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Cardiovascular collapse after return of spontaneous circulation in human out-of-hospital cardiopulmonary arrest
  1. John Mark Chestnut1,
  2. Andrew A Kuklinski1,
  3. Shannon W Stephens2,
  4. Henry E Wang2
  1. 1University of Alabama School of Medicine, Birmingham, Alabama, USA
  2. 2Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
  1. Correspondence to Dr Henry E Wang, Department of Emergency Medicine, University of Alabama at Birmingham, 619 19th Street South, JTN 266 Birmingham, AL 35249, USA; hwang{at}


Objective Animal studies describe cardiovascular collapse (CVC; hypotension or reoccurrence of cardiac arrest) after return of spontaneous circulation (ROSC) from cardiopulmonary arrest. Few studies describe CVC in humans. This study aimed to determine the occurrence of CVC in human out-of-hospital cardiopulmonary arrest (OHCA).

Methods Using observational data from a site of the Resuscitation Outcomes Consortium, the study analysed treated, non-traumatic OHCA achieving initial ROSC. CVC was defined as post-ROSC hypotension (systolic blood pressure ≤80 mm Hg), post-ROSC administration of epinephrine, vasopressin or dopamine, or post-ROSC recurrent cardiac arrest. The time period from initial ROSC to emergency department (ED) arrival was measured. The prevalence of and elapsed time to post-ROSC CVC was determined, censoring cases at the point of ED arrival and comparing clinical characteristics between CVC and non-CVC cases.

Results Of 1081 treated OHCA, ROSC occurred in 58 (5%; 95% CI 4% to 7%). CVC occurred in three cases of 58 ROSC (5%; 95% CI 1% to 14%), all due to recurrent cardiac arrest. The median ROSC to ED arrival time was 6 min (IQR 3–13 min). ROSC to CVC times were 1, 2 and 8 min. Patient sex, age, initial ECG rhythm, endotracheal intubation, bystander cardiopulmonary resuscitation and bystander automated external defibrillation were similar between CVC and non-CVC cases (p=0.11–1.00).

Conclusions In this series of treated OHCA, only a small fraction of patients experienced CVC after ROSC.

  • Cardiac arrest
  • cardiac care
  • emergency ambulance systems
  • emergency care systems
  • emergency medical services
  • resuscitation

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  • This study was presented at the National Association of EMS Physicians in Phoenix, Arizona, in January 2010. It was also presented at the SAEM Southeastern Regional Conference in Birmingham, Alabama, in April 2010.

  • Funding This study was supported by a cooperative agreement (5U01HL077863) with the National Heart, Lung and Blood Institute in partnership with the National Institute of Neurological Disorders and Stroke, the Canadian Institutes of Health Research (CIHR), Institute of Circulatory and Respiratory Health, Defense Research and Development Canada and the Heart and Stroke Foundation of Canada.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the Institutional Review Board of the University of Alabama at Birmingham.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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