Abstract
Out-of-hospital cardiac arrest (OHCA) is a significant public health problem in most westernized industrialized nations. In spite of national and international guidelines for cardiopulmonary resuscitation and emergency cardiac care, the overall survival of patients with OHCA was essentially unchanged for 30 years--from 1978 to 2008 at 7.6%. Perhaps a better indicator of Emergency Medical System (EMS) effectiveness in treating patients with OHCA is to focus on the subgroup that has a reasonable chance of survival, e.g., patients found to be in ventricular fibrillation (VF). But even in this subgroup, the average survival rate was 17.7% in the United States, unchanged between 1980 and 2003, and 21% in Europe, unchanged between 1980 and 2004. Prior to 2003, the survival of patients with OHCA, in VF in Tucson, Arizona was less than 9% in spite of incorporating previous guideline recommendations. An alternative (non-guidelines) approach to the therapy of patients with OHCA and a shockable rhythm, called Cardiocerebral Resuscitation, based on our extensive physiologic laboratory studies, was introduced in Tucson in 2003, in rural Wisconsin in 2004, and in selected EMS areas in the metropolitan Phoenix area in 2005. Survival of patients with OHCA due to VF treated with Cardiocerebral Resuscitation in rural Wisconsin increased to 38% and in 60 EMS systems in Arizona to 39%. In 2004, we began a statewide program to advocate chest compression-only CPR for bystanders of witnessed primary OHCA. Over the next five years, we found that survival of patients with a shockable rhythm was 17.7% in those treated with standard bystander CPR (mouth-to-mouth ventilations plus chest compression) compared to 33.7% for those who received bystander chest-compression-only CPR. This article on Cardiocerebral Resuscitation, by invitation following a presentation at the 2011 Danish Society Emergency Medical Conference, summarizes the results of therapy of patients with primary OHCA treated with Cardiocerebral Resuscitation, with requested emphasis on the EMS protocol.
Highlights
Out-of-hospital cardiac arrest (OHCA) is a significant public health problem in most westernized industrialized nations [1]
In spite of national and international guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiac care, the overall survival of patients with OHCA was essentially unchanged for 30 years—from 1978 to 2008 at 7.6% [2]
Following the 2005 guidelines, the Resuscitation Outcomes Consortium, arguably representing some of the better emergency medical system (EMS) in the United States and Canada, reported that the median survival rates for patients with OHCA due to ventricular fibrillation (VF) arrest managed with the 2005 guidelines had a survival rate of 22% [6]
Summary
Out-of-hospital cardiac arrest (OHCA) is a significant public health problem in most westernized industrialized nations [1]. The EMS component of cardiocerebral resuscitation The EMS or emergency medical service component of Cardiocerebral Resuscitation advocates a revised sequence of interventions for patients with primary cardiac arrest, not witnessed by EMS providers This component advocates the prompt initiation of 200 continuous chest compressions prior to and immediately after a single indicated direct current shock, altered airway management to Figure 3 Survival to hospital discharge in Arizona of patients with out-of-hospital cardiac arrest between the beginning of 2005 and the end of 2009 who received bystander guidelines recommended standard cardiopulmonary (Std-CPR) or compression only cardiopulmonary (CO-CPR) [23]. Airway management Airway management initially consists of passive ventilation by the insertion of an oral pharyngeal or supraglottic airway, and the provision of high flow oxygen via a non-rebreather mask (Figure 4) [13] This approach eliminates the two most common deleterious effects of endotracheal intubation (ETI) during cardiac arrest; prolonged interruptions of chest compressions and hyperventilation [35]. These facts and the improved survival in Arizona where CO-CPR was and is advocated, supports the contention that one of the more important interventions is the early initiation of bystander CPR
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