Prehospital Sudden Death: Need for Immediate Effective Resuscitation

To the Editor .—In a recent article, Raymond and co-workers 1 reported a study of nontraumatic sudden death in young adults occurring outside of the hospital. It must be noted that all patients in this study were managed at the scene by nonphysicians who performed cardiopulmonary resuscitation (CPR). The mean time between cardiac arrest and therapeutic management in the emergency room was 40 minutes. Among 83 patients, 75% were admitted to the hospital with clinical evidence of death or noneffective cardiac rhythm and, in spite of aggressive resuscitation by acute care physicians in the emergency room, could not be revived. It is not surprising that no positive result could be obtained after such a long time without effective coronary circulation in 25 patients reaching the hospital with cardiac asystole. We do agree with the authors that the most predominant prognostic factor is not the initial rhythm observed at the scene