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HIV Seroprevalence Among Adults Treated for Cardiac Arrest Before Reaching a Medical Facility -- Seattle, Washington, 1989-1990

As part of an ongoing study of determinants of out-of-hospital cardiac arrest, the Seattle - King County Department of Health conducted an anonymous human immunodeficiency virus (HIV) serosurvey of these patients in Seattle from January 1989 through December 1990. The serum specimens were obtained from patients for whom cardiopulmonary resuscitation (CPR) was initiated by bystanders or emergency medical technicians (EMTs) and for whom endotracheal intubation and intravenous therapy were administered by paramedics. This report summarizes preliminary findings from this survey.

The catchment area is served by one emergency medical response system. Blood specimens were obtained in the field (i.e., at the site of the cardiac arrest) from 604 (75%) of 805 patients aged 18-94 years who had CPR and endotracheal intubation and/or an intravenous catheter placed by paramedics. Persons who had an out-of-hospital cardiac arrest regardless of the underlying etiology (e.g., suspected drug overdose), except for those resulting from trauma, were included in the serosurvey. Those from whom specimens were obtained were similar in age and sex to those from whom specimens were not obtained (e.g., because the subject was not clinically stable). Blood specimens were obtained from 410 (68%) men and 194 (32%) women after essential emergency care had been provided and the patient was clinically stable, or unsuccessful resuscitation efforts were terminated. The serum specimens were grouped by sex and age of patients; all personal identifiers were removed before HIV testing. Blood specimens were screened for HIV antibody by enzyme immunoassay (EIA); specimens repeatedly reactive by EIA were evaluated by Western blot, which was interpreted according to standard criteria (1).

Of the 604 serum specimens tested, five (0.8%) were HIV seropositive (95% confidence interval (CI)=0.1%-1.5%). All five were men aged 35-55 years, including three ((12%) 95% CI=1%-24%) of 26 men aged 35-44 years and two ((5%) 95% CI=2%-12%) of 38 men aged 45-54 years.

To determine whether information collected and recorded by paramedics on the emergency medical service incident report (e.g., observing drug paraphernalia at the scene of the cardiac arrest or reported history of injecting-drug use (IDU)) would predict seropositivity, anonymous testing was repeated on 19 specimens obtained from men with histories of IDU documented by the incident report. Two of the five HIV seropositive men were identified among this high-risk subset; two ((11%) 95% CI=3%-24%) of 19 men with evidence of IDU and three ((0.8%) 95% CI=0.1%-1.6%) (p=0.01) of the 391 men without evidence of IDU were seropositive.

Reported by: D Siscovick, MD, L Cobb, MD, M Copass, MD, K Wicklund, PhD, Univ of Washington School of Medicine, Seattle; H Handsfield, MD, Seattle - King County Dept of Public Health. National Institute for Occupational Safety and Health; Hospital Infections Program and Div of HIV/AIDS, National Center for Infectious Diseases, CDC.

Editorial Note

Editorial Note: The seroprevalence of HIV in patients treated in emergency departments has been described previously (2,3). However, the seroprevalence in persons who have had an out-of-hospital cardiac arrest and received CPR in the field has not been characterized. In this report, the overall seroprevalence in such persons in Seattle was relatively low, and serologic evidence of HIV infections was not detected among women or among men aged greater than or equal to 55 years. Although HIV seroprevalence was highest in men known to have been injecting-drug users, information suggesting this or other potential risk factors for HIV infection was not available to persons who provided assistance to many of the patients in this study.

Under nontraumatic circumstances, the risk for HIV transmission would be expected to be low for persons initiating CPR, since CPR does not usually create the potential for parenteral or mucous membrane exposures to blood (4-6). HIV transmission has not been reported in paramedics or EMTs who have been exposed to infected persons during out-of-hospital cardiac arrest.

The risk for occupationally acquired HIV infection is likely to be similar for emergency medical service personnel who may be exposed to blood splashes or who must use sharp instruments or medical devices during out-of-hospital resuscitations and for health-care workers who provide the same type of care for HIV-infected patients in the hospital (7-9). Because HIV-infection (as well as hepatitis B and other bloodborne pathogen) status is unknown for most persons who have an out-of-hospital cardiac arrest (2,3,7), emergency medical service personnel should adhere to universal precautions during resuscitation attempts (7-9).

References

  1. CDC. Interpretation and use of the Western blot assay for serodiagnosis of human immunodeficiency virus type 1 infections. MMWR 1989;38(no. S-7).

  2. Kelen GD, Fritz S, Qaqish B, et al. Unrecognized human immunodeficiency virus infection in emergency department patients. N Engl J Med 1988;318:1645-50.

  3. Baker JL, Kelen GD, Silvertson KT, Quinn TC. Unsuspected human immunodeficiency virus in critically ill emergency patients. JAMA 1987;257:2609-11.

  4. Saviteer SM, White GC, Cohen MS, Jason J. HTLV-III exposure during cardiopulmonary resuscitation (Letter). N Engl J Med 1985;313:1606-7.

  5. Goebel F-D, Zoller WG, Erfle V, Hehlmann R. Resuscitation of patients with AIDS: risk of HIV transmission. AIDS-Forschung 1988;5:277-8.

  6. Bolon T, Patrone-Reese J, Dearmas L, Fayne T, Tulsie N. Reported, self-perceived, serious body fluid exposures among emergency medical technicians, paramedics, and firefighters (Abstract). Vol 2. VI International Conference on AIDS, San Francisco, June 20-24, 1990:417.

  7. CDC. Recommendations for prevention of HIV transmission in health-care settings. MMWR 1987;36(no. 2S).

  8. CDC. Update: universal precautions for prevention of transmission of human immunodeficiency virus, hepatitis B virus, and other bloodborne pathogens in health-care settings. MMWR 1988;37:377-82,387-8.

  9. CDC. Guidelines for prevention of transmission of human immunodeficiency virus and hepatitis B virus to health-care and public-safety workers. MMWR 1989;38(no. S-6).



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