Paratz, Elizabeth D. and Hansen, Carl Johann and Gerche, Andre La and Stub, Dion and Nehme, Ziad and Dantanarayana, Ashanti and Freedman, Kelila and Pflaumer, Andreas and Ingles, Jodie and Winkel, Bo Gregers and Tfelt-Hansen, Jacob (2025) Cardiac arrest while using the toilet: not uncommon and associated with adverse resuscitation profile. Resuscitation Plus, 25. p. 101047. ISSN 26665204
Full text not available from this repository.Abstract
BACKGROUND: Out-of-hospital cardiac arrest (OHCA) on the toilet has been reported to be common and possibly driven by straining or vagal stimulus. Toilet-associated OHCA may also create a challenging resuscitation environment. METHODS: The national Danish sudden death registry and state-wide Australian End Unexplained Cardiac Death (EndUCD) registry were examined. Persons with a fatal OHCA aged 5-50 years with autopsy-confirmed cardiac or unascertained aetiology were included. Resuscitation-related, aetiological and forensic factors were compared between persons experiencing fatal toilet-associated OHCA versus elsewhere. A composite variable of physiological conditions creating pressure-load or pressure-sensitivity was created, comprising hypertrophic cardiomyopathy, aortic stenosis/coarctation, and aortic aneurysm/dissection. RESULTS: Of 2,463young persons, 75 (3.0 %) experienced toilet-associated fatal OHCA while 2,388 (97.0 %) experienced out-of-toilet OHCA. Australians experienced toilet-associated OHCA 1.7 times more frequently than Danes (4.1 % vs 2.4 %, p = 0.016). Toilet-associated OHCA was less frequently witnessed (13.3 % vs 32.1 %, p = 0.001), with lower rates of bystander cardiopulmonary resuscitation (32.0 % vs 55.7 %, p < 0.0001) and shockable rhythm (5.9 % vs 23.8 %, p = 0.003) compared to non-toilet OHCA. Toxicological results were more frequently positive for illicit substances in toilet-associated OHCA (32.8 % vs 16.3 %, p < 0.0001). No differences were identified in OHCA aetiology, including rates of the composite variable of aetiologies such as hypertrophic cardiomyopathy and aortic dissection. CONCLUSION: 3.0 % of young fatal OHCA of cardiac aetiology is toilet-associated, with almost double the rates of toilet-associated OHCA in Australia compared to Denmark. No differences in OHCA aetiology were identified in toilet-associated OHCA. Resuscitation-related factors were adverse in toilet-related OHCA, highlighting the need for innovative ways to recognise and respond to toilet-associated OHCA.
| Item Type: | Article |
|---|---|
| Subjects: | R Medicine > R Medicine (General) |
| Depositing User: | Repository Administrator |
| Date Deposited: | 04 Dec 2025 04:15 |
| Last Modified: | 04 Dec 2025 04:15 |
| URI: | http://eprints.victorchang.edu.au/id/eprint/1760 |
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