Future Prospects in Out-of-hospital Cardiac Arrest Management

Authors

  • Guillaume Debaty 1. SAMU CHU Grenoble - Alpes, Boulevard de la Chantourne, 38700 La Tronche. 2. Laboratoire CNRS TIMC-IMAG, UMR 5525, CHU Grenoble – Alpes
  • Hélène Duhem 1. Service Urgences-SAMU CHU Grenoble - Alpes, Boulevard de la Chantourne, 38700. La Tronche. 2. Laboratoire CNRS TIMC-IMAG, UMR 5525, CHU Grenoble – Alpes. https://orcid.org/0000-0001-5272-5992
  • Damien Viglino 1. Service Urgences-SAMU CHU Grenoble - Alpes, Boulevard de la Chantourne, 38700 La Tronche. 2. INSERM U1042, Laboratoire HP2, CHU Grenoble – Alpes https://orcid.org/0000-0003-0622-7399

DOI:

https://doi.org/10.37051/mir-00087

Keywords:

Heart Arrest, Out-of-Hospital Cardiac Arrest, Cardiopulmonary Resuscitation, Advanced Cardiac Life Support

Abstract

Despite numerous advances in the management of out-of-hospital cardiac arrest (OHCA), survival with good neurological outcome did not improve significantly in the last years. The latest improvements and innovations from diagnosis to return of spontaneous circulation are discussed in this review. Education of the general population to life-saving techniques is mandatory in order to reduce the no-flow period. Sharpened education to cardiac arrest identification by dispatch centers and the use of mobile-phone applications dispatching nearby citizen to perform chest compressions also seem to be interesting leads. The systematic indexing of automated external defibrillators and drone-mediated on-scene delivery might reduce time-to-defibrillation. Cardiopulmonary resuscitation (CPR) aims to improve perfusion of major organs while reducing ischemia reperfusion injuries. Pre-hospital implementation of innovating medical responses such as resuscitative endovascular balloon occlusion of the aorta and extracorporeal circulation are currently being explored. The head and thorax elevation during CPR has also shown some promising results on experimental animal studies, but need to be confirmed by clinical studies. The question of optimal ventilation techniques is still under debate and invasive ventilation struggles to prove its superiority in the pre-hospital setting. Many current research studies are reconsidering the use of historical treatments of OHCA, such as epinephrine or amiodarone. Finally, the growing concern for good neurological outcome displayed by recent major clinical studies reflects the newly emphasized critical issue of neuroprotection during cardiac arrest.

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Published

2021-11-30

How to Cite

Debaty, G., Duhem, H., & Viglino, D. (2021). Future Prospects in Out-of-hospital Cardiac Arrest Management. Médecine Intensive Réanimation, 30(4), 297-310. https://doi.org/10.37051/mir-00087

Issue

Section

Original article

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