Heart Association Scientific Sessions 2009
Patients suffering from cardiac arrest who displayed prodromal symptoms
prior to arrest tended to get treated with emergency medical services earlier
and have better outcomes than those not displaying the symptoms.
Researchers for the population-based cohort study analyzed more than 2
million individuals in Osaka, Japan between 2003 and 2004, and focused on 1,066
witnessed out-of-hospital cardiac arrest cases of presumed cardiac etiology in
that population. Patients were included in the study if they were >18 years,
had cardiac arrest witnessed by bystanders and were treated with emergency
Of the 1,066 patients who experienced observed out-of-hospital cardiac
arrest, 651 had prodromal symptoms and 415 had no prodromal symptoms. Among the
patients with prodromal symptoms, 389 (59.8%) showed symptoms in the minutes
prior to cardiac arrest and 162 (24.9%) had symptoms an hour prior to cardiac
arrest. The most frequent prodromal symptoms were shortness of breath (27.5%),
followed by chest pain (20.6%) and syncope (12.9%). Patients who displayed
prodromal symptoms were more likely to receive early CPR by EMS than those who
did not have prodromal symptoms (P<.001). One-month survival was
greater in prodromal symptoms than those with no prodromal symptoms (12.1% vs.
7.7%, P=.023). Ventricular fibrillation as initial rhythm (OR=3.9; 95%
CI, 1.8-8.3), arrest after EMS arrival (OR=20.8; 95% CI, 1.5-280.7) and earlier
call to EMS (OR per minute=0.78; 95% CI, 0.66-0.92) were all associated with
better neurological outcomes.
While 60% of patients experienced symptoms within a few minutes of
arrest, the remaining 40% have symptoms within an hour, said Chika
Nishiyama, of the Kyoto University School of Public Health, said in a press
conference. Noticing such prodromal symptoms would facilitate early
activation of EMS and may prevent sudden cardiac death. - by Eric
For more information:
- Nishiyama C. Abstract 2702. Presented at: American Heart Association
Scientific Sessions 2009; Nov. 14-18; Orlando, Fla.