New ESC guideline calls for widespread CPR education, more AEDs in public places
To improve survival from cardiac arrest, basic life support training in schools and communities needs to be given to as many people as possible, according to a new guidance from the European Society of Cardiology.
The Guidelines for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death, presented at the ESC Congress and simultaneously published in the European Heart Journal, also call for placement of more automated external defibrillators in public places. Approximately 6 million people per year worldwide experience sudden cardiac arrest.
“The public is our major ally in the battle against sudden cardiac death in communities,” Jacob Tfelt-Hansen, MD, DMSc, professor and senior consultant in the department of cardiology at Copenhagen University Hospital, Denmark, guidelines task force chairperson, said in a press release. “Everyone, including schoolchildren, should learn how to do cardiopulmonary resuscitation (CPR) and use an AED. Both of these actions can save lives.”
The guideline committee gave Class I recommendations to public-access defibrillation at sites where cardiac arrest is more likely to occur, performance of prompt CPR by bystanders when cardiac arrest occurs, and promotion of community training in basic life support to increase the rates of bystander CPR and AED use. The guideline features a Class IIa recommendation (should be considered) for use of mobile phone-based alerting of bystander volunteers trained in basic life support to assist nearby patients with out-of-hospital cardiac arrest.
Since, in the Western world, 75% to 80% of sudden cardiac deaths are caused by CAD, the committee recommended promotion of habits that help avoid plaque buildup such as healthy diet, smoking cessation, weight loss, exercise and stress reduction. According to the committee, patients with MI should undergo revascularization to reduce risk for ventricular arrhythmias and sudden cardiac death.
Patients with MI or chronic CAD with severely reduced left ventricular function and symptoms of HF despite revascularization and medical therapy should receive an implantable cardioverter defibrillator to prevent sudden cardiac arrest if life expectancy with good quality of life is more than 1 year, the authors wrote.
LV ejection fraction remains the main tool to risk-stratify patients with chronic CAD, Nikolaos Dagres, MD, electrophysiologist at Heart Center Leipzig at the University of Leipzig, Germany, said during a presentation. In patients with CAD, an ICD is recommended in patients with NYHA class II or III HF and LVEF 35% or less, and it should be considered in patients with NYHA class I HF and LVEF 30% or less, Dagres said.
“We should not forget that we have excellent medication for heart failure treatment that is constantly increasing with the addition of new drug classes,” Dagres said. “All these drug classes do not only relieve symptoms of heart failure and improve prognosis, they also specifically reduce the risk for sudden cardiac death.
“The presence of structural heart disease is a major risk factor for sudden cardiac death in patients with ventricular arrhythmias,” Dagres said. “A previous episode of ventricular tachycardia or ventricular fibrillation must be considered as a very significant risk factor for a recurrent event.”
For patients with electrical disorders that raise risk for sudden cardiac arrest, the triggers related to the disorder should be identified and the patient should be counseled to avoid those triggers, according to the authors.
The committee also wrote that pre-participation CV evaluation of people playing competitive sports should be considered, as the incidence of sudden cardiac death is greater in athletes older than 35 years (2 to 6.3 per 100,000 participant-years) than in athletes 35 years and young (0.4 to 3 per 100,000 participant-years). Further, it recommended that sports centers should be equipped with AEDs and staffed by people trained in CPR and AED use.
“Excellent rates of survival with favorable neurological outcome after cardiac arrest have been reported in sports centers equipped with AEDs,” Katja Zeppenfeld, MD, PhD, FESC, FEHRA, professor of clinical electrophysiology and head of the clinical electrophysiology research and treatment center at Leiden University Medical Centre, Leiden, the Netherlands, and guidelines task force chairperson, said in the release.
The guidelines were endorsed by the Association for European Paediatric and Congenital Cardiology.
References:
- European Society of Cardiology. www.escardio.org/The-ESC/Press-Office/Press-releases/People-of-all-ages-should-learn-cardiopulmonary-resuscitation. Published Aug. 26, 2022. Accessed Aug. 27, 2022.
- Zeppenfeld K, et al. Eur Heart J. 2022;doi:10.1093/eurheartj/ehac262.
Collapse
Zeppenfeld K, et al. 2022 ESC guidelines for the management of patients with ventricular arrhythmias and prevention of sudden cardiac death. Presented at: European Society of Cardiology Congress; Aug. 26-29, 2022; Barcelona, Spain (hybrid meeting).
Read more about