Sudden cardiac arrest: Studies on risk and outcome

Sudden Cardiac Arrest (SCA) accounts for 15-20% of all natural deaths in Western Europe. SCA occurs predominantly in the general population and is often lethal. In the general population, the risk of SCA is influenced by multiple factors.
In order to reduce the number of deaths due to SCA, two main approaches can be distinguished: 1) identify those at risk in order to prevent SCA, and 2) optimize pre-hospital and in-hospital resuscitation care to improve survival after SCA. The risk of the occurrence of SCA itself can be studied, but also of markers of SCA risk, in order to explore possible mechanisms involved in SCA risk. Part I of this thesis presents four studies on SCA risk markers on the electrocardiogram: in patients with epilepsy, in patients with schizophrenia, and in hospitalized patients who receive haloperidol. Part II presents the rationale and outline of the ARREST registry (focusing on pharmacological, clinical and genetic risk factors of out-of-hospital cardiac arrest [OHCA]), a review on how drugs may that interact with the cardiac sodium channel and thereby increase SCA risk, and two studies on non-cardiac risk factors of OHCA (use of nortriptyline; history of obstructive pulmonary disease). Part III presents three studies on outcome of resuscitation attempts after OHCA. We show that patient characteristics (gender or co-morbidities) influence one’s chances to have access to and benefit from resuscitation care. Lastly, we demonstrate that increased use of automated external defibrillators (AEDs) is associated with increased survival rates after OHCA in the general population.