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Innovations in cardiopulmonary resuscitation: from scene to the hospital, ESC and the European Resuscitation Council

ESC Congress Report

  • Early ECLS in refractory cardiac arrest with short low-flow time may improve survival rate in case of failure of conventional methods.
  • The introduction of TH has fundamentally modified the traditional paradigms for prognostication after cardiac arrest.
  • Invasive treatment will only be of value if early CPR and early defibrillation are provided. 

 

Sudden Cardiac Death and Resuscitation


View the Slides from this session in ESC Congress 365

The tradition of Joint ESC-ERC Sessions, which started in Stockholm 1990, emphasizes the need and added value of multidisciplinary collaboration in the management of cardiac arrest.
Strategies for faster use of automated external defibrillators (AEDs) in out-of-hospital cardiac arrests (OHCA) are tested and implemented in many regions.

Ruud Koster (AMC, Amsterdam, NL) reported on the Dutch experience, a model for successful AED use in the community. Currently it can be expected that an AED is connected in OHCA in almost 60% of all OHCA patients before ambulance arrival. Dispatched AEDs shorten time to defibrillation less than onsite AEDs. Neurologic intact survival increased from 16.2% in 2006 to 19.7% in 2012. This was largely due to an improved survival rate among patients with shockable first rhythm (29.1 to 41.4%). The improved survival was fully explained by the contribution of AED use.

Holger Thiele (Univ. Schleswig-Holstein,Lübeck, DE) explored the limits and possibilities of extracorporeal life support in refractory cardiac arrest.
Early ECLS in refractory cardiac arrest with short low-flow time may improve survival rate in case of failure of conventional methods. For selection of potential survivors after ECLS, implantation prospective multicenter trials are needed. Also, justified ethical and economical questions need to be addressed: should we attempt to do everything which is technically possible?
Early identification of patients with no chance of a good neurological recovery will help to avoid inappropriate treatment and provide information for relatives.

Claudio Sandroni (Catholic University, Roma, IT) emphasised that the introduction of Therapeutic hypothermia (TH) has fundamentally modified the traditional paradigms for prognostication after cardiac arrest (American Academy of Neurology-AAN, 2006). These protocols are based on clinical observations (seizures, ocular reflexes, motor response), somatosensory evoked potentials (SSEP) and biomarkers (NSE) and were believed to predict poor outcome with 0% false positive rates and narrow confidence intervals.  
However, these AAN recommendations need updating because many studies evaluating these predictors have methodological limitations. But most importantly, these 2006 protocols were developed before the introduction of TH, and new evidence and new diagnostic technologies have become current practice.

Bernd Böttiger (Univ. Köln, DE) discussed the critical importance of sequential steps of the Chain of Survival following successful initial resuscitation. High-quality intensive care treatment must ensue to achieve the best possible outcome and to avoid disabling sequellae. Therapeutic hypothermia (TH) and primary PCI are cornerstones of treatment in post-resuscitation care. Resources, expertise and experience can be concentrated in cardiac arrest centres. Regional networks of care, as for trauma or myocardial infarction, can help to ensure that every patient after cardiac arrest receives the best possible treatment. But invasive treatment will only be of value if early CPR and early defibrillation are provided.

References


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SessionTitle:

Innovations in cardiopulmonary resuscitation: from scene to the hospital, ESC and the European Resuscitation Council

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.