Published online Aug 6, 2022. doi: 10.12998/wjcc.v10.i22.7738
Peer-review started: January 29, 2022
First decision: May 11, 2022
Revised: May 21, 2022
Accepted: June 17, 2022
Article in press: June 17, 2022
Published online: August 6, 2022
Processing time: 173 Days and 16.2 Hours
A low survival rate in patients with cardiac arrest is associated with failure to recognize the condition in its initial stage. Therefore, recognizing the warning symptoms of cardiac arrest in the early stage may play an important role in survival.
To investigate the warning symptoms of cardiac arrest and to determine the correlation between the symptoms and outcomes.
We included all adult patients with all-cause cardiac arrest who visited Peking University Third Hospital or Beijing Friendship Hospital between January 2012 and December 2014. Data on population, symptoms, resuscitation parameters, and outcomes were analysed.
Of the 1021 patients in the study, 65.9% had symptoms that presented before cardiac arrest, 25.2% achieved restoration of spontaneous circulation (ROSC), and 7.2% survived to discharge. The patients with symptoms had higher rates of an initial shockable rhythm (12.2% vs 7.5%, P = 0.020), ROSC (29.1% vs 17.5%, P = 0.001) and survival (9.2% vs 2.6%, P = 0.001) than patients without symptoms. Compared with the out-of-hospital cardiac arrest (OHCA) without symptoms subgroup, the OHCA with symptoms subgroup had a higher rate of calls before arrest (81.6% vs 0.0%, P < 0.001), health care provider-witnessed arrest (13.0% vs 1.4%, P = 0.001) and bystander cardiopulmonary resuscitation (15.5% vs 4.9%, P = 0.002); a shorter no flow time (11.7% vs 2.8%, P = 0.002); and a higher ROSC rate (23.8% vs 13.2%, P = 0.011). Compared to the in-hospital cardiac arrest (IHCA) without symptoms subgroup, the IHCA with symptoms subgroup had a higher mean age (66.2 ± 15.2 vs 62.5 ± 16.3 years, P = 0.005), ROSC (32.0% vs 20.6%, P = 0.003), and survival rates (10.6% vs 2.5%, P < 0.001). The top five warning symptoms were dyspnea (48.7%), chest pain (18.3%), unconsciousness (15.2%), paralysis (4.3%), and vomiting (4.0%). Chest pain (20.9% vs 12.7%, P = 0.011), cardiac etiology (44.3% vs 1.5%, P < 0.001) and survival (33.9% vs 16.7%, P = 0.001) were more common in males, whereas dyspnea (54.9% vs 45.9%, P = 0.029) and a non-cardiac etiology (53.3% vs 41.7%, P = 0.003) were more common in females.
Most patients had warning symptoms before cardiac arrest. Dyspnea, chest pain, and uncon
Core Tip: This was a retrospective study to investigate the correlation between the symptoms and the outcomes in cardiac arrest patients. A total of 65.9% of patients had symptoms before arrest. Dyspnea, chest pain, and unconsciousness were the most common symptoms. The patients with symptoms had a higher rate of initial shockable rhythm, restoration of spontaneous circulation (ROSC) and survival than patients without symptoms. The out-of-hospital cardiac arrest symptoms subgroup had a higher rate of bystander cardiopulmonary resuscitation, a shorter no flow time, and a higher ROSC rate. The in-hospital cardiac arrest symptoms subgroup had higher ROSC and survival rates. Immediate recognition of symptoms and activation of the emergency medical system could prevent resuscitation delay and improve the survival rate.