The chances of long-term survival increase significantly with prompt intervention following a cardiac arrest.
Every year in France, 40,000 people suffer from cardiac arrest. In Paris the chances of survival at 30 days were close to 10% in 2016, compared with 6% five years earlier. In Denmark, a country with 5.6 million inhabitants, the national registry’s rate of survival was 12% in 2013, compared to 5% in 2001. In the meantime, training of general population in resuscitation gestures and protocols in order to restart the heart was performed (cardiac massage started by a witness immediately after calling a specialized team, defibrillation if necessary). The result was a rise of the efficacy of resuscitation maneuvers from 18% in 2001 to 60% in 2013, according to the study published in the European Heart Journal. A key factor in increasing the survival of victims, survival which increased by 10%. It is important to note that the increase in resuscitation gestures by controls is not the only reason for this improvement. Quality care provided by emergency services and hospital care add to these results.
Since 2013, there has been a consensus within the Danish Cardiovascular Society that all victims of cardiac arrest whose heart is restarted (“recovered cardiac arrest”, in medical jargon) should benefit rapidly from a coronary angiography (examination to visualize the heart’s arteries), and, if one of them is occluded, a gesture to restore blood flow (angioplasty with stent). This means that they are brought by the emergency services directly to a hospital with a technical interventional cardiology platform.
By taking the 41,000 cardiac arrests collected in the Danish register between 2001 and 2013, Dr. Tranberg and his colleagues observed that 16000 patients had died before arriving to a hospital, 18000 were sent to local hospitals and 7000 were taken to an interventional cardiology center. The rate of survival was 29%. However, the study shows that the remoteness of the center does not significantly influence the survival rate. Once cardiac arrest is recovered, you can afford to lose a little time to go to a particularly experienced cardiac center.
In France, the transfer to a center with an interventional cardiology unit has already been carried out almost systematically for several years, but the quality of the hospital’s resuscitation service must also be taken into account, because the in-hospital management is almost as important as the initial phase of the recovery.
Regardless of the quality of medical services of the hospital where a cardiac arrest victim are transferred, the first few minutes are crucial. All adults should have the basic notions how to perform cardiac massage. Even before the transfer to a hospital, the most important thing is the initial management: the duration of the cardiac arrest before the first massage and the time taken to recover an effective cardiac rhythm.
