Presentation, management, and outcome of out of hospital cardiopulmonary arrest: comparison by underlying aetiology

Objective: To describe and compare presentation, management, and survival by aetiology of cardiopulmonary arrest. Design, setting, and patients: A retrospective cohort study was undertaken of all 21 175 first out of hospital cardiopulmonary arrests in Scotland between May 1991 and March 1998. Main outcome measure: Discharge alive from hospital. Results: Presumed cardiac disease accounted for 17 451 cases (82%), other internal aetiologies for 1814 (9%), and external aetiologies for 1910 ( 9%). Arrests caused by presumed cardiac disease had a better risk profile in terms of presence of a witness, bystander cardiopulmonary resuscitation, call response interval, and use of defibrillation; 1265 (7%) of those who arrested from presumed cardiac disease were discharged alive, compared with only 77 (2%) of those with non-cardiac disorders (p < 0.001). Among those defibrillated, call-response interval was associated with survival following arrests from both presumed cardiac and non-cardiac causes ( p < 0.001). Conclusions: Out of hospital cardiopulmonary arrests from non-cardiac causes were associated with worse crude survival than arrests from cardiac causes. Improvements in call-response interval and basic life support skills in the community would improve survival irrespective of the aetiology and should therefore be encouraged.