TY - JOUR
T1 - Survivors of Sudden Cardiac Arrest Presenting With Pulseless Electrical Activity
T2 - Clinical Substrate, Triggers, Long-Term Prognosis
AU - Holmstrom, Lauri
AU - Salmasi, Shiva
AU - Chugh, Harpriya
AU - Uy-Evanado, Audrey
AU - Sorenson, Chad
AU - Bhanji, Ziana
AU - Seifer, Madison
AU - Sargsyan, Arayik
AU - Salvucci, Angelo
AU - Jui, Jonathan
AU - Reinier, Kyndaron
AU - Chugh, Sumeet S.
N1 - Publisher Copyright:
© 2022 American College of Cardiology Foundation
PY - 2022/10
Y1 - 2022/10
N2 - Background: The proportion of sudden cardiac arrest (SCA) presenting as pulseless electrical activity (PEA) is rising, and survival remains low. The pathophysiology of PEA-SCA is poorly understood, and current clinical practice lacks specific options for the management of survivors. Objectives: In this study, the authors sought to investigate clinical profile, triggers, and long-term prognosis in survivors of SCA presenting with PEA. Methods: The community-based Oregon SUDS (Sudden Unexpected Death Study) (since 2002) and Ventura PRESTO (Prediction of Sudden Death in Multi-ethnic Communities) (since 2015) studies prospectively ascertain all out-of-hospital SCAs of likely cardiac etiology. Lifetime clinical history and detailed evaluation of SCA events is available. We evaluated all SCA survivors with PEA as the presenting rhythm. Results: The study population included 201 PEA-SCA survivors. Of these, 97 could be contacted for access to their clinical records. Among the latter, the mean age was 67 ± 17 years and 58 (60%) were male. After in-hospital examinations, 29 events (30%) were associated with acute myocardial infarction, and 5 (5%) had bradyarrhythmias. Among the remaining 63 patients (65%), specific triggers remained undetermined, although 31 (49%) had a previous history of heart failure. Of the 201 overall survivors, 91 (45%) were deceased after a mean follow-up of 4.2 ± 4.0 years. Survivors under the age of 40 years had an excellent long-term prognosis. Conclusions: Survivors of PEA-SCA are a heterogeneous group with high prevalence of multiple comorbidities, especially heart failure. Surprisingly good long-term survival was observed in young individuals. Acute myocardial infarction as the precipitating event was common, but triggers remained undetermined in the majority. Provision of individualized care to PEA survivors requires a renewed investigative focus on PEA-SCA.
AB - Background: The proportion of sudden cardiac arrest (SCA) presenting as pulseless electrical activity (PEA) is rising, and survival remains low. The pathophysiology of PEA-SCA is poorly understood, and current clinical practice lacks specific options for the management of survivors. Objectives: In this study, the authors sought to investigate clinical profile, triggers, and long-term prognosis in survivors of SCA presenting with PEA. Methods: The community-based Oregon SUDS (Sudden Unexpected Death Study) (since 2002) and Ventura PRESTO (Prediction of Sudden Death in Multi-ethnic Communities) (since 2015) studies prospectively ascertain all out-of-hospital SCAs of likely cardiac etiology. Lifetime clinical history and detailed evaluation of SCA events is available. We evaluated all SCA survivors with PEA as the presenting rhythm. Results: The study population included 201 PEA-SCA survivors. Of these, 97 could be contacted for access to their clinical records. Among the latter, the mean age was 67 ± 17 years and 58 (60%) were male. After in-hospital examinations, 29 events (30%) were associated with acute myocardial infarction, and 5 (5%) had bradyarrhythmias. Among the remaining 63 patients (65%), specific triggers remained undetermined, although 31 (49%) had a previous history of heart failure. Of the 201 overall survivors, 91 (45%) were deceased after a mean follow-up of 4.2 ± 4.0 years. Survivors under the age of 40 years had an excellent long-term prognosis. Conclusions: Survivors of PEA-SCA are a heterogeneous group with high prevalence of multiple comorbidities, especially heart failure. Surprisingly good long-term survival was observed in young individuals. Acute myocardial infarction as the precipitating event was common, but triggers remained undetermined in the majority. Provision of individualized care to PEA survivors requires a renewed investigative focus on PEA-SCA.
KW - acute myocardial infarction
KW - heart failure
KW - prognosis
KW - pulseless electrical activity
KW - sudden cardiac arrest
KW - treatment
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UR - http://www.scopus.com/inward/citedby.url?scp=85139292279&partnerID=8YFLogxK
U2 - 10.1016/j.jacep.2022.06.022
DO - 10.1016/j.jacep.2022.06.022
M3 - Article
C2 - 36057529
AN - SCOPUS:85139292279
SN - 2405-500X
VL - 8
SP - 1260
EP - 1270
JO - JACC: Clinical Electrophysiology
JF - JACC: Clinical Electrophysiology
IS - 10
ER -