Background: Despite resuscitative efforts, cardiac arrest (CA) continues to result in high mortality and poor prognosis. However, a gap remains in understanding the comparative outcomes of efforts in emergency departments (ED) over recent years. This study evaluated patients with CA during ED visits, with a particular focus on outcomes of mortality and transition of care. Methods: We conducted a retrospective cohort analysis using the National Emergency Department Sample (NEDS) database. The study population included patients aged 18 years or older who visited the ED between January 2016 and December 2020. Statistical analysis of patients and hospital characteristics included chi-squared tests for independence and multivariable logistic regression models to report the associations of factors with mortality in the ED and disposition from the ED. The primary outcome measured was mortality in the ED, and the secondary outcome included transition of care. Results: A total of 699,822,424 ED visits occurred between 2016 and 2020, with 1,414,060 (0.20%) CAs. The survival rate from CA ranged from 24.6% to 28.1%. In 2020, the rate of ED CA increased to 0.27%, with an inpatient mortality rate of 58.8%. There was no significant difference in mortality between sexes (p = 0.690). There was a trend for higher mortality in the ED among patients who were self-paid. Notably, the odds of transfer from the ED to other hospitals were significantly lower in minority groups. Conclusions: Our results showed significant disparities in ED mortality and patient disposition following cardiac arrest, highlighting the need for equitable healthcare resources and policies.

Background/Objectives: Left ventricular free wall rupture is a rare but catastrophic complication of acute myocardial infarction with extremely high mortality. Deaths occurring in water environments present unique forensic challenges requiring systematic evaluation of drowning, intoxication, trauma, and natural disease. This case report describes a fatal left ventricular free wall rupture occurring shortly after successful percutaneous coronary intervention (PCI), emphasizing the medicolegal differential diagnosis and the importance of comprehensive postmortem evaluation. Results: A 58-year-old man with non-ST-elevation myocardial infarction underwent successful PCI with three drug-eluting stents and was discharged home. Six hours later, he developed severe back pain and was found unresponsive in a bathtub. Autopsy demonstrated a 2.6 cm transmural rupture of the anterolateral left ventricular free wall with 150 mL of hemopericardium. Postmortem computed tomography (PMCT), performed as part of routine forensic evaluation, had identified hemopericardium prior to autopsy. Histology showed coagulative necrosis with neutrophilic infiltration. The rupture site was remote from stented vessels with no procedural injury. Toxicology revealed therapeutic medication levels. Pulmonary and scene findings did not support drowning as a cause of death. Conclusions: Ventricular free wall rupture remains a relevant cause of sudden death following myocardial infarction despite successful revascularization. Comprehensive forensic evaluation integrating scene investigation, macroscopic autopsy findings, histopathology, and toxicology is essential to distinguish natural disease progression from accidental or iatrogenic causes in deaths occurring in water environments. This case highlights that ventricular free wall rupture can occur shortly after apparently successful PCI and underscores the importance of comprehensive forensic evaluation in water-associated deaths.