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ARTICLE |

Survivors of Prehospital Cardiac Arrest FREE

Robert J. Myerburg, MD; Kenneth M. Kessler, MD; Liaqat Zaman, MD; Cesar A. Conde, MD; Agustin Castellanos, MD
[+] Author Affiliations

This article is one of a series sponsored by the American Heart Association.

Reprint requests to the Division of Cardiology, University of Miami School of Medicine, PO Box 016960, Miami, FL 33101 (Dr Myerburg).


JAMA. 1982;247(10):1485-1490. doi:10.1001/jama.1982.03320350081041
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BEFORE the early 1970s, the uniform fatality of prehospital cardiac arrest led research efforts almost exclusively to the fields of pathology and epidemiology. Then, with the development of community-based emergency medical systems (EMSs), clinical investigators developed an interest in the prognosis and management of survivors of prehospital cardiac arrest. The outcome of these efforts is summarized in this article.

Mechanisms of Prehospital Cardiac Arrest  The majority of prehospital cardiac arrests occur by the mechanism of ventricular fibrillation (VF), but other mechanisms, primarily ventricular tachycardia (VT) and various forms of bradyarrhythmias or asystole,1 also may cause sudden and unexpected cardiovascular collapse. Of 352 consecutive events observed between 1975 and 1978, in which (1) the onset of cardiac arrest was witnessed, (2) the EMS personnel were summoned without delay, and (3) arrival on the scene was documented to have occurred within four minutes of summons (Fig 1), the initial rhythm recorded

REFERENCES

Iseri LT, Humphrey SB, Siner EJ:  Prehospital brady-asystolic cardiac arrest . Ann Intern Med 1978;;88:741-745.
Myerburg RJ, Conde CA, Sung RJ, et al:  Clinical, electrophysiologic and hemodynamic profile of patients resuscitated from prehospital cardiac arrest . Am J Med 1980;;68:568-576.
Nagel EL, Liberthson RR, Hirschman JC, et al:  Emergency care , in Prineas JR, Blackburn H (eds): Sudden Coronary Death Outside Hospital. Circulation 1975;;52( (suppl 3) ):216.
Cobb LA, Werner JA, Trobaugh GB:  Sudden cardiac death: Parts 1 and 2 . Mod Concepts Cardiovasc Dis 1980;;49:31-36, 37-42.
Eisenberg MS, Copass MK, Hallstrom AP, et al:  Treatment of out-of-hospital cardiac arrests with rapid defibrillation by emergency medical technicians . N Engl J Med 1980;; 302:1379-1383.
Thompson RG, Hallstrom AP, Cobb LA:  Bystander-initiated cardiopulmonary resuscitation in the management of ventricular fibrillation . Ann Intern Med 1979;;90:737-740.
Copley DP, Mantle JA, Rogers WJ, et al:  Improved outcome for prehospital cardiopulmonary collapse with resuscitation by bystanders . Circulation 1977;;56:901-905.
Schaeffer WA, Cobb LA:  Recurrent ventricular fibrillation and modes of death in survivors of out-of-hospital ventricular fibrillation . N Engl J Med 1974;;293:259-262.
Baum RS, Alvarez H, Cobb LA:  Survival after resuscitation from out-of-hospital ventricular fibrillation . Circulation 1974;;50:1231-1235.
Liberthson RR, Nagel EL, Hirschman JC, et al:  Prehospital ventricular defibrillation: Prognosis and follow-up course . N Engl J Med 1974;;291:317-321.
Myerburg RJ, Ghahramani A, Mallon SM, et al:  Coronary revascularization in patients surviving unexpected ventricular fibrillation . Circulation 1975;;52( (suppl 3) ):219-220.
Blackburn H, deBacker G, Crow R, et al:  Epidemiology and prevention of ventricular ectopic rhythms . Adv Cardiol 1976;;18:208.
Myerburg RJ, Conde C, Sheps DS, et al:  Antiarrhythmic drug therapy in survivors of prehospital cardiac arrest: Comparison of effects on chronic ventricular arrhythmias and recurrent cardiac arrest . Circulation 1979;;59:855-863.
Lown B, Grayboys TB:  Management of patients with malignant ventricular arrhythmias . Am J Cardiol 1977;;39:910-919.
Ruskin JN, DiMarco JP, Garan H:  Out-of-hospital cardiac arrest: Electrophysiologic observations and selection of long-term antiarrhythmic therapy . N Engl J Med 1980;;303:607-613.
Josephson ME, Horowitz LN, Spielman SR, et al:  Electrophysiologic and hemodynamic studies in patients resuscitated from cardiac arrest . Am J Cardiol 1980;;46:949-955.
Horowitz LN, Josephson ME, Farshidi A, et al:  Recurrent sustained ventricular tachycardia: 3. Role of the electrophysiologic study in selection of antiarrhythmic regimens . Circulation 1978;;58:986-997.
Mason JW, Winkle RA:  Electrode-catheter arrhythmic induction in the selection and assessment of antiarrhythmic drug therapy for recurrent ventricular tachycardia . Circulation 1978;;58:971-975.
Myerburg RJ, Kessler KM, Kiem I, et al:  The relationship between plasma levels of procainamide, suppression of premature ventricular contractions, and prevention of recurrent ventricular tachycardia . Circulation 1981;;64:280-290.
Horowitz LN, Josephson ME, Kastor JA:  Intracardiac electrophysiologic studies as a method for the optimization of drug therapy in chronic ventricular arrhythmia . Prog Cardiovasc Dis 1980;;23:81-98.

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Iseri LT, Humphrey SB, Siner EJ:  Prehospital brady-asystolic cardiac arrest . Ann Intern Med 1978;;88:741-745.
Myerburg RJ, Conde CA, Sung RJ, et al:  Clinical, electrophysiologic and hemodynamic profile of patients resuscitated from prehospital cardiac arrest . Am J Med 1980;;68:568-576.
Nagel EL, Liberthson RR, Hirschman JC, et al:  Emergency care , in Prineas JR, Blackburn H (eds): Sudden Coronary Death Outside Hospital. Circulation 1975;;52( (suppl 3) ):216.
Cobb LA, Werner JA, Trobaugh GB:  Sudden cardiac death: Parts 1 and 2 . Mod Concepts Cardiovasc Dis 1980;;49:31-36, 37-42.
Eisenberg MS, Copass MK, Hallstrom AP, et al:  Treatment of out-of-hospital cardiac arrests with rapid defibrillation by emergency medical technicians . N Engl J Med 1980;; 302:1379-1383.
Thompson RG, Hallstrom AP, Cobb LA:  Bystander-initiated cardiopulmonary resuscitation in the management of ventricular fibrillation . Ann Intern Med 1979;;90:737-740.
Copley DP, Mantle JA, Rogers WJ, et al:  Improved outcome for prehospital cardiopulmonary collapse with resuscitation by bystanders . Circulation 1977;;56:901-905.
Schaeffer WA, Cobb LA:  Recurrent ventricular fibrillation and modes of death in survivors of out-of-hospital ventricular fibrillation . N Engl J Med 1974;;293:259-262.
Baum RS, Alvarez H, Cobb LA:  Survival after resuscitation from out-of-hospital ventricular fibrillation . Circulation 1974;;50:1231-1235.
Liberthson RR, Nagel EL, Hirschman JC, et al:  Prehospital ventricular defibrillation: Prognosis and follow-up course . N Engl J Med 1974;;291:317-321.
Myerburg RJ, Ghahramani A, Mallon SM, et al:  Coronary revascularization in patients surviving unexpected ventricular fibrillation . Circulation 1975;;52( (suppl 3) ):219-220.
Blackburn H, deBacker G, Crow R, et al:  Epidemiology and prevention of ventricular ectopic rhythms . Adv Cardiol 1976;;18:208.
Myerburg RJ, Conde C, Sheps DS, et al:  Antiarrhythmic drug therapy in survivors of prehospital cardiac arrest: Comparison of effects on chronic ventricular arrhythmias and recurrent cardiac arrest . Circulation 1979;;59:855-863.
Lown B, Grayboys TB:  Management of patients with malignant ventricular arrhythmias . Am J Cardiol 1977;;39:910-919.
Ruskin JN, DiMarco JP, Garan H:  Out-of-hospital cardiac arrest: Electrophysiologic observations and selection of long-term antiarrhythmic therapy . N Engl J Med 1980;;303:607-613.
Josephson ME, Horowitz LN, Spielman SR, et al:  Electrophysiologic and hemodynamic studies in patients resuscitated from cardiac arrest . Am J Cardiol 1980;;46:949-955.
Horowitz LN, Josephson ME, Farshidi A, et al:  Recurrent sustained ventricular tachycardia: 3. Role of the electrophysiologic study in selection of antiarrhythmic regimens . Circulation 1978;;58:986-997.
Mason JW, Winkle RA:  Electrode-catheter arrhythmic induction in the selection and assessment of antiarrhythmic drug therapy for recurrent ventricular tachycardia . Circulation 1978;;58:971-975.
Myerburg RJ, Kessler KM, Kiem I, et al:  The relationship between plasma levels of procainamide, suppression of premature ventricular contractions, and prevention of recurrent ventricular tachycardia . Circulation 1981;;64:280-290.
Horowitz LN, Josephson ME, Kastor JA:  Intracardiac electrophysiologic studies as a method for the optimization of drug therapy in chronic ventricular arrhythmia . Prog Cardiovasc Dis 1980;;23:81-98.
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