Prehospital cardiopulmonary resuscitation

The survival chain: The delay to restoration of spontaneous circulation is the key to prognosis of cardiac arrest occurring outside the hospital. Amon g the many etiologies of cardiac arrest sudden onset ventricular fibrillati on is the number one cause of sudden death in adults. Better prognosis depe nds on effective organisation founded on the concept of a "survival drain". Alert and resuscitation: By alerting the emergency units and performing the basic gestures of cardiopulmonary resuscitation (freeing the airways, mout h-to-mouth ventilation and closed chest cardiac massage) those witnessing t he event take the first steps in the survival chain while waiting for the p aramedical and medical teams to arrive. Defibrillation: In case of ventricular fibrillation, prognosis is directly related to the delay to defibrillation. Defibrillators used by specially tr ained paramedics before a physician arrives on the scene have considerably improved prognosis. Specialized resuscitation: Precise algorithms help guide treatment in accor dance with the observed cardiac rhythm. Tracheal intubation and artificial ventilation are fundamental. Among the useful drugs, epinephrine is by far the most important for improving myocardial and cerebral perfusion, improvi ng the chances of recovering spontaneous circulation. The only anti-arrhyth mic drug currently used is lidocaine infusion of alkaline fluid is only use ful in specific cases of prolonged resuscitation. Expired CO2 monitoring ma y be a useful guide, but discontinuing resuscitation is strictly a medical decision. After resuscitation: When spontaneous circulation has been achieved, the pa tient must be transported to a cardiac hospital for specialized care and et iological treatment.