Improving prognosis in out-of-hospital cardiac arrest through cardiac support and optimization of post-resuscitative care

Out-of-hospital cardiac arrest (OHCA) is a common lethal health problem. Despite significant advances in the diagnosis and treatment of cardiovascular disease, OHCA continues to be a major challenge with unacceptably high mortality and morbidity. Although most research into OHCA has focused on improving rates of return of circulation, many patients die in the post resuscitative period from a unique set of physiological insults, collectively termed the post cardiac arrest syndrome. Over the last decade several clinical trials have highlighted the importance of post-resuscitative care in optimizing survival and neurological recovery. Recently, there have been significant advances in management including recommendations related to regional systems of care, application of therapeutic hypothermia and the utilization of investigative procedures including emergent coronary angiography, cardiac support devices and other tools which provide prognostic information. Despite these advances there has been poor uptake of post-resuscitative care guidelines with significant differences in clinical outcomes between regions and institutions. This thesis focuses on post-resuscitative management in Australia, whilst also exploring new systems and models for OHCA patients in an effort to improve clinical outcomes.