2009 Dickinson W. Richards Memorial Lecture—Improving Survival From Out-of-Hospital Cardiac Arrest
A renewed understanding of resuscitation physiology has led to several bold new approaches to basic life support (BLS) and advanced cardiovascular life support (ACLS), as well as a recognition that aggressive postresuscitation care can have a major impact on long-term outcome. Concepts initially tested in basic and translational resuscitation research laboratories have within the past several years been piloted in a number of rural and urban communities. Several of these newer approaches to BLS, ACLS, and postresuscitation care have dramatically increased historical survival rates around the world. These include the following:
Hands-only BLS CPR. The survival rate for witnessed ventricular fibrillation in Tokyo increased from 11% to 19% when lay bystander rescuers performed chest compression– only or “hands-only” BLS as compared with chest compressions and mouth-to-mouth breathing. The American Heart Association endorsed “hands-only” BLS for encouraging more bystander CPR in March 2008.
New ACLS algorithm emphasizing uninterrupted chest compressions. The initial report of the use of this newly revised ACLS approach came from rural Wisconsin. The rate of 1-year survival from witnessed ventricular fibrillation cardiac arrest tripled, from 15% to 48%. A follow-up report 3 years later showed a persistent benefit, with a 3-year survival rate of 40%. In Phoenix, Arizona, introduction of this revised ALCS algorithm increased the rate of survival to hospital discharge with ventricular fibrillation cardiac arrest from 12% to 28%.
Postresuscitation care. Postresucitation care is the next great opportunity to improve long-term outcome among victims of out-of-hospital cardiac arrest. In Norway, the rate of 1-year survival among those resuscitated from out-of-hospital cardiac arrest increased from 26% to 56% after formalization of the postresuscitation care, with emphasis on providing mild therapeutic hypothermia and early catheterization and percutaneous coronary intervention where indicated. Case series reported in the literature suggest this approach can produce long-term survival rates of 70% among those initially resuscitated, with 80% of such long-term survivors being neurologically intact.
The near future holds more real promise for improving the outcome of those suffering cardiac arrest than ever before. Now is the time to move forward and provide improved care to all victims of sudden cardiac death.