‘Fifth link’ improves outcomes after out-of-hospital cardiac arrest

By Sarah Guy, MedWire Reporter

Neurologic outcomes for survivors of out-of-hospital cardiac arrest (OHCA) are significantly improved after implementation of the 2010 American Heart Association (AHA)'s fifth link in the chain-of-survival concept for postresuscitation care, show Japanese study results.

The link involves multidisciplinary postresuscitation care in a regional center, which, in the current study, included appropriate hemodynamic and respiratory management, therapeutic hypothermia, and percutaneous coronary intervention.

Takasi Tagami (Nippon Medical School, Tokyo) and colleagues report that a significantly greater proportion of OHCA patients treated during a 2-year period when the fifth link was implemented achieved a Cerebral Performance Category (CPC) score of 1 or 2 - indicating favorable neurologic outcome - than their counterparts treated during 2 pre-implementation years.

"Our data support the 5-step chain of survival concept in the current AHA guidelines," write Tagami and co-workers in Circulation.

The team assessed 1-month neurologic outcomes in 770 and 712 OHCA patients treated, respectively, before and after the implementation of the fifth link campaign in the Aizu region of Japan. There were no significant differences in potentially confounding factors between the two patient groups such as the rate of bystander CPR performance, age, gender, and presence of an initial shockable rhythm.

The rate of patients achieving a favorable neurologic outcome increased from 0.5% to 3.0% after initiation of the campaign, report the researchers, giving a significant odds ratio of 5.8.

Indeed, the proportion of survivors with this favorable outcome at 1 month post OHCA increased by a significant 10.3-fold among those treated after the implementation of the fifth link compared with before.

"These findings suggest that the fifth link is associated with quality of life among survivors," write Tagami et al. "Therefore, the fifth link is important for achieving the goal of resuscitation."

Implementation of the campaign also increased the rate of patients who survived to hospital discharge, from 2.3% to 4.2%, giving an odds ratio of 1.8.

"The coordinated and seamless actions of laypeople and healthcare providers, including EMS [emergency medical services] personnel, emergency medicine physicians, cardiologists, critical care physicians, nurses, medical engineers, and other key personnel, are required for managing OHCA," concludes the team.

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