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Successful Systems for Out-of-Hospital Resuscitation

  • Chapter
Cardiopulmonary Resuscitation

Part of the book series: Contemporary Cardiology ((CONCARD))

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Abstract

A patient with out-of-hospital cardiac arrest (CA) stands little chance for survival without prior organization and preparations for immediate resuscitation. Fortunately, many communities have achieved relative success with resuscitation since the 1970s. In the 1970s, cities such as Seattle and Milwaukee achieved overall survival-to-hospital discharge rates for the subgroup of patients with out-of-hospital ventricular fibrillation (VF) that exceeded 20 to 30% (1,2). Both of these communities used a classic deployment system for out-of-hospital CA that sent a three- to four-member firefighter crew as a neighborhood “first-responder” (FR) followed by a two- (or more) member paramedic ambulance crew. In cases of witnessed collapse in which the patient received immediate basic cardiopulmonary resuscitation (BCPR) by bystanders and presented to paramedics with VF, survival rates in these systems exceeded 40%. This finding was duplicated in several other communities, including the City of Houston Emergency Medical Services (EMS) system after a major restructuring in the 1980s (3).

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References

  1. Cobb LA, Alvarez H, Copass MK. A rapid response system for out-of-hospital cardiac emergencies. Med Clin North Am 1976; 60:283–290.

    PubMed  CAS  Google Scholar 

  2. McManus WF, Tresch DD, Darin JC. An effective prehospital emergency system. J Trauma 1977; 17: 304–310.

    PubMed  CAS  Google Scholar 

  3. Pepe PE, Mattox KL, Duke JH. Effect of full-time specialized physician supervision on the success of a large, urban emergency medical services system. Crit Care Med 1993; 21:1279–1286.

    PubMed  CAS  Google Scholar 

  4. Eisenberg M, Bergner L, Hallstrom A. Paramedic programs and out-of-hospital cardiac arrest: I factors associated with successful resuscitation. Am J Public Health 1979; 69:30–38.

    PubMed  CAS  Google Scholar 

  5. White RD, Vukov FL, Bugliosi TF. Early defibrillation by police: Initial experience with measurement of critical time intervals and patient outcome. Ann Emerg Med 1995; 23:1009–1013.

    Article  Google Scholar 

  6. Brown CG, Martin DR, Pepe PE, et al. A comparison of standard-dose and high dose epinephrine in cardiac arrest outside the hospital. The Multicenter High-Dose Epinephrine Study Group. N Engl J Med 1992; 327: 1051–1055.

    Article  PubMed  CAS  Google Scholar 

  7. Callaham M, Madsen CD, Barton CW, Saunders CE, Pointer J. A randomized clinical trial of high dose epinephrine and norepinephrine vs. standard-dose epinephrine in prehospital cardiac arrest. JAMA 1992; 268: 2667–2672.

    Article  PubMed  CAS  Google Scholar 

  8. Stiell IG, Hebert PC, Weitzman Bnea. A study of high-dose epinephrine in human CPR. N Engl J Med 1992; 237:1047–1050.

    Google Scholar 

  9. Caffrey SL, Willoughby PJ, Pepe PE, Becker LB. Public use of automated external defibrillators. N Engl J Med 2002; 347(16):1242–1247.

    Article  PubMed  Google Scholar 

  10. White RD. Early out-of-hospital experience with an impedance-compensating low-energy biphasic waveform automatic external defibrillator. J Interv Card Electrophysiol 1997; 1:203–208.

    Article  PubMed  CAS  Google Scholar 

  11. White RD, Hankins DG, Bugliosi TF. Seven years’ experience with early defibrillation by police paramedics in an emergency medical services system. Resuscitation 1998; 39:145–151.

    Article  PubMed  CAS  Google Scholar 

  12. Cummins RO, Ornato JP, Thies WH, Pepe PE. Improving survival from sudden cardiac arrest: the “chain of survival” concept. A statement for health professionals from the Advanced Cardiac Life Support Subcommittee and the Emergency Cardiac Care Committee, American Heart Association. Circulation 1991; 83:1832–1847.

    PubMed  CAS  Google Scholar 

  13. Lee SK, Vaaganes P, Safar P, Stezoski SW, Scanlon M. Effect of cardiac arrest time on cortical cerebral blood flow during subsequent standard external cardiopulmonary resuscitation in rabbits. Resuscitation 1989; 17: 105–117.

    Article  PubMed  CAS  Google Scholar 

  14. Pepe PE, Levine RL, Fromm RE, Curka PA, Clark PS, Zachariah BS. Cardiac arrest presenting with rhythms other than ventricular fibrillation: Contribution of resuscitation efforts toward total survivorship. Crit Care Med 1994; 21:1838–1843.

    Article  Google Scholar 

  15. Pepe PE. ACLS systems and training programs—do they make a difference? Respir Care 1995; 30: 427–433.

    Google Scholar 

  16. Stout J, Pepe PE, Mosesso VN Jr. All-advances life support vs. tiered-response ambulance systems. Prehosp Emerg Care 2000; 4:1–6.

    Article  PubMed  CAS  Google Scholar 

  17. Curka PA, Pepe PE, Ginger VF, Sherrard RD, Ivy MV, Zachariah BS. Emergency medical services priority dispatch. Ann Emerg Med 1993; 22:1688–1695.

    Article  PubMed  CAS  Google Scholar 

  18. Wik L, Hansen TB, Fylling F, et al. Delaying defibrillation to give basic cardiopulmonary resuscitation to patients with out-of-hospital ventricular fibrillation: a randomized trial. JAMA 2003; 289: 1389–1395.

    Article  PubMed  Google Scholar 

  19. Cobb LA, Fahrenbruch CE, Walsh TR, et al. Influence of cardiopulmonary resuscitation prior to defibrillation in patients with out-of-hospital ventricular fibrillation. JAMA 1999; 281:1182–1188.

    Article  PubMed  CAS  Google Scholar 

  20. Hallstrom A, Cobb L, Johnson E, Copass M. Cardiopulmonary resuscitation by chest compression alone or with mount-to-mouth ventilation. N Engl J Med 2000; 342:1546–1533.

    Article  PubMed  CAS  Google Scholar 

  21. Persse DE, Key CB, Bradley RN, Miller CC, Dhingra A. Cardiac arrest survival as a function of ambulance deployment strategy in a large urban emergency medical services system. Resuscitation 2003; 59: 97–104.

    Article  PubMed  Google Scholar 

  22. Stiell IG, Wells GA, Field B, et al. Advanced cardiac life support in out-of-hospital cardiac arrest. N Engl J Med 2004; 351:647–656.

    Article  PubMed  CAS  Google Scholar 

  23. Key CB, Pepe PE, Persse DE, Calderon D. Can first responders be sent to selected 9-1-1 emergency medical services calls without an ambulance? Acad Emerg Med 2003; 10:339–346.

    Article  PubMed  Google Scholar 

  24. Davis R. Six minutes to live or die.USA Today July 2003; 28-30, pp. A1–D7.

    Google Scholar 

  25. Sasser HC, Safar P, and the Brain Resuscitation Clinical Trial Study Group. Arterial hypertension after cardiac arrest is associated with good cerebral outcome in patients. Crit Car Med Suppl 1999; 27:A29.

    Article  Google Scholar 

  26. Wigginton JG, Pepe PE, Bedolla JP, DeTamble LA, Atkins JA. Sex-related differences in the presentation and outcome of out-of-hospital cardiopulmonary arrest: A multiyear, prospective population-based study. Crit Care Med 2002; 30(Suppl): S1–S6.

    Article  Google Scholar 

  27. Copass MK, Oreskovich MR, Bladergroen MR, Carrico CJ. Prehospital cardiopulmonary resuscitation of the critically injured patient. Am J Surgery 1984; 148:20–26.

    Article  CAS  Google Scholar 

  28. Durham LA, Richardson RJ, Wall MJ, Pepe PE, Mattox KL. Emergency center thoracotomy: impact of prehospital resuscitation. J Trauma 1992; 32:775–779.

    Article  PubMed  Google Scholar 

  29. Kudenchuk PJ, Cobb LA, Copass MK, et al. Amiodarone for resuscitation after out-of-hospital cardiac arrest due to ventricular fibrillation. N Engl J Med 1999; 341:871–878.

    Article  PubMed  CAS  Google Scholar 

  30. Dorian P, Cass D, Schwartz B, Cooper R, Gelaznikas R, Barr A. Amiodarone as compared with lidocaine for shock-resistant ventricular fibrillation. N Engl J Med 2002; 346:884–890.

    Article  PubMed  CAS  Google Scholar 

  31. Roppolo LP, Wigginton JA, Pepe PE. Emergency ventilatory management as a detrimental factor in resuscitation practices and clinical research efforts. In: Vincent J-L, ed. 2004 Yearbook of Intensive Care and Emergency Medicine. Berlin: Springer; 2004:139–151.

    Google Scholar 

  32. Aufderheide TP, Sigurdsson G, Pirrallo RG, et al. Hyperventilation-induced hypotension during cardiopulmonary resuscitation. Circulation 2004; 109:1960–1965.

    Article  PubMed  Google Scholar 

  33. Pepe PE, Raedler C, Lurie K, Wigginton JG. Emergency ventilatory management in hemorrhagic states: elemental or detrimental? J Trauma 2003; 54:1048–1057.

    PubMed  Google Scholar 

  34. Yu T, Weil MH, Tang W, et al. Adverse outcomes of interrupted precordial compression during automated defibrillation. Circulation 2002; 106(3):368–372.

    Article  PubMed  Google Scholar 

  35. Koster RW. Limiting ‘hands-off’ periods during resuscitation. Resuscitation 2003; 58(3):275–276.

    Article  PubMed  Google Scholar 

  36. Eftestol T, Sunde K, Steen PA. Effects of interrupting precordial compressions on the calculated probability of defibrillation success during out-of-hospital cardiac arrest. Circulation 2002; 105(19): 2270–2273.

    Article  PubMed  Google Scholar 

  37. Berg RA, Sanders AB, Kern KB, Hilwig RW, Heidenreich JW, Porter ME, Ewy GA. Adverse hemodynamic effects of interrupting chest compressions for rescue breathing during cardiopulmonary resuscitation for ventricular fibrillation cardiac arrest. Circulation 2001; 104:2465–70.

    Article  PubMed  CAS  Google Scholar 

  38. Niemann JT, Stratton SJ, Cruz B, et al. Outcome of out-of-hospital postcountershock asystole and pulseless electrical activity versus primary asystole and pulseless electrical activity. Crit Care Med 2001; 29: 2366–2370.

    Article  PubMed  CAS  Google Scholar 

  39. Niemann J, Cairns C, Sharma J, Lewis R. Treatment of prolonged ventricular fibrillation. Immediate countershock versus high-dose epinephrine and CPR preceding countershock. Circulation 1992; 85(1): 281–287.

    PubMed  CAS  Google Scholar 

  40. Pepe PE, Fowler R, Roppolo L, Wigginton J. Re-appraising the concept of immediate defibrillatory attempts for out-of-hospital ventricular fibrillation. Crit Care 2004; 8:41–45.

    Article  PubMed  Google Scholar 

  41. Menegazzi J, Seaberg D, Yealy D, Davis E, MacLeod B. Combination pharmacotherapy with delayed countershock vs. standard advanced cardiac life support after prolonged ventricular fibrillation. Prehosp Emerg Care 2000; 4(1):31–37.

    Article  PubMed  CAS  Google Scholar 

  42. Strohmenger HU, Lindner KJ, Keller A, Lindner IM, Pfenninger EG. Spectral analysis of ventricular fibrillation and closed-chest cardiopulmonary resuscitation. Resuscitation 1996; 33:155–161.

    Article  PubMed  CAS  Google Scholar 

  43. Strohmenger HU, Lindner KJ, Brown CG. Analysis of the ventricular fibrillation ECG signal amplitude and frequency parameters as predictors of counter shock success in humans. Chest 1997; 111:584–589.

    PubMed  CAS  Google Scholar 

  44. Strohmenger JU, Lindner KH, Keller A. Lindner IM, Pfenninger E, Bothner U. Effects of graded doses of vasopressin on median fibrillation frequency in a porcine model of cardiopulmonary resuscitation: Results of a prospective, randomized, controlled trial. Crit Care Med 1996; 24:1360–1365.

    Article  PubMed  CAS  Google Scholar 

  45. Angelos MG, Menegazzi JJ, Callaway CW. Bench to bedside: Resuscitation from prolonged ventricular fibrillation. Acad Emerg Med 2001; 8(9):909–924.

    PubMed  CAS  Google Scholar 

  46. Babbs CF, Nadkarni V. Optimizing chest compression to rescue ventilation ratios during one-rescuer CPR by professionals and lay persons: children are not just little adults. Resuscitation 2004; 61(2): 173–181.

    Article  PubMed  Google Scholar 

  47. Wenzel V, Krismer AC, Arntz HR, et al. A comparison of vasopressin and epinephrine for out-of-hospital cardiopulmonary resuscitation. N Engl J Med 2004; 350(2):105–113.

    Article  PubMed  CAS  Google Scholar 

  48. Benitez FL, Pepe PE. On-scene supervision. EMS Medical Director’s Handbook. Kuehl E. ed. St. Louis,MO: Mosby, 2002, pp. 330–339.

    Google Scholar 

  49. Pepe PE. Out-of-hospital resuscitation research: Rationale and strategies for controlled clinical trials. Ann Emerg Med 1993; 22:17–23.

    Article  PubMed  CAS  Google Scholar 

  50. Pepe PE, Swor RA, Ornato JP, et al. Resuscitation in the out-of-hospital setting: medical futility criteria for on-scene pronouncement of death. Prehosp Emerg Care 2001; 5:79–87.

    Article  PubMed  CAS  Google Scholar 

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Author information

Authors and Affiliations

  1. Emergency Medicine, Internal Medicine, Surgery and Public Health, University of Texas Southwestern Medical Center, Dallas, TX

    Paul E. Pepe MD, FACEP, FACP, FCCM

  2. The Parkland Health and Hospital System; Dispatch Operations, Dallas, TX

    Paul E. Pepe MD, FACEP, FACP, FCCM & Lynn P. Roppolo MD

  3. Dallas Metropolitan BioTel (EMS) System, Dallas, TX

    Paul E. Pepe MD, FACEP, FACP, FCCM

  4. Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, TX

    Lynn P. Roppolo MD

  5. Department of Medicine (Cardiology), University of Washington School of Medicine, Seattle, WA

    Leonard A. Cobb MD, FACP

  6. Medic One Support Group, Harborview Medical Center, Seattle, WA

    Leonard A. Cobb MD, FACP

Authors
  1. Paul E. Pepe MD, FACEP, FACP, FCCM
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  2. Lynn P. Roppolo MD
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  3. Leonard A. Cobb MD, FACP
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Editor information

Editors and Affiliations

  1. Department of Emergency Medicine, Virginia Commonwealth University Health System, Richmond, VA

    Joseph P. Ornato MD, FACP, FACC, FACEP  & Mary Ann Peberdy MD, FACC  & 

  2. Department of Internal Medicine (Cardiology), Virginia Commonwealth University Health System, Richmond, VA

    Joseph P. Ornato MD, FACP, FACC, FACEP  & Mary Ann Peberdy MD, FACC  & 

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© 2005 Humana Press Inc., Totowa, NJ

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Pepe, P.E., Roppolo, L.P., Cobb, L.A. (2005). Successful Systems for Out-of-Hospital Resuscitation. In: Ornato, J.P., Peberdy, M.A. (eds) Cardiopulmonary Resuscitation. Contemporary Cardiology. Humana Press. https://doi.org/10.1385/1-59259-814-5:649

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  • DOI: https://doi.org/10.1385/1-59259-814-5:649

  • Publisher Name: Humana Press

  • Print ISBN: 978-1-58829-283-4

  • Online ISBN: 978-1-59259-814-4

  • eBook Packages: MedicineMedicine (R0)

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