Cardiac arrest and prognosis

Cardiology PGY1 PGY2 PGY3 PGY4


This is one of the challenging topics in EM. when should you stop CPR? what parameters do you have to continue versus terminate CPR?Emergency Medicine Clinics of North America in the latest issue Feb 2012, has a brilliant article and summarized some of the points which we can consider as an EP to estimate rate of survival in cardiac arrest. As always, you have to ask yourself, does ROSC mean survival, does hospital to admit mean survival ? or hospital to discharge?

Prognostic Factors in out of hospital cardiac arrest:

1. Public vs Workplace

2. Age old vs young

3. CPR by bystander

4. Time to defibrillation: after or before EMS

5. Time of day Midnight vs AM

6. Gasping


Prognostic Factors in- hospital cardiac arrest:

1. Rhythm: VF/VT

2.Time to CPR and defibrillation

3. Hospital location: ward vs ICU, Dialysis

4.Time of day

5.AED use


Prognostic factors intra-arrest:

PETCO2:  10 @ 20 is bad!!!

Ultrasonography: Cardiac standstill means failed resuscitation regardless of rhythm or monitor

I had two cases with cardiac standstill and both had ROSC!!!

I recommend this article for all of the Emergency Physician and as well residents to read carefully.

LINK to article




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