Cardiac arrest can strike a seemingly healthy individual of any age, race, ethnicity, or gender at any time in any location, often without warning. Cardiac arrest is the third leading cause of death in the United States, following cancer and heart disease. Four out of five cardiac arrests occur in the home, and more than 90 percent of individuals with cardiac arrest die before reaching the hospital. First and foremost, cardiac arrest treatment is a community issue-local resources and personnel must provide appropriate, high-quality care to save the life of a community member. Time between onset of arrest and provision of care is fundamental, and shortening this time is one of the best ways to reduce the risk of death and disability from cardiac arrest. Specific actions can be implemented now to decrease this time, and recent advances in science could lead to new discoveries in the causes of, and treatments for, cardiac arrest. However, specific barriers must first be addressed.

Strategies to Improve Cardiac Arrest Survival examines the complete system of response to cardiac arrest in the United States and identifies opportunities within existing and new treatments, strategies, and research that promise to improve the survival and recovery of patients. The recommendations of Strategies to Improve Cardiac Arrest Survival provide high-priority actions to advance the field as a whole. This report will help citizens, government agencies, and private industry to improve health outcomes from sudden cardiac arrest across the United States.

Contents

• THE NATIONAL ACADEMIES
• COMMITTEE ON THE TREATMENT OF CARDIAC ARREST: CURRENT STATUS AND FUTURE DIRECTIONS
• Reviewers
• Preface
• Acknowledgments
• Summary
  • SCOPE OF WORK
  • A UNIFYING FRAMEWORK FOR CARDIAC ARREST
  • ESTABLISH ROBUST DATA COLLECTION AND DISSEMINATION
  • EDUCATE AND TRAIN THE PUBLIC
  • IMPROVE DELIVERY OF HIGH-QUALITY RESUSCITATION AND POST-ARREST CARE
  • INCREASE THE IMPACT OF CARDIAC ARREST RESEARCH AND THERAPIES
  • STRENGTHEN STAKEHOLDER COLLABORATION
  • REFERENCES
• 1. Introduction
  • COMMITTEE SCOPE OF WORK
  • DEFINING CARDIAC ARREST
  • THE CARDIAC ARREST CHAIN OF SURVIVAL
  • A SYSTEMS FRAMEWORK
  • OVERVIEW OF THE REPORT
  • REFERENCES
• 2. Understanding the Public Health Burden of Cardiac Arrest: The Need for National Surveillance
  • CARDIAC ARREST INCIDENCE AND OUTCOMES IN THE UNITED STATES
  • FACTORS INFLUENCING INCIDENCE AND SURVIVAL
  • ECONOMIC BURDEN OF POST-ARREST CARE
  • CARDIAC ARREST SURVEILLANCE
  • CONCLUSION
  • REFERENCES
• 3. The Public Experience with Cardiac Arrest
  • BYSTANDER CPR
  • PUBLIC ACCESS DEFIBRILLATION (PAD) PROGRAMS
  • OPPORTUNITIES
  • CONCLUSION
  • REFERENCES
• 4. Emergency Medical Services Response to Cardiac Arrest
  • OVERVIEW OF EMS
  • THE EMS RESPONSE TO CARDIAC ARREST
  • OPPORTUNITIES FOR IMPROVING THE RESPONSE
  • CONCLUSION
  • REFERENCES
• 5. In-Hospital Cardiac Arrest and Post-Arrest Care
  • TRANSITION OF CARE IN CARDIAC ARREST RESUSCITATION SYSTEMS
  • IN-HOSPITAL CARDIAC ARREST
  • POST-ARREST CARE
  • STRATEGIES TO IMPROVE THE QUALITY OF CARDIAC ARREST CARE IN HOSPITAL SETTINGS
  • CONCLUSION
  • REFERENCES
• 6. Resuscitation Research and Continuous Quality Improvement
  • THE STATE OF RESUSCITATION RESEARCH: ENHANCING THE SCIENCE
  • INFRASTUCTURE AND SUPPORT FOR RESUSCITATION RESEARCH
  • TRANSLATING SCIENCE INTO PRACTICE: THE ROLE OF EVIDENCE-BASED GUIDELINES
  • CONTINUOUS QUALITY IMPROVEMENT
  • STRENGTHENING COORDINATION AND ADVOCACY
  • CONCLUSION
  • REFERENCES
• 7. Recommendations and Key Opportunities
  • ESTABLISH ROBUST DATA COLLECTION AND DISSEMINATION
  • PUBLIC AWARENESS AND EDUCATION
  • IMPROVE THE DELIVERY OF HIGH-QUALITY RESUSCITATION CARE
  • ASSESSING HOSPITAL PERFORMANCE TO IMPROVE CARDIAC ARREST OUTCOMES
  • CARDIAC ARREST RESEARCH AND THERAPIES
  • STAKEHOLDER COLLABORATION
  • CONCLUSION
  • REFERENCES
• APPENDIXES
  • A Acronyms
  • B Meeting Agendas
  • C Committee Biographies
  • D Selected Results from Commissioned Analyses
  • E Map of U.S. States with CPR Training as a High School Graduation Requirement
  • F Utstein Guideline—Endorsed Data Elements for Reporting Out-of-Hospital Cardiac Arrest

This study was supported by Contract No. 200-2011-38807, TO #24, between the National Academy of Sciences and the Centers for Disease Control and Prevention; Contract No. HHSN26300031 between the National Academy of Sciences and the National Institutes of Health; Contract No. VA791-14-P-0865 between the National Academy of Sciences and the U.S. Department of Veterans Affairs; and with support from the American College of Cardiology, the American Heart Association, and the American Red Cross. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the authors and do not necessarily reflect the views of the organizations or agencies that provided support for the project.

Suggested citation:

IOM (Institute of Medicine). 2015. Strategies to improve cardiac arrest survival: A time to act. Washington, DC: The National Academies Press.

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.