Original contribution
Decision making in prehospital sudden cardiac arrest

https://doi.org/10.1016/S0196-0644(86)80185-8Get rights and content

Many studies of prehospital resuscitation report on selected populations. We examined a series of 445 unselected nontraumatic cardiac arrests. Emergency cardiac care (ECC) was not initiated in 126 (28%). ECC was begun in 319 (78%), but was terminated in 132 (33%). Ninety-four (21%) were admitted to the hospital with palpable pulses and organized rhythm (successful resuscitation), and 42 (9%) were discharged alive (saved). The successful resuscitation/save rate for patients presenting in ventricular fibrillation was 50%/25%. Multivariate regression analysis was used to identify the relative importance of significant variables in predicting survival, and the analysis identified the presence of ventricular fibrillation, short paramedic response times, and short paramedic treatment times.

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    Since so few patients have completed legal advance directives, and only a fraction of those have the document available, the default option for many physicians is to attempt resuscitation. Reported survival rates for patients with cardiac arrest vary in the literature and are dependent on many factors, including time elapsed since arrest (down time) [17,22,23], presenting electrical rhythm [24], early defibrillation [25,26], cardiac activity on bedside echocardiogram [27], underlying medical condition [28], response to prehospital advanced life support (ALS) protocols [29,30], age [31], and long-term care [32]. In summary, published reports have estimated survival for victims of cardiac arrest to hospital discharge between 0% and 16% [33–36].

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Presented at the University Association for Emergency Medicine Annual Meeting in Kansas City, Missouri, May 1985.

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