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[Cardiac arrest outside hospital: initial and subsequent cardiological management].

UNLABELLED
The prognosis of cardiac arrest outside hospital is directly related to the initial management. The aim of this work was to evaluate the characteristics of the initial and subsequent cardiological management of victims of cardiac arrest outside hospital with a retrospective analysis of data from the SAMU 35 (Emergency Medical Service, IIIe et Vilaine region) in the period April 1998 - April 2002.


RESULTS
533 non-traumatic cardiac arrests outside hospital were reported in 532 patients (average age 63 +/- 17, 73% male). The cardiac arrest occurred at home in 77% of cases. The initial cardiac rhythm documented was asystole in 63% of cases, ventricular fibrillation (VF) in 30% ventricular tachycardia (VT) in 1% and electromechanical dissociation in 6%. A cardiac aetiology was presumed in 294 (69%) of the 424 resuscitated patients. Among these, 22% (66/294) were admitted to coronary care units, 11% (31) left hospital alive, 8% (24) with no neurological sequelae. The survival rate for patients with cardiac arrest outside hospital in the presence of a witness and for whom the initial rhythm was VF or VT was 21%. The patient's age (<60 years)[OR: 1.05; CI 95%: 1.02-1.07; p < 0.001], rapid arrival of the SAMU (<10 min) [OR: 5.68; CI 95%: 1.42-22.7; p = 0.01] and resuscitation by the witness (OR: 8.26; CI 95%: 3.28-20.83; p < 0.001) were factors predictive of survival in a multivariate analysis. Coronary heart disease remains the principal cause of cardiac arrest in patients admitted to cardiology units (68%), with a recent coronary thrombosis shown in 40% of patients undergoing angiography (16/40).


CONCLUSION
the prognosis of cardiac arrest outside hospital remains bleak, with a mortality of 90%. The survival rate is higher if the initial management is optimal, associated with bystander resuscitation and an immediate emergency service response allowing rapid defibrillation. Diagnosis and management of acute coronary syndrome in a cardiological setting must be integrated into the strategy.