Impact of Changes in Resuscitation Practice on Survival and Neurological Outcome After Out-of-Hospital Cardiac Arrest Resulting From Nonshockable Arrhythmias

Abstract

Background-Out-of-hospital cardiac arrest (OHCA) claims millions of lives worldwide each year. OHCA survival from shockable arrhythmias (ventricular fibrillation/tachycardia) improved in several communities after implementation of American Heart Association resuscitation guidelines that eliminated "stacked" shocks and emphasized chest compressions. "Nonshockable" rhythms are now the predominant presentation of OHCA; the benefit of such treatments on nonshockable rhythms is uncertain. Methods and Results-We studied 3960 patients with nontraumatic OHCA from nonshockable initial rhythms treated by prehospital providers in King County, Washington, over a 10-year period. Outcomes during a 5-year intervention period after adoption of new resuscitation guidelines were compared with the previous 5-year historical control period. The primary outcome was 1-year survival. Patient demographics and resuscitation characteristics were similar between the control (nϭ1774) and intervention (nϭ2186) groups, among whom 471 of 1774 patients (27%) versus 742 of 2186 patients (34%), respectively, achieved return of spontaneous circulation; 82 (4.6%) versus 149 (6.8%) were discharged from hospital, 60 (3.4%) versus 112 (5.1%) with favorable neurological outcome; 73 (4.1%) versus 135 (6.2%) survived 1 month; and 48 (2.7%) versus 106 patients (4.9%) survived 1 year (all PՅ0.005). After adjustment for potential confounders, the intervention period was associated with an improved odds of 1.50 (95% confidence interval, 1.29 -1.74) for return of spontaneous circulation, 1.53 (95% confidence interval, 1.14 -2.05) for hospital survival, 1.56 (95% confidence interval, 1.11-2.18) for favorable neurological status, 1.54 (95% confidence interval, 1.14 -2.10) for 1-month survival, and 1.85 (95% confidence interval, 1.29 -2.66) for 1-year survival. Conclusion-Outcomes from OHCA resulting from nonshockable rhythms, although poor by comparison with shockable rhythm presentations, improved significantly after implementation of resuscitation guideline changes, suggesting their potential to benefit all presentations of OHCA. (Circulation. 2012;125:1787-1794.)

Ausbildung und Implementierung der Reanimation

“…Es ist allgemein anerkannt, dass Ersthelfer-CPR für das Überleben von Kreislaufstillständen außerhalb des Krankenhauses entscheidend ist. Thoraxkompressionen und frühe Defibrillation sind die Hauptdeterminanten des Überlebens beim außerklinischen Kreislaufstillstand, und es gibt Hinweise, dass sich mit Einführung von Laientrainings das 30-Tageund 1-Jahres-Überleben verbessert hat [8,9]. Aus diesen Gründen ist das primä-re Ziel der Reanimationsausbildung das Training von Laien in CPR.…”

Kurzdarstellung

“…Es ist allgemein anerkannt, dass Ersthelfer-CPR für das Überleben von Kreislaufstillständen außerhalb des Krankenhauses entscheidend ist. Thoraxkompressionen und frühe Defibrillation sind die Hauptdeterminanten des Überlebens beim außerklinischen Kreislaufstillstand, und es gibt Hinweise, dass sich mit Einführung von Laientrainings das 30-Tageund 1-Jahres-Überleben verbessert hat [906,907].…”

Out of Hospital Pediatric Cardiac Arrest: Prospective Study from Riyadh, Saudi Arabia

“…None of the patients in this study had a spontaneous return of circulation thus supporting literature reporting poor survival rates in out of hospital pediatric cardiac arrests. [1][2][3] This study reported the rate of CPR bring provided to pediatric patients in cardiac arrest with a known history of chronic illness compared to those without. The comparison discovered patients with a history of chronic illness, such as cerebral palsy with complications, congenital heart disease and arrhythmias, were less likely to receive CPR than healthy children.…”

“…Though uncommon, pediatric out of hospital cardiac arrests have a poor rate of survival and negative neurological outcomes for those that do survive. 2,3 Common causes of out of hospital cardiac arrest in pediatric patients were reported as sudden infant death syndrome, trauma and respiratory arrest. 2,4 Cardiac causes have been reported as the more common cause for out of hospital pediatric cardiac arrests, though it is uncommon to have an identifiable cause of cardiac arrest during the initial phase of resuscitation.…”

“…2,3 Common causes of out of hospital cardiac arrest in pediatric patients were reported as sudden infant death syndrome, trauma and respiratory arrest. 2,4 Cardiac causes have been reported as the more common cause for out of hospital pediatric cardiac arrests, though it is uncommon to have an identifiable cause of cardiac arrest during the initial phase of resuscitation. 1,[5][6] The incidence of non-traumatic out of hospital pediatric cardiac arrests have been reported to be 8-9 cases per 100,000 compared to 9-19 traumatic pediatric arrests per 100,000.…”