The Cardiocerebral Resuscitation protocol for treatment of out-of-hospital primary cardiac arrest

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

Gordon A Ewy¹ 

[1] University of Arizona Sarver Heart Center, University of Arizona, Tucson, AZ, 85704, USA

关键词: Out-of-hospital cardiac arrest;    Emergency medical system;    Primary cardiac arrest;    Cardiocerebral resuscitation;    Cardiopulmonary resuscitation;    Cardiac arrest;    Resuscitation;    Ventricular fibrillation;   

Others  :  826343
DOI  :  10.1186/1757-7241-20-65

 received in 2012-04-13, accepted in 2012-08-01,  发布年份 2012

【 摘 要 】

Out-of-hospital cardiac arrest (OHCA) is a significant public health problem in most westernized industrialized nations. In spite of national and international guidelines for cardiopulmonary resuscitation and emergency cardiac care, the overall survival of patients with OHCA was essentially unchanged for 30 years--from 1978 to 2008 at 7.6%. Perhaps a better indicator of Emergency Medical System (EMS) effectiveness in treating patients with OHCA is to focus on the subgroup that has a reasonable chance of survival, e.g., patients found to be in ventricular fibrillation (VF). But even in this subgroup, the average survival rate was 17.7% in the United States, unchanged between 1980 and 2003, and 21% in Europe, unchanged between 1980 and 2004. Prior to 2003, the survival of patients with OHCA, in VF in Tucson, Arizona was less than 9% in spite of incorporating previous guideline recommendations. An alternative (non-guidelines) approach to the therapy of patients with OHCA and a shockable rhythm, called Cardiocerebral Resuscitation, based on our extensive physiologic laboratory studies, was introduced in Tucson in 2003, in rural Wisconsin in 2004, and in selected EMS areas in the metropolitan Phoenix area in 2005. Survival of patients with OHCA due to VF treated with Cardiocerebral Resuscitation in rural Wisconsin increased to 38% and in 60 EMS systems in Arizona to 39%. In 2004, we began a statewide program to advocate chest compression-only CPR for bystanders of witnessed primary OHCA. Over the next five years, we found that survival of patients with a shockable rhythm was 17.7% in those treated with standard bystander CPR (mouth-to-mouth ventilations plus chest compression) compared to 33.7% for those who received bystander chest-compression-only CPR. This article on Cardiocerebral Resuscitation, by invitation following a presentation at the 2011 Danish Society Emergency Medical Conference, summarizes the results of therapy of patients with primary OHCA treated with Cardiocerebral Resuscitation, with requested emphasis on the EMS protocol.

【 授权许可】

   
2012 Ewy; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

Figure 4.

【 参考文献 】

• [1]Lloyd-Jones DM, Hong Y, Labarthe D, et al.: Defining and setting national goals for cardiovascular health promotion and disease reduction: the American Heart Association's strategic Impact Goal through 2020 and beyond. Circulation 2010, 121(4):586-613.
• [2]Sasson C, Rogers MA, Dahl J, Kellermann AL: Predictors of survival from out-of-hospital cardiac arrest: a systematic review and meta-analysis. Circ Cardiovasc Qual Outcomes 2010, 3:63-81.
• [3]Chamberlain D, Cummins RO, Abramson N: Recommended guidelines for uniform reporting of data from out-of-hospital cardiac arrest: The Utstein style. Resuscitation 1991, 22(1):1-26.
• [4]Rea TD, Eisenberg MS, Sinibaldi G, White RD: Incidence of EMS-treated out-of-hospital cardiac arrest in the United States. Resuscitation 2004, 63:17-24.
• [5]Atwood C, Eisenberg MS, Herlitz J, Rea TD: Incidence of EMS-treated out-of-hospital cardiac arrest in Europe. Resuscitation 2005, 67:75-80.
• [6]Nichol G, Thomas E, Callaway CW, et al.: Regional variation in out-of-hospital cardiac arrest incidence and outcome. JAMA 2008, 300:1423-1431.
• [7]American Heart Association Guidelines 2000 for cardiopulmonary resuscitation and emergency cardiovascular care: international consensus on science Circulation 2000, 102((I)):I-1-I-348.
• [8]Ewy GA: Cardiocerebral resuscitation should replace cardiopulmonary resuscitation for out-of-hospital cardiac arrest. Curr Opin Crit Care 2006, 12:189-192.
• [9]Ewy GA: Cardiocerebral resuscitation: the new cardiopulmonary resuscitation. Circulation 2005, 111:2134-2142.
• [10]Kern KB, Valenzuela TD, Clark LL, et al.: An alternative approach to advancing resuscitation science. Resuscitation 2005, 64:261-268.
• [11]Ewy GA: A new approach for out-of-hospital CPR: a bold step forward. Resuscitation 2003, 58:271-272.
• [12]Kellum MJ, Kennedy KW, Ewy GA: Cardiocerebral resuscitation improves survival of patients with out-of-hospital cardiac arrest. Am J Med 2006, 119:335-340.
• [13]Kellum MJ, Kennedy KW, Barney R, et al.: Cardiocerebral Resuscitation Improves Neurologically Intact Survival of Patients With Out-of-Hospital Cardiac Arrest. Ann Emerg Med 2008, 52:244-252.
• [14]Garza AG, Gratton MC, Salomone JA, Lindholm D, McElron J, Archer R: Improved patient survival using a modified resuscitation protocol for out-of-hospital cardiac arrest. Circulation 2009, 119:2597-2605.
• [15]Bobrow BJ, Ewy GA, Clark L, et al.: Passive oxygen insufflation is superior to bag-valve-mask ventilation for witnessed ventricular fibrillation out-of-hospital cardiac arrest. Ann Emerg Med 2009, 54:656-662.
• [16]Berg RA, Wilcoxson D, Hilwig RW, et al.: The need for ventilatory support during bystander CPR. Ann Emerg Med 1995, 26:342-350.
• [17]Berg RA, Kern KB, Hilwig RW, et al.: Assisted ventilation does not improve outcome in a porcine model of single-rescuer bystander cardiopulmonary resuscitation. Circulation 1997, 95(6):1635-1641.
• [18]Rea TD, Helbock M, Perry S, et al.: Increasing use of cardiopulmonary resuscitation during out-of-hospital ventricular fibrillation arrest: survival implications of guideline changes. Circulation 2006, 114:2760-2765.
• [19]Weisfeldt ML, Kerber RE, McGoldrick RP, et al.: Public access to defibrillation. The Automatic Defibrillation Task Force. Am J Emerg Med 1996, 14(7):684-692.
• [20]Zuercher M, Ewy GA: Gasping during cardiac arrest. Curr Opin Crit Care 2009, 15:185-188.
• [21]Zuercher M, Ewy GA, Otto CW, et al.: Gasping in response to basic resuscitation efforts: observation in a Swine model of cardiac arrest. Critical Care Research and Practice 2010, 1:1-7.
• [22]Bobrow BJ, Zuercher M, Ewy GA, et al.: Gasping during cardiac arrest in humans is frequent and associated with improved survival. Circulation 2008, 118:2550-2554.
• [23]Bobrow BJ, Spaite DW, Berg RA, et al.: Chest compression-only CPR by lay rescuers and survival from out-of-hospital cardiac arrest. JAMA 2010, 304:1447-1454.
• [24]Valenzuela T, Roe D, Nichol G, Clark L, Spaite D, Hardman R: Outcomes of rapid defibrillation by security officers after cardiac arrest in casinos. New Eng J Med 2000, 343:1206-1209.
• [25]Weisfeldt ML, Becker LB: Resuscitation after cardiac arrest: a 3-phase time-sensitive model. JAMA 2002, 288:3035-3038.
• [26]Steen S, Liao Q, Pierre L, Paskevicius A, Sjoberg T: The critical importance of minimal delay between chest compressions and subsequent defibrillation: a haemodynamic explanation. Resuscitation 2003, 58:249-258.
• [27]Sorrell VL, Bhatt RD, Berg RA, et al.: Cardiac magnetic resonance imaging investigation of sustained ventricular fibrillation in a swine model–with a focus on the electrical phase. Resuscitation 2007, 73(2):279-286.
• [28]Ewy GA: Alternative approaches to external chest compression. Circulation 1986, 74(6 Pt 2):IV98-101.
• [29]Ewy GA, Kellum MJ: Cardiocerebral resuscitation: a new approach to out-of-hospital cardiac arrest. In Cardiac Arrest: The Science and Practice of Resuscitation Medicine, 2nd Edition Cambridge University Press Edited by Paradis NA, Halperin HR, Karn KB, Venzel V, Chamberlain DA. 2007, 747-756.
• [30]Aufderheide TP, Pirrallo RG, Yannopoulos D, et al.: Incomplete chest wall decompression: a clinical evaluation of CPR performance by EMS personnel and assessment of alternative manual chest compression-decompression techniques. Resuscitation 2005, 64:353-362.
• [31]Ewy GA, Kern KB: Recent advances in cardiopulmonary resuscitation: cardiocerebral resuscitation. J Am Coll Cardiol 2009, 53:149-157.
• [32]Abella BS, Sandbo N, Vassilatos P, et al.: Chest compression rates during cardiopulmonary resuscitation are suboptimal: a prospective study during in-hospital cardiac arrest. Circulation 2005, 111:428-434.
• [33]Feneley MP, Maier GW, Kern KB, et al.: Influence of compression rate on initial success of resuscitation and 24 hour survival after prolonged manual cardiopulmonary resuscitation in dogs. Circulation 1988, 77:240-250.
• [34]Nolan JP, Perkins GD, Soar J: Chest Compression Rate: Where is the Sweet Spot? Circulation 2012, 125:2968-2970.
• [35]Aufderheide TP, Lurie KG: Death by hyperventilation: a common and life-threatening problem during cardiopulmonary resuscitation. Crit Care Med 2004, 32:S345-351.
• [36]Wang HE, Simeone SJ, Weaver MD, Callaway CW: Interruptions in cardiopulmonary resuscitation from paramedic endotracheal intubation. Ann Emerg Med 2009, 54:645-652.
• [37]Aufderheide TP: The problem with and benefit of ventilations: should our approach be the same in cardiac and respiratory arrest? Curr Opin Crit Care 2006, 12:207-212.
• [38]Yannopoulos D, Nadkarni VM, McKnite SH, et al.: Intrathoracic pressure regulator during continuous-chest-compression advanced cardiac resuscitation improves vital organ perfusion pressures in a porcine model of cardiac arrest. Circulation 2005, 112(6):803-811.
• [39]Ewy GA: Defining electromechanical dissociation. Ann Emerg Med 1984, 13:830-832.
• [40]Zuercher M, Kern KB, Indik JH, et al.: Epinephrine improves 24-hour survival in a swine model of prolonged ventricular fibrillation demonstrating that early intraosseous is superior to delayed intravenous administration. Anesth Analg 2011, 112:884-890.
• [41]Otto CW, Yakaitis RW, Ewy GA: Effect of epinephrine on defibrillation in ischemic ventricular fibrillation. Am J Emerg Med 1985, 3:285-291.
• [42]Olasveengen TM, Sunde K, Brunborg C, Thowsen J, Steen PA, Wik L: Intravenous drug administration during out-of-hospital cardiac arrest: a randomized trial. JAMA 2009, 302:2222-2229.
• [43]Haqihara A, Hasegawa M, Abe T, Nagata T, Wakata Y, Miyazaki S: Prehospital epinephrine use and survival among patients with out-of-hospital cardiac arrest. JAMA 2012, 307:1161-1168.
• [44]Jacobs IG, Finn JC, Jelinek GA, Oxer HF, Thompson PL: Effect of adrenaline on survival in out-of-hospital cardiac arrest: A randomised double-blind placebo-controlled trial. Resuscitation 2012, 83:e105.
• [45]Youngquist ST, Niemann JT: Regarding"Effect of adrenaline on survival in out-of-hospital cardiac arrest: A randomised double-blind placebo-controlled trial. Resuscitation 2012, 83:e105.
• [46]Spaite DW, Bobrow BJ, Vadeboncoeur TF, et al.: The impact of prehospital transport interval on survival in out-of-hospital cardiac arrest: implications for regionalization of post-resuscitation care. Resuscitation 2008, 79(1):61-66.
• [47]Spaite DW, Stiell IG, Bobrow BJ, et al.: Effect of transport interval on out-of-hospital cardiac arrest survival in the OPALS study: implications for triaging patients to specialized cardiac arrest centers. Ann Emerg Med 2009, 54:248-255.
• [48]Bobrow BJ, Kern KB: Regionalization of postcardiac arrest care. Curr Opin Crit Care 2009, 15:221-227.
• [49]Bobrow BJ, Vadeboncoeur TF, Clark L, Chikani V: Establishing Arizona's statewide cardiac arrest reporting and educational network. Prehosp Emerg Care 2008, 12:381-387.
• [50]Becker L, Gold LS, Eisenberg M, White L, Hearne T, Rea T: Ventricular fibrillation in King County, Washington: A 30-year perspective. Resuscitation 2008, 79:22-27.
• [51]Berdowski J, Blom MT, Bardai A, Tan HL, Tijssen JGP, Koster RW: Impact of onsite or dispatched automated external defibrillator use on survival after out-of-hospital cardiac arrest. Circulation 2011, 124:2225-2232.
• [52]Hupfl M, Selig HF, Nagele P: Chest-compression-only versus standard cardiopulmonary resuscitation: a meta-analysis. Lancet 2010, 376:1552-1557.