Prehospital Approaches to Treating Sudden Cardiac Death and Acute Myocardial Infarction

  • Joseph P. Ornato
  • Mary Ann Peberdy
Part of the Developments in Cardiovascular Medicine book series (DICM, volume 193)


In the last 25 years, most communities in the United States have developed sophisticated emergency medical services (EMS) systems that are designed to minimize death and disability from a variety of medical conditions. Sudden cardiac death (SCD) and acute myocardial infarction (AMI) account for the majority of life-threatening, nontraumatic, community emergencies affecting adults. The purpose of this chapter is to describe the pathophysiology and epidemiology of SCD and AMI, and to review the ways in which the EMS system design and function can maximize survival from these conditions.


Cardiac Arrest Sudden Cardiac Death Automate External Defibrillator Advanced Cardiac Life Support Emergency Medical Technician 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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  1. 1.
    Bossaert L, Van Hoeyweghen R, Cerebral Resuscitation Study Group. Bystander cardiopulmonary resuscitation (CPR) in out-of-hospital cardiac arrest. Resuscitation 17(Suppl.):S55, 1989.PubMedCrossRefGoogle Scholar
  2. 2.
    Cobb LA, Hallstrom AP. Community-based cardiopulmonary resuscitation: What have we learned? Ann N Y Acad Sci 382:330, 1982.PubMedCrossRefGoogle Scholar
  3. 3.
    Litwin PE, Eisenberg MS, Hallstrom AP, Cummins RO. The location of collapse and its effect on survival from cardiac arrest. Ann Emerg Med 16:787, 1987.PubMedCrossRefGoogle Scholar
  4. 4.
    Ornato JP, McNeill SE, Craren EJ, Nelson NM. Limitation on effectiveness of rapid defibrillation by emergency medical technicians in a rural setting. Ann Emerg Med 13:1096, 1984.PubMedCrossRefGoogle Scholar
  5. 5.
    Bayes de Luna A, Coumel P, Leclercq JF. Ambulatory sudden cardiac death: Mechanisms of production of fatal arrhythmia on the basis of data from 157 cases. Am Heart J 117:151, 1989.PubMedCrossRefGoogle Scholar
  6. 6.
    Myerburg RJ, Conde CA, Sung RJ, Mayooga-Cortes A, Mallon SM, Sheps DS, Appel RA, Castellanos A. Clinical, electrophysiologic and hemodynamic profile of patients resuscitated from prehospital cardiac arrest. Am J Med 68:568, 1980.PubMedCrossRefGoogle Scholar
  7. 7.
    Hinkle LE, Argyros DC, Hayes JC, Robinson T, Alonso DR. Pathogenesis of an unexpected sudden death: Role of early cycle ventricular contractions. Am J Cardiol 39:873, 1977.PubMedCrossRefGoogle Scholar
  8. 8.
    Klein RC, Vera Z, Mason DT, DeMaria AN, Awan NA, Amsterdam EA. Ambulatory Holter monitor documentation of ventricular tachyarrhythmias as mechanisms of sudden death in patients with coronary artery disease (abstr). Clin Res 27:7A, 1979.Google Scholar
  9. 9.
    Schaffer WA, Cobb LA. Recurrent ventricular fibrillation and modes of death in survivors of out-of-hospital ventricular fibrillation. N Engl J Med 293:260, 1975.CrossRefGoogle Scholar
  10. 10.
    Weaver WD, Cobb LA, Hailstrom AP, Fahrenbruch C, Copass MK, Ray R. Factors influencing survival after out-of-hospital cardiac arrest. J Am Coll Cardiol 7:754, 1986.CrossRefGoogle Scholar
  11. 11.
    American Heart Association. Standards and guidelines tor cardiopulmonary resuscitation (CPR) and emergency cardiac care (ECC). JAMA 255:2905, 1986.CrossRefGoogle Scholar
  12. 12.
    Eisenberg MS, Bergner L, Hallstrom A. Cardiac resuscitation in the community. Importance of rapid provision and implications for program planning. JAMA 241:1905, 1979.PubMedCrossRefGoogle Scholar
  13. 13.
    Cummins RO, Ornato JP, Thies WH, Pepe PE. Improving survival from sudden cardiac arrest: The “chain of survival” concept. Circulation 83:1832, 1991.PubMedGoogle Scholar
  14. 14.
    Walters G, Gluckman F. Planning a pre-hospital cardiac resuscitation programme: An analysis of community and system factors in London. JR Coll Physic Lond 23:107, 1989.Google Scholar
  15. 15.
    Stults KR. Phone first. J Emerg Med Services 12:78, 1987.Google Scholar
  16. 16.
    Alvarez H, Cobb LA. Experience with CPR training of the general public. In Proceedings of the National Conference on Standards for Cardiopulmonary Resuscitation and Emergency Cardiac Care. Dallas: American Heart Association, 1975:33.Google Scholar
  17. 18.
    Mayron R, Long RS, Ruiz E. The 911 emergency telephone number: Impact on emergency medical systems access in a metropolitan area. Am J Emerg Med 2:491, 1984.PubMedCrossRefGoogle Scholar
  18. 19.
    Hunt RC, Allison EJ Jr, Yates JG III. The need for improved emergency medical services in Pitt county. N C Med J 47:39, 1986.PubMedGoogle Scholar
  19. 20.
    Hunt RC, McCabe JB, Hamilton GC, Krohmer JR. Influence of emergency medical services systems and prehospital defibrillation on survival of sudden cardiac death victims. Am J Emerg Med 7:68, 1989.PubMedCrossRefGoogle Scholar
  20. 21.
    Thompson BM, Stueven HA, Mateer JR, Aprahamian CC, Tucker JF, Darin JC. Comparison of clinical CPR studies in Milwaukee and elsewhere in the United States. Ann Emerg Med 14:750, 1985.PubMedCrossRefGoogle Scholar
  21. 22.
    Kowalski R, Thompson BM, Horwitz L, Stueven H, Aprahamian C, Darin JC. Bystander CPR in prehospital coarse ventricular fibrillation. Ann Emerg Med 13:1016, 1984.PubMedCrossRefGoogle Scholar
  22. 23.
    Cobb LA, Werner JA, Trobaugh GB. Sudden cardiac death: 1. A decade’s experience wirh out-of-hospital resuscitation. Mod Concepts Cardiovasc Dis 49:31, 1980.PubMedGoogle Scholar
  23. 24.
    Murphy RJ, Luepker Rv, Jacobs DR Jr, Gillum RF, Folsom AR, Blackburn H. Citizen cardiopulmonary resuscitation training and use in a metropolitan area: The Minnesota Heart Survey Am J Public Health 74:513, 1984.PubMedGoogle Scholar
  24. 25.
    Selby ML, Kautz JA, Moore TJ, Gombeski WR Jr, Ramirez AG, Farge EJ, Forthofer RN. Indicators of response to a mass media CPR recruitment campaign. Am J Public Health 72:1039, 1982.PubMedGoogle Scholar
  25. 26.
    Litwin PE, Eisenberg MS, Hallstrom AP, Cummins RO. The location of collapse and its effect on survival from cardiac arrest. Ann Emerg Med 16:787, 1987.PubMedCrossRefGoogle Scholar
  26. 27.
    Mandel LP, Cobb LA. CPR training in the community. Ann Emerg Med 14:669, 1985.PubMedCrossRefGoogle Scholar
  27. 28.
    Gombeski WR, Jr, Effron DM, Ramirez AG, Moore TJ. Impact on retention: Comparison of two CPR training programs. Am J Public Health 72:849, 1982.PubMedGoogle Scholar
  28. 29.
    Muelleman RL, Ornato JP. Factors affecting the likelihood that CPR will be used by trained rescuers. Nebraska Med J 70:172, 1985.Google Scholar
  29. 30.
    St. Louis P, Carter WB, Eisenberg MS. Prescribing CPR: A survey of physicians. Am J Public Health 72:1158, 1982.Google Scholar
  30. 31.
    Goldberg RJ. Physicians and CPR training in highrisk family members. Am J Public Health 77:671, 1987.PubMedGoogle Scholar
  31. 32.
    Bossaert L, Van Hoeyweghen R, and the Cerebral Resuscitation Study Group. Evaluation of cardiopulmonary resuscitation (CPR) techniques. Resuscitation 17(Suppl.):S99, 1989.PubMedCrossRefGoogle Scholar
  32. 33.
    Ornato JP, Hallagan LF, McMahon SB, Peeples EH, Rostafinski AG. Attitudes of BCLS instructors about mouth-to-mouth resuscitation during the AIDS epidemic. Ann Emerg Med 19:151, 1990.PubMedCrossRefGoogle Scholar
  33. 34.
    Van Camp SP, Peterson RA. Cardiovascular complications of outpatient cardiac rehabilitation programs. JAMA 1160, 1986.Google Scholar
  34. 35.
    Haskell WL. Cardiovascular complications during exercise training in cardiac patients. Circulation 57:920, 1978.PubMedGoogle Scholar
  35. 36.
    Hossack KF, Hartwig R. Cardiac arrest associated with supervised cardiac rehabilitation. J Cardiac Rehab 2:402, 1982.Google Scholar
  36. 37.
    Ornato JP, McNeill SE, Craren EJ, Nelson NM. Limitations on effectiveness of rapid defibrillarion by emergency medical technicians in a rural setting. Ann Emerg Med 13:1096, 1984.PubMedCrossRefGoogle Scholar
  37. 38.
    Eisenberg MS, Copass MK, Hallstrom AP, Blake B, Bergner L, Short FA, Cobb LA. Treatment of out-of-hospital cardiac arrest with rapid defibrillation by emergency medical technicians. N Engl J Med 302:1379, 1980.PubMedCrossRefGoogle Scholar
  38. 39.
    Kerber RE. Statement on Early Defibrillation from the Emergency Cardiac Care Committee, American Heart Association. Circulation 83:2233, 1991.Google Scholar
  39. 40.
    Eisenberg MS, Moore J, Cummins RO, Andresen E, Litwin PE, Hallstrom AP, Hearne T. Use of the automatic external defibrillator in home of survivors of out-of-hospital ventricular fibrillation. Am J Cardiol 63:443, 1989.PubMedCrossRefGoogle Scholar
  40. 41.
    Swenson RD, Hill DL, Martin JS, Wirkus M, Weaver WD. Automatic external defibrillators used by family members to treat cardiac arrest (abstr). Circulation 76(Suppl. IV):IV463, 1987.Google Scholar
  41. 42.
    Weaver WD, Sutherland K, Wirkus MJ, Bachman R. Emergency medical care requirements for large public assemblies and a new strategy for managing cardiac arrest in this setting. Ann Emerg Med 18:155, 1989.PubMedCrossRefGoogle Scholar
  42. 43.
    Chadda KD, Kammerer RJ, Kuphal J, Miller K. Successful defibrillation in the industrial, recreational, and corporate settings by laypersons (abstr). Circulation 76(Suppl. IV):IV12, 1987.Google Scholar
  43. 44.
    Wilson BD, Graton MC, Overton J, Watson W. Unexpected ALS procedures on nonemergency ambulance calls: The value of a single tier system. Prehosp Disaster Med 6:382, 1991.Google Scholar
  44. 45.
    Cummins RO. From concept to standard-of-care? Review of the clinical experience with automated external defibrillators. Ann Emerg Med 18:1269, 1989.PubMedCrossRefGoogle Scholar
  45. 46.
    Pepe PE, Abramson NS, Brown CG. ACLS—Does it really work? Ann Emerg Med 23:1037, 1994.PubMedCrossRefGoogle Scholar
  46. 47.
    Ornato JP, Racht EM, Fitch JJ, Berry JF. The need for ALS in urban and suburban EMS systems. Ann Emerg Med 19:151, 1990.PubMedCrossRefGoogle Scholar
  47. 48.
    Gruppo Italiano per lo Studio delta Streptochinasi Nell’ Infarto Miocardico (GISSI). Effectiveness of intravenous thrombolytic treatment in acute myocardial infarction. Lancet 1:379, 1986.Google Scholar
  48. 49.
    Gruppo Italiano per lo Studio della Streptochinasi Nell’Infarto Miocardico (GISSI). Effectiveness of intravenous thrombolytic treatment in acute myocardial infarction. Lancet 1:397, 1986.PubMedGoogle Scholar
  49. 50.
    ISIS (Second International Study of Infarct Survival) Collaborative Group. Randomized trial of intravenous streptokinase, oral aspirin, both or neither among 17,187 cases of suspected acute myocardial infarction. ISIS-2. Lancet 2:349, 1988.Google Scholar
  50. 51.
    Wilcox RG, Olsson CG, Skene AM, Vonder Lippe G, Jensen G, Hampton JR (for the ASSET Study Group). Trial of tissue plasminogen activator for mortality reduction in acute myocardial infarction. Lancet 2:525, 1988.PubMedCrossRefGoogle Scholar
  51. 52.
    AIMS Trial Study Group. Effect of intravenous APSAC on mortality after acute myocardial infarction: Preliminary report of a placebo-controlled clinical trial. Lancet 1:545, 1988.Google Scholar
  52. 53.
    Weaver WD, Cerqueira M, Hallstrom AP, Litwin PE, Martin JS, Kudenchuk PJ, Eisenberg M, for the Myocardial Infarction Triage and Intervention Project Group. Prehospital-initiated vs. hospital-initiated thrombolytic therapy: The myocardial infarction triage and intervention trial.Google Scholar
  53. 54.
    Kereiakes DJ, Weaver WD, Anderson JL, et al. Time delays in the diagnosis and treatment of acute myocardial infarction: A tale of eight cities. Report from the pre-hospital study group and the Cincinnati Heart Project. Am Heart J 120:773, 1990.PubMedCrossRefGoogle Scholar
  54. 55.
    Castaigne AD, Duval AM, Dubois-Rande JL, et al. Prehospital administration of anisoylated plasminogen streptokinase activator complex in acute myocardial infarction. Drugs 33(Suppl. 3):231, 1987.PubMedCrossRefGoogle Scholar
  55. 56.
    European Myocardial Infarction Project (E.M.I.P) Subcommittee. Potential time savings with pre-hospital intervention in acute myocardial infarction. Eur Heart J 9:118, 1988.Google Scholar
  56. 57.
    Castaigne AD, Herve C, Duval-Moulin A, et al. Pre-hospital use of APSAC: Results of a placebo-controlled study. Am J Cardiol 64:3OA, 1989.CrossRefGoogle Scholar
  57. 58.
    Kennedy JW, Weaver WD. Potential use of thrombolytic therapy before hospitalization. Am J Cardiol 64:8A, 1989.PubMedCrossRefGoogle Scholar
  58. 59.
    Ornato JP. The earliest thrombolytic treatment of acute myocardial infarction: Ambulance or emergency department? Clin Cardiol 13:VIII27, 1990.PubMedGoogle Scholar
  59. 60.
    Ho MT, Eisenberg MS, Litwin PE, et al. Delay between onset of chest pain and seeking medical care: the effect of public education. Ann Emerg Med 18:727, 1989.PubMedCrossRefGoogle Scholar
  60. 61.
    Herlitz J, Hartford M, Blohm M, et al. Effect of a media campaign on delay times and ambulance use in suspected acute myocardial infarction. Am J Cardiol 64:90, 1989.PubMedCrossRefGoogle Scholar
  61. 62.
    American College of Emergency Physicians Board of Directors. American College of Emergency Physicians Policy Statement: Prehospital use of thrombolytic agents. Dallas: American College of Emergency Physicians, October 1993.Google Scholar
  62. 63.
    Aufderheide TP, Hendley GE, Thakur RK, Mateer JR, Stueven HA, Olson DW, Hargarten KM, Laitinen F, Robinson N, Preuss KC, Hoffman RG. The diagnostic impact of prehospital 12-lead electrocardiography. Ann Emerg Med 19:1280, 1990.PubMedCrossRefGoogle Scholar
  63. 64.
    Kowalenko T, Kereiakes DJ, Gibler WB. Prehospital diagnosis and treatment of acute myocardial infarction: A critical review. Am Heart J 123:181, 1991.CrossRefGoogle Scholar

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© Kluwer Academic Publishers 1997

Authors and Affiliations

  • Joseph P. Ornato
  • Mary Ann Peberdy

There are no affiliations available

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