How can we improve survival after cardiac arrest? What are the most important issues?
Bernd W. Böttiger: For me, after having done experimental resuscitation research and clinical resuscitation research and after I have performed and participated in several multicentered trials, I think the most important issue is lay cardiopulmonary resuscitation (CPR). The emergency medical service systems will arrive after the collapse after 6, 8, 10, 12 minutes, or maybe even later, but if there is no blood flow anymore the brain starts to die after 3 to 5 minutes. So the most important issue is lay resuscitation, and that is the reason why we educate schoolchildren in CPR.
Other important issues are focusing on the coronary arteries or thinking about percutaneous coronary intervention (PCI) after return of spontaneous circulation, doubling in survival. Another important issue is temperature management; this is also protective for the brain. And I would say another important issue is the right way of prognostication, so we do not stop therapy too early in those patients who have a good chance of survival.