Out of hospital cardiac arrest: Past, present, and future

Abstract

Advances in resuscitation following out-of-hospital cardiac arrest (OHCA) provide an opportunity to improve public health. This review reflects on past developments, present status, and future possibilities using the science-education-implementation framework of the Utstein Formula and the clinical framework of the links in the chain of survival. With the discovery of CPR and defibrillation in the mid 20th century, resuscitation developed a scientific construct for progress. Systems of emergency community response provided operational efficiency to treat OHCA.Contemporary resuscitation involves integrated interventions in the chain of survival: early recognition, early CPR, early defibrillation, expert and timely advanced life support and hospital care, and multidimensional rehabilitation. Implementation of scientific advances is especially challenging given the unexpected nature of OHCA, the need for time-sensitive interventions, and the substantial collective of stakeholders involved in the chain of survival.Systematic measurement provides the foundation to evaluate performance and guide implementation initiatives. For many systems, telecommunicator CPR and high-performance CPR by emergency professionals are accessible, near-term programs to improve OHCA outcome. Smart technologies that activate, coordinate, and/or coach community "volunteers" to accelerate early CPR and defibrillation have conceptual promise, though robust implementation has been achieved by only a handful of systems. Longer-term strategies may leverage technology to develop a high-fidelity "lifedetector" or engineer and disseminate a specialized consumer defibrillator designed to bridge care until arrival of professional response.

Development and validation of an interpretable prehospital return of spontaneous circulation (P-ROSC) score for patients with out-of-hospital cardiac arrest using machine learning: A retrospective study

“…However, we need to take caution while interpreting these hypotheses, as EMS is a complex, multifactorial system where survival and favorable neurologic outcomes are even more significant measures to take into account. 33 Along with the above functions, P-ROSC could also serve as a quality management tool, similar to the RACA score, to provide objective comparisons across EMS systems. 5 …”

Clinical effects of hyperbaric oxygen therapy on paroxysmal sympathetic hyperactivity after cardiopulmonary resuscitation: a case series

“…The onset of CA is both sudden and critical. While some patients can regain spontaneous circulation after successful CPR, the survival rate only ranges from 6-10.8% [4]. Because brain tissue is poorly tolerant to ischaemia and hypoxia, the prognosis for patients is often severely poor.…”

A survey on technologies used during Out of Hospital Cardiac Arrest

“…This step can be observed by a bystander or an intelligent device such as a smartphone, smartwatch, or camera. The witnessing of the patient's collapse is essential as a delay in identifying the patient suffering an OHCA delays the workflow and rapidly decreases the patient's survival chances 23,24,25 .…”

“…These devices use ECG data, pulse data or accelerator data to detect if the patient is experiencing cardiac arrest or not. These solutions are highly effective as they can detect and report sudden cardiac arrest in situations where no bystander witnesses the event 50,51,24 .…”

“…A recent study confirms that if a patient experiences agonal breathing during CPR, then the patient's survival chances are 17% higher than a cardiac arrest patient without agonal breathing 60 . A bystander can quickly identify agonal breathing in a patient; in cases when a bystander is not present, researchers have proposed solutions that can detect agonal breathing using microphones built-in smart devices such as mobile phones and smart speakers 23,47,24 .…”