Management of sudden cardiac arrest

Sudden cardiac arrest, and in particular sudden out-of-hospital cardiac arrest (OHCA) remains a major public health concern in which survival statistics, and in particular neurologically intact survival statistics, have remained largely unimproved over many decades. Overall survival remains approximately 10%, being somewhat better in victims receiving bystander cardiopulmonary resuscitation (CPR), and those who are found to have a shockable rhythm (i.e., VT or VF). CPR and defibrillation (especially public-access defibrillation) remain the essential immediate management tools. However, recent research has introduced several novel adjunctive interventions (e.g., mechanical compression-decompression devices, 'head-up' CPR methodology, portable extra-corporeal circulatory assistance [ECPR]) that will hopefully impact survival positively. In any case, it is apparent that no single resuscitative tool will be sufficient to markedly improve OHCA survival; the combined application of a multi-faceted strategy is needed. This might comprise bystander CPR, combined use of 'head-up' CPR along with impedance threshold valve [ITD] and active compression-decompression mechanical chest compression devices. Application of mobile ECPR devices as early as possible during resuscitation appears to improve outcomes albeit expensive and complex to deploy broadly. Employed together, these novel steps, offer the possibility of moving the survival needle in a positive direction.