Out-of-hospital Cardiac Arrest Patient Characteristics: Comparing ventricular arrhythmia and Pulseless Electrical Activity.

BACKGROUND: The proportion of patients suffering out-of-hospital cardiac arrest presenting with ventricular arrhythmias/ventricular fibrillation (VT/VF) is decreasing, while the proportion presenting with pulseless electrical activity (PEA) is increasing. Cardiac arrest interventions target VT/VF and survival rates from PEA are much lower. The aim of this study was to compare clinical characteristics of those suffering PEA and VT/VF. METHODS: We examined the past medical history of all patients suffering cardiac arrest in the Wellington region between 2008-2012 and compared clinical features of those with PEA to VT/VF. RESULTS: We identified 749 cardiac arrests in the study period, and were able to obtain detailed medical histories in 735 (98%) cases. The presenting rhythm was VF/VT in 337 (46%) cases, PEA in 127 (17%), and asystole in 271 (37%). Patients with PEA were older (68±14 versus 63±15 years, p=0.003), a higher proportion were female (35% versus 22%, p=0.002) and were less likely to have prior cardiovascular disease than those with VT/VF (48% versus 59%, p=0.03). Respiratory disease was more common in those with PEA (35% versus 23%, p=0.008). CONCLUSION: The population suffering PEA differs from the VT/VF cohort in a number of ways, and PEA is associated with significantly worse outcomes.

Restructuring Structural Heart Disease Practice During the COVID-19 Pandemic: JACC Review Topic of the Week.

Patients with structural heart disease are at increased risk of adverse outcomes from the coronavirus disease-2019 (COVID-19) due to advanced age and comorbidity. In the midst of a global pandemic of a novel infectious disease, reality-based considerations comprise an important starting point for formulating clinical management pathways. The aims of these "crisis-driven" recommendations are: 1) to ensure appropriate and timely treatment of structural heart disease patients; 2) to minimize the risk of COVID-19 exposure to patients and health care workers; and 3) to limit resource utilization under conditions of constraint. Although the degree of disruption to usual practice will vary across the United States and elsewhere, we hope that early experiences from a heart team operating in the current global epicenter of COVID-19 may prove useful for others adapting their practice in advance of local surges of COVID-19.