For those of us who got comfortably used to seeing changes in resuscitation science every five years, the past few years have seemed fast-paced. But the rate of change is accelerating. It's time to fasten your seat belt.
Thanks to the pioneering work of the past few years, we are now beginning to accumulate solid data on what works and what doesn't.
Here's what I suspect lies ahead:
First, the age of five-year updates is behind us. I think we'll see changes in resuscitation science guidelines far more frequently than every five years.
Second, a dirty little secret has surfaced: most people don't do CPR well enough. I think we will see an increasing focus on the quality of the resuscitation effort: fewer and shorter interruptions in chest compressions, compressions more compliant with the two inches or more guideline, and shorter pauses between the cessation of chest compressions and the delivery of the shock.
Additionally, the evidence is growing compellingly in favor of more broadly pursuing therapeutic hypothermia, not only for cardiac arrest victims, but others. The trick here is to get the hospitals who receive cardiac arrest patients from ambulances to get the equipment and establish the protocols that will permit them to continue therapeutic hypothermia, once a chilled patient arrives in their ED. (You really shouldn't be initiating TH in the ambulance unless the hospital to which you are transporting the resuscitated victim can continue it.)
I, for one, will be spending considerable energy pushing for these changes over the next few years. i hope that my pre-hospital companions across the land will press for the same changes in their geographic areas. There is no reasonable excuse to lose the number of people to cardiac arrest as we do, particularly in light of the fact that there is a 10:1 difference in success rates in different geographies.
We have never been so close to being able to make a difference. Please help make it happen.