Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 6, 2022; 10(22): 7738-7748
Published online Aug 6, 2022. doi: 10.12998/wjcc.v10.i22.7738
Correlation between the warning symptoms and prognosis of cardiac arrest
Kang Zheng, Yi Bai, Qiang-Rong Zhai, Lan-Fang Du, Hong-Xia Ge, Guo-Xing Wang, Qing-Bian Ma
Kang Zheng, Yi Bai, Qiang-Rong Zhai, Lan-Fang Du, Hong-Xia Ge, Qing-Bian Ma, Department of Emergency Medicine, Peking University Third Hospital, Beijing 100191, China
Guo-Xing Wang, Department of Emergency Medicine, Beijing Friendship Hospital, Beijing 100050, China
Author contributions: Zheng K and Ma QB designed the study; Zheng K and Bai Y participated in the acquisition, analysis, and interpretation of the data, and drafted the initial manuscript; Zhai QR, Du LF, Ge HX and Wang GX participated in the acquisition and analysis of the data; Ma QB revised the article critically for important intellectual content; all authors have read and approve the final manuscript.
Supported by Clinical Medicine Plus X-Young Scholars Project, Peking University, The Fundamental Research Funds for The Central Universities, No. PKU2022LCXQ008.
Institutional review board statement: The study was reviewed and approved by the Peking University Third Hospital Medical Science Research Ethics Committee, No. IRB00006761-M2019353.
Informed consent statement: Informed consent was waived.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at maqingbian@bjmu.edu.cn.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Qing-Bian Ma, MD, Director, Department of Emergency Medicine, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing 100191, China. maqingbian@bjmu.edu.cn
Received: January 29, 2022
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
Abstract
BACKGROUND

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.

AIM

To investigate the warning symptoms of cardiac arrest and to determine the correlation between the symptoms and outcomes.

METHODS

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.

RESULTS

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.

CONCLUSION

Most patients had warning symptoms before cardiac arrest. Dyspnea, chest pain, and unconsciousness were the most common symptoms. Immediately recognizing these symptoms and activating the emergency medical system prevents resuscitation delay and improves the survival rate of OHCA patients in China.

Keywords: Cardiac arrest; Warning symptoms; Immediate recognition; Etiology; Cardiopulmonary resuscitation; Prognosis

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.