Dr. Leo L Bossaert,
In 2010 ERC Guidelines for CPR were published after an international review and consensus on science by ILCOR. The joint ERC-ESC session “Sudden death and surroundings” focused on hot points in early management of cardiac arrest patients.
N Danchin (Paris, France) Short time to reperfusion is essential for good outcome in STEMI. PPCI is preferred over prehospital fibrinolysis if delivered early and in a PCI center matching quality standards. Real life registries demonstrated that time to PPCI is frequently prolonged. If time to PCI is expected to be too long, early fibrinolysis is a valid alternative. Combining both reperfusion strategies, the pharmaco-invasive approach, is most promising. Initial data needs to be confirmed.
R Koster (Amsterdam, Netherlands) Early use of an AED by lay rescuers is simple, safe and saves lives. Survival is highest if an AED is used that is placed close to the victim (office, sport facility, shopping center), but such use is rare. Survival benefit is poor if the AED must be transported to the site by police or firefighters. For the 70-80% of cardiac arrests that happen at home solutions may be found in local volunteers with smart phone alerts from the dispatch center and AEDs available within residential areas.
N Nikolaou (Athens, Greece) Acute coronary syndromes (ACS) are the majority cause of OHCA. In patients who regain consciousness after ROSC, PCI should be performed as in other patients with ACS. Emergency PCI should also be considered in comatose survivors of cardiac arrest. ST elevation identifies patients with high risk for acute coronary occlusion but absence of ST elevation does not rule out the need for PCI. Urgent PCI and therapeutic hypothermia should be incorporated in post-resuscitation protocols.
B Böttiger (Cologne, Germany) Gaps in our knowledge of cardiac arrest and resuscitation science were actively identified during the ILCOR process. This served as a guidance for preparing the 2010 Guidelines. During this process, many open questions were addressed but many more questions remained unanswered: How can we identify ACS patients that benefit most from PCI ? Cooling: who, when, how ? Prognostication: when and how ?
Sudden death and surroundings
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