Pulse loss after out-of-hospital cardiac resuscitation linked to in-hospital death

   Individuals with cardiac arrest who receive CPR, are resuscitated, and then lose their pulse again before reaching the emergency department have a greater chance of dying in the hospital, according to a study presented by David D. Salcido, MPH, of the University of Pittsburgh, Pennsylvania, and colleagues.

   The researchers studied by examining incidents of “re-arrest” among 18,937 cases of out-of-hospital cardiac arrest in 2006-2008 at 10 sites in North America. Emergency medical service personnel treated 11,456 patients (average age 64), reviving 4609.

   Of the 3116 patients whose health status at emergency department arrival was available, 15.2% had lost their pulse after being revived outside the hospital. Survival to hospital discharge for those in re-arrest was 7.8% compared with 33.3% for patients who had not gone into rearrest.   

    “The phenomenon of re-arrest ... loss of pulses after successful return of spontaneous circulation ... is of interest in resuscitation research because even transient loss of pulses prior to hospital arrival may have a detrimental impact on patient outcomes,” the researchers noted. “Patients who experience RA may also demonstrate specific pathology, the identification and treatment of which may lead to better outcomes.”