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Prodromal Symptoms Signal Better Neurological Outcomes After Cardiac Arrest: Presented at AHA

By Bruce Sylvester

ORLANDO, Fla -- November 17, 2009 -- Most out-of-hospital cardiac arrest (OHCA) patients have prodromal symptoms, and recognising them can increase the chance of faster intervention and neurologically favourable survival, according to a study presented here at the American Heart Association (AHA) 2009 Scientific Sessions.

"We found that over 60% of out-of-hospital cardiac arrest patients had prodromal symptoms and were more likely to receive emergency medical system [EMS] CPR [cardiopulmonary resuscitation] earlier followed by better outcomes," said study investigator Chika Nishiyama, RN, MPH, Kyoto University School of Public Health, Kyoto, Japan, on November 15.

For this prospective observational study, the investigators enrolled all patients aged >=18 years who had suffered OHCA of cardiac aetiology and were witnessed and treated by EMS personnel in Osaka, Japan, from January 2003 through December 2004.

The primary endpoint was neurologically favourable 1-month survival. Researchers evaluated data from 1,066 witnessed OHCA cases, of whom 651 (61.1%) showed prodromal symptoms.

The mean age of prodromal patients was 71.3 years and of nonprodromal patients was 68.5 years (P = .004). More than 60% of each group were male. Among prodromal patients, 18.3% had a history of cardiac arrest, compared with 10.6% of the nonprodromal patients (P = .001).

The investigators reported that 59.8% (n = 389) of patients experienced prodromal symptoms a few minutes before arrest, and 24.9% (n = 162) reported symptoms 1 hour before arrest, the most frequent symptoms being shortness of breath (27.5%), chest pain (20.6%), and syncope (12.9%). Atypical symptoms were reported by 34.7% of the patients. Patients with prodromal symptoms received earlier CPR by EMS than did nonprodromal patients (mean 8 vs 10 minutes; P < .001).

One-month survival was significantly better among prodromal patients, 12.1%, versus 7.7% for nonprodromal patients (P = .023), as was neurologically favourable 1-month survival, and 6.1% versus 1.9%, respectively (P = .041)

Cardiac arrest after EMS arrival (odds ratio [OR], 20.8; 95% confidence interval [CI], 1.5-280.7), ventricular fibrillation as initial rhythm (OR, 3.9; 95% CI, 1.8-8.3), and earlier call (OR per minute, 0.78; 95% CI, 0.66-0.92) were associated with better neurological outcomes.

"Noticing prodromal symptoms would facilitate early activation of EMS, help prevent sudden cardiac death, and improve neurologically favourable survival," Nishiyama concluded.

[Presentation title: Prodromal Symptoms of Out-of-Hospital Cardiac Arrest: Report From a Large-Scaled Population-Based Study. Abstract 2702]

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