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advanced life support (ALS)

Epidemiology:
  • Mortality:
    • Survival to hospital discharge is 1% for asystole and 6% for PEA, when out-of-hospital cardiac arrests was attended by emergency medical services personnel and the initial rhythm was non-shockable. Survival outcomes did not improve over a 10-year period from 2003 to 2013 (3,5).
    • One-month survival with neurologically favourable outcome in elderdly out-of-hospital cardiac arrest victims improved from 1% (1999) to 5% (2011) (3,6).
    • Viable survival after perioperative CPR can be roughly estimated at 25% (approximately 50% survival with 50% good recovery in survivors) (7).
Symptoms:
Measurements:
  • Update of the Utstein resuscitation registry templates for out-of-hospital cardiac arrest for cardiac arrest and cardiopulmonary resuscitation outcome reports (3,4).
Treatment:
  • A preoperative conversation in which the anesthesiologist and the patient with a DNR order (or the designated surrogate) can come to consensus about whether to resuscitate and if so, to what extent, is recommended. In some cases, all parties may concede to retain the DNR order unter General anesthesia; however, attempts should be made to understand why the Patient wishes the surgery but does not wish the procedures that are essential to the success of the anesthesia and the surgery (7).
Complications:
  • It is important to identify and measure cognitive impairments as they are common and often not recognised. Memory problems are common and can have high impact on life including rehabilitation, daily activities, work, family life and relationships and quality of life. Well-designed cognitive rehabilitation programmes should be made available for patients recovering from cardiac arrests (2).
Future risks:
  • The timing of rearrest ist also concerning as it is most often observed 4-7 minutes after return of circulation, during the time interval when transport is likely being initiated (1).
References:
  1. Theresa M. Olasveengen et al. Insight into the black hole currently characterizing the initial post arrest phase. Resuscitation. 2015;87:A3-A4: full text | pdf.
  2. Joyce Yeung et al. Focus on the brain of the cardiac arrest survivor. Resuscitation. 2015;88;A5-6: full text | pdf.
  3. J.P. Nolan et al. Resuscitation highlights in 2014. Resuscitation. 2015;89:A1-6: full text | pdf.
  4. Gavin D. Perkins et al. Cardiac arrest and cardiopulmonary resuscitation outcome reports: update of the Utstein resuscitation registry templates for out-of-hospital cardiac arrest. Resuscitation. 2014: full text | pdf.
  5. E. Andrew et al. Outcomes following out-of-hospital cardiac arrest with an initial cardiac rhythm of asystole or pulseless electrical activity in Victoria, Australia. Resuscitation. 2014;85:1633-9: full text | pdf.
  6. Katimura T et al. Trends in survival among elderly patients with out-of-hospital cardiac arrest: a prospective, population-based observation from 1999 to 2011 in Osaka. Resuscitation. 2014;85:1432-8: full text | pdf.
  7. Shona Kalkman et al. Survival after Perioperative Cardiopulmonary Resuscitation - Providing an Evidence Base for Ethical Management of Do-not-resuscitate Orders. Anesthesiology. 2016;124:723-30: full text | pdf.