Cardiac arrest: Treatment is prevention?

International audience ; The management of cardiac arrest has benefited from recent advances in cardiopulmonary resuscitation techniques. However, despite improvements, the incidence of sudden cardiac death is still high, with more than 4.1 deaths per 100,000 person-years in the United States, and continues to have very low survival rates at hospital discharge - 8% on average - ranging from 0% to 18% [1–3]. In response to this issue, research and interventions on cardiac arrest prevention has been greatly developed. As early as 2005, the International Liaison Committee on Resuscitation included prevention of out-of-hospital cardiac arrest as the first link in the chain of survival, alongside "early recognition" and "calling for help" [4]. In a recent JAMA review, the prevention of in-hospital cardiac arrests was considered "potentially possible with recognition of deterioration and early intervention", in contrast to the prevention of out-of-hospital cardiac arrests which is qualified as "often impossible given the lack of pre-cardiac arrest monitoring", though they mainly relate to secondary prevention rather than primary [5]. A Lancet review focusing on out-of-hospital cardiac arrest briefly mentions primary prevention in the control of risk factors in the case of cardiac pathologies, but this theme is reinforced in the latest updates [6]. Furthermore, the usefulness of implantable defibrillators for treating serious ventricular rhythm disorders has been showed a long time ago, with a reduction of sudden death by primary and secondary prevention [7,8].