Skip to main content
SpringerLink
Log in

Improving the Local Chain-of-Survival to Improve Survival After Out-of-Hospital Cardiac Arrest

  • Chapter
Annual Update in Intensive Care and Emergency Medicine 2013

Part of the book series: Annual Update in Intensive Care and Emergency Medicine ((AUICEM))

  • 2696 Accesses

Abstract

Approximately 275,000 Europeans every year suffer from out-of-hospital cardiac arrest (OHCA) and are treated by the local Emergency Medical Systems (EMS) [1, 2]. Despite evolving evidence based guidelines for cardiopulmonary resuscitation (CPR), survival rates after OHCA have not improved much in the majority of places around the world. However, there is a huge variety in worldwide survival, with some cities having survival rates greater than 20–30 % and some with just a few percent survival [1, 2]. These significant survival differences can partly be explained by different definitions of OHCA [2], but are mainly due to overall quality within the local chain-of-survival [3] (Fig. 1, upper left panel): Early arrest recognition and call for help, early CPR, early defibrillation, and early postresuscitation care. Whereas CPR and defibrillation have received the most attention and been the major research areas over the present three decades, postresuscitation care has received more focus just in the last 10 years.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 139.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 179.00
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. Atwood C, Eisenberg MS, Herlitz J, Rea TD (2005) Incidence of EMS-treated out-of-hospital cardiac arrest in Europe. Resuscitation 67:75–80

    Article  PubMed  Google Scholar 

  2. Berdowski J, Berg RA, Tijssen JG, Koster RW (2010) Global incidences of out-of-hospital cardiac arrest and survival rates: Systematic review of 67 prospective studies. Resuscitation 81:1479–1487

    Article  PubMed  Google Scholar 

  3. Cummins RO, Ornato JP, Thies WH, Pepe PE (1991) 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 83:1832–1847

    Article  PubMed  CAS  Google Scholar 

  4. Jacobs I, Nadkarni V, Bahr J et al (2004) Cardiac arrest and cardiopulmonary resuscitation outcome reports: update and simplification of the Utstein templates for resuscitation registries: a statement for healthcare professionals from a task force of the International Liaison Committee on Resuscitation (American Heart Association, European Resuscitation Council, Australian Resuscitation Council, New Zealand Resuscitation Council, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Councils of Southern Africa). Circulation 110:3385–3397

    Article  PubMed  Google Scholar 

  5. Abella BS, Alvarado JP, Myklebust H et al (2005) Quality of cardiopulmonary resuscitation during in-hospital cardiac arrest. JAMA 293:305–310

    Article  PubMed  CAS  Google Scholar 

  6. Wik L, Kramer-Johansen J, Myklebust H et al (2005) Quality of cardiopulmonary resuscitation during out-of-hospital cardiac arrest. JAMA 293:299–304

    Article  PubMed  CAS  Google Scholar 

  7. Berdowski J, Schmohl A, Tijssen JG, Koster RW (2009) Time needed for a regional emergency medical system to implement resuscitation Guidelines 2005-The Netherlands experience. Resuscitation 80:1336–1341

    Article  PubMed  Google Scholar 

  8. Chamberlain DA, Hazinski MF (2003) Education in resuscitation. Resuscitation 59:11–43

    Article  PubMed  Google Scholar 

  9. Castrén M (2008) Pre-hospital airway management – time to provide the same standard of care as in the hospital. Acta Anaesthesiol Scand 52:877–878

    Article  PubMed  Google Scholar 

  10. Weinert CR, Mann HJ (2008) The science of implementation: changing the practice of critical care. Curr Opin Crit Care 14:460–465

    Article  PubMed  Google Scholar 

  11. Neumar RW, Barnhart JM, Berg RA et al (2011) Implementation strategies for improving survival after out-of-hospital cardiac arrest in the United States: consensus recommendations from the 2009 American Heart Association Cardiac Arrest Survival Summit. Circulation 123:2898–2910

    Article  PubMed  Google Scholar 

  12. Lund I, Skulberg A (1976) Cardiopulmonary resuscitation by lay people. Lancet 2:702–704

    Article  PubMed  CAS  Google Scholar 

  13. Sunde K, Eftestol T, Askenberg C, Steen PA (1999) Quality assessment of defibrillation and advanced life support using data from the medical control module of the defibrillator. Resuscitation 41:237–247

    Article  PubMed  CAS  Google Scholar 

  14. Naess AC, Steen PA (2004) Long term survival and costs per life year gained after out-of-hospital cardiac arrest. Resuscitation 60:57–64

    Article  PubMed  Google Scholar 

  15. Lund-Kordahl I, Olasveengen TM, Lorem T, Samdal M, Wik L, Sunde K (2010) Improving outcome after out-of-hospital cardiac arrest by strengthening weak links of the local Chain of Survival; quality of advanced life support and post-resuscitation care. Resuscitation 81:422–426

    Article  PubMed  Google Scholar 

  16. Advanced Life Support Working Party of the European Resuscitation Council (1992) Guidelines for advanced life support. Resuscitation 24:111–121

    Article  Google Scholar 

  17. Anonymous (2000) Guidelines for cardiopulmonary resuscitation and emergency cardiovascular care – An international consensus on science. Resuscitation 46:3–437

    Article  Google Scholar 

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

    Article  PubMed  Google Scholar 

  19. Engdahl J, Abrahamsson P, Bång A, Lindqvist J, Karlsson T, Herlitz J (2000) Is hospital care of major importance for outcome after out-of-hospital cardiac arrest? Experience acquired from patients with out-of-hospital cardiac arrest resuscitated by the same Emergency Medical Service and admitted to one of two hospitals over a 16-year period in the municipality of Göteborg. Resuscitation 43:201–211

    Article  PubMed  CAS  Google Scholar 

  20. The Hypothermia After Cardiac Arrest (HACA) study group (2002) Mild TH to improve the neurologic outcome after cardiac arrest. N Engl J Med 346:549–556

    Article  Google Scholar 

  21. Bernard SA, Gray TW, Buist MD et al (2002) Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. N Engl J Med 346:557–563

    Article  PubMed  Google Scholar 

  22. Langhelle A, Tyvold SS, Lexow K, Hapnes S, Sunde K, Steen PA (2003) In-hospital factors associated with improved outcome after out-of-hospital cardiac arrest. A comparison between four regions in Norway. Resuscitation 56:247–263

    Article  PubMed  CAS  Google Scholar 

  23. Herlitz J, Engdahl J, Svensson L, Angquist KA, Silfverstolpe J, Holmberg S (2006) Major differences in 1-month survival between hospitals in Sweden among initial survivors of out-of-hospital cardiac arrest. Resuscitation 70:404–409

    Article  PubMed  CAS  Google Scholar 

  24. Carr BG, Kahn JM, Merchant RM, Kramer AA, Neumar RW (2009) Inter-hospital variability in post-cardiac arrest mortality. Resuscitation 80:30–34

    Article  PubMed  Google Scholar 

  25. Kajino K, Iwami T, Daya M et al (2010) Impact of transport to critical care medical centers on outcomes after out-of-hospital cardiac arrest. Resuscitation 81:549–554

    Article  PubMed  Google Scholar 

  26. Wnent J, Seewald S, Heringlake M et al (2012) Choice of hospital after out-of-hospital cardiac arrest - a decision with far reaching consequences - a study in a large German city. Crit Care 16:R164

    Article  PubMed  Google Scholar 

  27. Sunde K, Pytte M, Jacobsen D et al (2007) Implementation of a standardised treatment protocol for post resuscitation care after out-of-hospital cardiac arrest. Resuscitation 73:29–39

    Article  PubMed  Google Scholar 

  28. Tømte O, Andersen GØ, Jacobsen D, Drægni T, Auestad B, Sunde K (2011) Strong and weak aspects of an established post-resuscitation treatment protocol-A five-year observational study. Resuscitation 82:1186–1193

    Article  PubMed  Google Scholar 

  29. Olasveengen TM, Wik L, Kramer-Johansen J, Sunde K, Pytte M, Steen PA (2007) Is CPR quality improving? A retrospective study of out-of-hospital cardiac arrest. Resuscitation 75:260–266

    Article  PubMed  Google Scholar 

  30. Olasveengen TM, Vik E, Kuzovlev A, Sunde K (2009) Effect of implementation of new resuscitation guidelines on quality of cardiopulmonary resuscitation and survival. Resuscitation 80:407–411

    Article  PubMed  Google Scholar 

  31. Stiell IG, Wells GA, Field B et al (2004) Advanced Cardiac Life Support in Out-of-Hospital Cardiac Arrest. N Engl J Med 351:647–656

    Article  PubMed  CAS  Google Scholar 

  32. Olasveengen TM, Sunde K, Brunborg C, Thowsen J, Steen PA, Wik L (2009) Intravenous drug administration during out-of-hospital cardiac arrest: a randomized trial. JAMA 302:2222–2229

    Article  PubMed  Google Scholar 

  33. Deakin CD, Nolan JP, Soar J et al (2011) European Resuscitation Council Guidelines for Resuscitation 2010 Section 4. Adult advanced life support Resuscitation 81:1305–1352

    Google Scholar 

  34. Nolan JP, Lyon RM, Sasson C et al (2012) Advances in the hospital management of patients following an out of hospital cardiac arrest. Heart 98:1201–1206

    Article  PubMed  Google Scholar 

  35. Becker L, Gold LS, Eisenberg M, White L, Hearne T, Rea T (2008) Ventricular fibrillation in King County, Washington: A 30-year perspective. Resuscitation 79:22–27

    Article  PubMed  Google Scholar 

  36. Iwami T, Nichol G, Hiraide A et al (2009) Continuous improvements in “chain of survival” increased survival after out-of-hospital cardiac arrests: a large-scale population-based study. Circulation 119:728–734

    Article  PubMed  Google Scholar 

  37. Møller Nielsen A, Lou Isbye D, Knudsen Lippert F, Rasmussen LS (2012) Engaging a whole community in resuscitation. Resuscitation 83:1067–1071

    Article  PubMed  Google Scholar 

  38. Lick CJ, Aufderheide TP, Niskanen RA et al (2011) Take Heart America: A comprehensive, community-wide, systems-based approach to the treatment of cardiac arrest. Crit Care Med 39:26–33

    Article  PubMed  Google Scholar 

  39. Lindner TW, Søreide E, Nilsen OB, Torunn MW, Lossius HM (2011) Good outcome in every fourth resuscitation attempt is achievable–an Utstein template report from the Stavanger region. Resuscitation 82:1508–1513

    Google Scholar 

  40. Nichol G, Thomas E, Callaway CW et al (2008) Regional variation in out-of-hospital cardiac arrest incidence and outcome. JAMA 300:1423–1431

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Surgical Intensive Care Unit Ullevål, Department of Anesthesiology, Division of Emergencies and Critical Care, Oslo University Hospital, 0407, Oslo, Norway

    K. Sunde

Authors
  1. K. Sunde
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to K. Sunde .

Editor information

Editors and Affiliations

  1. Erasme Hospital, Université libre de Bruxelles, Brussels, Belgium

    Jean-Louis Vincent Prof.

Rights and permissions

Reprints and permissions

Copyright information

© 2013 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Sunde, K. (2013). Improving the Local Chain-of-Survival to Improve Survival After Out-of-Hospital Cardiac Arrest. In: Vincent, JL. (eds) Annual Update in Intensive Care and Emergency Medicine 2013. Annual Update in Intensive Care and Emergency Medicine. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-35109-9_24

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-35109-9_24

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-35108-2

  • Online ISBN: 978-3-642-35109-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation