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Out-of-hospital cardiac arrest: contemporary management and future perspectives
  1. Roberto Nerla,
  2. Ian Webb,
  3. Philip MacCarthy
  1. Department of Cardiology, King's College Hospital, London, UK
  1. Correspondence to Professor Philip MacCarthy, Department of Cardiology, King's College Hospital, Denmark Hill, London SE5 9RS, USA; philip.maccarthy{at}nhs.net

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Learning objectives

  • To learn the optimal management of patients with out-of-hospital cardiac arrest (OOHCA).

    • Perform basic life support and advanced cardiac life support (ACLS).

    • Lead and coordinate the actions of an ACLS team.

    • Appreciation of the importance of working in a team with lay persons, paramedics and other medical personnel during resuscitation.

    • Recognising the urgent management and triage of OOHCA survivors.

    • Emergency and peri-resuscitation echocardiography.

  • To appreciate the literature supporting an early invasive strategy investigating OOHCA survivors.

  • To understand optimal protocols and patient pathways to improve outcome.

    • Diagnostic work-up and risk stratification of survivors.

    • Causes of cardiorespiratory arrest, identification of patients at risk and early implementation of corrective treatment of reversible causes.

Curriculum topic: Acute cardiovascular care

Introduction

The scale of the problem

Out-of-hospital cardiac arrest (OOHCA) remains a leading cause of death in developed countries.1 In spite of clear improvements in treatments and patient pathways, all-comer survival is still <10%,1 ,2 with significant variability in registry outcomes dependent on geography, sophistication of ambulance services and the clinical experience of treating centres.3 Between 2013 and 2014, of 28 000 reported OOHCA cases in England, the overall survival to hospital discharge was only 8.7%.4 However, these data encompass all patient groups, including those with and without return of spontaneous circulation (ROSC), those with and without ‘shockable heart rhythms’ (SHR) and patients with highly variable time delays to implementation of resuscitation—all important factors that significantly skew results and outcomes. These factors also challenge the interpretation of the available literature.

The ‘chain of survival’

Approximately 80% of OOHCAs occur at home and 20% in public places.5 The current rate of initial bystander cardiopulmonary resuscitation (CPR) in England is reported as 43%,6 including both spontaneous bystander-initiated CPR and bystander-performed CPR prompted by Emergency Services over the telephone. Approximately 20% of OOHCA patients are in an SHR (ie, treatable by defibrillation) by the time the emergency …

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