Cardiac disease is the most common cause of mortality in Western countries, with most deaths due to
out-of-hospital cardiac arrest (OHCA). In Sweden, 5000-10 000 OHCAs occur annually. During the last decade, the time from
cardiac arrest to start of
cardiopulmonary resuscitation (
CPR) and defibrillation has increased, whereas survival has remained unchanged or even increased.
Resuscitation of OHCA patients is based on the 'chain-of-survival' concept, including early (i) access, (ii)
CPR, (iii) defibrillation, (iv)
advanced cardiac life support and (v) post-
resuscitation care. Regarding early access, agonal breathing, telephone-guided
CPR and the use of 'track and trigger systems' to detect deterioration in patients' condition prior to an arrest are all important. The use of compression-only
CPR by bystanders as an alternative to standard
CPR in OHCA has been debated. Based on recent findings, guidelines recommend telephone-guided chest compression-only
CPR for untrained rescuers, but trained personnel are still advised to give standard
CPR with both compressions and ventilation, and the method of choice for this large group remains unclear and demands for a randomized study. Data have shown the benefit of public access defibrillation for dispatched rescuers (e.g. police and fire fighters) but data are not as strong for the use of automated
defibrillators (AEDs) by trained or untrained rescuers. Postresuscitation, use of
therapeutic hypothermia, the importance of specific prognostic survival factors in the intensive care unit and the widespread use of
percutaneous coronary intervention have all been considered. Despite progress in research and improved treatment regimens, most patients do not survive OHCA. Particular areas of interest for improving survival include (i) identification of high-risk patients prior to their arrest (e.g. early warning symptoms and genes); (ii) increased use of bystander
CPR training (e.g. in schools) and simplified
CPR techniques; (iii) better identification of high-incidence sites and better recruitment of AEDs (via mobile phone solutions?); (iv) improved understanding of the use of
therapeutic hypothermia; (v) determining which patients should undergo immediate coronary angiography on hospital admission; and (vi) clarifying the importance of
extracorporeal membrane oxygenation during
CPR.