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Ventricular Tachyarrhythmias After Cardiac Arrest in Public Versus at Home
Study Questions:
Is the initial rhythm recorded during resuscitation influenced by the site at which out-of-hospital cardiac arrest (OHCA) occurs?
Methods:
This was a prospective, multicenter cohort study of 12,930 patients (mean age 66 years) with OHCA treated by emergency medical service (EMS) personnel.
Results:
OHCAs occurred more often at home (n = 9,564) than in public (n = 2,042). Ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT) was 2.3-fold more likely after bystander-witnessed OHCA in a public location (60%) versus at home (35%), even after adjusting for the EMS response time. Among OHCAs in which a bystander used an automatic external defibrillator (AED), the initial rhythm was VF/VT significantly more often in public locations (79%) than at home (36%). The rates of survival to hospital discharge were significantly higher after OHCA in public locations (20%) than at home (8%). Survival to hospital discharge when an AED was employed by a bystander was 34% in public locations compared to 12% at home.
Conclusions:
The initial recorded rhythm in OHCA is VF/VT more than twice as often when the OHCA occurs in a public location than at home. Accordingly, the incremental value of an AED for improving survival after OHCA is greater in public locations than in the home.
Perspective:
The longer the duration of the cardiac arrest, the higher the probability that asystole or electromechanical dissociation is the first recorded rhythm. But in this study, the lower incidence of a shockable rhythm at home was found to be independent of the EMS response time. OHCA at home versus in public could be an indicator of more severe heart disease, perhaps explaining the lower probability of a shockable rhythm.
Keywords: Defibrillators, Tachycardia, Ventricular, Resuscitation, Out-of-Hospital Cardiac Arrest, Emergency Medical Services, Ventricular Fibrillation, Heart Arrest, Reaction Time
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