Prehospital interventions to improve neurological outcome following cardiac arrest.
As many cases of cardiac arrest occur outside of the health care setting, prehospital treatment may dramatically affect patient outcomes. The three major interventions that have been studied are chest compressions and ventilation, electrical defibrillation, and medications. Recent studies show that increasing the rate of cardiopulmonary resuscitation (CPR), decreasing the rate of ventilation, and initiation of CPR prior to defibrillation may result in improved survival. Biphasic defibrillators can restore perfusing rhythms while minimizing myocardial injury. Public access to automatic defibrillators has been shown to increase the survival of cardiac arrest patients. Medications such as amiodarone, vasopressin, and thrombolytics also may have a role in the prehospital treatment of cardiac arrest. Recent advances in these areas will be reviewed with a discussion of the effect of each intervention on the restoration of circulation and neurological outcomes.
Little
Charles M
CM
Division of Emergency Medicine, Department of Surgery, University of Colorado School of Medicine, Colorado Emergency Medicine Research Center, Denver, Colorado, USA.
Paradis
Norman A
NA
Heard
Kennon
K
D000889:Anti-Arrhythmia Agents / Q000494:pharmacology / Q000627:therapeutic use; D020520:Brain Infarction / Q000209:etiology* / Q000503:physiopathology / Q000517:prevention & control*; D016887:Cardiopulmonary Resuscitation / Q000592:standards / Q000639:trends; D047548:Defibrillators / Q000592:standards / Q000639:trends; D005343:Fibrinolytic Agents / Q000494:pharmacology / Q000627:therapeutic use; D006323:Heart Arrest / Q000150:complications* / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D020925:Hypoxia-Ischemia, Brain / Q000209:etiology* / Q000503:physiopathology / Q000517:prevention & control*; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000494:pharmacology / Q000627:therapeutic use
D000889:Anti-Arrhythmia Agents; D005343:Fibrinolytic Agents; D014662:Vasoconstrictor Agents