Abstract
The elements of Chains of Survival, including activation of emergency response, high-quality cardiopulmonary resuscitation (CPR), defibrillation, advanced resuscitation, post-cardiac arrest care and recovery, 1 are keys to successful resuscitation outcomes in adult out-of-hospital arrests. Over the years, efforts have been made to try to improve poor resuscitation outcomes by evaluating and filling gaps in the chains.
Locally, the Hong Kong College of Emergency Medicine (HKCEM), besides being an academic body for training emergency physician specialists, is also an International Training Centre (ITC) of the American Heart Association (AHA). HKCEM ITC has been providing life support courses, including Basic Life Support (BLS), Adult Cardiac Life Support (ACLS) and Paediatric Advanced Life Support (PALS) to healthcare providers for about two decades.
For better survival of cardiac arrest patients, bystander CPR and automated external defibrillator (AED) use by the public are essential. HKCEM, in conjunction with the Hong Kong Society for Emergency Medicine and Surgery, and the Resuscitation Council of Hong Kong, advocates the incorporation of ‘cardiopulmonary resuscitation and the use of automated external defibrillators’ into the local secondary education curriculum. Legislation for a ‘Good Samaritan Law’ to protect citizens who perform CPR and use AED is also advocated. 2 The above two measures have yet to take place, and more effort needs to be made so as to win support and improve the survival of cardiac arrest patients.
The current ventilation strategy recommended by AHA for cardiac arrests is synchronous compression-ventilation for patients without use of an advanced airway and asynchronous method with ventilation once every 6 s for those with an advanced airway. 3 In this issue of Hong Kong Journal of Emergency Medicine (HKJEM), Küçükceran et al. 4 explored compression and ventilation effects when synchronous versus asynchronous compression-ventilation methods were performed without advanced airway in mannequin models. The authors found that the chest compression fraction (CCF) in the asynchronous scenario was higher than for the synchronous scenario, whereas ventilation volume was lower in the asynchronous scenario.
In evaluating in-hospital cardiac arrests (IHCA), Hsu et al. 5 conducted a case-control study on a population-data subset in a 15-year period and noted that the risk of IHCA was 3.37 for the patients admitted for pneumonia. Extracorporeal membrane oxygenation (ECMO) for cardiac arrests could be the only hope of survival in selected patients. Ye 6 studied 43 acute myocardial infarction-induced cardiac arrests in which patients were treated with ECMO and primary percutaneous coronary intervention. The author found that several factors, including number of diseased vessels, conventional CPR duration and left anterior descending artery as the culprit vessel, are independent risk factors for death.
For emergency airway management, various intubation equipment and techniques were studied in this current issue. Regarding standard first aid (SFA) among undergraduates in Hong Kong, Ng et al. 7 performed a cross-sectional survey of 385 undergraduates and found unsatisfactory ‘good SFA knowledge’ (15.2%), but encouraging ‘good SFA attitude’ (71.3%).
The roles of Emergency physicians in resuscitation, whether in the pre-hospital or in-hospital arenas, are crucial and ever-evolving. Engagement of the public, aligning clinicians’ practice with best evidence, multi-specialty collaborations and digital transformations are ways forward to resuscitate patients better and hopefully to achieve favourable outcomes.
