Emergency procedures

Sudden Cardiac Arrest

It is well documented that the chances of survival following a sudden cardiac arrest are minimal (Herlitz, et al., 2003; Ramaswammy and Page, 2003; Valenzuela, 2003). In Europe cardiovascular disease accounts for around 40% of all deaths under the age of 75 years. One third of patients with coronary artery disease die before they reach hospital (Evans, 1998; Resuscitation Council UK, 2000). In most of these deaths the presenting rhythm is ventricular fibrillation (VF) or pulseless ventricular tachycardia, both potentially reversible by defibrillation. In the USA there are 450000 unexpected cardiac arrests each year, 25% of which occur in public places (Caffrey, et al., 2002).

The 'Chain of Survival' is a well-documented model for effective cardiopulmonary resuscitation for the past decade (Cummins, et al., 1991; Evans, 1998). It is acknowledged as the 'gold standard' of resuscitation practice. It sets out four components required to achieve survival following cardiac arrest: early access to help, early basic life support (BLS), early defibrillation and early advanced life support.

Given that rapid defibrillation is considered the only treatment for VF, all health care professionals, especially those working in the CR setting, should be trained in the use of automated defibrillators (AED). This is now particularly pertinent to the increasing numbers of programmes held in a community setting, where a 999 ambulance would be the first emergency responder. There have also been developments in public access to defibrillation equipment, largely based on a recent study conducted in Chicago airports (Caffrey, et al., 2002). With ambulance response times of 8 to 15 minutes, they identified average percentage of survival without an AED present of only 5 to 10%. However, with an AED available, and administered within five minutes, long-term survival increased to 67%. With each minute of delay before attempted defibrillation, the chance of a successful outcome reduces by 7-10% (American Heart Association, 1998; Evans, 1998).

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