Advertisement

More evidence that out-of-hospital cardiac arrest is preventable

  • Ziad Nehme
    Affiliations
    Centre for Research and Evaluation, Ambulance Victoria, Doncaster, Victoria, Australia

    Department of Community Emergency Health and Paramedic Practice, Monash University, Frankston, Victoria, Australia

    Department of Epidemiology and Preventive Medicine, Monash University, Prahran, Victoria, Australia
    Search for articles by this author
  • Karen Smith
    Correspondence
    Corresponding author at: Centre for Research and Evaluation, Ambulance Victoria, 375 Manningham Road, Doncaster, Victoria, 3108 Australia.
    Affiliations
    Centre for Research and Evaluation, Ambulance Victoria, Doncaster, Victoria, Australia

    Department of Community Emergency Health and Paramedic Practice, Monash University, Frankston, Victoria, Australia

    Department of Epidemiology and Preventive Medicine, Monash University, Prahran, Victoria, Australia

    School of Primary, Aboriginal and Rural Health Care, University of Western Australia, Crawley, Western Australia, Australia
    Search for articles by this author
      For decades, system-based interventions for out-of-hospital cardiac arrest (OHCA) have concentrated on the emergency response to the event after it has already occurred.
      • Cummins R.O.
      • Ornato J.P.
      • Thies W.H.
      • Pepe P.E.
      Improving survival from sudden cardiac arrest: the “chain of survival” concept. A statement for health professionals from the Advanced Cardiac Life Support Subcommittee and the Emergency Cardiac Care Committee, American Heart Association.
      Although essential, the approach is not without its limitations. Survival from OHCA is time sensitive, and therapeutic interventions are often ineffective if the time from collapse to their initiation exceeds 10 min.
      • Fridman M.
      • Barnes V.
      • Whyman A.
      • et al.
      A model of survival following pre-hospital cardiac arrest based on the Victorian Ambulance Cardiac Arrest Register.
      This short window of opportunity limits what can be achieved by even the most capable emergency systems, particularly as much of this time can be misused by bystanders who delay taking appropriate action.
      • Takei Y.
      • Inaba H.
      • Yachida T.
      • Enami M.
      • Goto Y.
      • Ohta K.
      Analysis of reasons for emergency call delays in Japan in relation to location: high incidence of correctable causes and the impact of delays on patient outcomes.
      • Nehme Z.
      • Andrew E.
      • Cameron P.
      • et al.
      Direction of first bystander call for help is associated with outcome from out-of-hospital cardiac arrest.
      In addition, as many as half of all OHCA patients experience irreversible death before the arrival of emergency medical service (EMS) personnel,
      • Berdowski J.
      • Berg R.A.
      • Tijssen J.G.
      • Koster R.W.
      Global incidences of out-of-hospital cardiac arrest and survival rates: Systematic review of 67 prospective studies.
      and this problem highlights a major pitfall (and opportunity) in the existing emergency response to OHCA.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Resuscitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Cummins R.O.
        • Ornato J.P.
        • Thies W.H.
        • Pepe P.E.
        Improving survival from sudden cardiac arrest: the “chain of survival” concept. A statement for health professionals from the Advanced Cardiac Life Support Subcommittee and the Emergency Cardiac Care Committee, American Heart Association.
        Circulation. 1991; 83: 1832-1847
        • Fridman M.
        • Barnes V.
        • Whyman A.
        • et al.
        A model of survival following pre-hospital cardiac arrest based on the Victorian Ambulance Cardiac Arrest Register.
        Resuscitation. 2007; 75: 311-322
        • Takei Y.
        • Inaba H.
        • Yachida T.
        • Enami M.
        • Goto Y.
        • Ohta K.
        Analysis of reasons for emergency call delays in Japan in relation to location: high incidence of correctable causes and the impact of delays on patient outcomes.
        Resuscitation. 2010; 81: 1492-1498
        • Nehme Z.
        • Andrew E.
        • Cameron P.
        • et al.
        Direction of first bystander call for help is associated with outcome from out-of-hospital cardiac arrest.
        Resuscitation. 2014; 85: 42-48
        • Berdowski J.
        • Berg R.A.
        • Tijssen J.G.
        • Koster R.W.
        Global incidences of out-of-hospital cardiac arrest and survival rates: Systematic review of 67 prospective studies.
        Resuscitation. 2010; 81: 1479-1487
        • Huikuri H.V.
        • Castellanos A.
        • Myerburg R.J.
        Sudden death due to cardiac arrhythmias.
        N Engl J Med. 2001; 345: 1473-1482
        • Muller D.
        • Agrawal R.
        • Arntz H.R.
        How sudden is sudden cardiac death?.
        Circulation. 2006; 114: 1146-1150
        • Nishiyama C.
        • Iwami T.
        • Kawamura T.
        • et al.
        Prodromal symptoms of out-of-hospital cardiac arrests: a report from a large-scale population-based cohort study.
        Resuscitation. 2013; 84: 558-563
        • Norris R.M.
        Circumstances of out of hospital cardiac arrest in patients with ischaemic heart disease.
        Heart. 2005; 91: 1537-1540
        • Marijon E.
        • Uy-Evanado A.
        • Dumas F.
        • et al.
        Warning symptoms are associated with survival from sudden cardiac arrestwarning symptoms and sudden cardiac arrest.
        Ann Intern Med. 2015; 164: 23-29
        • Nehme Z.
        • Bernard S.
        • Andrew E.
        • Cameron P.
        • Bray J.E.
        • Smith K.
        Warning symptoms preceding out-of-hospital cardiac arrest: do patient delays matter?.
        Resuscitation. 2018; 123: 65-70
        • Nolan J.
        • Soar J.
        • Eikeland H.
        The chain of survival.
        Resuscitation. 2006; 71: 270-271
        • Deakin C.D.
        The chain of survival: not all links are equal.
        Resuscitation. 2018; 126: 80-82
        • Shuvy M.
        • Koh M.
        • Qiu F.
        • et al.
        Health care utilization prior to out-of-hospital cardiac arrest: a population-based study.
        Resuscitation. 2019; 141: 158-165
        • Nichol G.
        • Thomas E.
        • Callaway C.W.
        • et al.
        Regional variation in out-of-hospital cardiac arrest incidence and outcome.
        JAMA. 2008; 300: 1423-1431
        • de Vreede-Swagemakers J.J.M.
        • Gorgels A.P.M.
        • Dubois-Arbouw W.I.
        • et al.
        Out-of-hospital cardiac arrest in the 1990s: a population-based study in the Maastricht area on incidence, characteristics and survival.
        J Am Coll Cardiol. 1997; 30: 1500-1505
        • Weeke P.
        • Folke F.
        • Gislason G.H.
        • et al.
        Pharmacotherapy and hospital admissions before out-of-hospital cardiac arrest: a nationwide study.
        Resuscitation. 2010; 81: 1657-1663
        • Fishman G.I.
        • Chugh S.S.
        • Dimarco J.P.
        • et al.
        Sudden cardiac death prediction and prevention: report from a National Heart, Lung, and Blood Institute and Heart Rhythm Society Workshop.
        Circulation. 2010; 122: 2335-2348
        • Nehme Z.
        • Andrew E.
        • Bernard S.
        • et al.
        Impact of a public awareness campaign on out-of-hospital cardiac arrest incidence and mortality rates.
        Eur Heart J. 2017; 38: 1666-1673
        • Nehme Z.
        • Cameron P.A.
        • Akram M.
        • et al.
        Effect of a mass media campaign on ambulance use for chest pain.
        Med J Aust. 2017; 206: 30-35