Factors influencing survival to hospital discharge

There are several stages in this chain of survival and multiple factors which influence these stages. It is therefore essential for an Emergency Physician to consider all these factors during the decision making process.

1. Pre-Cardiac Arrest factors associated with adverse outcome

a – Patient factors:

• Increasing Age
• Associated Co-morbidities

b – Event related factors:

• Unwitnessed Event

2. During Cardiac Arrest factors associated with adverse outcome

• Delayed Initiation of Cardio-Pulmonary Resuscitation (CPR)
• Pulseless Electrical Activity (PEA) or Asystole as initial rhythm
• Delayed Defibrillation of patients in Ventricular Fibrillation (VF) or Pulseless Ventricular Tachycardia (VT)
• Longer Duration of CPR

3. Post Cardiac Arrest factors associated with adverse outcome

• temperature over 37.7
• Delayed Coronary Catheterisation in patients who had a shockable initial rhythm (VF or VT)
• Excessive oxygenation of patients
• Inadequate maintenance of Arterial Blood Pressure (BP)
• Early prognostication and withdrawal of life support treatment (WLST)