Basic life support training essential for all people to improve survival after cardiac arrest

Basic life support training essential for all people to improve survival after cardiac arrest

Basic life support training in schools and communities is essential to improving survival after cardiac arrest, according to European Society of Cardiology (ESC) guidelines published online today in the European Heart Journal. Guidelines for the treatment of patients with ventricular arrhythmias and the prevention of sudden cardiac death call for more automated external defibrillators (AEDs) in public places such as shopping centers, stadiums and train stations.

Every year, up to six million people worldwide suffer sudden cardiac arrest, of which less than 10% survive. Research into how to predict and prevent cardiac arrest is ongoing, but the general public will see immediate survival gains. “The public is our most important ally in the fight against sudden cardiac death in communities,” said Professor Jacob Tfelt-Hansen, chair of the guidelines task force from Copenhagen University Hospital, Denmark. "Everyone, including school children, should learn how to perform cardiopulmonary resuscitation (CPR) and use an AED. Both can save lives."

To go a step further, emergency services should consider adopting cell phone systems to locate and activate volunteers near victims, allowing early resuscitation attempts before paramedics arrive.

Katja Zeppenfeld, Chair of the Guidelines Task Force, Professor, Leiden University Medical Centre, Netherlands

In the Western world, 75-80% of sudden cardiac deaths are caused by coronary heart disease. The risk can be reduced through heart-healthy habits such as not smoking, eating a nutritious diet, losing excess weight, exercising and reducing stress - all of which help prevent plaque buildup and clot formation in the coronary arteries.

In heart attack patients, revascularization to open the blocked coronary artery reduces the risk of ventricular arrhythmias and sudden cardiac death. It also helps preserve heart function by restoring normal blood flow to the heart muscle. After revascularization, which can be achieved through percutaneous procedures or bypass surgery, the most important factor associated with the occurrence of sudden cardiac death is the remaining function in the left ventricle. Professor Tfelt-Hansen said: “Patients with a myocardial infarction or chronic coronary artery disease who, despite revascularization and medication, have severely impaired left ventricular function and symptoms of heart failure are at risk of sudden cardiac death and an implantable cardioverter-defibrillator is indicated.”

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Sudden cardiac death can also be caused by electrical problems in the heart. Patients diagnosed with conditions that increase the likelihood of sudden cardiac arrest must avoid the specific triggers associated with their illness. For example, people with a rare electrical disorder called catecholaminergic polymorphic ventricular tachycardia (CPVT) should avoid competitive and strenuous exercise and stressful environments. Disease and patient-specific lifestyle adjustments should be discussed with the treating cardiologist.

In athletes, the incidence of sudden cardiac death increases with increasing age from 0.4-3 per 100,000 participant-years in those under 35 years of age to 2-6.3 per 100,000 participant-years in those over 35 years of age. On average, one in 14 sudden cardiac deaths in athletes occurs in women. Prior to participation, cardiovascular evaluation of competitive athletes should be considered with the goal of identifying undiagnosed conditions so that cardiac arrest can be prevented. In middle-aged and older athletes, the most common cause of sudden cardiac death is coronary artery disease, and risk assessment is recommended before initiating vigorous exercise. Professor Zeppenfeld said: “Excellent survival rates with favorable neurological outcomes after cardiac arrest have been reported from sports centers equipped with AEDs.

Advice is provided to assess victims of sudden cardiac death and their relatives. Hereditary heart disease is diagnosed in 25-70% of victims under the age of 50, and the family left behind is often at risk. A comprehensive autopsy is recommended, ideally in all cases of sudden death, but particularly in persons under 50 years of age, to determine the likely cause and possible role of a genetic disorder. Relatives should be examined in a specialized clinic if they suspect hereditary heart disease.

New guidelines are also provided for the assessment of sudden cardiac arrest survivors and families. Survivors without an obvious non-cardiac cause should be evaluated by multidisciplinary teams, with imaging performed to assess cardiac structure and function. Genetic testing can identify a mutation, and families should be evaluated at a specialized clinic in cases of possible hereditary heart disease.

Source:

European Society of Cardiology (ESC)

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