Practical Emergency Medicine:Management of cardiac arrest

in the community

Dr. H K Tong

Consultant A&E Dept QMH

Hon Associate Professor HKU

What is the chance of

survival for street arrest?

Study done from 1990 to 1992 in KWHSurvival only 3%

Survival for out-of-hospital

cardiac arrest 1999

< 2%

Leung LP, Wong TW, Tong HK, Lo CB, Kan PG. Out-of-hospital cardiac arrest in Hong Kong. Prehosp Emerg Care 2001;5:308-11.

Initial rhythm

Leung LP et al.Prehospital Emergency Care 2001;5:308-11.

Out-of-hospital Cardiac Arrest Survival in some Asian Locations

Location

(Year)

Hong Kong

(1992) Wong

Taipei

(1993) Hu

Hong Kong

(1995) Lui

Hong Kong

(1999) Leung

Japan

(1999) Mashiko

Singapore

(2002) Eng No. of OHCASurvival %Call-to-patient Call-to-shock time (min)time (min)263554744320292054831.41.61.253.52147.46.426.42710.216.721.616.3711.12

Why is the survival rate so low?

Chain of Survival Concept

Chain is as strong as the weakest link.

Chain of Survival (AHA)BystanderBystanderAmbulanceEmerg Dept

Activate EMS Early CPR Rapid Defib ACLS Post-arrest care

Collapse to defibrillation time is a critical factor for survival

OPALS

Survival

4.2%

The key to survival is

defibrillation within 4-6 minutes

of collapse

F/59 sudden severe chest pain

with cold sweat

Driven by husband to QMH

A&E

Cardiac arrest en route, son

performed CPR at backseat.

Arrived A&E in VF

Resuscitated with 11X

defibrillation, 9 doses of adrenalin-- NSR with good

perfusion

Emergency PCI followed by

hypothermic resuscitation in ICU for 24 hours

XXXXXXX

XXXDay 5…..

AHA Guidelines 2000 recommends PAD, if

Response times of fewer than 5 minutes, from EMS call to countershock, cannot be reliably achieved, and

in areas where there exists a reasonable probability of at least 1 AED use in

5 years

A person has collapsed…

What should you do stat!

From ABC to CAB