Abstract
Despite well developed emergency medical services with rapid response advanced life support capabilities, survival rates following out-of-hospital ventricular fibrillation (VF) have remained bleak in many venues. Generally, these poor resuscitation rates are attributed to delays in the performance of basic cardiopulmonary resuscitation by bystanders or delays in defibrillation, but recent laboratory data suggest that the current standard of immediately providing a countershock as the first therapeutic intervention may be detrimental when VF is prolonged beyond several minutes. Several studies now suggest that when myocardial energy supplies begin to dwindle following more prolonged periods of VF, improvements in coronary artery perfusion must first be achieved in order to prime the heart for successful return of spontaneous circulation after defibrillation. Therefore, before countershocks, certain pharmacologic and/or mechanical interventions might take precedence during resuscitative efforts. This evolving concept has been substantiated recently by clinical studies, including a controlled clinical trial, demonstrating a significant improvement in survival when basic cardiopulmonary resuscitation is provided for several minutes before the initial countershock. Although this evolving concept differs from current standards and may pose a potential problem for automated defibrillator initiatives (e.g. public access defibrillation), successful defibrillation and return of spontaneous circulation have been rendered more predictable by evolving technologies that can score the VF waveform signal and differentiate between those who can be shocked immediately and those who should receive other interventions first.
Highlights
Sudden out-of-hospital cardiac arrest (SOHCA) remains one of the major causes of death for men and women alike in Western societies, accounting for more than 250,000 lives lost annually in the USA alone [1,2]
Most cases of SOHCA are caused by a highly reversible yet time dependent process, namely ventricular fibrillation (VF), which in turn creates a tremendous opportunity for public health intervention [1,2,3,4]
Cardiac life support (ACLS) capabilities, survival rates follow- tail’ regimen, including high-dose adrenaline, ing SOHCA have remained very low in most venues, even for antiarrhythmics, and antioxidants, Menegazzi and colleagues out-of-hospital VF [1,2,3,4]
Summary
Sudden out-of-hospital cardiac arrest (SOHCA) remains one of the major causes of death for men and women alike in Western societies, accounting for more than 250,000 lives lost annually in the USA alone [1,2]. Comparison of survival rates (successful hospital discharge) in Seattle, USA, during the years when emergency responders made defibrillation attempts their first priority (1990–1993) versus subsequent years there is a finite amount of time before EMS is called after the collapse, and that there is another minute or two required to reach the patient’s side and deliver the shock after onscene arrival of EMS This ‘4 min response interval’ may translate into a 7 or 8 min period of VF, and one should (1994–1996), when they provided 90 seconds of basic cardiopulmonary resuscitation before defibrillatory attempts for out-ofhospital cases of ventricular fibrillation. Niques such as the active compression–decompression pump, ‘vest’ CPR, the inspiratory threshold device and mini-
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