Therapeutic hypothermia and coronary angiography are mandatory after out-of-hospital cardiac arrest: No

Excerpt

Sudden out-of-hospital cardiac arrest is a major health problem throughout the world and in spite of increased awareness in society and improved pre-hospital and hospital care, overall survival remains around 10 % [1, 2]. An impressive effort to create a prospective population-based registry covering all out-of-hospital cardiac arrest patients in greater Paris was made and the results from the first 2 years are published in this issue of the journal [3]. The high quality registry study excluded cardiac arrest of obvious non-cardiac aetiology resulting in 3,816 patients in whom a resuscitation attempt was made, which translates into a yearly incidence of 0.6 ‰ per inhabitant, similar to what has previously been reported [4]. Admission rate to hospital was impressively high, 35 %, while 8 % were discharged alive. The size and quality of this registry make it unique, including the systematic collection of pre-hospital and in-hospital background and treatment data. A retrospective control was performed in a sample of intensive care units (ICUs) indicating that an outstanding 99 % of all cardiac arrest patients admitted alive were identified during the study period [3], which is notably higher than in previous reports [5]. It is encouraging that the pre-hospital factors strongly associated with survival to discharge remain the same as earlier identified—initial shockable rhythm, younger age, bystander CPR and cardiac arrest in a public place—suggesting ways to improve pre-hospital performance by educating more lay people, deployment of defibrillators and by engaging fire-fighters, police, taxi drivers etc. …