Out-of-hospital cardiac arrest: recent advances in resuscitation and effects on outcome

Abstract

Successful treatment of out-of-hospital cardiac arrest remains an unmet health need. Key elements of treatment comprise early recognition of cardiac arrest, prompt and effective cardiopulmonary resuscitation (CPR), effective defibrillation strategies and organised post-resuscitation care. The initiation of bystander CPR followed by a prompt emergency response that delivers high quality CPR is critical to outcomes. The integration of additional tasks such as defibrillation, airway management, vascular access and drug administration should avoid interruptions in chest compressions. Evidence for the routine use of CPR prompt/feedback devices, mechanical chest compression devices and pharmacological therapy is limited.

Epinephrine in out-of-hospital cardiac arrest:A critical review

“…CPR has long been established as a vitally effective intervention with an OR for survival of between 1.23–5.01 in a recent meta-analysis. [36] Interruptions in chest compressions cause a fall in diastolic pressure, which reduces coronary perfusion pressure resulting in a decrease in survival to hospital discharge of between 14%–18% for every 5-second increase in both pre- and peri-shock pause durations. [36] Interruptions in chest compressions to establish parental access may diminish chances of survival.…”

“…[36] Interruptions in chest compressions cause a fall in diastolic pressure, which reduces coronary perfusion pressure resulting in a decrease in survival to hospital discharge of between 14%–18% for every 5-second increase in both pre- and peri-shock pause durations. [36] Interruptions in chest compressions to establish parental access may diminish chances of survival. A randomized control trial where patients either received advanced cardiac life support with intravenous drugs or ACLS without intravenous drugs demonstrated no difference in survival to hospital discharge.…”

Almanac 2013: acute coronary syndromes

“…Sudden Cardiac Arrest SCA is a less common but often fatal presentation of ACS (53). While there are other reasons for SCA, especially in younger patients, the most common cause for tachyarrhythmic cardiac arrests in patients over 40 is myocardial ischaemia (4,37).…”

Bystander CPR: New aspects of CPR training among students and the importance of bystander education level on survival

“…The use of standard CPR (compressions and ventilations) versus compressions only is widely debated. 84 Some studies have reported that compressions-only CPR has comparable results or leads to improved survival after OHCA in adults compared with standard CPR, [108][109][110][111] whereas others studies show increased survival and a more favourable neurologic outcomes with standard CPR after OHCA (mainly patients with CA of noncardiac cause, when there was a delay in the start of CPR or in younger people). 205 A contributing reason for the different study results may be differences in age and cause of CA.…”

“…76,83 Fear of doing harm, lack of BLS skills and fear of doing it incorrectly are common reasons for not wanting to perform CPR. 76,[83][84][85][86] Data indicate that elementary schoolchildren are less fearful about CPR training than teenagers. 13 In CPR training, it is important to emphasize that laypeople cannot do anything wrongthe only wrong thing would be to do nothing.…”