We propose the latter to be expressed as the “rate of recognition”. An analogous consideration regarding the recognition of causes by ETs has not been published previously. The true rate may have been higher because the causes in 15% of all episodes remained unknown despite close investigation, and we could not decide whether the ETs made the correct considerations about the causes of arrest in these episodes. A Finnish-Swedish study by

Saarinen et al., including patients with IHCA between 2003 and 2010, demonstrated superior 30-day survival among resuscitated PEA patients whose underlying causes were appropriately treated.9 Whether appropriate treatment was based on the recognition of cause by the ETs was not reported in this study. PEA or asystole was the first documented rhythm in 71% of episodes in the present study. This is not very different from 67% Selleck VX-770 non-VF/VT arrests in a study by Gwinnutt et al. or 79% in the Get with the Guidelines Resuscitation registry study by Girotra et al. with 84,625 hospitalised patients.17 and 18 In this context, our findings seem representative for a larger population. Interestingly, the one-way association between VF/VT as the first documented

rhythm and the cause being cardiac, predominantly myocardial infarction, was pronounced (Fig. 2). This appears to be an important aspect when considering the underlying FDA approved Drug Library screening aetiology and may raise the question of the need for urgent revascularisation, anti-arrhythmic drugs or beta-blockers if tolerated. When the initial rhythm was PEA or asystole, the causes were not strictly non-cardiac, and approximately half of all cardiac episodes presented with PEA or asystole as well (Fig. 2). Patients in VF or VT demonstrated

a high probability of survival to discharge (54%). In the current study, we found that the clinical conditions triggering IHCA sometimes consisted of a coexistence of underlying aetiologies and direct causes. Somewhere in the chain of survival, information about the aetiology and cause of arrest becomes crucial Abiraterone for the choice of treatment. The appropriate timing of this was not studied in this study. Should the clarification of causes be given priority during ALS? Cause-specific treatment can be prepared and initiated immediately if ROSC is achieved. In certain cases of cardiac arrest, achieving ROSC may be fully dependent on a specific therapeutic measure, e.g., pericardiocentesis during cardiac tamponade or fluid resuscitation during septic shock. The total survival to hospital discharge rate was 25%, which is relatively high compared with larger studies with comparable patient categories.18 and 19 Such comparisons may be confounded by medical-cultural differences in do-not-resuscitate (DNR) orders and differences in patient categories with higher probabilities of ROSC, e.g., monitored VF patients. Additionally, different practices in post-cardiac arrest care may influence the survival to discharge probabilities.