Mon25October0757PM 5

A 58-year-old man with a history of anterior myocardial infarction collapses in the supermarket which fortunately is situated near a local hospital. Bystander cardiopulmonary resuscitation is initiated and continued for four minutes whilst waiting for the paramedic team to arrive.

On attachment of the defibrillator the initial rhythm is that of a bradyarrhythmia. There is no response to atropine and the rhythm changes to pulseless electrical activity. Resuscitation continues for a further six minutes in the back of the ambulance en route to the hospital.

In hospital the patient is intubated and there is return of spontaneous circulation. However the patient remains comatose.

Which of the following indicators point to a poor survival rate after a cardiac arrest in this man?

(Please select 1 option)

Time taken for advanced life support to commence

Insertion of endotracheal tube

History of cardiac disease This is the correct answer

Bradyarrhythmia not responding to atropine Incorrect answer selected

The patient's age

Explanation

After the return of spontaneous circulation following cardiac arrest, family members will often ask of a patient's chance of survival and of the likelihood of a good recovery. In order to be able to make an informed decision regarding further management of such a patient, it is important for a clinician to be aware of key prognostic indicators.

The following factors are all predictors of poor survival following a cardiac arrest:

Sepsis

Cerebrovascular accident with severe neurologic deficit

Cancer or Alzheimer disease

History of more than two chronic diseases

A history of cardiac disease, and

Prolonged CPR more than five minutes.

Poor prognostic features in post arrest patients who survive until admission:

Persistent coma after CPR (persistent vegetative state)

Hypotension, pneumonia, and/or renal failure after CPR

Need for intubation or pressors

History of class III or IV heart failure, and

Older age.

Reference:

Engdahl J, Bång A, Lindqvist J, Herlitz J. Can we define patients with no and those with some chance of survival when found in asystole out of hospital? Am J Cardiol. 2000;86(6):610-4.

Greene HL. Sudden arrhythmic cardiac death--mechanisms, resuscitation and classification: the Seattle perspective. Am J Cardiol. 1990;65(4):4B-12B.

Marwick TH, Case CC, Siskind V, Woodhouse SP. Prediction of survival from resuscitation: a prognostic index derived from multivariate logistic model analysis. Resuscitation. 1991;22(2):129-37.

de Vreede-Swagemakers JJ, Gorgels AP, Dubois-Arbouw WI, et al. Circumstances and causes of out-of-hospital cardiac arrest in sudden death survivors. Heart. 1998;79(4):356-61.

Weaver WD, Cobb LA, Hallstrom AP, et al. Factors influencing survival after out-of-hospital cardiac arrest. J Am Coll Cardiol. 1986 Apr;7(4):752-7.

Answer Statistics

1

29%

2

3%

3

33%

4

33%

5

4%

Times answered: 273