis because of sample hemolysis. At 6 months, favorable outcome was observed in nine patients (19.6%). Thirty patients (69.8%) died and four (9.3%) remained in a persistent vegetative state. The 34 patients (81.4%) in group 1 had significantly higher NSE levels (median 44.24 ng/ml, range 8.1 to 370) than those in group 2 (25.26 ng/ml, range 9.28 to 55.41; p = 0.034). CONCLUSION: Early determination of serum NSE levels is a valuable ancillary method for assessing outcome after in-hospital cardiac arrest.

Aged↗
PubMed2004

CSF levels of neurofilament is a valuable predictor of long-term outcome after cardiac arrest.

AIMS: Prognostication of brain damage after cardiac arrest mainly relies on clinical observations. Recently, it has been shown that biochemical markers of brain damage measured in serum aid in this process. In the present study, we wanted to test the usefulness of CSF determinations of a neuronal protein, the neurofilament protein (NFL). METHODS AND RESULTS: Lumbar punctures were performed during week 2 or 3 in 22 patients surviving cardiac arrests. CSF NFL concentrations were analysed using an ELISA. Levels were increased in cardiac arrest patients. Patients with poor outcome according to the Glasgow outcome scale (GOS), low performance at a mini mental state examination (MMSE) and dependent according to Katz at 1 year follow up had the highest NFL levels. The NFL levels correlated well with anoxia time and coma depth. High positive and negative predictive values, particularly for poor outcome according to GOS were observed. CONCLUSIONS: Levels of CSF NFL give a reliable measure of the brain damage following cardiac arrest and the levels are highly predictive of poor outcome. This observation urges the development of sensitive serum assays of this marker to be used in the clinical setting.

Adult↗
PubMed1998

A revised role for the hospital cardiac arrest team?

This prospective study assesses the role of the hospital cardiac arrest team. We have determined who is responsible for return of spontaneous circulation in those patients who survive to discharge. A total of 83 adult patients were analysed over a 5 month period. Fifty-five patients had cardiopulmonary resuscitation after an in hospital cardiac arrest and circulation was restored in 14 (25.5%). Eight (14.5%) patients survived to discharge. All eight survivors had circulation restored by the first responder before arrival of the cardiac arrest team. Six survivors had witnessed ventricular fibrillation and successful defibrillation by nursing staff. The two other survivors had cardiac arrests in the presence of doctors. Twenty-eight patients had pre-hospital cardiac arrests and were attended by the cardiac arrest team in the emergency department. Six patients had circulation restored by the emergency medical services prior to hospital arrival and four (14%) survived to discharge. Two patients had circulation restored in the emergency department by the arrest team and none survived to discharge. All the survivors to hospital discharge had first responder return of spontaneous circulation. We suggest a revised role for the cardiac arrest team.

Adult↗