Cardiocerebral Resuscitation Improves Neurologically Intact Survival of Patients With Out-of-Hospital Cardiac Arrest
Presented at the 2007 American Heart Association meeting, November 2007, Orlando, FL.
Received 4 October 2007; received in revised form 10 December 2007; accepted 7 February 2008. published online 31 March 2008.
Refers to article:
Progress in Improving Neurologically Intact Survival From Cardiac Arrest
, 21 May 2008
Arthur B. Sanders
Annals of Emergency Medicine
September 2008 (Vol. 52, Issue 3, Pages 253-255) Full Text |
Full-Text PDF (71 KB)
Study objective
In an effort to improve neurologically normal survival of victims of cardiac arrest, a new out-of-hospital protocol was implemented by the emergency medical system medical directors in 2 south-central rural Wisconsin counties. The project was undertaken because the existing guidelines for care of such patients, despite their international scope and periodic updates, had not substantially improved survival rates for such patients during nearly 4 decades.
Methods
The neurologic status at or shortly after discharge was documented for adult patients with a witnessed collapse and an initially shockable rhythm. Patients during two 3-year periods were compared. During the 2001 through 2003 period, in which the 2000 American Heart Association guidelines were used, data were collected retrospectively. During the mid-2004 through mid-2007 period, patients were treated according to the principles of cardiocerebral resuscitation. Data for these patients were collected prospectively. Cerebral performance category scores were used to define the neurologic status of survivors, and a score of 1 was considered as “intact” survival.
Results
In the 3 years preceding the change in protocol, there were 92 witnessed arrests with an initially shockable rhythm. Eighteen patients survived (20%) and 14 (15%) were neurologically intact. During the 3 years after implementation of the new protocol, there were 89 such patients. Forty-two (47%) survived and 35 (39%) were neurologically intact.
Conclusion
In adult patients with a witnessed cardiac arrest and an initially shockable rhythm, implementation of an out-of-hospital treatment protocol based on the principles of cardiocerebral resuscitation was associated with a dramatic improvement in neurologically intact survival.
aDepartments of Emergency Medicine at Mercy Health System, Janesville, WI
bDepartment of Emergency Medicine, Beloit Memorial Hospital, Beloit, WI
Address for reprints: Michael J. Kellum, MD, W9675 Homburg Ln, Whitewater, WI 53190; 262-949-2270, fax 262-245-2303
Supervising editor: Theodore R. Delbridge, MD, MPH
Author contributions: MJK, KWK, RB, FAK, MB, and GAE participated in development of the out-of-hospital protocol. MJK and KWK were responsible for data collection. Training and supervision of participants was done by MJK, KWK, RB, FAK, and MB. MZ provided statistical analysis. MJK and GAE drafted the article, and all authors participated in its revisions. MJK had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. MJK takes responsibility for the paper as a whole.
Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article that might create any potential conflict of interest. The authors have stated that no such relationships exist. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement.
Publication dates: Available online March 28, 2008.
ABSTRACT