This supplement was developed to present the proceedings and recommendations from the International State of the Future of Resuscitation Conference held in September 2018 in Oakland, California.
Together, the authors share a common passion to help improve outcomes after cardiac arrest. Collectively, we established a program in 2015 called Take Heart America: A sudden cardiac arrest initiative that focuses on best practices and successful “bundles of care,” therapeutic interventions proven to improve out-of-hospital cardiac arrest (OHCA) resuscitations. Most importantly, care that results in patients leaving the hospital neurologically intact.
The conference was offered by Take Heart America in collaboration with:
- Alameda County, California;
- Dutch Resuscitation Council;
- Consortium of Metropolitan EMS Directors (the “Eagles” Coalition);
- French Resuscitation Council;
- Minnesota Resuscitation Consortium; and
- JEMS (Journal of Emergency Medical Services).
Experts from around the world, who are now part of a new International Resuscitation Collaborative, discussed a wide range of topics related to advances in resuscitation science and clinical practice.
The goal was to discuss ways to combine the best evidence and experience from the innovative work of the participants to optimize the systems-of-care approach to cardiac arrest.
The International Resuscitation Collaborative identified six areas within an optimal bundle of OHCA care where new interventions have been developed and have been shown to synergistically improve neurologically favorable survival rates.
These areas are:
- Improved methods to enhance community response or “citizen activation,” so that CPR and defibrillation are provided more rapidly by lay rescuers after cardiac arrest;
- Improved CPR hemodynamics with technologies that provide significantly greater cerebral and coronary blood flow, and lower intracranial pressure compared with traditional manual CPR;
- Methods and technologies that provide greater circulation and hemodynamic stability in patients with refractory ventricular fibrillation (v fib), buying time for more definitive treatments;
- Improved ways to reduce reperfusion injury;
- Better diagnostic and therapeutic approaches for cerebral monitoring and neuroprognostication to optimize post-resuscitation care; and
- Predictive analytics to enhance in-hospital triage and prevent occurrence of in-hospital cardiac arrest.
This supplement will provide you with the most up-to-date science and technology, including expert opinions and the latest preclinical and clinical evidence that can be used today and in the future to optimize outcomes after cardiac arrest.
Cardiac arrest is a disease state that’s still a leading cause of death around the world and one that has touched many of us personally. What’s striking is that average national survival rates have barely increased at all over the last 30 years across this country and around the world.
National and international survival rates with good brain function after a cardiac arrest remain around 7%. However, if you have a cardiac arrest today in many places, such as Alameda County, Calif., and are treated with all the new technology that Mike Jacobs, Karl Sporer, MD, James Pointer, MD, and others have introduced over the last 20 years, you would have an overall chance of survival—regardless of your first rhythm—of > 30%, and upwards of 60% for a v fib rhythm.
So, we know that the concept of a bundle of cardiac arrest care can and does work well. We also know, and do not accept that, when these technologies aren’t used all together, survival rates are at a national average of around 7%.
The bundle of care approach is now used effectively for cardiac arrest resuscitation in Alameda County and Rialto, California; Henry County, Georgia; Palm Beach County, Florida; Anchorage, Alaska; Lucas County, Ohio; Amsterdam, the Netherlands; Paris, France; and widely throughout the Twin Cities of Minneapolis and St. Paul, Minnesota.
You’ll find that this supplement’s content focuses on the current science and recommendations for resuscitative practices for cardiac arrest patients in areas such as the systematic approach to resuscitation using rapid response; mechanical chest compression and impedance threshold devices in the field, as well as in the hospital; high-quality, uninterrupted and controlled, sequential elevation of the head and torso during CPR; REBOA (for traumatic cardiac arrest) and ECMO for refractory v fib cases.
Over the past four decades, many complex disease states have been treated with a bundle of care. It’s critical to understand that although each element of the bundle of care by itself may not be effective in complex disease states, when used together they’re often lifesaving.