Role of the Fifth Link of Chain of Survival in Management of Out-of-Hospital Cardiac Arrest

Abstract

Cardiac arrest is defined as the absence of mechanical cardiac activity determined by the absence of pulse and normal breathing. It is characterized by abrupt loss of consciousness caused by lack of adequate cerebral blood flow because of failure of cardiac pump function. It almost always leads to death in the absence of a successful intervention, although spontaneous reversions occur rarely.

The incidence of Emergency Medical Services (EMS)-assessed Out-of-hospital cardiac arrest (OHCA) reported by the Resuscitation Outcome Consortium (ROC) Investigators (ROC Investigators, November 23, 2015) to the total population of the United States suggests that each year, 110.8 individuals per 100 000 population or 356 500 people of any age or 347 000 adults experience EMS-assessed OHCA.

Disease of the coronary arteries and its consequences account for at least 80% of OHCA and Sudden Cardiac Deaths (SCDs) in Western countries, and the non-ischemic cardiomyopathies are responsible for another 10% to 15%. Coronary artery disease is also the most common cause in many areas of the world in which the prevalence of atherosclerosis is lower.

Sudden Cardiac Arrest (SCA) has many etiologies (ie, cardiac or noncardiac causes), circumstances (eg, witnessed or unwitnessed), and settings (eg, out-of-hospital or in-hospital). This heterogeneity suggests that a single approach to resuscitation is not practical, but a core set of actions provides a universal strategy for achieving successful resuscitation. These actions are termed the links in the “Chain of Survival”.