From the Guidelines
Sudden cardiac arrest in New Zealand requires immediate response following the "chain of survival": early recognition and calling 111, immediate CPR, rapid defibrillation, and advanced medical care, as outlined in the 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care 1. The first step in managing sudden cardiac arrest is to ensure the scene is safe, then check for responsiveness. If the person is unresponsive, call 111 immediately and start CPR with 30 chest compressions followed by 2 rescue breaths. It is essential to push hard and fast in the center of the chest at a rate of 100-120 compressions per minute. Some key points to consider when responding to sudden cardiac arrest include:
- Using an AED (automated external defibrillator) as soon as one is available, as these devices are increasingly found in public places throughout New Zealand 1.
- Continuing CPR until emergency services arrive, as the first few minutes after cardiac arrest are crucial, and brain damage can begin within 4-6 minutes without oxygen.
- Learning CPR and knowing the location of nearby AEDs can significantly increase a victim's chance of survival, as emphasized in the practical management of sudden cardiac arrest on the football field 1. New Zealand has implemented initiatives to improve survival rates, including public access defibrillation programs and community CPR training. It is also important to consider the cause of the arrest, as an arrest is presumed to be of cardiac etiology unless it is known or likely to have been caused by trauma, submersion, drug overdose, asphyxia, exsanguination, or any other non-cardiac cause, as stated in the update and simplification of the Utstein templates for resuscitation registries 1.
From the Research
Sudden Cardiac Arrest in New Zealand
- Sudden cardiac arrest is a significant health issue in New Zealand, with a low survival rate without early cardiopulmonary resuscitation (CPR) and defibrillation 2.
- The use of automated external defibrillators (AEDs) can improve survival rates following out-of-hospital cardiac arrest, but their effectiveness depends on various factors, including prompt use and proper technique 3.
- The chain of survival, which includes early access, early CPR, early defibrillation, and early acute cardiac life support, is crucial for improving survival rates from cardiac arrest 4.
Survival Rates and Defibrillation Efficacy
- A study in the Wellington region of New Zealand found that the 2005 resuscitation guideline changes did not significantly increase survival to hospital discharge, but did improve survival to hospital admission 5.
- The study also found that first-shock efficacy decreased from 68% to 62%, and second shock efficacy decreased from 47% to 27%, although these changes were not statistically significant 5.
- The proportion of patients with return of spontaneous circulation (ROSC) increased from 34% to 42%, and the proportion surviving to hospital increased significantly from 22% to 36% 5.
Special Circumstances and Cardiac Arrest
- Cardiac arrest can be caused by special circumstances, such as asphyxia, trauma, pulmonary embolism, accidental hypothermia, anaphylaxis, or COVID-19, and during pregnancy or perioperatively 6.
- These circumstances often have a preventable cause and require additional interventions to correct a reversible cause during resuscitation 6.
- Early chest compressions and, when indicated, a defibrillation shock from a bystander give the best chance of survival with a good neurological status, regardless of the cause of cardiac arrest 6.