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PubMed1996

Out-of-hospital cardiac arrest. Evaluation of one year of activity in Saint-Etienne's emergency medical system using the Utstein style.

OBJECTIVE: To provide researchers with a description of the method of dealing with out-of-hospital cardiac arrests, and the results thereof, using the Utstein style. DESIGN: a series of out-of-hospital cardiac arrests between 1 October 1991 and 31 September 1992. SETTING: a French 'departement' (administrative subdivision). POPULATION: 570,000 inhabitants; area: 2600 km2; emergency medical system consisting of two levels of response: the Emergency and Resuscitation Mobile Unit and the Fire Service. PATIENTS: a sample of 380 patients found to have neither palpable pulse nor independent respiration. RESULTS: of the 234 (61%) patients in whom resuscitation was attempted, 41 (17%) were hospitalised and 12 (5%) discharged were still alive at 1 year follow-up. Of the patients who showed signs of cardiac arrest of cardiac aetiology, classified as having initial ventricular fibrillation (VF) rhythms: 62% of the cases (5/8) were alive at 1 year if the cardiac arrest occurred in the presence of emergency medical personnel; 6% of the cases (2/31) were alive at 1 year if the cardiac arrest occurred in the presence of non-specialised bystanders.

Ambulances↗
PubMed1995

Prognosis among survivors of prehospital cardiac arrest.

STUDY OBJECTIVE: To describe the prognosis in consecutive patients discharged from hospital after prehospital cardiac arrest. PATIENTS: All patients in the community of Göteborg who were discharged from hospital after out-of-hospital cardiac arrest between 1981 and 1991. RESULTS: Two hundred forty-three patients were discharged from hospital during the observation period, of whom 80% initially experienced ventricular fibrillation. Among patients discharged, 21% died during the first year; after 10 years, 82% had died. Age, sex, previous history of cardiovascular disease, circumstances at the time of cardiac arrest, complications during hospitalization, and discharge medications were assessed as predictors of 1-year mortality. Independent predictors of death during follow-up were history of myocardial infarction (P < .001), no prescription of beta-blockers at discharge (P < .01), age (P < .05), and cerebral performance category (CPC) at discharge (P < .05). CONCLUSION: Among patients who survived out-of-hospital cardiac arrest, one of five died during the first year and one of five survived 10 years after discharge. Prognosis was associated with a history of myocardial infarction, prescription of beta-blockers at discharge, age, and CPC at discharge.

Adolescent↗
PubMed1984

Considerations in the long-term management of survivors of cardiac arrest.

The heterogeneity of resuscitated patients at risk of recurrent cardiac arrest serves to make their management difficult and complex. It is logical that therapy should be tailored to each patient and certainly to the mechanism whereby sudden cardiac death occurred. It is important, also, to recognize that not all resuscitated victims are at high risk for recurrence and that aggressive interventions are not necessarily mandatory. In the patient with cardiac arrest related to transient myocardial ischemia, a direct approach toward relieving ischemia seems appropriate. Antiarrhythmic agents may have a role in the treatment of some patients, but to this date the efficacy of such therapy is speculative, at best. The development and testing of agents that have "antifibrillatory" properties seems a logical approach at this time. Clearly, efforts to lessen the mortality of patients who have been resuscitated from out-of-hospital cardiac arrest are important, not only for the particular patients themselves, but also in an effort to develop rational, prophylactic interventions for the large numbers of patients with coronary heart disease who are at risk for the development of sudden cardiac death.

Adrenergic beta-Antagonists↗
PubMed1997

One-year survival after out-of-hospital cardiac arrest in Bonn city: outcome report according to the 'Utstein style'.

Outcome after prehospital cardiac arrest was examined in the EMS system of Bonn, a midsized urban community, and presented according to the Utstein style. The data were collected from January 1st, 1989 to December 31st, 1992 by the Bonn-north ALS unit, which serves 240,000 residents. Fifty-six patients suffered from cardiac arrest of non-cardiac aetiology and were excluded; 464 patients were resuscitated after cardiac arrest of presumed cardiac aetiology (incidence of CPR attempts: 48.33 per year/100,000 population). The collapse was unwitnessed, bystander witnessed or EMS personnel witnessed in 178, 214 or 72 patients, respectively. In these subgroups discharge rates and 1-year survival accounted for 7.3% (4.5%), 22.9% (15.9%) and 16.7% (11.1%), respectively. Thirty-four patients were discharged without neurological deficits (cerebral performance category 1: CPC 1), 22 and nine patients scored CPC 2 or CPC 3, respectively. Nine patients were comatose (CPC 4) when they were discharged and remained in this state until they died. Of the 50 1-year survivors 35 lived without neurological deficit, eight demonstrated mild (CPC 2) and five severe (CPC 3) cerebral disability at 1-year after resuscitation, and, finally, two patients remained comatose for more than 1 year. The Utstein template recommends the selection of patients who were found in VF after bystander witnessed collapse. In our cohort 118 patients met these criteria. Of them 41 (35%) could be discharged from hospital and 28 (24%) lived more than 1 year. The comparison of our data with those from double-response EMS systems of other communities revealed that, in midsized urban and suburban communities the highest discharging rates could be achieved. Our study demonstrated that survival depends crucially on short response intervals and life support which will be performed by well-trained emergency technicians, paramedics and physicians.

Aged↗
PubMed1993

A comparison of active compression-decompression cardiopulmonary resuscitation with standard cardiopulmonary resuscitation for cardiac arrests occurring in the hospital.

BACKGROUND: Recent studies have demonstrated improved cardiopulmonary circulation during cardiac arrest with the use of a hand-held suction device (Ambu CardioPump) to perform active compression-decompression cardiopulmonary resuscitation (CPR). The purpose of this study was to compare active compression-decompression with standard CPR during cardiac arrests in hospitalized patients. METHODS: All patients over the age of 18 years who had a witnessed cardiac arrest while hospitalized at our center were enrolled in this trial; they were randomly assigned according to their medical-record numbers to receive either active compression-decompression or standard CPR. The study end points were the rates of initial resuscitation, survival at 24 hours, hospital discharge, and neurologic outcome. Compressions were performed according to the recommendations of the American Heart Association (80 to 100 compressions per minute; depth of compression, 3.8 to 5.1 cm [1.5 to 2 in.]; and 50 percent of the cycle spent in compression). RESULTS: Sixty-two patients (45 men and 17 women) with a mean age (+/- SE) of 68 +/- 2 years were entered into the trial. Sixty-two percent of the patients who underwent active compression-decompression were initially resuscitated, as compared with 30 percent of the patients who received standard CPR (P < 0.03); 45 percent of the patients who underwent active compression-decompression survived for at least 24 hours, as compared with 9 percent of patients who underwent standard CPR (P < 0.004). Two of the 62 study patients survived to hospital discharge; both were randomly assigned to receive active compression-decompression. Neurologic outcome, as measured by the Glasgow coma score, was better with active compression-decompression (8.0 +/- 1.3) than with standard CPR (3.5 +/- 0.3; P < 0.02). CONCLUSIONS: In this preliminary study, we found that, as compared with standard CPR, active compression-decompression CPR improved the rate of initial resuscitation, survival at 24 hours, and neurologic outcome after in-hospital cardiac arrest. Larger trials will be required to assess the potential benefit in terms of long-term survival.

Aged↗
PubMed2001

Prediction of lidocaine tissue concentrations following different dose regimes during cardiac arrest using a physiologically based pharmacokinetic model.

BACKGROUND: The purpose of our study was to develop a physiologically based pharmacokinetic (PBPK) model describing the behavior of lidocaine in humans by scaling up physiological variables from animal models of cardiac arrest. We attempted to identify the optimal dose regime for lidocaine during cardiac arrest using this model. METHODS AND RESULTS: We designed a flow-dependent PBPK model representing nine body tissues for lidocaine. Physiological organ flow rates, tissue volumes, and plasma-tissue partition parameters for lidocaine in humans were taken from the literature. Data from published animal studies were used to estimate loss of organ blood flow during cardiac arrest and lidocaine tissue partition coefficients. The model assumed a 70 kg cardiac arrest patient. The following five lidocaine dose regimes were simulated: (1) 4 mg/kg i.v. push (IVP) (2) 1.5 mg/kg IVP then 1.5 mg/kg IVP in 4 min, (3) 3 mg/kg IVP, (4) 2 mg/kg IVP, and (5) 1.5 mg/kg IVP. A simulation of Regimen 2, which is the current American Heart Association (AHA) recommendation, suggests that the concentration of lidocaine is suboptimal at the decision point (3-5 min) to administer another dose. Regimen 4 offers a slightly more rapid progress towards optimal cardiac concentrations and more acceptable brain concentrations compared to regimes 1-3. CONCLUSION: Simulations from our PBPK model suggest that the current AHA lidocaine dose regime for cardiac arrest may not result in optimal lidocaine concentrations in the heart and brain. Simulations suggest that 2 mg/kg IVP may be the most acceptable lidocaine dose regime during cardiac arrest.

Algorithms↗
PubMed2002

Characteristics and outcome among patients suffering from in hospital cardiac arrest in relation to the interval between collapse and start of CPR.

AIM: To describe survival after in-hospital cardiac arrest in relation to the interval between collapse and start of cardiopulmonary resuscitation (CPR). PATIENTS: All patients suffering in-hospital cardiac arrest in Sahlgrenska University Hospital in Göteborg, Sweden between 1994 and 1999 in whom resuscitative efforts were attempted and for whom the interval between collapse and start of CPR was known. METHODS: Prospective recording of various factors at resuscitation including the interval between collapse and start of CPR. Retrospective evaluation via medical records of patients' previous history, clinical situation prior to cardiac arrest and final outcome. RESULTS: Survival to discharge was 33% among the 344 patients in whom CPR was started within the first minute as compared with 14% among the 88 patients in whom CPR started more than 1 min after collapse (P=0.008). The corresponding figures for patients found in ventricular fibrillation was 50 versus 32% (NS); for patients found in pulseless electrical activity 9 versus 3% (NS) and for patients found in asystole 19 versus 0% (NS). Correcting for dissimililarties in the previous history and factors at resuscitation, the adjusted odds ratio and 95% confidence limits for being discharged from hospital when CPR was started within 1 min compared with a later start was 3.06 with 95% confidence limits of 1.59-6.31. CONCLUSION: Among patients with in-hospital cardiac arrest in whom the interval between collapse and start of CPR was known, we found that in 80% of the cases CPR was started within the first minute after collapse. Among these patients, survival to discharge was twice that of patients in whom CPR was started later. These results highlight the importance of immediate CPR after in-hospital cardiac arrest.

Aged↗
PubMed1986

Lorcainide therapy in a cardiac arrest population.

Thirty-eight patients with prior history of cardiac arrest underwent programmed electrical stimulation (PES) studies and serial drug testing. Lorcainide was tested acutely in all 38 patients and prevented ventricular tachycardia (VT) or ventricular fibrillation (VF) induction in 14 patients and failed in 24 (efficacy rate 37%). Procainamide had failed clinically (cardiac arrest or breakthrough VT) in 16 patients, seven patients had previously severe adverse side effects, and thus only 15 were tested on procainamide at PES testing with seven protected. Following initial studies, 14 patients were started on lorcainide oral therapy and 24 on other therapy determined effective at PES testing (N-acetylprocainamide-two, flecainide-nine, bethanidine-three, slow-release procainamide hydrochloride-three, quinidine-two, cibenzoline-one, amiodarone-four). After 29 +/- 7 months follow-up, three are alive on lorcainide therapy, five discontinued therapy due to side effects; six died--three sudden deaths (33%) and two cardiac deaths (both myocardial infarctions). Twenty out of 24 patients are alive who were started on PES predicted effective therapy other than lorcainide; four died--three sudden deaths (13%) and one cardiac nonsudden death. Antiarrhythmic therapy guided by PES studies gives overall encouraging results in a cardiac arrest group of patients. Lorcainide, however, is not tolerated well and affords less protection against a sudden death recurrence than is noted in a population on other antiarrhythmic therapy predicted effective at PES testing.

Arrhythmias, Cardiac↗
PubMed1997

Immediate coronary angiography in survivors of out-of-hospital cardiac arrest.

BACKGROUND: The incidence of acute coronary-artery occlusion among patients with sudden cardiac arrest outside of the hospital is unknown, and the role of reperfusion therapy has not been determined. We therefore performed immediate coronary angiography and angioplasty when indicated in survivors of out-of-hospital cardiac arrest. METHODS: Between September 1994 and August 1996, coronary angiography was performed in 84 consecutive patients between the ages of 30 and 75 years who had no obvious noncardiac cause of cardiac arrest. RESULTS: Sixty of the 84 patients had clinically significant coronary disease on angiography, 40 of whom had coronary-artery occlusion (48 percent). Angioplasty was attempted in 37 patients and was technically successful in 28. Clinical and electrocardiographic findings, such as the occurrence of chest pain and the presence of ST-segment elevation, were poor predictors of acute coronary-artery occlusion. The in-hospital survival rate was 38 percent. Multivariate logistic-regression analysis revealed that successful angioplasty was an independent predictor of survival (odds ratio, 5.2; 95 percent confidence interval, 1.1 to 24.5; P=0.04). CONCLUSIONS: Acute coronary-artery occlusion is frequent in survivors of out-of-hospital cardiac arrest and is predicted poorly by clinical and electrocardiographic findings. Accurate diagnosis by immediate coronary angiography can be followed in suitable candidates by coronary angioplasty, which seems to improve survival.

Adult↗
PubMed2003

Diagnosis and management of out-of-hospital cardiac arrest secondary to coronary artery spasm.

OBJECTIVE: The clinical features of coronary artery spasm as a cause of cardiac arrest were determined in a prospective study on out-of-hospital cardiac arrest (OHCA). METHODS: Coronary angiography was performed at admission in 300 consecutive patients with no obvious non-cardiac cause of OHCA. In survivors with no or minimal coronary artery stenosis, a second angiography with provocation test and electrophysiological testing were performed at 1 month. RESULTS: Spasm was demonstrated in ten patients. Diagnosis was based upon (1) spontaneous spasm on the admission angiogram (3 patients), (2) transient significative ST-segment elevation at follow-up in patients with no or non-significant coronary artery lesions (4 patients) and (3) spasm during the 1 month provocation test (3 patients). Six patients survived at 1 month; spasm occurred during a new provocation test in five despite treatment with high dosage calcium channel blockers leading to coronary stenting in two, an internal cardiovertor defibrillator in one, and increased drug therapy with prolonged hospitalization in the remainder. At a mean follow-up of 55+/-27 months, no recurrent cardiac arrest occurred. CONCLUSION: Systematic coronary angiograms and provocation tests in survivors of OHCA allow prompt diagnosis of coronary artery spasm. Residual spasm despite treatment with calcium channel blockers is frequent. Therapy should therefore be guided by repetitive provocation tests, and seems to avoid recurrence of cardiac arrest.

Calcium Channel Blockers↗
PubMed1994

Novel rat cardiac arrest model of posthypoxic myoclonus.

We describe the time course of and pharmacology associated with auditory-induced muscle jerks following cardiac arrest in rats. The data indicate that several key features of this model mimic those of human posthypoxic myoclonus. Similar to the human form, the muscle jerks appear in the rats following an acute hypoxic episode (cardiac arrest). Initially, it is known that both spontaneous and auditory-induced myoclonus are present in these animals; some cardiac-arrested rats also exhibit seizures. Over the first few days after the arrest, episodes of both the seizure activity and spontaneous myoclonus disappear. The auditory-induced myoclonus continues to worsen, reaches a peak about 2 weeks after the arrest, then declines over time to subnormal levels. The auditory-induced muscle jerks exhibited by the cardiac arrested animals are attenuated by the typical antimyoclonic drugs 5-hydroxytryptophan, valproic acid, and clonazepam. In addition, the novel anticonvulsant felbamate was found to have antimyoclonic properties. The data suggest that this rat cardiac arrest model may be a valuable tool for investigating the pathophysiologic mechanisms of posthypoxic myoclonus and for developing new therapeutic strategies for treating the disorder.

5-Hydroxytryptophan↗
PubMed1988

Predictive value of Glasgow coma score for awakening after out-of-hospital cardiac arrest. Cerebral Resuscitation Study Group of the Belgian Society for Intensive Care.

The Glasgow coma score (GCS) during days 1-6 after cardiac arrest was used to predict neurological outcome in 360 resuscitated victims of out-of-hospital cardiac arrest. A predictive rule based on the best GCS of 216 patients resuscitated in 1983-84 (prediction group) was constructed, and its predictive power was tested on 133 patients treated in 1985 (test group). Neurological outcome was correctly predicted 2 days after cardiac arrest in 80% of the prediction group, with a best GCS of 10 or above and 4 or below as cutoff points. For patients with a best GCS of 5-9, prediction of outcome was possible 6 days after cardiac arrest, with a best GCS of 8 during the first 6 days as the single cutoff point. The rule was then validated in the test group: the sensitivity was 96%; the specificity 86%; the negative predictive value 97%; and the positive predictive value 77%. These data suggest that this simple GCS-based rule can be helpful in predicting outcome in patients resuscitated after out-of-hospital cardiac arrest, but confirmation of these data is required in a prospective study in a larger number of patients.

Belgium↗
PubMed2006

In-hospital cardiac arrest is associated with use of non-antiarrhythmic QTc-prolonging drugs.

AIMS: QTc interval-prolonging drugs have been linked to cardiac arrhythmias, cardiac arrest and sudden death. In this study we aimed to quantify the risk of cardiac arrest associated with the use of non-antiarrhythmic QTc-prolonging drugs in an academic hospital setting. METHODS: We performed a case-control study in which patients, for whom intervention of the advanced life support resuscitation team was requested for cardiac arrest between 1995 and 2003 in the Academic Medical Centre, Amsterdam, were compared with controls regarding current use of non-antiarrhythmic QTc-prolonging drugs. Odds ratios (OR) and 95% confidence intervals (CI) were calculated using unconditional logistic regression, adjusting for potential confounding factors. RESULTS: A statistically significant increased risk of cardiac arrest (OR 2.1, 95% CI 1.2, 3.5) was observed in patients who received QTc-prolonging drugs (42/140). The risk was more pronounced in patients receiving doses > 1 defined daily dose (OR 2.5, 95% CI 1.1, 5.9), patients taking > 1 QTc-prolonging drug simultaneously (OR 4.8, 95% CI 1.6, 14) and patients taking pharmacokinetic interacting drugs concomitantly (OR 4.0, 95% CI 1.2, 13). CONCLUSIONS: Use of non-antiarrhythmic QTc-prolonging drugs in hospitalized patients with several underlying disease is associated with an increased risk of cardiac arrest. The effect is dose related and pharmacokinetic drug-drug interactions increase the risk substantially. Physicians caring for inpatients should be made aware of the fact that these non-antiarrhythmic drugs may be hazardous, so that potential risks can be weighed against treatment benefits and additional cardiac surveillance can be requested, if necessary.

Aged↗
PubMed2000

Inspiratory impedance during active compression-decompression cardiopulmonary resuscitation: a randomized evaluation in patients in cardiac arrest.

BACKGROUND: Blood pressure is severely reduced in patients in cardiac arrest receiving standard cardiopulmonary resuscitation (CPR). Although active compression-decompression (ACD) CPR improves acute hemodynamic parameters, arterial pressures remain suboptimal with this technique. We performed ACD CPR in patients with a new inspiratory threshold valve (ITV) to determine whether lowering intrathoracic pressures during the "relaxation" phase of ACD CPR would enhance venous blood return and overall CPR efficiency. METHODS AND RESULTS: This prospective, randomized, blinded trial was performed in prehospital mobile intensive care units in Paris, France. Patients in nontraumatic cardiac arrest received ACD CPR plus the ITV or ACD CPR alone for 30 minutes during advanced cardiac life support. End tidal CO(2) (ETCO(2)), diastolic blood pressure (DAP) and coronary perfusion pressure, and time to return of spontaneous circulation (ROSC) were measured. Groups were similar with respect to age, gender, and initial rhythm. Mean maximal ETCO(2), coronary perfusion pressure, and DAP values, respectively (in mm Hg), were 13.1+/-0.9, 25.0+/-1.4, and 36.5+/-1.5 with ACD CPR alone versus 19.1+/-1.0, 43.3+/-1.6, and 56.4+/-1.7 with ACD plus valve (P<0.001 between groups). ROSC was observed in 2 of 10 patients with ACD CPR alone after 26.5+/-0.7 minutes versus 4 of 11 patients with ACD CPR plus ITV after 19.8+/-2.8 minutes (P<0.05 for time from intubation to ROSC). Conclusions-Use of an inspiratory resistance valve in patients in cardiac arrest receiving ACD CPR increases the efficiency of CPR, leading to diastolic arterial pressures of >50 mm Hg. The long-term benefits of this new CPR technology are under investigation.

Adult↗
PubMed2005

Clinical evaluation of an inspiratory impedance threshold device during standard cardiopulmonary resuscitation in patients with out-of-hospital cardiac arrest.

OBJECTIVE: To determine whether an impedance threshold device, designed to enhance circulation, would increase acute resuscitation rates for patients in cardiac arrest receiving conventional manual cardiopulmonary resuscitation. DESIGN: Prospective, randomized, double-blind, intention-to-treat. SETTING: Out-of-hospital trial conducted in the Milwaukee, WI, emergency medical services system. PATIENTS: Adults in cardiac arrest of presumed cardiac etiology. INTERVENTIONS: On arrival of advanced life support, patients were treated with standard cardiopulmonary resuscitation combined with either an active or a sham impedance threshold device. MEASUREMENTS AND MAIN RESULTS: We measured safety and efficacy of the impedance threshold device; the primary end point was intensive care unit admission. Statistical analyses performed included the chi-square test and multivariate regression analysis. One hundred sixteen patients were treated with a sham impedance threshold device, and 114 patients were treated with an active impedance threshold device. Overall intensive care unit admission rates were 17% with the sham device vs. 25% in the active impedance threshold device (p = .13; odds ratio, 1.64; 95% confidence interval, 0.87, 3.10). Patients in the subgroup presenting with pulseless electrical activity had intensive care unit admission and 24-hr survival rates of 20% and 12% in sham (n = 25) vs. 52% and 30% in active impedance threshold device groups (n = 27) (p = .018, odds ratio, 4.31; 95% confidence interval, 1.28, 14.5, and p = .12, odds ratio, 3.09; 95% confidence interval, 0.74, 13.0, respectively). A post hoc analysis of patients with pulseless electrical activity at any time during the cardiac arrest revealed that intensive care unit and 24-hr survival rates were 20% and 11% in the sham (n = 56) vs. 41% and 27% in the active impedance threshold device groups (n = 49) (p = .018, odds ratio, 2.82; 95% confidence interval, 1.19, 6.67, and p = .037, odds ratio, 3.01; 95% confidence interval, 1.07, 8.96, respectively). There were no statistically significant differences in outcomes for patients presenting in ventricular fibrillation and asystole. Adverse event and complication rates were also similar. CONCLUSIONS: During this first clinical trial of the impedance threshold device during standard cardiopulmonary resuscitation, use of the new device more than doubled short-term survival rates in patients presenting with pulseless electrical activity. A larger clinical trial is underway to determine the potential longer term benefits of the impedance threshold device in cardiac arrest.

Aged↗
PubMed1995

Bystander vs EMS first-responder CPR: initial rhythm and outcome in witnessed nonmonitored out-of-hospital cardiac arrest.

OBJECTIVES: To assess whether outcome and first-monitored rhythm for patients who sustain a witnessed, nonmonitored, out-of-hospital cardiac arrest are associated with on-scene CPR provider group. METHODS: A retrospective, cohort analysis was conducted in a suburban, heterogeneous EMS system. Patients studied were > or = 19 years of age, had had an arrest of presumed cardiac origin between July 1989 and January 1993, had gone into cardiac arrest prior to ALS arrival, and had received CPR on collapse. First-monitored rhythms and survival rates were compared for two patient groups who on collapse either: 1) had received CPR by nonprofessional bystanders (BCPR) or 2) had received CPR by on-scene EMS system first responders (FRCPR). RESULTS: Of 217 cardiac arrest victims, 153 (71%) had received BCPR and 64 (29%) had received FRCPR. The BCPR patients were slightly younger (62.4 vs 68.4 years, p = 0.01) and had slightly shorter ALS response intervals (6.4 vs 7.7 minutes, p = 0.02). There was no difference in BLS response time intervals or automatic external defibrillator (AED) use rates. The percentage of patients with a first-monitored rhythm of pulseless ventricular tachycardia/ventricular fibrillation (VT/VF) and the percentage of patients grouped by CPR provider who survived to hospital admission or to hospital discharge were: [see text]

Adult↗
PubMed2002

Near death experiences in cardiac arrest: visions of a dying brain or visions of a new science of consciousness.

Very little is known about the dying process and in particular the state of the human mind at the end of life. Cardiac arrest is the final step in the dying process irrespective of cause, and is also the closest physiological model of the dying process. Recent studies in cardiac arrest survivors have indicated that although the majority of cardiac arrest survivors have no memory recall from the event, nevertheless approximately 10% develop memories that are consistent with typical near death experiences. These include an ability to 'see' and recall specific detailed descriptions of the resuscitation, as verified by resuscitation staff. Many studies in humans and animals have indicated that brain function ceases during cardiac arrest, thus raising the question of how such lucid, well-structured thought processes with reasoning and memory formation can occur at such a time. This has led to much interest as regards the potential implications for the study of consciousness and its relationship with the brain, which still remains an enigma. In this article, we will review published research examining brain physiology and function during cardiac arrest as well as its potential relationship with near death experiences during this time. Finally, we will explore the contribution that near death experiences during cardiac arrest may make to the wider understanding of human consciousness.

Attitude to Death↗
PubMed1997

Survivors of out of hospital cardiac arrest: their prognosis, longevity and functional status.

This paper reports, consistent with Utstein Style definitions, 13 years experience observing out-of-hospital cardiac arrest survivors' prognosis, longevity and functional status. We report for all patients, available outcome information for out-of-hospital cardiac arrest survivors in Göteborg Sweden between 1980 and 1993. Patients were followed for at least 1 year and some for over 14 years. From 1980 to 1993 Göteborg EMS treated 3754 out-of-hospital cardiac arrests. 9% (n = 324) were discharged from the hospital alive. Survivors' median age was 67 and 21% (n = 67) were women. Mortality rate was: 21% (n = 61) at 1 year; 56% (n = 78) by 5 years; and 82% (n = 32) by 10 years following the arrest. During the first 3 years, 16% (n = 46) experienced another cardiac arrest, 19% (n = 53) had an acute myocardial infraction and a total of 81% (n = 232) were rehospitalized for various conditions. 14% (n = 40) returned to previous employment, and 74% (n = 229) had retired before their arrest occurred. Cerebral performance categories (CPC) scores were: At hospital discharge N = 324; Data available for 320-1 = 53% (n = 171), 2 = 21% (n = 66), 3 = 24% (n = 77), 4 = 2% (n = 6). One year post arrest N = 263; Data available for 212-1 = 73% (n = 156), 2 = 9% (n = 18), 3 = 17% (n = 36), 4 = 1% (n = 2). Overall, 21% (n = 61) of cardiac arrest survivors died during the first year, and an additional 16% (n = 46) experienced another arrest. 73% of those patients who were still alive after 1 year returned to pre-arrest function.

Adolescent↗