Current State
Little progress has been made over the last 5 years with out of hospital cardiac arrest survival at 12% and in-hospital survival at 25% with only a fraction of those with good neurologic outcome. Progress in CPR techniques have had limited impact on improving good neurological outcomes and survival. Newer techniques including end tidal CO2 and continuous real time automated feedback on depth, rate and recoil of compressions offer promise as a resuscitation guide.
Preexisting models
For many years, the standard model for resuscitation training has revolved around the American Heart Association (AHA) guidelines, which are based on expert consensus and updated every five years. After release of the guidelines, modifications are made to advanced cardiac life support (ACLS) and BLS courses. The ACLS and BLS philosophies have focused on standardization to ensure consistency across training centers and between hospitals and EMS agencies. However, in many EMS systems, the static and generic curriculum, divorced from institution- or agency-specific performance improvement data and ongoing scientific updates, has resulted in ACLS and BLS devolving into “merit badge” requirements. Rather than considering the biennial course as an opportunity to learn new information or practice critical resuscitation skills, some providers take a “tell me what I need to do to get my card” approach, with little personal investment in the training.
New models
Seeking change in the climate of resuscitation are forcing a re-evaluation of our traditional model. Resuscitation science is undergoing a renaissance, with an explosion of new information and rapid progression in our understanding of the basic mechanisms of ischemia-reperfusion. Not only does this force more frequent updates, but it has also led to a more complex understanding of cardiopulmonary arrest. This means the prospect of a single algorithm or training platform to address different patient populations, provider types, crew configurations and equipment may be unrealistic at best— and potentially harmful at worst. The ART of cardiac resuscitation can be improved by the ART program