Outcomes after ventricular fibrillation out-of-hospital cardiac arrest: expanding the chain of survival.

Coronary heart disease is the most common cause of death in the United States, with ventricular fibrillation (VF) the most common initial rhythm when cardiac disease causes arrest. Survival after VF out-of-hospital cardiac arrest (OHCA) depends on a sequence of events called the chain of survival, which Includes rapid access to emergency medical services, cardiopulmonary resuscitation, defibrillation, and advanced care. Because of widespread implementation of defibrillation programs, more patients survive VF OHCAs, making subsequent care of these patients important. Early hospitalization must focus on potential neurologic injury and therapy targeted at the underlying cardiac disease and antiarrhythmic therapy for long-term secondary prevention of sudden death. Attention to certain cohorts who are at high risk despite their underlying disease, such as women and elderly patients, is necessary. These cohorts may have the greatest response to short-term and long-term therapies for cardiac rehabilitation. With these approaches, long-term survival and quality of life after VF OHCA are favorable. Broadening the focus of the chain of survival to include in-hospital and long-term care will further improve favorable outcomes achieved in an early defibrillation program.