PULSELESS
ELECTRICAL ACTIVITY WITH WITNESSED ARREST AS A PREDICTOR OF SUDDEN DEATH FROM
MASSIVE PULMONARY EMBOLISM IN OUTPATIENTS.
Courtney
DM, et al. Resuscitation 2001 Jun;49(3):265-72
BACKGROUND:
the objective was to determine clinical characteristics that can quickly
distinguish sudden death from massive pulmonary embolism (MPE) from other
causes of sudden death.
METHODS
AND RESULTS: all medical examiner reports from Charlotte, NC from 1992 to 1999
(n=4926) were hand-searched for cases of sudden death which met the inclusion
criteria: non-traumatic death, age 18-65 years, transported to an emergency
department (ED), and autopsy performed. Supplemental data from ED and
prehospital records were retrieved to complete documentation. Data were
analyzed by univariate odds ratios (OR) followed by chi-square (chi(2))
recursive partitioning for decision tree construction. Three hundred eighty
four cases met inclusion criteria; MPE was the second most frequent cause of
cardiac arrest in this cohort (37/384, 9.6%). The mean age of subjects with MPE
(40.2+/-11.1 years) was significantly lower compared with non-PE subjects
(46.5+/-9.9 years). Pulseless electrical activity was observed as the initial
arrest rhythm (primary PEA) in 52/384 (13.5%) subjects. Out of 52 subjects with
primary PEA, 28 (53%) died from MPE. Odds ratio data indicated significant
association of MPE with female gender, arrest witnessed by medical providers,
presence of primary PEA, and return of spontaneous circulation. The most
accurate decision rule to recognize MPE consisted of witnessed arrest+primary
PEA. This rule generated sensitivity=67.6% and specificity=94.5% and yielded a
posttest probability of MPE of 57%.
CONCLUSIONS:
outpatients with witnessed cardiac arrest and primary PEA carry a high
probability of MPE.