Guidelines Call for Stronger, More Coordinated Cardiac Arrest Response

When someone collapses from cardiac arrest, everything that happens after that moment can impact a person’s chances of survival. New resuscitation guidelines lay out instructions for a quick, well-choreographed team approach — from bystanders and 911 dispatchers to emergency response personnel and hospital medical staff.

The new American Heart Association guidelines, published last week in Circulation, call on cities and counties nationwide to strengthen and monitor every step in how they respond to cardiac arrests that occur outside a hospital. The objective is to improve survival, which varies widely across the country, according to the guidelines.

“Your chances of surviving a cardiac arrest shouldn’t depend on which city you live in, or which EMS system responds or which hospital you go to,” said Robert Neumar, M.D., Ph.D., immediate past chair of the AHA’s Emergency Cardiovascular Care Committee. He is also a professor and chair of the University of Michigan Health System’s Department of Emergency Medicine.

More than 326,000 Americans have cardiac arrests outside of a hospital each year. The heart suddenly stops, most often because of a chaotic heart rhythm called ventricular fibrillation, or VF. CPR can manually circulate a small amount of blood, and an automated external defibrillator, or AED, can shock the heart back to a normal rhythm.

Survival rates for cardiac arrest caused by VF are in the single digits in many urban areas. Nationally, the survival rate for bystander-witnessed VF cardiac arrest is 31 percent. When all forms of cardiac arrest are considered, the outcome is more dismal: only 10 percent survive.

Survival rates won’t improve simply by “having faster ambulances or taller hospitals,” said Clifton Callaway, M.D., Ph.D., chair of the AHA’s Emergency Cardiovascular Care Committee and a professor of emergency medicine at the University of Pittsburgh.

What’s needed, the guidelines say, are structured response systems  that successfully execute the “chain of survival.” That includes calling 911, giving immediate and effective CPR, defibrillating, providing basic and advanced life support and delivering post-arrest care, such as cooling patients to minimize brain damage and treating heart blockages that led to the cardiac arrest.

Communities nationwide are already seeing the payoff of such coordinated efforts.

In King County, Washington, which includes Seattle, the survival rate for witnessed VF arrest went from the mid-teens in the early 1970s to 55 percent in 2014, according to King County’s Emergency Medical Services Division. The county’s all-time high survival rate of 62 percent  happened in 2013.

Mickey Eisenberg, M.D., is the medical director of King County EMS and credits close collaboration within a complex response system.

“There’s no secret sauce,” said Eisenberg, a professor of emergency medicine at the University of Washington. The improvements, he said, have come from training and meticulously measuring and examining performance.

“Our mantra is ‘measure, improve, measure, improve,’” Eisenberg said.