Abstract and Introduction
Abstract
Successful treatment of out-of-hospital cardiac arrest remains an unmet health need. Key elements of treatment comprise early recognition of cardiac arrest, prompt and effective cardiopulmonary resuscitation (CPR), effective defibrillation strategies and organised post-resuscitation care. The initiation of bystander CPR followed by a prompt emergency response that delivers high quality CPR is critical to outcomes. The integration of additional tasks such as defibrillation, airway management, vascular access and drug administration should avoid interruptions in chest compressions. Evidence for the routine use of CPR prompt/feedback devices, mechanical chest compression devices and pharmacological therapy is limited.
Introduction
Epidemiological data estimate the global incidence of adult out-of-hospital cardiac arrest (OHCA) at 95.9 cases per 100 000 person-years. Resuscitation by emergency medical services (EMS) is attempted in approximately half to two-thirds of these cases. The cause is presumed cardiac in approximately 85% of EMS-treated OHCA. The incidence and outcomes vary between countries. In Europe survival to hospital discharge is approximately 9% although there is marked regional variation (1–31%). Despite the demographic characteristics of patients changing (ageing population, lower proportion of patients with an initial shockable rhythm) there is some evidence that outcomes are improving through strengthening the links in the chain of survival (cardiac arrest recognition, early cardiopulmonary resuscitation (CPR), early defibrillation, effective post-resuscitation care).