ABSTRACT
The aim of this study was to assess management of patients resuscitated after pre-hospital cardiac arrest, initially indicated to preserve neurological status, the aetiological investigation only being undertaken when the outcome is favourable. Eighty-nine pre-hospital cardiac arrests were analysed retrospectively. The hospital survival was 16%, death being due to neurological lesions (55%), uncontrollable haemodynamic instability -39%) or other causes (7%). One year after the initial episode, none of the survivors had died, all living autonomously without (8 patients) or with minimal neurological sequellae (5 patients). These results are concordant with reports in the literature. The 11 cases of cardiac arrest with a favourable outcome of presumed cardiac origin underwent coronary angiography (6 cases) or endocavitary electrophysiological investigation (8 cases). These investigations showed or suggested an ischaemic process in 4 cases, an arrhythmia in 6 cases and severe valvular heart disease in 1 case. The independent predictive factors of survival were a Glasgow score of 6 or more on admission, the persistence of a light reflex and benign EEG appearances according to Synek's classification. The authors conclude that these results are comparable to those reported in the literature with aetiological investigations reserved for cases of favourable neurological outcome. The investigations including coronary angiography and electrophysiological investigation are essential as shown by the diversity of the cardiac pathologies identified.
Subject(s)
Heart Arrest/complications , Nervous System Diseases/etiology , Outcome Assessment, Health Care , Patient Admission , Adult , Aged , Aged, 80 and over , Coronary Angiography , Electrophysiology , Female , Follow-Up Studies , Heart Arrest/diagnosis , Heart Arrest/therapy , Humans , Male , Middle Aged , Quality of Life , Survival AnalysisABSTRACT
Survival rate after out-of-hospital cardiac arrest varies according to evaluation criteria. It can be estimated that in 22 to 63% of the cases, effective hemodynamic performance is restored although hospital mortality is much higher, reaching 63%. Death, frequent after prolonged cardiac arrest, is usually due to recurrent cardiac arrest or the effects of prolonged anoxia. Mortality in patients who survive the hospitalization period is approximately 20% during the year following discharge. Consequently one year after out-of-hospital cardiac arrest, only 5% of the patients are still alive. The quality of life varies greatly in these survivors; the course of neurological sequellae may be favorable in approximately half but leads to death in others. The primary factor predicting survival is the underlying pathology, highly influenced by age. Inversely, factors predicting a more favorable outcome include ventricular tachycardia as the origin of cardiac arrest, presence of other people at onset and rapid recovery of spontaneous hemodynamic activity. Loss of consciousness for more than 24 hours, defective bulbar reflexes and anomalies on the electroencephalogram are signs of gravity as are high blood glucose, major brain edema and abolition of somesthesic and auditive evoked potentials.
