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Rearrest after prehospital resuscitation
E Brooke Lerner1, Michael O'Connell, Ronald G Pirrallo
1Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA. eblerner@mcw.edu
Prehospital Emergency Care
|November 9, 2010
Summary
Many out-of-hospital cardiac arrest (OHCA) patients who regain a pulse (return of spontaneous circulation, ROSC) experience a second arrest before reaching the hospital. These patients have significantly lower survival rates to hospital discharge.
Area of Science:
- Emergency medicine
- Cardiology
- Resuscitation science
Background:
- Out-of-hospital cardiac arrest (OHCA) presents a critical challenge in emergency medical services (EMS).
- Achieving return of spontaneous circulation (ROSC) is a key milestone, but subsequent rearrest can compromise patient outcomes.
- Understanding the incidence and characteristics of rearrest post-ROSC is crucial for improving survival rates.
Purpose of the Study:
- To quantify the frequency of rearrest in OHCA patients who achieve ROSC during EMS care.
- To analyze the demographic and clinical characteristics associated with rearrest.
- To determine the impact of rearrest on survival to hospital discharge.
Main Methods:
- Retrospective review of a countywide EMS patient care database from 2000-2008.
- Inclusion of all OHCA patients who received attempted resuscitation.
- Identification of patients achieving ROSC and subsequent rearrest, with comparative analysis of arrest characteristics and survival outcomes.
Main Results:
- Of 7,296 OHCA patients, 2,454 (34%) achieved field ROSC.
- Nearly half (39%) of those with ROSC experienced rearrest before hospital arrival.
- Patients experiencing rearrest had significantly lower survival to hospital admission (53% vs. 85%) and discharge (15% vs. 35%).
Conclusions:
- A substantial proportion of OHCA patients achieving ROSC suffer a subsequent rearrest during pre-hospital care.
- Rearrest significantly diminishes the likelihood of survival to hospital discharge.
- Further research into strategies to prevent or manage rearrest is warranted.
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