Failed prehospital resuscitation following out-of-hospital cardiac arrest: are further efforts in the emergency department warranted?

Study objectives To compare the clinical course and survival rates of patients who arrive in the emergency department with a pulse and those who arrive pulseless following out-of-hospital cardiac arrest. Study design Retrospective chart review. Patients All normothermic adult patients presenting to the emergency department of an Adelaide teaching hospital following an arrest of presumed cardiac origin over a two year period. Results Of 27 patients arriving with a pulse in the emergency department, 15 (56%) survived to hospital discharge. Of 247 patients arriving pulseless in the emergency department, 20 had return of spontaneous circulation following further resuscitation and were admitted. Only three (1%) of these patients survived to hospital discharge. The comparative survival rates for the pulse present (56%) and pulseless (1%) groups is statistically significant (P < 0.0001) with odds ratio of 102. All three survivors in the pulseless group arrested in the presence of ambulance personnel, two in the ambulance just prior to arrival at the hospital. Conclusion Continued resuscitation of patients who arrive pulseless in the emergency department following out-of-hospital cardiac arrest is not indicated. Exceptions are patients who arrest in the presence of ambulance officers and those with persistent ventricular fibrillation. We propose a set of national guidelines that will assist ambulance personnel and emergency department staff in determining when to discontinue resuscitative efforts.