Factors associated with out-of-hospital cardiac arrest with pulseless electric activity: a population-based study

Background — Many patients with out-of-hospital cardiac arrest (OHCA) present with pulseless electric activity (PEA) rather than shockable rhythm. Despite improvements in resuscitation care, survival of PEA patients remains dismal. Our main objective was to characterize OHCA patients by initial presenting rhythm and to evaluate independent determinants of PEA.

Methods — A population-based study was conducted using the Toronto Rescu Epistry database with linkage to administrative data in Ontario, Canada. We included patients > 20 years, who had non-traumatic cardiac arrests from 2005 to 2010. Multivariable logistic regression models were constructed to determine factors predicting the occurrence of PEA vs. shockable rhythm vs. asystole.

Results — Of the 9,882 included patients who received treatment, 24.5% had PEA, 26.3% had shockable rhythm, and 49.2% had asystole. PEA patients had a mean age of 72 years, 41.2% were female, had multiple comorbidities, and 53.4% were hospitalized in the past year. As compared to shockable rhythm, PEA patients were older, more likely to be women, and had more comorbidities. As compared to asystole, PEA patients had similar baseline and clinical characteristics, but were substantially more likely to have an arrest witnessed by emergency medical services (OR = 13), or by bystander (OR = 3.24). Mortality at 30 days was 95.5%, 77.9%, and 98.9% for patients with PEA, shockable rhythm, asystole, respectively.

Conclusions — Patient characteristics differed substantially in those presenting with PEA and shockable rhythm. In contrast, the main distinguishing factor between PEA and asystole cardiac arrest related mainly to factors at the time of the cardiac arrest.