Out-of-Hospital Cardiac Arrest Resuscitation Systems of Care: A Scientific Statement From the American Heart Association

Abstract

ABSTRACT:The American Heart Association previously recommended implementation of cardiac resuscitation systems of care that consist of interconnected community, emergency medical services, and hospital efforts to measure and improve the process of care and outcome for patients with cardiac arrest. In addition, the American Heart Association proposed a national process to develop and implement evidence-based guidelines for cardiac resuscitation systems of care. Significant experience has been gained with implementing these systems, and new evidence has accumulated. This update describes recent advances in the science of cardiac resuscitation systems and evidence of their effectiveness, as well as recent progress in dissemination and implementation throughout the United States. Emphasis is placed on evidence published since the original recommendations (ie, including and since 2010). Cardiac arrest is loss of mechanical activity of the heart confirmed by the absence of signs of circulation.1 Approximately 356 461 people are treated for out-of-hospital cardiac arrest (OHCA) annually in the United States.2 One third of cases occur without any prior recognized heart disease; half occur without any prodromal symptoms.3 Despite robust systems of care for patients with trauma and rapidly evolving systems of care for patients with ST-segment-elevation myocardial infarction (STEMI) and stroke, the majority of communities do not achieve optimal survival after OHCA because of large discrepancies in resuscitation-related processes of care.4-6 As a result, survival to hospital discharge varies significantly both across different regions and by presenting rhythm. 7,8 Survival increases significantly if the OHCA is quickly recognized and responded to with prompt activation of 9-1-1, bystander-initiated cardiopulmonary resuscitation (CPR), bystander and/or basic first responder application of an automated external defibrillator (AED) before arrival of other emergency medical services (EMS) providers on scene, advanced life support, and postresuscitation care. The American Heart Association (AHA) previously recommended implementation of cardiac resuscitation systems of care that consist of interconnected community, EMS, and hospital efforts to measure and improve the process and outcome of care for patients with cardiac arrest.10 Simultaneously, the AHA proposed a national process to develop and implement evidence-based guidelines for the implementation and measurement of such systems. The 2015 AHA guidelines for CPR and emergency cardiovascular care delved deeper into the elements of an effective system of care for both OHCA and in-hospital cardiac arrest.11 This update on OHCA resuscitation systems of care describes recent advances, evidence

Delivery of Automated External Defibrillators (AED) by Drones: Implications for Emergency Cardiac Care

“…Among EMS-treated patients with OHCA in 2015, 21.3% presented with an initial shockable rhythm [2]. Rapid access to defibrillation, therefore, is paramount to OHCAvictim survival with optimal neurological and functional outcomes [7]. Although the likelihood of survival is increased when by- standers witness, recognize, and respond to OHCA victims in a rapid manner, barriers to this full potential persist [8].…”

“…Over the past decade, cardiac resuscitation systems of care have been developed to increase bystander access to defibrillators [7]. In Denmark, Hansen and colleagues (2017) examined the association between AED placement and both by- stander defibrillator and survival rates after nationwide dissemination of AEDs, registration of AEDs with location linked to EMS dispatchers, dispatcher-guided use, and public education [9].…”

“…PAD is both difficult to implement and impractical because of the rarity of cardiac arrest in the larger community. One of the primary barriers to PAD is the strategic placement in largely public locations for bystanders to find, retrieve, and bring to OHCA victims [7, 14]. Public locations, such as shopping malls, are limited by hours of operation and only 20% of OHCAs occur in public settings.…”

Incidence and prognosis of cardiopulmonary arrest due to acute myocardial infarction in 85 consecutive patients

“…Providing systematic post-CPA care following the return of spontaneous circulation is very important for the prognosis of the CPA group when the initial rhythm is VF or pulseless ventricular tachycardia. TH contributes to improvements in neurological outcomes in patients after out-of-hospital CPA [24,25]. In general, candidates for TH after out-of-hospital CPA are expected to have a poor prognosis.…”

Lights and Siren Transport and the Need for Hospital Intervention in Non-Trauma Patients: A Prospective Study

“…Recent studies have demonstrated that up to a quarter of life-threatening situations, such as airway obstruction, severe dyspnoea, hemodynamic instability and abnormal Glasgow Coma Scale, require TCHI [8][9][10]. As proposed by the American Heart Association and the American Stroke Association since 2013, acute ST-elevation myocardial infarction (STEMI), suspicion of acute stroke and out-of-hospital cardiac arrest (OHCA) require rapid transportation from the field (fast-track) to benefit from an urgent procedure and therefore also may be considered as TCHI [16][17][18].…”