Dynamics and state transitions during resuscitation in out-of-hospital cardiac arrest

Resuscitation
Eirik SkogvollPetter Andreas Steen

Abstract

The state or rhythm during resuscitation, i.e. ventricular fibrillation/tachycardia (VF/VT), asystole (ASY), pulseless electrical activity (PEA), or return of spontaneous circulation (ROSC) determines management. The state is unstable and will change either spontaneously (e.g. PEA-->ASY) or by intervention (e.g. VF-->ASY after DC shock); temporary ROSC may also occur. To gain insight into the dynamics of this process, we analyzed the state transitions over time using real-life data. Detailed recordings from 304 episodes of attempted resuscitation from out-of-hospital cardiac arrests of presumed cardiac etiology were obtained from modified Heartstart 4000 defibrillators. State transitions were visualized and described, and analyzed in terms of a Markov probability model. The median number of state transitions was 5 (range 1-39), and more transitions were observed with VF than PEA or asystole as the initial rhythm. Of 105 patients (35%) who regained ROSC at some point during CPR, only 65 (21%) achieved sustained ROSC; suggesting an unrealized survival potential. A 3-min transition probability matrix was estimated: for example, a patient early in VF has a probability of 31% to be in ASY, 32% of still being in VF, 5% to have tempor...Continue Reading

Citations

Feb 20, 2016·Resuscitation·Ali Bahrami RadTrygve Eftestøl
Aug 3, 2011·Medicina clínica·Luis Alberto Pallás BeneytoVicente Miguel Bayarri
Oct 13, 2009·Medicina intensiva·E Moreno-MillánS Pozuelo-Pozuelo
Jun 16, 2009·Resuscitation·Jan Terje KvaløyPetter Andreas Steen
Mar 3, 2009·Resuscitation·Kari Anne Haaland ThorsenPetter Andreas Steen
Nov 7, 2015·American Heart Journal·Devraj Sukul, Brahmajee K Nallamothu
May 17, 2014·Prehospital Emergency Care : Official Journal of the National Association of EMS Physicians and the National Association of State EMS Directors·Allison C KollerJames J Menegazzi
Mar 10, 2017·Prehospital Emergency Care : Official Journal of the National Association of EMS Physicians and the National Association of State EMS Directors·Jun TomioTetsuya Sakamoto
Jun 30, 2019·Journal of Clinical Medicine·Vittorio AntonagliaGianfranco Sanson

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