Cardiac arrest management: any news? When the literature does not meet clinical practice

Abstract

The percentage of patients transported alive to hospital after an out-of-hospital cardiac arrest has increased in recent years thanks to growing population education. In 2010 the International Liaison Committee on Resuscitation (ILCOR) has published new guidelines for the management of cardiac arrest. These guidelines present several new features, but cardiac compression remains the mainstay of optimal cardiopulmonary resuscitation. Use of atropine and endotracheal drugs are no longer recommended, and early ultrasound evaluation and intraosseous vascular access are new methods now standardized. The best chances of improving patient prognosis are in the period immediately after return of spontaneous circulation (ROSC). It is well known that most patients who experience cardiac arrest without an obvious extra-cardiac cause, show significant underlying coronary artery disease. Hence, the importance of widespread and early use of primary percutaneous coronary intervention. An early percutaneous coronary intervention was found to be crucial not only in increasing survival, but also in improving neurological outcome at discharge. The ILCOR consensus statement suggests that therapeutic hypothermia should be considered as the standard treatment for comatose patients resuscitated from cardiac arrest. This was supported by the evidence that moderate hypothermia is the only treatment for post-ROSC as it is associated with a significant increase in survival. For this reason, it should be started as early as possible, preferably in the pre-hospital setting. Despite the bulk of available literature on the early treatment of cardiac arrest, the studies carried out in Italy indicate that most post-ROSC patients are undertreated or untreated. This results in poor resource utilization with a high social and personal impact that involves both the patients and their families. Teamwork activities addressing the chain of survival become a fundamental tool for the treatment of resuscitated patients. Given the crucial importance of the time elapsing from collapse to cardiopulmonary resuscitation in terms of final prognosis, efforts should be made to promote the "culture of cardiopulmonary resuscitation" not only among health professionals, but also among the general population.