The American Heart Association estimates that in 2015, there were 350,000 out-of-hospital cardiac arrests (OHCAs).
1 Survival rates vary
widely, but the estimated overall survival rate in the
United States is approximately 12%.
All emergency medical systems occasionally see at
least one subgroup with even less chance of survival,
Nonetheless, the typical approach to these refractory cardiac arrest patients is simply “more of the
same;” typically this means continued CPR, repeated defibrillation attempts and administration of ACLS
medications, the latter unproven at best, and thought by some to be of little value.
What’s the expectation if such treatment hasn’t worked earlier? Certainly, there are rare cases with
return of spontaneous circulation (ROSC) on the “nth” defibrillation attempt or after very lengthy ACLS
efforts, but these seem to be the exception rather than the rule.
Trends & Changes
Current best practices
for refractory cardiac arrest
By Karl B. Kern, MD