Resuscitation of Patients in Ventricular Fibrillation from the Perspective of Emergency Medical Services PDF
Cardiology Research and Clinical Developments Series
Since the first use of basic life support (BLS) and defibrillation in the prehospital setting in Belfast in 1966, few would argue that there have been major improvements in the rate of survival for out-of-hospital cardiac arrests. Indeed, until the widespread introduction of BLS and defibrillators to emergency medical service (EMS) vehicles, an out-of-hospital cardiac arrest would mean certain death.
The initial rhythm of a patient in cardiac arrest is predictive of their chances of survival. In this regard, the rhythms with the highest rate of survival to hospital discharge are ventricular fibrillation (VF) and ventricular tachycardia (VT). In the past century we have learnt much about VF and VT, with this knowledge forming the bedrock of present day resuscitation guidelines. In the last decade there has been a truly international effort, headed by the International Liaison Committee on Resuscitation (ILCOR), aimed at reducing the mortality from cardiac arrest. This effort has resulted in the publication of the 2005 guidelines for resuscitation. While there is still much to learn, the 2005 guidelines appear to have reduced mortality from VF/VT arrests more than any before.
The concept of providing cardiopulmonary resuscitation (CPR), defibrillation, and advanced cardiac life support, in a timely fashion to reduce mortality from cardiac arrests evolved in the late 1980‟s. It was formalised in 1991 by Cummings as the “Chain of Survival”. It is the role of EMS, with regards to cardiac arrest, to provide the final critical links in the chain of survival. Aside from this vital function, EMS have been invaluable in enabling an assessment of the impact of the many changes to resuscitation protocols over the years on the mortality rate from cardiac arrest by facilitating research in the pre-hospital domain.
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