The early response to out-of-hospital cardiac arrest in Victoria, Australia

2017-01-09T05:14:44Z (GMT) by Ziad Nehme
Internationally, out-of-hospital cardiac arrest (OHCA) is a leading cause of morbidity and mortality. Despite three decades of improvements to the chain of survival, a report published in 2010 suggests that internationally pooled survival rates from OHCA remain unchanged. Many international emergency medical service (EMS) agencies have described contemporary approaches to improving the early response to OHCA patients, through the introduction of innovative system- and community-based interventions. In Australia, there is little published evidence describing the early response to OHCA and the association between initiatives to improve cardiac arrest care and clinical outcomes. <br>        In this thesis comprised of published works, I aim to explore the challenges in optimising early response to OHCA in Victoria, Australia. This thesis is organised into two major themes, describing the response to OHCA patients both before, and after, the event occurs. Until now, almost no attention has been given to prevention strategies that may help to reduce the short-term risk of developing an OHCA. In the first section of the thesis, I present compelling evidence to support recent changes to the first link in the chain of survival, and suggest that interventions to improve patient recognition of the prodromal symptoms may help to significantly reduce episodes of OHCA in the community. This work is supported by two further studies, which indicate that the frequency of typical prodromal symptoms preceding OHCA is high, and increasing public awareness of these typical warning symptoms could also lead to an increase in EMS use. <br>        The second section of this thesis explores the contemporary systems-based response to OHCA in Victoria, and describes the value of state-wide initiatives to improve bystander cardiopulmonary resuscitation (CPR) and survival outcomes. This section also describes opportunities to improve the emergency system response further by eliminating avoidable delays to accessing EMS and identifying disparities in the response to OHCA across metropolitan and rural areas of Victoria. This work demonstrates that a contemporary and innovative approach, which targets all links in the chain of survival, can be highly effective at reducing the burden of OHCA in the community. Addressing the future challenges to optimising the early response to OHCA in Victoria is also discussed.