Pulseless electrical activity and unsuccessful out-of-hospital resuscitation:: What is the cause of death?

Aims: To study the cause of deaths after witnessed cardiac arrest followed by pulseless electrical activity and unsuccessful of out-of-hospital resuscitation; and to detect any differences between causes of death determined at autopsy and those inferred from clinical history. Methods: In this prospective observational study, data were collected from 91 individuals treated by the emergency medical services in three urban communities in southern Finland. Results: Cause of death was determined at autopsy in 59 cases and without autopsy in 32 cases. There were significantly more diagnoses of acute myocardial infarction and fewer of pulmonary embolism and aortic dissection and rupture among cases without autopsy compared with those followed by autopsy. Conclusion: In unsuccessful resuscitation from out-of-hospital cardiac arrest with pulseless electrical activity as initial rhythm, an autopsy should be performed to determine the correct cause of death. (C) 2007 Elsevier Ireland Ltd. All rights reserved.