2020 Korean Guidelines for Cardiopulmonary Resuscitation. Part 1. Update process and highlights

Abstract

BACKGROUNDOut-of-hospital cardiac arrest (OHCA) is one of the growing medical issues in developing and developed countries. The incidence of OHCA ranges from 24 to 186 per 100,000 population, and varies according to ethnic group, country, and region. 1 The annual incidence of OHCA in Korea increased from 21,905 (44.3 per 100,000 population) in 2008 to 30,539 (59.5 per 100,000 population) in 2018. 2 Considering the demographic structure of Korea, which is entering an aging society, the incidence of cardiac arrest is likely to increase. The survival rate of victims of cardiac arrest is affected by various factors such as the demographic and social characteristics of each country or community, the effectiveness of the emergency medical system (EMS), the rate of bystander cardiopulmonary resuscitation (CPR), and the public access defibrillation program. Although 60 years have passed since the introduction of modern CPR, the survival rate of victims of cardiac arrest remains low. The survival-to-discharge rate of OHCA in Korea increased from 3.0% in 2008 to 8.6% in 2018, and the rate of favorable neurological outcomes increased from 0.9% in 2008 to 5.1% in 2018. 2 The survival rate of OHCA in the United States, Europe, and Japan, where research on cardiac arrest started early, CPR education was provided to citizens and public access defibrillation programs were implemented, is over 10%. [3][4][5] Cardiac arrest occurs in locations outside the hospital such as home, street, public places, or sports facilities. Due to the nature of OHCA, witnesses who are not medical personnel play an important role in the process of rescuing a victim of cardiac arrest. The survival of victims of OHCA is affected by the effectiveness of out-of-hospital rescue activities, including the recognition of cardiac arrest by witnesses, bystander CPR, response time of the EMS, and on-site use of

Analysis of Anxiety or Depression and Long-term Mortality Among Survivors of Out-of-Hospital Cardiac Arrest

“…However, the Society of Critical Care Medicine’s International Consensus Conference recently recommended that serial assessments for postintensive care syndrome–related problems continue for 2 to 4 weeks after hospital discharge and should be prioritized among high-risk patients using identified screening tools to prompt referrals for services or more detailed assessments . Recent studies on the rehabilitation requirement for patients who survive cardiac arrest have been performed, and guidelines for the rehabilitation of patients with critical illness have been published . Peskine et al advised that a specific rehabilitation program for patients following OHCA or patients at risk of impaired functioning is warranted.…”

“… 32 Recent studies on the rehabilitation requirement for patients who survive cardiac arrest have been performed, and guidelines for the rehabilitation of patients with critical illness have been published. 14 , 16 , 31 Peskine et al 31 advised that a specific rehabilitation program for patients following OHCA or patients at risk of impaired functioning is warranted. Based on data from these studies, the recent International Liaison Committee on Resuscitation guidelines emphasize the importance of psychological as well as physical rehabilitation in individuals who survive cardiac arrest.…”

“…5 Consequently, studies have reported the prevalence of depression and anxiety among patients after OHCA and changes in health-related quality of life due to psychiatric disorders. [11][12][13][14][15] A systematic review and meta-analysis recently reported that the prevalence of psychiatric disorders in survivors of OHCA was higher than that in the general population, stressing the importance of improving physical and mental outcomes in individuals who experience OHCA. 16 However, to our knowledge, long-term mortality among surviving individuals with psychiatric disorders after OHCA has not yet been reported.…”

“…In 2020, a sixth link in the chain of survival highlighting recovery was added to the American Heart Association guideline to emphasize the importance of recovery and survivorship in resuscitation outcomes . Consequently, studies have reported the prevalence of depression and anxiety among patients after OHCA and changes in health-related quality of life due to psychiatric disorders . A systematic review and meta-analysis recently reported that the prevalence of psychiatric disorders in survivors of OHCA was higher than that in the general population, stressing the importance of improving physical and mental outcomes in individuals who experience OHCA …”

The future of resuscitation

“…1,2 Although CPR guidelines have been updated based on scientific evidence and implemented in clinical practice, no major breakthroughs have been made to improve the survival rate or neurological recovery of cardiac arrest patients. [2][3][4] Recently, challenges and trials have been attempted in the field of resuscitation with technological advances and system development. This commentary seeks to introduce the future of resuscitation in terms of cardiac arrest treatment and resuscitation science.…”