Survival after cardiac arrest depends on early recognition and call for help, early cardiopulmonary resuscitation, early defibrillation and advanced life support and post-resuscitation care. This sequence of events is often referred to as the ‘chain of survival’. Although advanced life support is an essential part of the ‘chain of survival’, it has never been proven to improve outcome. On the other hand, early access to emergency medical care, early bystander cardiopulmonary resuscitation (CPR) and early defibrillation are clearly associated with better survival to hospital discharge [
]. Furthermore, tailored post-resuscitation care seems of utmost importance: resuscitative therapeutic hypothermia, for instance, improves survival and neurological outcome [
- Stiel I.A.
- Wells G.A.
- Field B.
- Spaite D.W.
- Nesbitt L.P.
- De Maio V.J.
- et al.
Advanced cardiac life support in out-of-hospital cardiac arrest.
N Engl J Med. 2004; 351: 647-656
- The hypothermia after cardiac arrest study group
Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest.
N Engl Med. 2002; 346: 546-549
3]. Despite such advantages, however, outcome after out-of-hospital cardiac arrest remains very poor. Even when only ventricular fibrillation (VF) is considered, survival rates after hospital discharge range from 3 to 33% [
- Bernard S.A.
- Gray T.W.
- Buist M.D.
- Jones B.M.
- Silvester W.
- Gutteridge G.
- et al.
Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia.
N Engl J Med. 2002; 346: 557-563
]. Reported survival rates to hospital discharge after in-hospital cardiac arrest varies from 0–42%, the most common range being between 15 and 20% [
- Bunch T.J.
- White R.D.
- Gersh B.J.
- Meverden R.A.
- Hodge D.O.
- Ballman K.V.
- et al.
Long-term outcomes of out-of-hospital cardiac arrest after successful early defibrillation.
N Engl J Med. 2003; 348: 2626-2633
- Sandroni C.
- Nolan J.
- Cavallaro F.
- Antonelli M.
In-hospital cardiac arrest: incidence, prognosis and possible measures to improve survival.
Intensive Care Med. 2007; 33: 237-245
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- Advanced cardiac life support in out-of-hospital cardiac arrest.N Engl J Med. 2004; 351: 647-656
- Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest.N Engl Med. 2002; 346: 546-549
- Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia.N Engl J Med. 2002; 346: 557-563
- Long-term outcomes of out-of-hospital cardiac arrest after successful early defibrillation.N Engl J Med. 2003; 348: 2626-2633
- In-hospital cardiac arrest: incidence, prognosis and possible measures to improve survival.Intensive Care Med. 2007; 33: 237-245
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Published online: April 30, 2008
Accepted: March 11, 2008
Received: March 9, 2008
© 2008 European Federation of Internal Medicine. Published by Elsevier Inc. All rights reserved.