Factors Affecting the Treatment Results of In-hospital Pulseless Ventricular Tachycardia and Ventricular Fibrillation

Ahn, Shin; Lim, Kyung Soo; Kim, Won Young; Kim, Won

Abstract

PURPOSE
This study was performed to report the outcomes of in-hospital cardiac arrest where the presenting rhythm was pulseless ventricular tachycardia/ventricular fibrillation (VT/VF) by using the modified "in-hospital Utstein style template" and to find the factors affecting the outcome.
METHODS
Between January 2002 and December 2003, prospective study including all adult cardiopulmonary arrest patients with pulseless VT/VF was performed. Return of spontaneous circulation (ROSC) lasting more than 20 minutes, 24-hour-survival, and hospital discharge rates were measured for short-term results. Six-months and one-year survival rates were measured for long-term results.
RESULTS
One hundred seven patients had primary pulseless VT/VF. Of the 107, 65 achieved ROSC, and 30 were discharged alive. Twelve gained 6-month survival, and 10 survived more than 1 year. The PAM index and the PAR score in the ROSC group were 5.2+/-3.4 and 3.6+/-4.2 respective, which were lower than those in the non-ROSC group. The numbers of patients defibrillated within 3 minutes were 28 in the ROSC group and 7 in the non-ROSC group. The PAM index and the PAR score in the discharged surviving patients were 4.4+/-2.7 and 2.5+/-3.3, which were lower than those in the in-hospital death group. The ROSC, the 24-hour-survival, and the survival-discharge rates were higher in the defibrillated-first group than the group defibrillated after other intervention.
CONCLUSION
The PAM index and the PAR score are related to both ROSC and survival discharge, but early defbrillation is related to the ROSC only. Rapid defibrillation prior to any other intervention improves survival from pulseless VT/VF in in-hospital cardiac arrest victims, and the time to first shock is critical in enhancing the ROSC rate.