Community-based responses to impending or actual cardiac arrest and advances in post-cardiac arrest care.

Out-of-hospital cardiac arrest remains a major epidemiologic, clinical, scientific, and public health challenge. Emergency rescue systems (EMS) based in fire departments initially demonstrated encouraging outcomes as new strategies were developed in communities led by people committed to such programs, but the overall impact on survival has been modest. With improvement in automated external defibrillator (AED) technology in recent years, there has been increasing interest in their use by non-conventional responders in recent years. In parallel with the AED strategies, adjunctive strategies and therapies have been developed. These include the demonstration that interventions targeted to reperfusion of the ischemic myocardium, such as thrombolytic therapy given by EMS responders, clarification of the role of intravenous amiodarone for electrophysiologically-resistant cardiac arrest victims, and demonstration of a role for hypothermia in post-cardiac arrest. Thus, the range of pre-hospital and in-hospital strategies for improving cardiac arrest survival continues to broaden. The major lesson learned during the past two decades is that no single strategy can be relied upon to yield a major impact on the mortality from out-of-hospital cardiac arrest. The cumulative effect of multiple strategies, working together toward the same goal, will ultimately provide additive effects on outcomes. Carefully thought out strategic approaches can maximize the effect on total mortality.