Pulseless electrical activity: treatment during and after cardiopulmonary resuscitation and patient survival

Research output: ThesisDoctoral ThesisCollection of Articles

Abstract

Aims: The aim was to investigate the treatment of cardiac arrest (CA) patients with pulseless electrical activity (PEA) during and after cardiopulmonary resuscitation (CPR). Material and Methods: Treatment of the underlying cause of PEA during CPR was evaluated among in-hospital cardiac arrest (IHCA) patients. Factors determining the intensity of hospital care, treatment methods and survival after out-of-hospital cardiac arrest (OHCA) with PEA was evaluated by comparing patients treated at Level 1-3 ICUs, with Level 3 referring to most advanced care, and ordinary wards. Differences between the Nordic ICUs in admission criteria and post-resuscitation care were evaluated with a questionnaire. Long-term survival after PEA and quality of life was estimated. Results: In one-fifth of IHCA PEA patients, a specific reason was found and treated during CPR. They had a favorable 30-day survival rate (32% vs 11%) compared to standard CPR patients, but young age was the only individual prognostic factor. Longer time to return of spontaneous circulation (ROSC) and advanced age decreased the admission rate to Level 2 or 3 ICUs, whereas good pre-arrest CPC increased it independently. Over half of the Nordic ICUs reported having a protocol according to which OHCA patients are admitted to the ICU: 16% do not admit patients with initial PEA or asystole. Treatment with targeted temperature management (TTM) (4%) or early coronary angiography (CAG, 3%) was very rare among Finnish PEA patients. In the Nordic ICUs, usage rates of TTM for all actively treated OHCA patients varied between 20-69% and use of early CAG varied between 13-54%. Of OHCA patients with PEA, 17% survived 1-year with a good neurological outcome. The neurological outcome was better with more intensive care, but only short time to ROSC and young age independently associated with good neurologic outcome. 6% of OHCA PEA patients survived 5 years and 87% of factors related to quality of life were evaluated as normal or mildly impaired. Conclusions: Treatment of the underlying cause of PEA during CPR was not independently associated with outcome, but larger studies are needed. Despite international guidelines promoting intensive care, TTM and early CAG, the implementation seems to vary between the Nordic countries and hospitals, partly because of inconclusive evidence among PEA patients. Good neurologic survival was more common with more intensive levels of post-resuscitation care, but level of care was not an independent predictor for outcome. The documentation of favorable chances for good outcomes after PEA might encourage physicians to attempt causal treatment during CPR and motivate to consider more intensive level of care and TTM.
Original languageEnglish
Supervisors/Advisors
  • Silfvast, Tom, Supervisor
  • Virkkunen, Ilkka, Supervisor, External person
Award date16 Nov 2018
Place of PublicationHelsinki
Publisher
Print ISBNs978-951-51-4666-3
Electronic ISBNs978-951-51-4667-0
Publication statusPublished - 2018
MoE publication typeG5 Doctoral dissertation (article)

Fields of Science

  • Cardiopulmonary Resuscitation
  • Heart Arrest
  • +therapy
  • Out-of-Hospital Cardiac Arrest
  • Patient Selection
  • Intensive Care Units
  • Survival
  • Quality of Life
  • Emergency Medical Services
  • Scandinavian and Nordic Countries
  • 3126 Surgery, anesthesiology, intensive care, radiology

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