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Accuracy and impact of presumed cause in patients with cardiac arrest
I Kürkciyan1, G Meron, W Behringer
1Department of Emergency Medicine, General Hospital of Vienna, University of Vienna, Austria.
Insights
Recognizing the cause of cardiac arrest is challenging, with 11% of initial presumptions being incorrect. Accurate cause identification is linked to better patient survival and neurological outcomes.
Area of Science:
- Emergency Medicine
- Cardiology
- Critical Care
Background:
- International guidelines emphasize distinguishing cardiac from noncardiac causes of cardiac arrest.
- Accurate etiological diagnosis is crucial for appropriate patient management and research comparability.
Purpose of the Study:
- To determine the agreement rate between the initially presumed cause and the definitive cause of cardiac arrest.
- To evaluate the impact of accurate cause identification on patient outcomes.
Main Methods:
- Retrospective analysis of cardiac arrest cases in an urban tertiary care hospital.
- Comparison of emergency room physician's presumed cause with definitive cause determined by clinical evidence or autopsy.
- Assessment of sensitivity and specificity of presumed cardiac origin.
Main Results:
- In 569 patients, the presumed cause was correct in 89% and incorrect in 11%.
- Cardiac origin was presumed in 71% and definitively identified in 69%; noncardiac origin was presumed in 25% and identified in 31%.
- Commonly overlooked noncardiac causes included pulmonary embolism and cerebral disorders. Asystole was more frequent when the presumed cause was undetermined or incorrect.
Conclusions:
- The cause of cardiac arrest is often misidentified, particularly with non-ventricular fibrillation rhythms.
- Discrepancies in presumed versus definitive causes may impact study comparability, treatment strategies, and patient prognosis.
- Correctly identified causes of cardiac arrest correlated with significantly improved survival and neurological outcomes.
Background:
International guidelines recommend differentiation between cardiac and noncardiac causes of cardiac arrest. The aim of this study was to find the rate of agreement between primarily postulated and definitive causes of cardiac arrest.
Methods And Results:
We retrospectively analyzed the primarily presumed cause of cardiac arrest as determined by the emergency room physician on admission in all patients admitted to the emergency department of one urban tertiary care hospital. This was compared with the definitive cause as established by clinical evidence or autopsy. Within 4 years, the initially presumed cause was unclear in 24 (4%) of 593 patients. In the remaining 569 patients, the presumed cause was correct in 509 (89%) and wrong in 60 (11%) cases. Cardiac origin was presumed in 421 (71%) and the definitive cause in 408 (69%) cases. Noncardiac origin was presumed in 148 (25%) and the definitive cause in 185 (31%) patients. Presumed cardiac cause was sensitive (96%) but less specific (77%). Noncardiac causes such as pulmonary embolism, cerebral disorders, or exsanguination were those most frequently overlooked. Asystole occurred significantly more often in patients in whom presumed cause remained undetermined or differed from the definitive cause.
Conclusions:
Cause of cardiac arrest is not as easily recognized as anticipated, especially when the initial rhythm is different from ventricular fibrillation. This might affect comparability of study results, therapeutic strategies, prognosis, and outcome. Patients in whom the presumed cause was confirmed as being correct had significantly better survival and neurological outcome.