Advanced Cardiac Life Support in Out-of-Hospital Cardiac Arrest

• Published in: The New England journal of medicine Vol. 351; no. 7; pp. 647 - 656
• Main Authors: Stiell, Ian G, Wells, George A, Field, Brian, Spaite, Daniel W, Nesbitt, Lisa P, De Maio, Valerie J, Nichol, Graham, Cousineau, Donna, Blackburn, Josée, Munkley, Doug, Luinstra-Toohey, Lorraine, Campeau, Tony, Dagnone, Eugene, Lyver, Marion
• Format: Journal Article
• Language: English
• Published: Boston, MA Massachusetts Medical Society 12.08.2004
• Subjects: Adolescent; Adult; Advanced Cardiac Life Support; Aged; Airway management; Biological and medical sciences; Cardiac arrest; Cardiopulmonary resuscitation; Community; CPR; Defibrillators; Electric Countershock; Emergency medical care; Emergency Medical Services; Female; General aspects; Heart Arrest - mortality; Heart Arrest - therapy; Heart attacks; Hospitalization; Humans; Logistic Models; Male; Medical sciences; Middle Aged; Multivariate Analysis; Odds Ratio; Ontario; Outcome Assessment (Health Care); Survival Rate; Urban Health Services; Ontario; Heart; Medicine; Support; Out of hospital; Advanced stage; Hospital; Public health
• ISSN: 0028-4793; 1533-4406
• DOI: 10.1056/NEJMoa040325

Rapid defibrillation is the key intervention known to improve the outcome of out-of-hospital cardiac arrest. This study showed that the addition of advanced cardiac life support (endotracheal intubation and the administration of intravenous medications) to a program of rapid defibrillation did not further improve the outcome. The addition of advanced cardiac life support to a program of rapid defibrillation did not further improve the outcome. Sudden cardiac arrest occurring outside the hospital is an important public health problem. Almost half a million deaths per year in the United States are attributed to sudden cardiac arrest, and 47 percent of those deaths occur outside hospitals. 1 Most communities have overall survival rates of less than 5 percent for cardiac arrests occurring outside the hospital. There is no evidence that these rates are increasing, despite extensive use of advanced treatments and technology. 2 , 3 The American Heart Association's four-step “chain of survival” concept has been promoted as a means of optimizing community responses. 4 Better survival has been associated with . . .