Persistent poor outcomes: A call to action to implement post-cardiac arrest neurologic care and prognostication guidelines.

Although the past two decades have seen remarkable developments in the science of post-cardiac arrest care, the outcomes of these patients beyond the realm of clinical trials and tertiary care centers do not appear to reflect these advancements fully. Extensive population data indicate that since the widespread implementation of cardiopulmonary resuscitation (CPR) and defibrillation technology in the mid-20th century, both the overall survival of out-of-hospital cardiac arrest (OHCA) patients and the proportion with favorable neurologic outcomes have remained largely stagnant: a recent American Heart Association (AHA) report on national registry data on cardiac arrest indicates that overall survival for OHCA has remained at approximately 10% over the past decade. 1 Tsao C.W. et al. Heart Disease and Stroke Statistics-2022 Update: A Report From the American Heart Association. Circulation. 2022; 145: e153-e639 Crossref PubMed Scopus (1389) Google Scholar Strikingly, overall survival to hospital discharge after emergency medical services-treated OHCA actually declined from 2016 to 2020, with no clear explanation for this trend other than the coincidental COVID-19 pandemic. 1 Tsao C.W. et al. Heart Disease and Stroke Statistics-2022 Update: A Report From the American Heart Association. Circulation. 2022; 145: e153-e639 Crossref PubMed Scopus (1389) Google Scholar , 2 Coute R.A. et al. Estimating the impact of the COVID-19 pandemic on out-of-hospital cardiac arrest burden of disease in the United States. J Am Coll Emerg Phys Open. 2022; 3: e12811 PubMed Google Scholar