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Cardiac arrest under age 40: etiology and prognosis
Insights
Young patients experiencing cardiac arrest have a poor hospital discharge prognosis, but neurologically intact survival rates are similar to older populations. Diverse causes necessitate searching for reversible conditions.
Area of Science:
- Emergency Medicine
- Cardiology
- Pediatric Critical Care
Background:
- Cardiac arrest in young individuals (1-39 years) presents unique challenges.
- Understanding the specific demographics, rhythms, and etiologies is crucial for improving outcomes.
Purpose of the Study:
- To analyze the characteristics, causes, and outcomes of cardiac arrest in a young patient population.
- To compare survival and neurological intactness in young cardiac arrest survivors versus the general population.
Main Methods:
- Retrospective review of 84 patients aged 1-39 years presenting with cardiac arrest between 1979 and 1982.
- Analysis of presenting rhythms, bystander CPR rates, resuscitation efforts, and etiologies.
- Autopsy data and clinical history used to determine causes of death.
Main Results:
- Ventricular fibrillation and asystole were the most common presenting rhythms (37% each).
- Toxic exposure/ingestion (26%) and atherosclerotic heart disease (23%) were leading etiologies.
- Only 5% of patients survived to discharge, but all survivors were neurologically intact.
Conclusions:
- Young patients with cardiac arrest have a lower survival rate to discharge compared to the overall population.
- Despite lower discharge rates, the proportion of neurologically intact survivors is comparable.
- A broad diagnostic approach to identify reversible causes is essential in this demographic.
Abstract:
Between January 1979 and December 1982, 84 patients between the ages of 1 and 39 years presented to the emergency department in a state of cardiac arrest. There were 58 male patients (69%) and 26 female patients (31%) in the group. Presenting rhythms were ventricular fibrillation (37%), asystole (37%), idioventricular rhythm (14%), heart block (4%), bradycardia (4%), ventricular tachycardia (3%), and electromechanical dissociation (3%). Thirty-two percent had bystander CPR. Of 21 patients initially resuscitated (25%), only four (5%) survived to discharge from the hospital. All survivors were neurologically intact. Seventy-five of the 80 patients who died (90%) underwent autopsy. Cause of death in the five remaining patients was inferred from clinical history. Etiologies of the cardiac arrests were the following: toxic exposure or ingestion (26%), atherosclerotic heart disease (23%), undetermined (11%), pulmonary embolism (6%), hemorrhage (6%), epilepsy (2%), cardiomyopathy (7%), myocarditis (2%), pneumonia (4%), and one case each of airway obstruction, asthma, peptic disease, and septic shock. Diverse etiologies should lead to a diagnostic search for reversible conditions in young patients. The prognosis for hospital discharge is poorer in the young population than is reported in our overall cardiac arrest population; however, numbers of neurologically intact survivors are similar in the young and the overall cardiac arrest population.