Considerations for improving survival from out-of-hospital cardiac arrest

doi:10.1016/S0196-0644(86)80862-9

Annals of Emergency Medicine

Volume 15, Issue 10, October 1986, Pages 1181-1186

https://doi.org/10.1016/S0196-0644(86)80862-9 Get rights and content

Since the implementation of a paramedic system in Seattle, yearly survival rates from out-of hospital cardiac arrest due to ventricular fibrillation have averaged 25% without any significant increase over the years. Outcome for cardiac arrest associated with other rhythms has been poor: when asystole was the first rhythm recorded, only 1% of patients survived; when electromechanical dissociation was initially present, only 6% survived. For cases of electromechanical dissociation, neither the type of rhythm nor the rate appear to influence outcome. Survival from ventricular fibrillation can be improved by shortening the delay to initiation of CPR and to defibrillation. When outcome in 244 witnessed arrests was related to the times to beginning CPR and to initial defibrillation, mortality increased 3% each minute until CPR was begun and 4% a minute until the first shock was delivered. New strategies that minimize delays appear to have the greatest promise for improving survival after cardiac arrest.

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Cited by (218)

The difference in myocardial injuries and mitochondrial damages between asphyxial and ventricular fibrillation cardiac arrests
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Ventricular fibrillation (VF) and asphyxia account for most cardiac arrests but differ in cardiac arrest course, neurologic deficit, and myocardial damage. In VF resuscitation, cardiac mitochondria were known to be damaged via excess generation of reactive oxygen species. This study evaluated the difference of cardiac mitochondrial damages between VF and asphyxial cardiac arrests.
In the VF + electrical shock (ES) group, VF was induced and untreated for 5 minutes, followed by 1 minute of cardiopulmonary resuscitation (CPR) and 1 ES of 5 J. Animals were killed immediately after ES. In the asphyxia group, cardiac arrest was induced by airway obstruction, and then pulselessness was maintained for 5 minutes, followed by 1 minute of CPR. The animals were killed immediately after CPR. The histology and ultrastructural changes of myocardium and complex activities and respiration of mitochondria were evaluated. The mitochondrial permeability transition pore opening was measured based on mitochondrial swelling rate.
The histopathologic examinations showed myocardial necrosis and mitochondrial damage in both cardiac arrests. Instead of regional damages of myocardium in the VF + ES group, the myocardial injury in the asphyxia group distributed diffusely. The asphyxia group demonstrated more severe mitochondrial damage than the VF + ES group, which had a faster mitochondrial swelling rate, more decreased cytochrome c oxidase activity, and more impaired respiration.
Both VF and asphyxial cardiac arrests caused myocardial injuries and mitochondrial damages. Asphyxial cardiac arrest presented more diffuse myocardial injuries and more severe mitochondrial damages than VF cardiac arrest.
Treatment of Ventricular Tachycardia and Cardiac Arrest
2012, Cardiovascular Therapeutics: A Companion to Braunwald's Heart Disease: Fourth Edition
Optimizing the timing of defibrillation: The role of ventricular fibrillation waveform analysis during cardiopulmonary resuscitation
2012, Critical Care Clinics
AED in Europe. Report on a survey
2010, Resuscitation
Based on the strategies for community defibrillation defined by a joint policy conference of ESC and ERC, we have conducted a survey to identify the current status of AED programmes in Europe.
All registered visitors to the website of the ERC were contacted by e-mail and invited to participate in a web-based survey.
Of the 983 usable responses, 899 came from 36 European countries, representing a total of 748 million inhabitants. In 11 countries AED use by non-physicians has been implemented partially. All but 3 countries reported that first-tier ambulances are equipped with defibrillators. In 13 countries everybody is allowed to use an AED and in 11 countries anybody who has been trained. In 14 countries there are a few community responder programmes, in 14 countries there are hardly any, and in 7 countries there are none. Thirteen countries have implemented a few on-site responder programmes; in 16 countries there are hardly any such programmes, and in 7 countries none. Programmes for home responders can hardly be found in 19 countries; in-hospital programmes exist in 7 countries nearly everywhere. Only 1 country reported that epidemiologic and/or economic evaluations are carried out nearly everywhere when planning AED programmes. Nationwide registries to collect data from resuscitation attempts have been set up in 4 countries. In 27 countries inventories for AEDs can be found here and there.
Much has been achieved concerning the provision and use of AEDs in Europe, but there is still a long way to go.
Automated external defibrillators: An up-to-date
2010, Praticien en Anesthesie Reanimation
L’arrêt cardiaque (AC) ou mort subite de l’adulte représente près de 60 000 décès en France. Sa prise en charge constitue donc un véritable problème de santé publique. La cause la plus fréquente de mort subite est une fibrillation ventriculaire (FV). La survie des victimes est directement corrélée au délai de délivrance d’un choc électrique externe. La réalisation d’une défibrillation précoce par les premiers intervenants de la « chaîne de survie » et un matériel adapté à cet usage sont nécessaires pour améliorer les chances de survie des victimes. Grâce à l’évolution de la loi française, les défibrillateurs automatisés externes (DAE) ont pu passer d’un usage uniquement médical à un usage aux professionnels de santé non médecins et jusqu’à tout récemment à un usage grand public. En généralisant cet usage au public, on estime que 3000 à 4000 vies pourraient être sauvées chaque année en France. Il est cependant nécessaire d’organiser un programme conjoint d’information et de formation auprès du public et des instances locales pour atteindre cet objectif.
Cardiac arrest or sudden death in adults represents nearly 60,000 deaths each year in France. Its management is actually a health care issue. Ventricular fibrillation is the cardiac arrhythmia most frequently documented after sudden death. Patient's outcome is directly correlated to the delay of administration of an external electric shock. Early defibrillation by the first responders of the “survival chain” and an adapted equipment are necessary to improve the victims’ survival. Due to the evolution of the French law, automated external defibrillators (AEDs) that were used only by physicians, and then by health care professionals, have recently been made available for public use. By extending the use of AEDs to public access, one can estimate that 3000 to 4000 lives could be saved every year in France. However, in order to achieve this objective, it is necessary to inform and organize a training program for the population.
Responding to Sudden Death in the Community: Cardiopulmonary Resuscitation With Prompt Defibrillation
2010, Revista Espanola de Cardiologia Suplementos
La respuesta a la parada cardiaca extrahospitalaria debe ser una prioridad para todos los sistemas sanitarios por su elevada incidencia y sus dramáticas consecuencias. Es la tercera causa de mortalidad en las sociedades avanzadas.
La estrategia asistencial descansa en los cuatro eslabones de la «cadena de supervivencia»: la alerta inmediata, el soporte vital básico realizado por los testigos, la desfibrilación temprana y, por último, el soporte vital avanzado precoz, seguido de los cuidados intensivos tras la resucitación. La efectividad de esta cadena está condicionada por su eslabón más débil; los elementos clave para la supervivencia son las compresiones torácicas precoces, realizadas con mínimas interrupciones, y la desfibrilación temprana.
La introducción del desfibrilador externo semiautomático ha hecho posible que se plantee como objetivo realista lograr un tiempo de desfibrilación < 5 min. Su utilización por los servicios de emergencias sanitarios y cuerpos de seguridad es efectiva y eficiente, como también lo es su introducción en espacios públicos adecuadamente seleccionados, aunque en este caso su eficiencia puede variar significativamente según las características y el nivel de riesgo del espacio donde se ubiquen.
Responding to an out-of-hospital cardiac arrest should be a priority for all health-care systems because of the high incidence and dramatic consequences of such events. Cardiac arrest is the third leading cause of mortality in developed countries.
The strategy for providing emergency assistance is based on the four links of the «chain of survival»: rapid notification of the emergency services, the provision of basic life support by bystanders, prompt defibrillation and, finally, prompt provision of advanced life support, followed by post-resuscitation intensive care. The effectiveness of this chain of events depends on its weakest link and the key elements for survival are prompt chest compression, carried out with minimal interruption, and prompt defibrillation.
The development of semiautomated external defibrillators has made it possible to regard carrying out defibrillation within 5 minutes as a realistic objective. Their use by emergency health services and by first-aid facilities is effective and efficient, as is their introduction into properly selected public areas. However, in public areas, their efficiency could be significantly affected by the nature of the area in which they are located and by the level of risk at that location.

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: Presented at the University Association for Emergency Medicine Annual Meeting in Kansas City, Missouri, May 1985.

: Supported in part by a Grant-in-Aid from the American Heart Association with contributions in part by the American Heart Association of Washington and the Medic I — Emergency Medical Services Foundation.

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Original contributionConsiderations for improving survival from out-of-hospital cardiac arrest

Ann Emerg Med

JACEP

JACEP

Ann Emerg Med

Am J Cardiol

Basic training program. Instructor's lesson plans

Ventricular defibrillation: A comparative trial using 175-J and 320-J shocks

N Engl J Med

Use of calcium in prehospital cardiac arrest

Ann Emerg Med

Clinical, electrophysiologic and hemodynamic profile of patients resuscitated from prehospital cardiac arrest

Am J Med

The survival benefit of bystander cardiopulmonary resuscitation in a paramedic served metropolitan area

Am J Public Health

Mobile coronary care in the management of prehospital cardiac arrest. St Paul, Minnesota, experience

Minn Med

The Brighton resuscitation ambulances: A continuing experiment in prehospital care by ambulance staff

Br Med J

Bystander-initiated cardiopulmonary resuscitation in the management of ventricular fibrillation

Ann Intern Med

Who shall live? Who shall die?

The use of calcium chloride in cardiac resuscitation

Circulation

Original contribution
Considerations for improving survival from out-of-hospital cardiac arrest