Landmark International ICU Study Delivers Major Post-Cardiac Arrest Care Finding

The high-profile collapse of Danish footballer Christian Eriksen during a recent European match reminds us how crucial decisions made following cardiac arrest can save lives.

In New Zealand, half of those who survive cardiac arrest and reach hospital remain critically ill and require Intensive Care Unit (ICU) support.

A five-year study, undertaken across Europe, North America, Australia, and New Zealand, and led here in Aotearoa by the Medical Research Institute of New Zealand (MRINZ) has explored whether controlling body temperature as a part of standard care to prevent brain damage for those who survive a cardiac arrest improves patient outcomes.

Recently announced ‘Targeted Hypothermia versus Targeted Normothermia after Out-of-Hospital Cardiac Arrest’ trial (TTM-2) results have conclusively proven that cooling survivors of cardiac arrest to below a normal body temperature does not improve their rates of recovery.

These findings will very likely result in significant changes to standard clinical practice both here in Aotearoa New Zealand and internationally.

On Saturday, 14 June 2021, millions of spectators watched in alarm as 29-year-old Danish footballer Christian Eriksen suffered a cardiac arrest and collapsed on the field in the middle of a UEFA European Championship game.

Christian’s heart had stopped, and he collapsed unconscious immediately. His collapse was witnessed, and he received prompt CPR. A defibrillator was used to restart his heart and he rapidly recovered consciousness.

Christian Eriksen is now in a stable condition in a hospital in Copenhagen, thanks to receiving immediate life-saving medical attention through the ‘Chain of Survival’.

Surviving a cardiac arrest depends on a ‘Chain of Survival’:
1. Recognition of cardiac arrest and activation of the emergency response system
2. Early cardiopulmonary resuscitation (CPR) with an emphasis on chest compressions
3. Rapid defibrillation
4. Advanced resuscitation by Emergency Medical Services and other healthcare providers
5. Post-cardiac arrest care in an inpatient critical-care facility with a comprehensive care plan
6. Recovery including additional treatment, observation, rehabilitation, and psychological support

A strong ‘Chain of Survival’ can greatly improve chances of survival and recovery for victims of cardiac arrest. Almost 1 in 3 cardiac arrests happen in a public place and performing CPR increases the chance of survival, as bystander CPR is a vital link in the ‘Chain of Survival.’

Christian Eriksen was lucky, as for him, the ‘Chain of Survival’ was strong. Most patients who suffer a cardiac arrest are not this fortunate.

Each week, in New Zealand, between 5 and 10 patients who have suffered from a cardiac arrest end up unconscious and on life support in an intensive care unit (ICU). Around half of these patients suffer permanent brain damage and either end up dependent or die as a consequence of their cardiac arrest. For these patients, ‘Post-cardiac arrest care' is a critical link in the ‘Chain of Survival’.