Outcomes after in-hospital ventricular fibrillation

Abstract

Introduction: Numerous reports document the survival of in-hospital ventricular fibrillation (VF), but there are none that report the long survival. Objectives: Determine survival to hospital discharge of patients with in-hospital VF and 5 years after the event. Methods: All cardiac arrest treated with CPR in adult patients, between April 2004 and June 2006, in an University Hospital of Cardiology, were registered and followed during 5 years. Data were collected according to the Utstein format and recorded immediately after each resuscitation attempt. Medical records of these patients were reviewed five years after the arrest. Results: A total of 800 attempted CPRs were performed. From all cardiac arrests 190 (25.7%) had VF or tachycardia without pulse (VT) as initial rhythmic of arrest. From all patients in VF/VT, 68 (35.8%) survived to hospital discharge. Stepwise logistic regression showed pre arrest normal systolic ventricular function (OR 4.4, 95%CI 1.68 –11.26) as independent predictor of increased survival. Predictors of low survival were: age> 60 years (OR 0.42, 95%CI 0.19 – 0.9), hypotension as cause of arrest (OR 0.13, 95%CI 0.27– 0.63), the presence of infections (OR 0.082, 95%CI 0.31– 0.217), the use of more than 3 doses of epinephrine (OR 0.23, 95% CI 0.076 – 0.67) and bicarbonate (OR 0.18, 95%CI 0.032–1.037) during resuscitation efforts. Five years after the event, 62 patients had medical records available. Forty eight patients (77%) were alive. The most important cardiovascular interventions during this period were coronary bypass surgery/angioplasty in 52%, implantation of cardioversor defibrillator in 26%, valvar surgery in 8% and cardiac transplantation in 5% of patients. Conclusion: Survival to hospital discharge of patients with VF/VT, in a cardiology specialty hospital, was similar of those in general hospital. In addition of traditional predictors, normal systolic ventricular function was an indicator of survival. Five years later, survival was very high, which could be related with the large cardiologic interventions.