Treatment for Out-of-Hospital Cardiac Arrest

During the past 40 years, knowledge has accumulated that survival increases significantly if the OHCA is quickly recognized and responded to with prompt activation of 911, bystander-initiated cardiopulmonary resuscitation (CPR), lay application of an automated external defibrillator (AED) before arrival of emergency medical services (EMS) providers on scene, advanced life support, and postresuscitation care.1 Recent analyses of a multicenter observational study have demonstrated that multiple components of CPR process are associated with survival in patients with OHCA.2,3 However, there are significant and important variations in the process and outcome for care for patients with OHCA.4–6 These differences appear to be much larger than variations associated with care of other acute cardiovascular conditions such as ST-elevation myocardial infarction.7 Despite advances in resuscitation knowledge, many communities have not achieved significant improvements in outcomes after OHCA over time.8 This lack of improvement in survival has led some skeptics to conclude that the glass is half empty and that patients with OHCA have a dismal prognosis.Articles see pp 1868, 1876, and 1883Recently, tantalizing suggestions that outcomes after OHCA can improve over time have emerged from multicenter observational studies, including Arizona9 and Denmark.10 The relative contribution of interventions to increased survival in these communities is difficult to tease out because multiple changes in resuscitation care were implemented contemporaneously. Three important papers published in this issue of Circulation provide compelling evidence that the nation and the world is improving resuscitation care over time.11–13 Each of these large cohort studies demonstrates that OHCA is indeed a treatable condition and that a community can improve outcomes after OHCA.The first analysis described temporal changes in risk-adjusted survival after OHCA.12 Included were patients with OHCA of noncardiac cause who were …