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New Recommendations to Improve Cardiac Arrest Survival

  • Carol Pearson

When someone's heart stops beating, every second counts. Only six percent of people who go into cardiac arrest survive. In the U.S., that means 600,000 deaths a year. The Institute of Medicine (IOM), an independent advisory group, found survival rates "unacceptably low" - and has issued recommendations to improve those numbers.

Dr. Lance Becker, a professor of Emergency Medicine at the University of Pennsylvania, was part of the study group. He said most people confuse cardiac arrest with a heart attack. People can survive heart attacks, but without immediate help, they do not survive cardiac arrest.

He said, "A cardiac arrest is where the very mechanical beating of the heart stops suddenly and that is an emergency that will be death producing if it’s not corrected in minutes."

A heart attack is caused by a blocked artery that cuts off the blood supply to the heart muscle. It's not necessarily deadly, but it can lead to cardiac arrest. To improve the odds of survival, the study group issued guidelines that involve hospitals, emergency responders and the public.

The recommendations include more training so ordinary citizens can deliver cardiopulmonary resuscitation, or CPR, to get the heart started again. They also could learn to use an automated external defibrillator, a machine that delivers an electrical shock to the heart in an effort to return it to normal rhythm.

Only about three percent of Americans get annual CPR training and even fewer know how to use a defibrillator. This lack of knowledge, the study group concluded, contributes to dismal survival rates.

"The most important thing for America is to have a full system that can start right out on the street," Dr. Becker said. He added, "The early applications of chest compressions and calling 911 [a telephone number to report emergencies] is proven to save lives. And you don’t have to do it perfectly. The important thing is to just start doing it."

Other recommendations include:

• Establishing a national registry of cardiac arrest to monitor performance, identify problems, and track progress, both in hospitals and with emergency medical teams who respond to crises.
• Helping state and local education departments to include CPR and use of an automated external defibrillator training as middle- and high-school graduation requirements.
• Developing strategies to improve systems of care in hospitals.
• Encouraging training and setting up performance comparisons within hospitals and EMS and health care systems.
• Expanding research in cardiac arrest resuscitation and promoting innovative technologies and treatments.

In an article in the Journal of the American Medical Association, study co-authors wrote, "Despite its large public health footprint, cardiac arrest does not resonate with the public and policy makers the same way as other conditions, such as stroke or cancer. Many complex social, political, and practical considerations have contributed to an environment in which death from cardiac arrest appears to have become an accepted norm."

Becker said individuals and medical teams in developing countries could benefit from research and practices in the U.S. These countries are experiencing an increase in the numbers of people who go into cardiac arrest as their lifestyles change with increased urbanization and unhealthy changes in diet. Although cardiac arrest predominantly affects older people, it can strike anyone, including children.

The IOM study was sponsored by the American Heart Association, the American Red Cross, the American College of Cardiology, the Centers for Disease Control and Prevention, the National Institutes of Health, and the U.S. Department of Veterans Affairs. The IOM is an advisory group only and lacks the ability to enforce its recommendations.