Confirmation

Are you sure you want to sign out?

Sign Out Cancel

Clinical Practice Guidelines
Drug Monographs
Clinical Resources
What's New
BCEHS Handbook FAQ
About BCEHS Handbook
Licence Level Filtering

PCP ACP CCP EMR DISPATCH

Paramedic CAT (Critically Appraised Topic)

009 | Prodromal symptoms in Sudden Cardiac Arrest

Author	Jacob Hutton	Date	2020-07-17
Reviewer	-	Edited	2020-10-22

Case Study

You arrive at a private residence for an adult male feeling unwell. Upon arrival, the patient complains of respiratory difficulty and subsequently experiences a sudden cardiac arrest (SCA) while attempting to ambulate to a chair. Following successful resuscitation and transportation to the nearest appropriate centre, you wonder how this patients’ symptoms compare with other symptom profiles preceding SCA, and if any clinical insights are to be gained from awareness of these profiles.

PICO Question

“For patients in the pre-hospital setting who experience sudden cardiac arrest, does the prevalence of certain symptoms compared to the prevalence of other symptoms predict risk of SCA and survival to hospital discharge?”

Population	Adult patients in the pre-hospital setting who experience sudden cardiac arrest
Intervention	The presence of certain preceding symptoms
Comparison	The presence of differing preceding symptoms
Outcome	Prediction of SCA and survival to hospital discharge

Search Strategy

Pubmed: ("OHCA" OR "cardiac arrest") AND ("prodromal" OR "preceding" OR "symptoms" OR "warning") AND ("prehospital" OR "paramedics" OR "EMS" OR "911")

Search Outcome

124 Results (10 Relevant) on 2020-07-17

Clinical Bottom Line

Approximately 1 in 20 sudden cardiac arrests (SCAs) in the pre-hospital setting are witnessed by paramedics. Prodromal symptoms are present in over 40% of patients several minutes before they experience SCA. The most frequent prodromal symptom is dyspnea (27.6%), followed by chest pain (20.7%), and syncope (12.7%).

While age and sex-standardized rates of good neurological outcome are better in patients with prodromal symptoms than in patients with no prodromal symptoms, several studies suggest that risk analysis based on existence of prodromal symptoms can be further classified into 2 categories: 1) patients experiencing chest pain and 2) patients experiencing dyspnea. Patients presenting with chest pain appear to be as much as 5 times more likely to survive SCA than patients complaining of dyspnea. Some research has demonstrated that nearly 10% of patients experiencing pre-hospital SCA have been assessed by EMS in the preceding 48 hours and not transported to hospital based on crew discretion.

There is evidence that scoring with the NEWS2 tool for risk evaluation will accurately detect and help mitigate under triage for these patients.

Relevant References

Chia MYC, Kwa TPW, Wah W, et al. Comparison of Outcomes and Characteristics of Emergency Medical Services (EMS)-Witnessed, Bystander-Witnessed, and Unwitnessed Out-of-Hospital Cardiac Arrests in Singapore. 2019. [LINK]
De Maio VJ, Stiell IG, Wells GA, Spaite DW; OPALS Study Group. Cardiac arrest witnessed by emergency medical services personnel: descriptive epidemiology, prodromal symptoms, and predictors of survival. 2000. [LINK]
Deakin CD, Quartermain A, Ellery J. Do Patients Suffering an Out-of-Hospital Cardiac Arrest Present to the Ambulance Service With Symptoms in the Preceding 48hrs? 2019. [LINK]
Hung SW, Chu CM, Su CF, Tseng LM, Wang TL. Effect of preceding medications on resuscitation outcome of out-of-hospital cardiac arrest. 2017. [LINK]
Karam N, Bataille S, Marijon E, et al. Incidence, Mortality, and Outcome-Predictors of Sudden Cardiac Arrest Complicating Myocardial Infarction Prior to Hospital Admission. 2019. [LINK]
Lee SY, Song KJ, Shin SD, Hong KJ. Epidemiology and outcome of emergency medical service witnessed out-of-hospital-cardiac arrest by prodromal symptom: Nationwide observational study. 2020. [LINK]
Nehme Z, Bernard S, Andrew E, Cameron P, Bray JE, Smith K. Warning symptoms preceding out-of-hospital cardiac arrest: Do patient delays matter? 2018. [LINK]
Nishiyama C, Iwami T, Kawamura T, et al. Prodromal symptoms of out-of-hospital cardiac arrests: a report from a large-scale population-based cohort study. 2013. [LINK]
Tresch DD, Thakur RK, Hoffmann RG, Aufderheide TP, Brooks HL. Comparison of outcome of paramedic-witnessed cardiac arrest in patients younger and older than 70 years. 1990. [LINK]
Williams TA, Tohira H, Finn J, Perkins GD, Ho KM. The ability of early warning scores (EWS) to detect critical illness in the prehospital setting: A systematic review. 2016. [LINK]