Journal of the American College of Cardiology
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J. Am. Coll. Cardiol. · Jan 2013
ReviewAlternative approach to improving survival of patients with out-of-hospital primary cardiac arrest.
Out-of-hospital cardiac arrest (OHCA) is a common cause of death. In spite of recurring updates of guidelines, the survival of patients with OHCA was essentially unchanged from the mid 1970s to the mid 2000s, averaging 7.6% for all OHCA and 17.7% for OHCA due to ventricular fibrillation. In the past, changes in one's approach to resuscitation had to await the semi-decennial publications of guidelines. ⋯ Using cardiocerebral resuscitation as a model for CQI, neurologically intact survival of patients with OHCA in ventricular fibrillation improved in 2 rural counties in Wisconsin, from 15% to 39%, and in 60 emergency medical systems in Arizona, to 38%. By advocating chest compression only CPR for bystanders of patients with primary OHCA and encouraging the use of cardiocerebral resuscitation by emergency medical systems, survival of patients with primary cardiac arrest in Arizona increased over a 5-year period from 17.7% to 33.7%. We recommend that all emergency medical systems determine their baseline survival rates of patients with OHCA and a shockable rhythm, and consider implementing the CQI approach if the community does not have a neurologically intact survival rate of at least 30%.