Long-term survival after prehospital cardiac arrest: Analysis of outcome during an 8 year study

Robert J Myerburg, K. M. Kessler, D. Estes, C. A. Conde, R. M. Luceri, L. Zaman, P. L. Kozlovskis, Agustin Castellanos

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Abstract

We analyzed long-term follow-up data accumulated during an 8 year study of survivors of prehospital cardiac arrest. All patients included in this study were primary entrants via community-based rescue systems; patients who were tertiary referrals (survivors of cardiac arrest from other hospitals) were not included in this analysis. In the group of 61 patients entering our study between 1975 and 1980, with a follow-up to 1983, there have been a total of 24 deaths (39%). Sixteen of the 24 deaths were the result of recurrent cardiac arrest; eight were nonsudden cardiac deaths or noncardiac deaths. The mean duration from entry to death in the nonsurvivors was 27.5 ± 19.7 months, and the time from the index event to last follow-up in the long-term survivors was 59.9 ± 19.4 months. Life table analysis demonstrated a 10% rate of recurrence of cardiac arrest in the first year, with a 5% per year rate in each of the subsequent 3 years. Left ventricular ejection fractions at entry were not significantly different between survivors (mean = 45.3 ± 13.6%) and nonsurvivors (mean = 37.6 ± 12.6%), and the severity of ejection fraction abnormality at entry did not correlate with time to death in the nonsurvivors. However, ejection fraction was significantly lower in patients who died from causes other than recurrent cardiac arrest than in those who died of cardiac arrest (24.5 ± 9.1% vs. 42.7 ± 9.2%; p < .002). Frequency and Lown classifications of ventricular arrhythmias in patients on long-term antiarrhythmic therapy during follow-up did not distinguish those patients who were to have recurrent cardiac arrest from those who continued as long-term survivors. The 10% 1 year and 15% 2 year recurrence rates in survivors of prehospital cardiac arrest, unselected except for exclusion of acute myocardial infarction as a precipitating event, provide a minimum goal for outcome against which risk in various subgroups and effectiveness of other methods of intervention can be measured.

Original languageEnglish
Pages (from-to)538-546
Number of pages9
JournalCirculation
Volume70
Issue number4
StatePublished - Dec 13 1984

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Heart Arrest
Survivors
Survival
Recurrence
Life Tables
Stroke Volume
Cardiac Arrhythmias
Referral and Consultation
Myocardial Infarction

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Myerburg, R. J., Kessler, K. M., Estes, D., Conde, C. A., Luceri, R. M., Zaman, L., ... Castellanos, A. (1984). Long-term survival after prehospital cardiac arrest: Analysis of outcome during an 8 year study. Circulation, 70(4), 538-546.

Long-term survival after prehospital cardiac arrest : Analysis of outcome during an 8 year study. / Myerburg, Robert J; Kessler, K. M.; Estes, D.; Conde, C. A.; Luceri, R. M.; Zaman, L.; Kozlovskis, P. L.; Castellanos, Agustin.

In: Circulation, Vol. 70, No. 4, 13.12.1984, p. 538-546.

Research output: Contribution to journalArticle

Myerburg, RJ, Kessler, KM, Estes, D, Conde, CA, Luceri, RM, Zaman, L, Kozlovskis, PL & Castellanos, A 1984, 'Long-term survival after prehospital cardiac arrest: Analysis of outcome during an 8 year study', Circulation, vol. 70, no. 4, pp. 538-546.
Myerburg RJ, Kessler KM, Estes D, Conde CA, Luceri RM, Zaman L et al. Long-term survival after prehospital cardiac arrest: Analysis of outcome during an 8 year study. Circulation. 1984 Dec 13;70(4):538-546.
Myerburg, Robert J ; Kessler, K. M. ; Estes, D. ; Conde, C. A. ; Luceri, R. M. ; Zaman, L. ; Kozlovskis, P. L. ; Castellanos, Agustin. / Long-term survival after prehospital cardiac arrest : Analysis of outcome during an 8 year study. In: Circulation. 1984 ; Vol. 70, No. 4. pp. 538-546.
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abstract = "We analyzed long-term follow-up data accumulated during an 8 year study of survivors of prehospital cardiac arrest. All patients included in this study were primary entrants via community-based rescue systems; patients who were tertiary referrals (survivors of cardiac arrest from other hospitals) were not included in this analysis. In the group of 61 patients entering our study between 1975 and 1980, with a follow-up to 1983, there have been a total of 24 deaths (39{\%}). Sixteen of the 24 deaths were the result of recurrent cardiac arrest; eight were nonsudden cardiac deaths or noncardiac deaths. The mean duration from entry to death in the nonsurvivors was 27.5 ± 19.7 months, and the time from the index event to last follow-up in the long-term survivors was 59.9 ± 19.4 months. Life table analysis demonstrated a 10{\%} rate of recurrence of cardiac arrest in the first year, with a 5{\%} per year rate in each of the subsequent 3 years. Left ventricular ejection fractions at entry were not significantly different between survivors (mean = 45.3 ± 13.6{\%}) and nonsurvivors (mean = 37.6 ± 12.6{\%}), and the severity of ejection fraction abnormality at entry did not correlate with time to death in the nonsurvivors. However, ejection fraction was significantly lower in patients who died from causes other than recurrent cardiac arrest than in those who died of cardiac arrest (24.5 ± 9.1{\%} vs. 42.7 ± 9.2{\%}; p < .002). Frequency and Lown classifications of ventricular arrhythmias in patients on long-term antiarrhythmic therapy during follow-up did not distinguish those patients who were to have recurrent cardiac arrest from those who continued as long-term survivors. The 10{\%} 1 year and 15{\%} 2 year recurrence rates in survivors of prehospital cardiac arrest, unselected except for exclusion of acute myocardial infarction as a precipitating event, provide a minimum goal for outcome against which risk in various subgroups and effectiveness of other methods of intervention can be measured.",
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