Editorial comment
1
Acknowledgements This study was supported by grants from The Swedish Heart and Lung Foundation and The Gothen- burg Medical Society. References ihI [71 PI Pantridge JF, Geddes JS. A mobile intensive care unit in the management of myocardial infarction. Lancet 1967; ii: 271-273. Cobb LA, Werner JA. Trobaugh GB. Sudden cardiac death: a decade’s experience with out-of-hospital resuscitation. Mod Con- cepts Cardiovasc Dis 1980: 49: 31-36. Cobb LA, Baum RS, Alverez III, H, Schaffer WA. Resuscitation from out-of-hospital ventricular fibrillation: 4 years follow-up. Circulation 1975; 51 -52 (Suppl III): 223 -228. Ekstriim L, Herlitz J, Wennerblom B, Axelsson A, Bdng A. Holmberg S. Survival after cardiac arrest outside hospital over a I2-year period in Gothenburg. Resuscitation 1994; 27: 181~. 187. Herlitz J. Ekstriim L. Wennerblom B, Bdng A, Axelsson .& Holmberg S. Factors associated with an increased chance of survival after out of hospital cardiac arrest found in ventricular fibrillation. Eur Heart J. 1994: 15: 162% 1633. Cummins RO, Chamberlain DA, Abramson NS, Allen M, Bas- kett PJ. Becker L, Bossdert L, Delooz HH, Dick WF, Eisenberg MS. Recommended guidelines for uniform reporting of data from out-of-hospital cardiac arrest: the Utstein style. A state- ment for health professionals from a task force of the American Heart Association, the European Resuscitation Council, the Heart and Stroke Foundation of Canada, and the Australian Resuscitation Council. Circulation 1991: 84(2): 960-975. Roth R. Stewart RD. Rogers K. Camon GM. Out-of-hospital cardiac arrest: factors associated with survival. Ann Emerg Med 19)x4: 13: 237 -143. Weaver W, Cobb LA. Hallstrom AP, Copass MK, Ray R. Emery M. Fahrenbruch C. Considerations for improving sur- v~\aI from out-of-hospital cardiac arrest. Ann Emerg Med 1986: 15: 1181 1186. [9] Eisenberg MS. Bergner L, Hallstrom A. Cardiac resuscitation in the community. Importance of rapid provision and implications for program planning. J Am Med Assoc 1979; 241: 1905~~1907. [II)] Weaber WD, Hill D, Fahrenbruch CE, Copass MK, Martin JS. Cobb LA, Hallstrom AP. Use of the automatic external defibril- lator in the management of out-of-hospital cardiac arrest. N Enpl J Med 1988: 319: 661 -666. II ‘I [I21 [I31 [I41 Ujl [IhI [171 [I81 [I91 WI PII m ~31 ~41 [251 Cummins RO. Eisenberg MS. Prehospital cardtopulmonary rc- huscitation: is it effective? JAMA 198.5; 253: 1408 2412. Cummins RO. Eisenberg MS, Hallstrom At’. Litwin PE. Sur- vival of out-of-hospital cardiac arrest with early initiation of cardiopulmonary resuscitation. Am J Emerg Med l9Si: 3: I 1-i 119. Ritter G. Wolfe RA. Goldstein S et al. The cflbct ol hystandel (‘PR on survival of out-of-hospital cardiac .trrcht tizlirns ,Irn Heart .I 1985: 110: 931 937 Gray W,4. Prehospital resuscitation: the yoc~~l. ihe bad and the futile. JAMA 1993: 270: 1471 1472. Mclntqre KM. Loosening criteria for withholding prehospital cardiopulmonar) resuscitation. Arch Interri Mtsd 1093: 15.3: ?I89 -1191. Jecker NS. Schneiderman LJ. An ethical anaiyis of rhc .futilit,’ in the 1992 American Heart Association Ciuidelineh for car- diopulmonaq resuscitation and emergency 1 al-tliac c;ire. \rch Intern Med 1993: 153: 7195 2198. Kellermann 4L. Staves DR, Hackman BB. In. hospital resuscita- tion following unsuccessful prehospital ad\.rnced cardiac lift support. “heroic efforts” or an exerc& in ftltilitq? Ann Emcrg Med 1088: I7 5X9 mSU4. Gray WA. C‘apone RJ, Most AS. C~nsuccessl’ul emrrgcncy medi- cal resuscitation: are continued efforts in the <‘mergencq depart- ment justified? N Engl J Med 1991: 32.5: 149: 1398. Bonnin MJ, Swor RA. Outcomes in unsuccessful field resuscita- tion attempts. Ann Emerg Med 19X9: 1X: 50’ 511. Kellermann AL. Hackman BB. Somes G. I’rediclmg [he out- ccme of unsuccessful prehospital advanced cardiac lift support. JrIM.4 1993: ‘70: 1433 1436. Bonnin MJ. Pcpe PE. Kimball RT. Clark P?. Distinct criteria for termination of re\uscitation in the our-c>i”-hospital yetting. JAM-\ 1993: 270. I457 1467. Smith JP. Boilal BI. Guidelines for diwontinuirtg prchospltal CPR in the emergency department: ,I rclic’w Ann Enlc,rp Mcd 19853 IJ: 1093 1098. L.cM,ia LM. Ruoft‘ B. Rush c’. Stothcrt JC Jr. I\ emergency department resuscitation of out-of-hospital cardiac arrest victnn< who arrive pulscle\s worthwhile? Am .I Em;~rp Mrd 1990; R: IIX 120. Gregor> JJ. Keruin J. Resuscitation after carlliac itrrcbt outside the hospital. h hgl J Med 1992: 316. 149h. VUI tier HoeLen JG, Waandcrs 11. C’omplcr LA. :an der Weyden PKC‘. Meinders ,4E. Prolonged rc\uscitation effort\ for cardiac arrest patrents who cannot he rc~uscitarec! at the scene: \zho is like11 !o benefit’? .\t~ii f:mcr:c 91cd !‘@I: 22. 1659 I 66: Editorial comment The paper from Dr Herlitz and colleagues from Goteborg addresses the difficult area of patients who have not immediately responded to defibrillation or other treatment during out-of-hospital management of cardiac arrest. These patients comprise a large subgroup of all car- diac arrest patients treated in emergency departments and pose considerable problems. Previous resports from North America have gone so far as to suggest that no patients will survive. Herlitz and his colleagues provide important evidence showing that longterm survivors in this situation are extremely few and go some way to suggesting sub-groups of patients in whom the continu- ation of CPR on arrival at hospital mat not be war- ranted.
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Acknowledgements
This study was supported by grants from The Swedish Heart and Lung Foundation and The Gothen- burg Medical Society.
References
ihI
[71
PI
Pantridge JF, Geddes JS. A mobile intensive care unit in the management of myocardial infarction. Lancet 1967; ii: 271-273. Cobb LA, Werner JA. Trobaugh GB. Sudden cardiac death: a decade’s experience with out-of-hospital resuscitation. Mod Con- cepts Cardiovasc Dis 1980: 49: 31-36. Cobb LA, Baum RS, Alverez III, H, Schaffer WA. Resuscitation from out-of-hospital ventricular fibrillation: 4 years follow-up. Circulation 1975; 51 -52 (Suppl III): 223 -228. Ekstriim L, Herlitz J, Wennerblom B, Axelsson A, Bdng A. Holmberg S. Survival after cardiac arrest outside hospital over a I2-year period in Gothenburg. Resuscitation 1994; 27: 181~. 187. Herlitz J. Ekstriim L. Wennerblom B, Bdng A, Axelsson .& Holmberg S. Factors associated with an increased chance of survival after out of hospital cardiac arrest found in ventricular fibrillation. Eur Heart J. 1994: 15: 162% 1633. Cummins RO, Chamberlain DA, Abramson NS, Allen M, Bas- kett PJ. Becker L, Bossdert L, Delooz HH, Dick WF, Eisenberg MS. Recommended guidelines for uniform reporting of data from out-of-hospital cardiac arrest: the Utstein style. A state- ment for health professionals from a task force of the American Heart Association, the European Resuscitation Council, the Heart and Stroke Foundation of Canada, and the Australian Resuscitation Council. Circulation 1991: 84(2): 960-975. Roth R. Stewart RD. Rogers K. Camon GM. Out-of-hospital cardiac arrest: factors associated with survival. Ann Emerg Med 19)x4: 13: 237 -143. Weaver W, Cobb LA. Hallstrom AP, Copass MK, Ray R. Emery M. Fahrenbruch C. Considerations for improving sur- v~\aI from out-of-hospital cardiac arrest. Ann Emerg Med 1986: 15: 1181 1186.
[9] Eisenberg MS. Bergner L, Hallstrom A. Cardiac resuscitation in the community. Importance of rapid provision and implications for program planning. J Am Med Assoc 1979; 241: 1905~~1907.
[II)] Weaber WD, Hill D, Fahrenbruch CE, Copass MK, Martin JS. Cobb LA, Hallstrom AP. Use of the automatic external defibril- lator in the management of out-of-hospital cardiac arrest. N Enpl J Med 1988: 319: 661 -666.
II ‘I
[I21
[I31
[I41
Ujl
[IhI
[171
[I81
[I91
WI
PII
m
~31
~41
[251
Cummins RO. Eisenberg MS. Prehospital cardtopulmonary rc- huscitation: is it effective? JAMA 198.5; 253: 1408 2412. Cummins RO. Eisenberg MS, Hallstrom At’. Litwin PE. Sur- vival of out-of-hospital cardiac arrest with early initiation of cardiopulmonary resuscitation. Am J Emerg Med l9Si: 3: I 1-i 119. Ritter G. Wolfe RA. Goldstein S et al. The cflbct ol hystandel (‘PR on survival of out-of-hospital cardiac .trrcht tizlirns ,Irn Heart .I 1985: 110: 931 937 Gray W,4. Prehospital resuscitation: the yoc~~l. ihe bad and the futile. JAMA 1993: 270: 1471 1472. Mclntqre KM. Loosening criteria for withholding prehospital cardiopulmonar) resuscitation. Arch Interri Mtsd 1093: 15.3: ?I89 -1191. Jecker NS. Schneiderman LJ. An ethical anaiyis of rhc .futilit,’ in the 1992 American Heart Association Ciuidelineh for car- diopulmonaq resuscitation and emergency 1 al-tliac c;ire. \rch Intern Med 1993: 153: 7195 2198. Kellermann 4L. Staves DR, Hackman BB. In. hospital resuscita- tion following unsuccessful prehospital ad\.rnced cardiac lift support. “heroic efforts” or an exerc& in ftltilitq? Ann Emcrg Med 1088: I7 5X9 mSU4. Gray WA. C‘apone RJ, Most AS. C~nsuccessl’ul emrrgcncy medi- cal resuscitation: are continued efforts in the <‘mergencq depart- ment justified? N Engl J Med 1991: 32.5: 149: 1398. Bonnin MJ, Swor RA. Outcomes in unsuccessful field resuscita- tion attempts. Ann Emerg Med 19X9: 1X: 50’ 511. Kellermann AL. Hackman BB. Somes G. I’rediclmg [he out- ccme of unsuccessful prehospital advanced cardiac lift support. JrIM.4 1993: ‘70: 1433 1436. Bonnin MJ. Pcpe PE. Kimball RT. Clark P?. Distinct criteria for termination of re\uscitation in the our-c>i”-hospital yetting. JAM-\ 1993: 270. I457 1467. Smith JP. Boilal BI. Guidelines for diwontinuirtg prchospltal CPR in the emergency department: ,I rclic’w Ann Enlc,rp Mcd 19853 IJ: 1093 1098. L.cM,ia LM. Ruoft‘ B. Rush c’. Stothcrt JC Jr. I\ emergency department resuscitation of out-of-hospital cardiac arrest victnn< who arrive pulscle\s worthwhile? Am .I Em;~rp Mrd 1990; R: IIX 120. Gregor> JJ. Keruin J. Resuscitation after carlliac itrrcbt outside the hospital. h hgl J Med 1992: 316. 149h. VUI tier HoeLen JG, Waandcrs 11. C’omplcr LA. :an der Weyden PKC‘. Meinders ,4E. Prolonged rc\uscitation effort\ for cardiac arrest patrents who cannot he rc~uscitarec! at the scene: \zho is like11 !o benefit’? .\t~ii f:mcr:c 91cd !‘@I: 22.
1659 I 66:
Editorial comment
The paper from Dr Herlitz and colleagues from Goteborg addresses the difficult area of patients who have not immediately responded to defibrillation or other treatment during out-of-hospital management of cardiac arrest.
These patients comprise a large subgroup of all car- diac arrest patients treated in emergency departments and pose considerable problems. Previous resports from
North America have gone so far as to suggest that no patients will survive. Herlitz and his colleagues provide important evidence showing that longterm survivors in this situation are extremely few and go some way to suggesting sub-groups of patients in whom the continu- ation of CPR on arrival at hospital mat not be war- ranted.
