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Early Defibrillation for Out-of-Hospital Cardiac Arrest: Long-Term Outcomes

The benefits for patients with documented ventricular fibrillation were clear in this study.

Since 1990, emergency personnel in Rochester, Minnesota, and surrounding communities have provided early defibrillation to victims of out-of-hospital cardiac arrest. Researchers followed 200 consecutive patients who suffered out-of-hospital cardiac arrests in these communities and who received early defibrillation for documented ventricular fibrillation (VF).

Of the 200, 72% survived to hospital admission and 40% were alive and neurologically intact at discharge. At physician discretion, survivors underwent revascularization or received antiarrhythmic drug therapy and/or implantable-cardioverter defibrillators. Not surprisingly, the mean time from the 911 call to first defibrillation was significantly shorter among survivors to discharge than among nonsurvivors (5.7 vs. 6.6 minutes).

Nineteen patients died during a mean follow-up of 4.8 years. The overall expected 5-year survival rate of 79% was similar to that of a control group from the same community (matched for age, sex, and heart-disease type) who had not experienced cardiac arrests. The 50 cardiac-arrest survivors who completed standard quality-of-life questionnaires at last follow-up scored similarly to the U.S. general population on 9 of 10 QOL measures; the exception was the vitality measure, on which the survivor group fared worse.

Comment: This study shows how effective early defibrillation can be. Remarkably, 72% of patients with cardiac arrest and VF survived to hospital admission, 40% were discharged neurologically intact, and survivors to discharge had excellent long-term prognoses and near-normal quality of life. However, only patients with documented VF were included, and the time to first shock was very short. Also, this study was conducted in a small community; the system might not work quite as well in a major city. Nevertheless, the findings should send a clear message about the effectiveness of early defibrillation and should encourage more communities to provide it.

— Hugh Calkins, MD

Published in Journal Watch Cardiology August 15, 2003

Citation(s):

Bunch TJ et al. Long-term outcomes of out-of-hospital cardiac arrest after successful early defibrillation. N Engl J Med 2003 Jun 26; 348:2626-33.

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