Temporal Trends in Incidence and Survival From Sudden Cardiac Arrest Manifesting With Shockable and Nonshockable Rhythms: A 16-Year Prospective Study in a Large US Community - 20/09/23
Abstract |
Study objective |
The proportion of nonshockable sudden cardiac arrests (pulseless electrical activity and asystole) continues to rise. Survival is lower than shockable (ventricular fibrillation [VF]) sudden cardiac arrests, but there is little community-based information on temporal trends in the incidence and survival from sudden cardiac arrests based on presenting rhythms. We investigated community-based temporal trends in sudden cardiac arrest incidence and survival by presenting rhythm.
Methods |
We prospectively evaluated the incidence of each presenting sudden cardiac arrest rhythm and survival outcomes for out-of-hospital events in the Portland, Oregon metro area (population of approximately 1 million, 2002 to 2017). We limited inclusion to cases of likely cardiac cause with resuscitation attempted by emergency medical services.
Results |
Out of 3,723 overall sudden cardiac arrest cases, 908 (24%) presented with pulseless electrical activity, 1,513 (41%) with VF, and 1,302 (35%) with asystole. The incidence of pulseless electrical activity-sudden cardiac arrest remained stable over 4-year periods (9.6/100,000 in 2002 to 2005, 7.4/100,000 in 2006 to 2009, 5.7/100,000 in 2010 to 2013, and 8.3/100,000 in 2014 to 2017; unadjusted beta [β] −0.56; 95% confidence interval [CI], −3.98 to 2.85). The incidence of VF-sudden cardiac arrests decreased over time (14.6/100,000 in 2002 to 2005, 13.4/100,000 in 2006 to 2009, 12.0/100,000 in 2010 to 2013, and 11.6/100,000 in 2014 to 2017; unadjusted β −1.05; 95% CI, −1.68 to −0.42) and asystole-sudden cardiac arrests (8.6/100,000 in 2002 to 2005, 9.0/100,000 in 2006 to 2009, 10.3/100,000 in 2010 to 2013, and 15.7/100,000 in 2014 to 2017; unadjusted β 2.25; 95% CI −1.24 to 5.73) did not change significantly over time. Survival increased over time for pulseless electrical activity-sudden cardiac arrests (5.7%, 4.3%, 9.6%, 13.6%; unadjusted β 2.8%; 95% CI 1.3 to 4.4) and VF-sudden cardiac arrests (27.5%, 29.8%, 37.9%, 36.6%; unadjusted β 3.5%; 95% CI 1.4 to 5.6), but not for asystole-sudden cardiac arrests (1.7%, 1.6%, 4.0%, 2.4%; unadjusted β 0.3%; 95% CI, −0.4 to 1.1). Enhancements in the emergency medical services system’s pulseless electrical activity-sudden cardiac arrest management were temporally associated with the increasing pulseless electrical activity survival rates.
Conclusions |
Over a 16-year period, the incidence of VF/ventricular tachycardia decreased over time, but pulseless electrical activity incidence remained stable. Survival from both VF-sudden cardiac arrests and pulseless electrical activity-sudden cardiac arrests increased over time with a more than 2-fold increase for pulseless electrical activity-sudden cardiac arrests.
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| Please see page 464 for the Editor’s Capsule Summary of this article. |
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| Supervising editor: Keith A. Marill, MD, MS. Specific detailed information about possible conflicts of interest for individual editors is available at editors. |
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| Author contributions: SSC designed and conceived the study; supervised the study; obtained funding; drafted the manuscript; acquired, analyzed, or interpreted the data; critically reviewed the manuscript for important intellectual content; and was responsible for the manuscript as a whole. HC managed the data; acquired, analyzed, or interpreted the data; performed statistical analysis; and critically reviewed the manuscript for important intellectual content. LH obtained funding; drafted the manuscript; acquired, analyzed, or interpreted the data; performed statistical analysis; and was responsible for the manuscript as a whole. AUE acquired, analyzed, or interpreted the data and critically reviewed the manuscript for important intellectual content. JJ acquired, analyzed, or interpreted the data and critically reviewed the manuscript for important intellectual content. KR acquired, analyzed, or interpreted the data; performed statistical analysis; and critically reviewed the manuscript for important intellectual content. |
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| All authors attest to meeting the four ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. |
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| Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject ofs this article as per ICMJE conflict of interest guidelines (see www.icmje.org). The authors have stated that no such relationships exist. This work is funded, in part, by the National Institutes of Health, National Heart, Lung, and Blood Institute Grants R01HL145675 and R01HL147358 to SSC. SSC holds the Pauline and Harold Price Chair in Cardiac Electrophysiology at Cedars-Sinai. LH is a postdoctoral fellow visiting from the Research Unit of Internal Medicine, Medical Research Center Oulu, the University of Oulu and Oulu University Hospital, Oulu, Finland, and is funded by the Sigrid Jusélius Foundation, The Finnish Cultural Foundation, Instrumentarium Science Foundation, Orion Research Foundation, and Paavo Nurmi Foundation. The funding sources had no involvement in the preparation of this work or the decision to submit it for publication. |
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| Data sharing statement: Deidentified participant data will be made available along with the analytic code and a data dictionary defining each field. Data requests should be made to the corresponding author at sumeet.chugh@cshs.org. Data can be available upon manuscript publication. |
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| A podcast for this article is available at www.annemergmed.com. |
Vol 82 - N° 4
P. 463-471 - octobre 2023 Retour au numéro
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