Cardiac arrest survivors before they reach hospital. Beyond cardiopulmonary resuscitation.

Since their creation in the 1970s, coronary care units have become established as specialized units for the management of cardiac arrest associated with acute myocardial infarction. The 40% mortality rate common at that time was soon reduced by 50% as a result of the identification and early treatment of ventricular fibrillation. Over the following 20 years, research in coronary care units tended to concentrate on reducing infarct size and on treating and preventing heart failure, thus reducing mortality by a further 50%. In the current age of percutaneous interventionism, half a century after the introduction of coronary care units, 30-day mortality for patients with acute coronary syndrome and ST segment elevation is less than 0.5% if the patient reaches hospital alive and conscious and does not have heart failure upon admission. Indeed, once protocols for the early management of these patients have become established and simplified, most will probably not require admission to these specialized units. In the search for new targets for improvement, coronary care units are slowly turning into critical cardiac care units and have begun to concentrate on clinical situations in cardiology that require complex management or those that still produce a high rate of complications. To comply with the founding philosophy of coronary care units, research in such units should probably concentrate on those processes in which little progress has been made and that still produce high morbidity. Although survivors of out-of-hospital cardiac arrest account for only a small number of hospital admissions, they currently represent a group with some of the highest complications and mortality rates in critical cardiac care units and therefore consume a significant proportion of their available resources. For the field of critical cardiac care to advance, an essential first step is to understand the current situation. A recent article published in Revista Española de Cardiologı́a discusses a joint