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Pre-hospital resuscitation: breathing life into a stale subject
  1. C F M Weston
  1. Correspondence to:
    Dr Clive F M Weston
    Clinical Effectiveness and Evaluation Unit, Royal College of Physicians of London, 11 St Andrews Place, London NW1 4LE, UK; cfmwlycos.com

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Is there anything left to learn about the management of cardiac arrest outside hospital?

In the second half of the 20th century, cardiologists played an influential role both in the development of techniques used in pre-hospital resuscitation and in the organisation of systems to deliver such emergency care.1,2 In the UK this included doctor manned mobile coronary care units, the training of ambulance crew in advanced life support skills, and the equipping of all emergency ambulances with defibrillators. More recently, however, most British cardiologists have become disinterested and less involved in the management of this manifestation of heart disease.

CARDIOLOGISTS’ APATHY

There are many reasons for this apparent apathy. It is partly explained by the increasing contribution of other specialists in accident and emergency medicine and the expansion of posts for medical directors within the ambulance service, together with the expanding workload of cardiologists within a hospital environment. Moreover, the hoped-for glut of survivors from prehospital cardiac arrest has not materialised. Some large community programmes have reported disappointing survival rates3 and the effect of prehospital resuscitation upon overall community death rates is small.4 There is also a perception that there is nothing new to learn about resuscitation. After all, basic life support techniques have changed little over the past 40 years, community training programmes in cardiopulmonary resuscitation are well established, and ambulance paramedics can deliver both defibrillation and, in many cases, drugs, according to advanced life support protocols. The links within the “chain of survival” have been well described5 and the predictors of survival are confirmed, and found to be similar in most studies. These predictors of survival appear self evident: the absence of co-morbidity, a witness to the collapse, prompt cardiopulmonary resuscitation (CPR) of good quality by a bystander, a “shockable rhythm” on arrival of the …

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