Strategies for prevention of SCD at community level

Strategies for prevention of SCD at community level

Problems with preventive strategy

1. 80% occurs at home, only 15% occur in streets or in public places
2. Risk stratification is easy at individual level, but not at a community level
3. Reluctance to start resuscitation due to unwillingness to give mouth to mouth breathing and also the worry about legal problems in case of unwitnessed death

Chain of survival was described in 1991: early access to Emergency Medical Service, early CPR, early defibrillation, early ACLS

Markers of futility:

1. Unwitnessed cardiac arrest – almost no survival
2. Response time more than 8 min – survival < 0.3%
3. If the initial rhythm is asystole or pulseless electrical activity

AED should be available in airports, convention centres, sporting arenas, casinos, shopping malls and large office building.

Public access to defibrillation trial: NEJM 2004; 20,000 Volunteers, 1600 AEDs, 239 episodes of SCD. Only those with bystander CPR successful. Prevented 16 extra deaths [1].

Reference

1. A P Hallstrom, J P Ornato, M Weisfeldt, A Travers, J Christenson, M A McBurnie, R Zalenski, L B Becker, E B Schron, M Proschan, Public Access Defibrillation Trial Investigators. Public-access defibrillation and survival after out-of-hospital cardiac arrest. N Engl J Med. 2004 Aug 12;351(7):637-46.