Fall/Winter 2015 Vol. 15 Number 2

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Hanging on a Heartbeat

Strategies to Survive Cardiac Arrest

It can happen in the blink of an eye. Someone suddenly collapses. When you approach to see what happened, you notice the person is unconscious. When you check for a pulse, you find none. These are the signs of cardiac arrest -- a disturbance in the electrical activity of the heart that causes it to stop beating -- and it strikes almost 600,000 people each year in the U.S., killing the vast majority of them.

A recent Academies report presents a series of strategies and actions to improve the chances for survival and quality of life following cardiac arrest, which some estimates suggest is the third leading cause of death in the U.S. behind cancer and heart disease.

For those who experience cardiac arrest outside of a hospital, the survival rate is less than 6 percent. Survival rates depend greatly on where the cardiac arrest occurs, and each minute without treatment decreases the likelihood of surviving without disability, said the study committee that wrote the report. And the chance of survival drops by 10 percent with every passing minute between collapse and return of spontaneous circulation, although new research offers hope in extending this time.

Effective treatment demands an immediate response from someone who can recognize cardiac arrest, call 911, start CPR, and use an automated external defibrillator (AED). Decreasing the time between the onset of cardiac arrest and the first chest compression is critical, the committee said. Although evidence indicates that bystander CPR and AED use can significantly improve a victim's chance of survival and the outcomes from cardiac arrest, each year less than 3 percent of the U.S. population receives CPR training, leaving many bystanders unprepared to respond. The committee recommended greater public awareness and that CPR and AED training take place in middle and high schools, workplaces, and other community settings.

Furthermore, EMS systems vary in capacity and resources to respond to complex medical events. Despite a lack of national oversight of EMS systems, which can contribute to fragmentation and an absence of system-wide coordination in response to cardiac arrest, some communities have demonstrated that focused leadership with accountability can improve cardiac arrest outcomes. Educating and training EMS professionals to administer "high-performance CPR" -- which emphasizes team-related factors such as communication and collaboration -- and providing dispatcher-assisted CPR can help increase the likelihood of positive outcomes.

"Cardiac arrest survival rates are unacceptably low," said Robert Graham, chair of the committee. "Cardiac arrest treatment is a community issue, requiring a wide range of people to be prepared to act, including bystanders, family members, first responders, emergency medical personnel, and health care providers."

Although the terms are often used interchangeably, cardiac arrest is different and medically distinct from a heart attack. A heart attack occurs when blood flow to an area of the heart is blocked by a narrowed or completely obstructed coronary artery, resulting in the damage of heart muscle. Heart attack symptoms may include pain, dizziness, and shortness of breath, among others. The treatment goal for a heart attack is to reopen blocked arteries and restore blood flow, whereas cardiac arrest treatment aims to restore circulation and electric rhythm.

The committee also recommended establishing a national registry of cardiac arrest; developing strategies to improve systems of care within hospital settings, such as setting national accreditation standards related to cardiac arrest for hospitals and health care systems; and creating a national cardiac arrest collaborative to unify the field and identify common goals, including research priorities and action strategies.

-- Jennifer Walsh

Strategies to Improve Cardiac Arrest Survival: A Time to Act. Committee on the Treatment of Cardiac Arrest: Current Status and Future Directions, Board on Health Sciences Policy, Institute of Medicine (2015, 456 pp.; ISBN 978-0-309-37199-5; available from the National Academies Press, tel. 1-800-624-6242; $74.00 plus $5.00 shipping for single copies).

The committee was chaired by Robert Graham, director of the national program office for Aligning Forces for Quality at George Washington University, Washington, D.C. The study was sponsored by the American Heart Association, American Red Cross, American College of Cardiology, Centers for Disease Control and Prevention, National Institutes of Health, and U.S. Department of Veterans Affairs.

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