Improving Care of Out-of-Hospital Cardiac Arrest: Next Steps.

Abstract

> Humanity’s greatest advances are not in its discoveries—but in how those discoveries are applied. > > –Bill Gates Cardiac arrest is a common cause of death, afflicting >300 000 patients per year in the United States, with a case fatality rate of 95%.1 Many of these deaths may be prevented with improved resuscitation efforts. Considerable progress has been made in the last 5 years on how to improve survival from out-of-hospital cardiac arrest, but the opportunity to improve outcome remains largely unrealized. In recent years, the data have increased regarding who suffer cardiac arrest, where, how they are treated, and related outcomes. Several informative registries are found, in both the United States and other countries, with the most detailed major North American registry being in the National Institutes of Health-sponsored ROC program (Resuscitation Outcomes Consortium) and the most extensive being CARES (Cardiac Arrest Registry to Enhance Survival). Both registries have provided important insights, including that more than half of patients with cardiac arrest have underlying ischemic heart disease and more than three quarters of cardiac arrests occur in patients’ homes. An important analysis from ROC showed regional heterogeneity in survival of patients with presumed cardiac arrest with shockable rhythm, ranging from 8% in Alabama to 40% in Seattle, suggesting an opportunity to improve care by adapting best practices around the …