40-Novel Strategy for Identifying an Optimal Bundle of Management for Sudden Cardiac Arrest
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Resuscitation, 2021
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The Society of Critical Care Medicine's Critical Care Congress features internationally renowned faculty and content sessions highlighting the most up-to-date, evidence-based developments in critical care medicine. This is a presentation from the 2021 Critical Care Congress held virtually from January 31-February 12, 2021.

Paul E. Pepe


Introduction/Hypothesis: With the challenges posed by traditional clinical trial methods, the purpose of this analysis was to alternatively construct a highly-detailed yet practical, attainable roadmap for enhancing the likelihood of neurologically-intact survival following sudden cardiac arrest.

Methods: Population-based outcomes following out-of-hospital cardiac arrest (OHCA) were collated for ten demographically/geographically-diverse U.S. 9-1-1 EMS systems (EMS-10) that had recently reported significant improvements in neuro-intact survival after introducing a comprehensive bundled system of care including evolving strategies for incorporating innovative technologies, highly-choreographed, street-wise tactics and pragmatic training methods for EMS, hospitals and the public at large. Detailed inventories of in-common elements were collated from the EMS-10 and assimilated. For reference, combined 1-year outcomes for OHCA from the EMS-10 were compared to concurrent U.S. outcomes reported by the well-established Cardiac Arrest Registry to Enhance Survival (CARES).

Results: Compared with CARES (n=78,704), EMS-10 cohorts (n=2,911) demonstrated significantly-increased likelihoods of return of spontaneous circulation (mean 37.4% vs. 31.5%; p<0.001) and neurologically-favorable hospital discharge, particularly after witnessed collapses involving bystander CPR and shockable cardiac rhythms (mean 10.7% vs. 8.4%; p<0.001; and 41.6% vs. 29.2%; p<0.001, respectively). In-common elements were: population-wide CPR training, 9-1-1 system-connected smart phone applications, expedited dispatcher procedures, CPR quality monitoring, mechanical CPR, devices for enhancing negative intrathoracic pressure regulation, extracorporeal membrane oxygenation protocols, body temperature management, rapid cardiac angiography and intensive involvement of medical directors, operational and quality assurance officers and training staff.

Conclusions: Based on clear commonalities assimilated from 10 highly-functioning EMS systems, the likelihood of neurologically-favorable survival following OHCA will likely be improved substantially in other communities that conscientiously introduce well-sequenced, highly-choreographed, system-wide portfolios of both traditional and non-conventional approaches to training, technologies and physiological management.



Meta Tag
Content Type Presentation
Knowledge Area Resuscitation
Knowledge Level Intermediate
Knowledge Level Advanced
Membership Level Select
Tag Cardiac Arrest
Year 2021
Paul Pepe
optimal management bundle
sudden cardiac arrest
clinical trials
coordinated interventions


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