Key components of a community response to out-of-hospital cardiac arrest

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Abstract

Out-of-hospital cardiac arrest (OHCA) remains a leading cause of death worldwide, with substantial geographical, ethnic and socioeconomic disparities in outcome. Successful resuscitation efforts depend on the ‘chain of survival’, which includes immediate recognition of cardiac arrest and activation of the emergency response system, early bystander cardiopulmonary resuscitation (CPR) with an emphasis on chest compressions, rapid defibrillation, basic and advanced emergency medical services and integrated post-cardiac arrest care. Well-orchestrated telecommunicator CPR programmes can improve rates of bystander CPR — a critical link in the chain of survival. High-performance CPR by emergency medical service providers includes minimizing interruptions in chest compressions and ensuring adequate depth of compressions. Developing local, regional and statewide systems with dedicated high-performing cardiac resuscitation centres for post-resuscitation care can substantially improve survival after OHCA. Innovative digital tools for recognizing cardiac arrest where and when it occurs, notifying potential citizen rescuers and providing automated external defibrillators at the scene hold the promise of improving survival after OHCA. Improved implementation of the chain of survival can save thousands of lives each year.

Key points

  • Out-of-hospital cardiac arrest (OHCA) remains a major public health problem with substantial socioeconomic and ethnic disparities in outcome.

  • Improved implementation of the ‘chain of survival’, including immediate recognition of cardiac arrest and activation of the emergency response system, early high-quality cardiopulmonary resuscitation (CPR) and integrated post-cardiac arrest care, can save thousands of lives each year.

  • Well-orchestrated telecommunicator CPR programmes can substantially increase rates of bystander CPR, which can lead to higher overall survival after OHCA.

  • High-performance CPR by emergency medical service providers relies on minimizing interruptions in chest compressions and ensuring adequate depth of compressions.

  • Implementing local, regional and statewide systems with dedicated cardiac resuscitation centres for post-resuscitation care can substantially improve survival after OHCA.

  • Exciting, innovative technologies for recognizing cardiac arrest where and when it occurs, notifying potential citizen rescuers and providing automated external defibrillators at the scene are promising.

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Fig. 1: Out-of-hospital chain of survival.

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Acknowledgements

D.D.B. is supported by a T32 postdoctoral training grant from the National Heart, Lung, and Blood Institute (T32 HL007604).

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Nature Reviews Cardiology thanks J. Soar and other anonymous reviewer(s) for their contribution to the peer review of this work.

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Correspondence to Robert A. Berg.

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Berg, D.D., Bobrow, B.J. & Berg, R.A. Key components of a community response to out-of-hospital cardiac arrest. Nat Rev Cardiol 16, 407–416 (2019) doi:10.1038/s41569-019-0175-4

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