Volume 73 Number 1 January 2006	back to contents

1Department of Emergency Medicine, Mount Sinai School of Medicine, New York, NY; and 2Clinical Trial Center, University of Washington, Seattle, WA.

Address all correspondence to Lynne D. Richardson, M.D., F.A.C.E.P., Department of Emergency Medicine, Box 1620, Mount Sinai School of Medicine, One Gustave L. Levy Place, New York, NY 10029; lynne.richardson@mssm.edu

Accepted for publication August 2005.

ABSTRACT

Out-of-hospital cardiac arrest (OOH-CA) is a leading cause of mortality and the focus of significant research. Recent studies provide new evidence that may change our management of OOH-CA and improve outcomes.

The findings of two recently published studies of OOH-CA are reviewed in this article. The first, the Public Access Defibrillation Trial, was a randomized, controlled trial of public access defibrillation in 993 community facilities in the U.S. and Canada . It demonstrated that a community strategy to train laypersons to respond to cardiac arrests significantly increased survival to hospital discharge following OOH-CA in nonresidential community units with community members trained and equipped to provide public access defibrillation, compared to community units with community members trained to provide cardiopulmonary resuscitation (CPR) without any capacity for defibrillation. The second, the European Resuscitation Council Vasopressor during Cardiopulmonary Resuscitation Study, was a randomized, controlled, double-blinded trial that compared vasopressin to epinephrine as the initial pharmacological therapy for 1,219 patients who sustained OOH-CA. The study demonstrated that vasopressin is similar to epinephrine for OOH-CA due to ventricular fibrillation or pulseless electrical activity, and superior to epinephrine for the initial treatment of asystolic arrest; it also demonstrated that the combination of vasopressin and epinephrine is superior to epinephrine alone in the treatment of refractory, out-of-hospital cardiac arrest. Studies on alternative CPR techniques and adjunctive devices for CPR were also reviewed.

We conclude that pre-hospital access to defibrillators and the use of vasopressin in the management of asystole hold promise for improving survival for patients with out-of-hospital cardiac arrest.

KEYWORDS

Cardiac arrest, out-of-hospital cardiac arrest, defibrillation, public access defibrillation, cardiopulmonary resuscitation, alternative cardiopulmonary resuscitation, interposed abdominal compression cardiopulmonary resuscitation, active compression-decompression cardiopulmonary resuscitation.

MSSM Home

Back Issues | Indexes | Search | Journal Home