After a Heart Attack - Now What?

Regional care system improves survival and neurological outcomes for cardiac arrest patients

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) Survival rates tend to be low when a person's heart stops beating. Researchers have found that adding specialized treatment after cardiac arrest is key to surviving with preserved brain functioning.

Cardiac arrest patients taken directly to advanced medical care systems or transported to a specialty hospital after a heartbeat was established fared considerably better than patients that did not receive such care, a recent study found.

Advanced care includes artery-opening angioplasty, therapeutic hypothermia, appropriate fluids and cardiovascular medications and respiratory management.

"Call 9-1-1 immediately when someone suffers cardiac arrest."

Takashi Tagami, MD, PhD, lead author of the study and an assistant professor at Nippon Medical School in Japan, said that when the study began there were concerns that the number of survivors with severe neurological disabilities would increase. However, that did not happen.

Instead the findings suggested that the "fifth link," a term the American Heart Association uses to refer to advanced treatments in the chain of survival for cardiac arrest patients, improved the quality of life among survivors.

The American Heart Association established the recommended "Chain of Survival" for cardiac arrest patients in 2010. The steps include dialing 9-1-1, early CPR, early defibrillation and early advanced cardiovascular life support. The “fifth link” was added to the guidelines in 2010.

During the study, which began in 2006, researchers followed 1,492 cardiac arrest patients in Japan after implementing a regional care system that included the "fifth link." The average age was 76 and 58 percent were men. The research was completed in late 2010.

Investigators compared data on patients who suffered cardiac arrest prior to implementation of the regional care system to that of patients who did receive advanced care.

They found that 2.3 percent of cardiac arrest patients who did not receive advanced care survived until hospital discharge compared to 4.2 percent after the program was implemented.

At one month, 51 percent of surviving patients had good neurological outcomes versus only 19 percent prior to implementation of the system. One-month survival with a favorable neurologic outcome improved from 0.5 percent to 3 percent.

Survival for out-of-hospital cardiac arrest not related to trauma is extremely low – only about 11 percent of patients treated by emergency medical services workers. Immediate care is key to survival and favorable neurological outcomes.

“Post-cardiac arrest care requires a multidisciplinary approach to intensive care that is difficult to implement in a non-specialized hospital,” Dr. Tagami said. “This study indicates that the introduction of the regional resuscitation system of care, the ‘fifth link,’ made it possible to treat all potential survivors in the ICU of a specialized hospital.”

The study was recently published in Circulation, an American Heart Association journal.

Reviewed by: 
Review Date: 
July 31, 2012
Last Updated:
March 19, 2013