Resource-Poor Resuscitation: Approach to Cardiac Arrest in a Developing Country



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BACKGROUND: As part of its Advanced Cardiac Life Support (ACLS) guidelines, the American Heart Association (AHA) recommends immediate cardiac monitoring for adults in cardiac arrest and, in cases of Ventricular Fibrillation (VF) or pulseless Ventricular Tachycardia (pVT), early administration of electric shocks with a cardiac defibrillator. In the United States, cardiac monitors and defibrillators are available in all hospitals for use during in-hospital cardiac arrest. Furthermore, the use Automated External Defibrillators (AEDs) is encouraged for out-of-hospital arrests. In geographically remote, resource-limited areas, cardiac defibrillators may not be readily available. OBJECTIVE: This paper aims to evaluate the availability and efficacy of in-hospital cardiac defibrillation and discuss the potential global health goal of improving defibrillator access in Peru. METHODS: An online literature search was performed looking for key words. Retrieved articles, their references, and past literature reviews on the subject were screened for relevance. RESULTS: In the United States, overall survival to discharge for cardiac arrest is low; however, there is well-established evidence that the use of ACLS guidelines improves outcomes for cardiac arrest. Patients who present in shockable rhythms are more likely to survive than those in non-shockable rhythms when a defibrillator is available. Identification of the precipitating acute medical illness is a moderate predictor of both initial rhythm and chance of survival. In Peru, etiologies of in- hospital cardiac arrest is somewhat different. Few scientific data are available for cardiac arrest outcomes or defibrillator availability in Peru. CONCLUSION: Physicians practicing international medicine must recognize and adapt to differences in patient demographics and resource availability. In Peru and similar lesser-developed countries, basic public health need such as potable water and vaccines remain a priority. Efforts to improve outcomes for in-hospital arrest should focus on teaching high-quality CPR. When sufficient infrastructure is in place, improving access to defibrillators would be an appropriate next step.

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