Abstract

Out-of-hospital cardiac arrest (OOHCA) is a common public health problem, with large and important regional variations in outcomes. Survival rates vary widely among patients treated with OOHCA by emergency medical services (EMS), or among patients transported to the hospital after return of spontaneous circulation. Most regions lack a well-coordinated approach to post-cardiac arrest care. Effective hospital-based interventions for OOHCA exist but are used infrequently. Increased volume of patients or procedures of individual providers and hospitals is associated with better outcomes for several other clinical disorders. Regional systems of cardiac resuscitation include a process for identification of patients with OOHCA, standard field and hospital care protocols for patients with OOHCA, monitoring of care processes and outcome, and periodic review and feedback of these quality improvement data to identify problems and implement solutions. Similar systems have improved provider experience and patient outcomes for those with ST-elevation myocardial infarction and life-threatening traumatic injury. Many more people could survive OOHCA if regional systems of cardiac resuscitation were implemented and maintained. The time has come to do so wherever feasible.

Key words: out-of-hospital cardiac arrest, emergency medical services, hospital-based interventions, regional systems of cardiopulmonary resuscitation (CPR), monitoring, outcome, transport time, improve of quality, survival

Abstract

The formalizing post resuscitation care to include therapeutic hypothermia and cardiac angiography with percutaneous coronary intervention when needed could significantly improve survival following cardiac arrest. Any sudden death patient suspected to have a cardiac origin for their cardiac arrest should be considered for early catheterization and subsequent percutaneous coronary intervention (PCI) if a culprit lesion can be identified. Successful PCI improves survival to hospital discharge and cerebral performance category in patients with or without ST elevation. Current ‘report carding' methodology needs to be changed regarding those resuscitated from cardiac arrest (patients with cardiac arrest not including them in any statistical reporting on PCI mortality report cards).

Key words: percutaneous coronary intervention, hypothermia, cardiac arrest, survival to hospital discharge, cerebral performance category, PCI report carding

Abstract

The clinical practice of resuscitation science is dependent on discoveries generated in the basic science and animal laboratory and then translated into clinical trials for application in humans. The successful implementation of prospective, randomized, controlled, clinical trials in the field of cardiac arrest remains challenging and continues to evolve. Funding for clinical trials of cardiac arrest is limited, and there are significant obstacles to performing such studies because of the inability to obtain informed consent under these emergency circumstances. The absence of reliable national statistics on cardiac arrest, evaluation of neurological outcome, and potential confounders such as post-resuscitation hospital-based care and quality of cardiopulmonary resuscitation (CPR) continue to challenge cardiac arrest clinical trials. Nonetheless, the immense public health burden of cardiac arrest is being recognized, appropriate public health initiatives to address the problem are being implemented, and the resuscitation research community is meeting this challenge.

Keywords: resuscitation, clinical trials, funding, informed consent, neurological and functional assessments, standards

Abstract

Ventricular fibrillation (VF) is the primary rhythm associated with cardiac arrest characterized as rapid, disorganized contractions of the heart with complex electrocardiogram (ECG) patterns. Recent studies have reported that performing cardiopulmonary resuscitation (CPR) procedure prior to shock increases the survival rate especially especially when VF is untreated for more than 5 minutes. The waveform analysis is objective help in the choice of the right therapy (shock parameters, shock first or CPR first, drug administration). This analysis is a precondition of individually optimized defibrillation and contribute substantially to an increased quality of CPR and reduce delivery of failed rescue shock. Animal and clinical studies confirmed that ventricular fibrillation waveform analysis contains information to reliably predict the countershock success rate and further improved countershock outcome prediction.

Keywords: cardiac arrest, ventricular fibrillation, waveform analysis, prediction defibrillation success, effectiveness of chest compression, uninterrupted cardiopulmonary resuscitation

Abstract

The refibrillation was a frequent event in out-of-hospital cardiac arrest (OHCA). The number of recurrences of ventricular fibrillation (VF) is in inverse relationship with survival. In this article we discuss about causes and mechanism of refibrillation. The amiodarone and new technical solution (defibrillators that may allow continuous monitoring of the heart rhythm, while chest compressions continue and recommend defibrillation when refibrillation occurs) are promising new strategy to improve outcome of OHCA and recurrent VF.

Keywords: out-of-hospital cardiac arrest, ventricular fibrillation, defibrillation, refibrillation, amiodarone, continuous monitoring of the heart rhythm