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ABSTRACT
Objective. Upper body cyanosis is a physical finding sometimes noted at the time of cardiac resuscitation. We attempted to determine the incidence and significance of upper body cyanosis in cases of nontraumatic cardiac arrest. Methods. This was a retrospective case-control study. We reviewed all nontraumatic cardiac arrests evaluated by King County, Washington emergency medical system (EMS) personnel during 2000-2004 and identified patients with upper body or nipple-line cyanosis. Those patients who were autopsied comprised the cases for our study. Cases were age and sex matched with controls who also had cardiac arrest with an autopsy but no mention of cyanosis. Results. EMS personnel treated 3,526 patients, age 18 and older, for nontraumatic out-of-hospital cardiac arrest. One hundred eight (3.1%) had specific mention of upper chest or nippleline cyanosis, of whom 38 had autopsy. Among the 38 autopsy cases, 6 were died of hemopericardium compared to none in age- and sex-matched controls. Conclusion. Cardiac arrest with upper chest or nipple-line cyanosis had a higher incidence of hemopericardium or dissecting thoracic aortic aneurysm than patients without mention of cyanosis. Key words: heart arrest; cyanosis; emergency medical services; emergency medical technicians; cardiac tamponade.
PREHOSPITAL EMERGENCY CARE 2007;11:207-209
INTRODUCTION
Several factors are associated with survival after sudden cardiac arrest including rhythm, bystander cardiopulmonary resuscitation (CPR), and times to CPR and defibrillation.1,2 We are not aware, however, of any physical findings associated with outcome from cardiac arrest, other than rigor mortis or lividity, which are indicative of death. In our ongoing review of all cardiac arrests treated by emergency medical services (EMS) personnel in our community, we have noted that the presence of upper chest cyanosis or cyanosis superior to the nipple line is occasionally noted by paramedics and EMTs. Anecdotally, numerous paramedics have reported that patients with the finding of nipple-line cyanosis cannot be successfully resuscitated. We undertook a review of out-of-hospital nontraumatic cardiac arrest to determine the incidence and significance of upper chest and nipple-line cyanosis. We hypothesized that upper chest cyanosis was due to some mechanical pathology that led to vascular congestion above the level of the heart.
METHODS
EMS System and Study Setting
The study setting occurred in King County, Washington (excluding the city of Seattle), which has a population of approximately 1.2...