Clinical PaperProdromal symptoms of out-of-hospital cardiac arrests: A report from a large-scale population-based cohort study☆
Introduction
Out-of-hospital cardiac arrest (OHCA) is a common public health problem accounting for more than 60% of deaths from cardiovascular diseases.1, 2, 3 Although fatalities from acute myocardial infarction (AMI) have been decreasing mainly due to recent substantial advances in in-hospital treatments, many AMI patients die before arriving at a hospital.4 In Japan, approximately 60,000 OHCAs of cardiac origin occur every year, and the number has been steadily increasing.5, 6 Despite continuous improvements in the “chain of survival”, survival after OHCA remains low.1, 2, 6, 7
Cardiac arrest is the first manifestation in about one third of AMI cases.8 It is well known that most OHCAs occur in persons who have neither past history nor major risk factors of heart disease, which makes it quite difficult to predict the occurrence of OHCAs.8 On the other hand, one study indicated that some OHCA patients had manifested prodromal symptoms before their arrests.9 If we knew specific symptoms suggesting the threat of a cardiac arrest, we could develop preventive measures against OHCA.
The Utstein Osaka Project, launched in 1998, is a large, ongoing, prospective, population-based cohort study of OHCA in Osaka, Japan that covers 8.8 million people.6, 10, 11 Approximately 5000 OHCA patients were newly registered in this project every year. For this study, we collected data on prodromal symptoms in addition to the Utstein-style data. The objective of this study is to describe the prodromal symptoms of OHCA focusing on the onset of the symptom in relation of etiology of cardiac arrests, and to analyze the association between those symptoms and their outcomes after OHCA.
Section snippets
Study design, population, and setting
The present study was carried out within the Utstein Osaka Project, which is a prospective, population-based cohort study of all persons with OHCA who are treated by emergency medical service (EMS) personnel in the city of Osaka, Japan. This study included all OHCA patients aged 18 years or older who were presumed to be of cardiac and non-cardiac origin and who were witnessed by bystanders or EMS personnel from January 1, 2003 through December 31, 2004. Osaka is the third largest city in Japan
Patients’ characteristics and resuscitation situations
A total of 3093 OHCA cases of age 18 years or older were documented during the study period. Among them, resuscitation was attempted in 2999, and 1183 were witnessed by bystanders and 283 were witnessed by EMS (Fig. 1). Of those who were witnessed, 1042 were presumed to be of cardiac origin and 424 of non-cardiac origin.
Table 1 shows patients’ and resuscitation characteristics according to etiology of cardiac arrests. Patients with presumed cardiac origin were more likely to have past history
Discussion
This study clearly demonstrated that many OHCA patients regardless of type of etiology manifested prodromal symptoms prior to their arrests. Although there are some articles on prodromal symptoms in cardiac arrests, most studies focused on specific situations such as younger generation,14 athletes,15 cardiac disease patients,16 or people with family history of cardiac disease,17 and there were few studies like ours. A small study from Germany reported that 50% of OHCA occurred after typical
Conclusions
This large population-based observational study indicated that over 60% of OHCA patients had prior symptoms to their cardiac arrests, and 40% of such symptoms had been manifested at least several minutes before their arrests regardless of etiology.
Early activation of the EMS system by recognizing these prodromal symptoms might improve outcomes after OHCA.
Conflicts of interest
There are no conflicts of interest to declare.
Role of funding source
This work was supported by a grant from the Fire Disaster Management Agency (for studies concerning a strategy for applying the results of the Utstein report to the improvement of emergency service), and by a Japan Heart Foundation Research Grant.
Acknowledgements
We greatly appreciate the dedication of Hiroshi Morita, Hidekazu Yukioka, Hisashi Sugimoto, Toshifumi Uejima, Kikushi Katsurada, Masafumi Kishimoto, Chizuka Shiokawa, Masahiko Nitta, Akihiko Hirakawa, Hiroshi Rinka, Kentaro Kajino, Yasuo Ohishi, Tomoyoshi Mouri, and Hiroyuki Yokoyama, as well as of other members of the Utstein Osaka Project for their contribution to the organization, coordination, and oversight of the steering committee. We wish to thank Masahiko Ando at Center for Advanced
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A Spanish translated version of the abstract of this article appears as Appendix in the final online version at http://dx.doi.org/10.1016/j.resuscitation.2012.10.006.