Future cardiopulmonary resuscitation: should we adopt dedicated systems of care?

Abstract

Cardiac arrest is one of the important major health issues [5]. In Europe, more than 300,000 patients have a cardiac arrest during a single year. During the last 30 years, treatment recommendations have been devised to deliver the best way of emergency care. New scientific understanding is continually reflected in updated treatment recommendations from the International Liaison Committee on Resuscitation (ILCOR). Nevertheless, only a small group of victims survived the event and are still alive more than 1 year after the arrest. To improve long-term survival, every link of the chain of survival must be analyzed and – if necessary – optimized [14]. Starting with bystander cardiopulmonary resuscitation (CPR), we found a huge variety in the incidence of resuscitation efforts before professional Emergency Medical Services (EMS) arrived on scene [8]. All over Europe this figure differs between 10 and 70%, and has a different impact on the first step of success, called ‘return of spontaneous circulation’ (ROSC). Following the BLS sequence, EMS advanced life support started with chest compression, airway management, drug administration, treatment of reversible causes for the arrest and – if necessary – defibrillation. Success of BLS and EMS treatment, also measured in ROSC or admission to hospital, can be achieved in more than 40% all over Europe. But ROSC is only the first step of survival. Different studies during the last years evaluated the role of postROSC treatment. A post-resuscitation care bundle was defined. A recommendation for temperature management, coronary angiography and optimized intensive care treatment was devised in the 2005 and 2010 ILCOR guidelines [6]. Several studies and register analyses demonstrated the impact of good post-resuscitation care [7]. Several studies have demonstrated that outcome after OHCA can be improved with the implementation of mild therapeutic hypothermia (MTH) and target temperature management (TTM) [1,3,15,20], as well as percutaneous coronary intervention (PCI) [2,17,18] and the combination of both [9,11,18]. Nevertheless, single treatment or combinations of treatments are only one part of successful post-resuscitation care.