Improving Cardiac Arrest Outcomes: Fine-tuning or Paradigm Shift?

Abstract

In the 1970-80ies we studied barbiturates, moderately severe hypothermia, free radical scavengers and calcium blockers without impacting outcome after cerebral ischemia. In fact cardiac arrest outcome in general did not improve much until 2005. We underestimated the impact of CPR quality. Long pauses in inadequate depth chest compressions, particularly before, during and after series of defibrillation attempts were documented and found detrimental. We and others have shown that quality can be improved, but as with quality work also outside the health care industry, it requires continuous focus, local champions and continuous feedback both on performance and results. This is true both pre-and in-hospital, both during CPR and in the post-arrest period. The controversy of CPR or defibrillation first is solved, at least for the moment. The place of drugs during CPR is questionable, without solid clinical evidence for improved long term outcome for any drug. Although not universally achieved, significant improvements in cardiac arrest outcome have been reported by some pre- and in-hospital services over the last 5-6 years due to fine-tuning of the treatment process including much focus on the post-arrest period with temperature control/hypothermia and coronary interventions. There are more fine-tuning challenges ahead, and better implementation of known science is required, but what about paradigm shifts? We tend to forget that globally cardiac arrest of non-cardiac origin is a much larger challenge and opportunity that cardiac arrest of cardiac origin, both as potential lives saved, and even more as life-years saved.