Sudden cardiac arrest: clinical characteristics and predictors of survival

Much remains unknown about the conditions surrounding the occurrence of prehospital sudden cardiac arrest. We have investigated the clinical characteristics and predictors of survival in a total of 90 consecutive patients in whom sudden cardiac arrest (SCA) happened to occur during their hospitalization in general wards over the past 19 years. The types of arrhythmia present at the time of SCA were ventricular fibrillation (in 46% of cases), ventricular tachycardia (19%), and bradyarrhythmia (35%). The underlying causes were coronary artery disease (45%), cardiomyopathy (20%), and valvular disease (14%). SCA showed a circadian pattern, with many cases during the day and few at night. Prodromal symptoms included chest pain (16% of patients), dyspnea (11%) and palpitations (2%). Of the total of 90 subjects, 26 (29%) were discharged from hospital alive, and SCA recurred in 24% of these. The 5-year survival rate was 52%. The most important predictors of survival examined were initiation of cardiopulmonary resuscitation, NYHA class, and time of SCA. Of those in whom cardiopulmonary resuscitation was initiated within 1 min, 52% were discharged alive, but all of those not receiving it within 10 min died.