Sudden cardiac death

Abstract

Introduction: Sudden cardiac arrest continues to be the leading cause of death in the industrialized world.

Sources of data: Original papers, reviews and guidelines.

Areas of agreement: Community programs for lay bystander cardiopulmonary resuscitation (CPR) and automatic external defibrillation improve outcomes. Post-arrest care, including targeted temperature management (TTM) combined with early coronary angiography and percutaneous coronary intervention, is helpful for those suffering cardiac arrest during an ST-segment elevation myocardial infarction.

Areas of controversy: (1) The optimal approach to encourage lay bystanders to assist with resuscitation efforts. (2) Whether TTM combined with early coronary angiography is cost effective for those without ST elevation on their post-arrest ECG is unknown.

Growing points: Increasing data show that chest compression-only CPR is preferred by lay rescuers and improves local survival rates.

Areas timely for developing research: Randomized clinical trials are underway to examine the utility of early coronary angiography in the treatment of post-arrest patients without ST-segment elevation.

Keywords: cardiac arrest; chest compression-only CPR; post-arrest coronary angiography; public access defibrillation; refractory out-of-hospital cardiac arrest.