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J Korean Soc Emerg Med > Volume 25(6); 2014 > Article
Journal of The Korean Society of Emergency Medicine 2014;25(6): 737-746.
Clinical Analysis of Prehospital Heartsavers Surviving Out-of-hospital Cardiac Arrest of Cardiac Origin
Kyung In Park, Gyun Moo Kim, Tae Chang Jang
Department of Emergency Medicine, Catholic University of Daegu, School of Medicine, Daegu, Korea. emzzang@cu.ac.kr
ABSTRACT
PURPOSE:
Sudden cardiac death is still a major cause of death and a burden to national public health. Out-of-hospital cardiac arrest (OHCA) patients achieving field Return of spontaneous circulation (ROSC) have better survival rates and good neurological outcomes. The study was designed for analysis of prehospital and hospital clinical characteristics of Heartsaver patients surviving OHCA of cardiac origin.
METHODS:
A retrospective study was conducted on 31 Heartsaver patients surviving OHCA by Emergency Medical Service (EMS) from March, 2011 to May, 2014; 24 cardiogenic-Heartsaver patients were enrolled in this study. They were divided into the myocardial infarction group (MI group) and the non-myocardial infarction group (Non-MI group) by final diagnosis for comparison of prehospital and in-hospital characteristics.
RESULTS:
The etiology of cardiac arrest cause of cardiogenic-Heartsaver was categorized according to five groups, including myocardial infarction (29.2%), Brugada syndrome (25.0%), idiopathic ventricular fibrillation (25.0%), idiopathic ventricular tachycardia (8.3%), and coronary spasm (12.5%). Most patients had good neurological outcomes, Cerebral Performance Categories scale (CPC) median was 1.0(1.0-1.0). The MI group showed higher average age (57.1+/-6.49 vs 52.3+/-13.0, p=0.036), high incidence of ST-segment elevation (42.9%), and nonspecific-ST or T-wave change (24.9%) in electrocardiogram (ECG) after ROSC, higher incidence of regional wall motion abnormality in Echocardiography (85.7% vs 23.5%, p=0.009), and higher peak level of CK-MB, troponin I within 12 hours (p=0.005, p=0.014). Some Non-MI patients had undergone an electrophysiologic study and received an implantable cardioverter defibrillator.
CONCLUSION:
Cardiogenic OHCA patients should be examined by cardiac enzyme, ECG, echocardiography, and coronary angiography in order to differentiate etiology. Besides, to prevent sudden cardiac death from fatal arrhythmia, electrophysiologic study and implantable cardioverter defibrillator insertion therapy must be considered.
Key words: Sudden cardiac death, Implantable cardioverter defibrillator, Out-of-Hospital cardiac arrest, Emergency medical service
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