Slides ROSC Lecture 1 Part 2

7/28/2019 Slides ROSC Lecture 1 Part 2

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Cardiac arrest is a massive public health problem

Cardiac arrest is a leading cause of deathin the developed world

Over 300,000 people in the U.S. suffer cardiacarrest each year

Most victims die before hospital arrival

Less than 10% leave the hospital alive

Cardiac arrest commonly strikes people in their 50s and 60soften active, generally health peopleand strikes with fewwarning signs or symptoms


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Survival from cardiac arrest is highly variable

Survival from cardiac arrest depends on where you live

From a large research study in 2008, showing survival tohospital discharge for victims of cardiac arrest:

Survivalto

discharge

Dallas Pittsburgh Portland Seattle

4.5%7.0%

10.6%

16.3%

Nichol et al, JAMA 2008


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Why is cardiac arrest survival so variable?

Cardiac arrest survival depends on the successful

performance of the chain of survival

Not all communities have the same strengths in this chain

Early access Prompt Rapid Early advanced

(calling 911) CPR defibrillation care delivery


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Survival variability is from multiple factors

Public knowledge about CPR, willingness toperform CPR varies from community tocommunity

Availability of automated externaldefibrillators (AEDs) differs widely as well

Quality of Emergency Medical Services (EMS)response widely variable


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Example: variable public knowledge of AEDs

A survey study conducted in a major

European train station in 2011 queriedmembers of the public about AEDs

Findings from laypersons surveyed:

Only 38% could identify an AEDOnly 46% could describe purpose of AEDOnly 36% knew AEDs could be used by public

If someone collapsed from cardiac arrest inyour local train station, would people know to

grab an AED and use it? Is one available?

Schober et al, Ann Emerg Med 2011


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Timeline of survival from cardiac arrest

Minutes after cardiac arrest onset

0 2 4 6 8 10 12

Survival

100

80

60

40

20

0

Chance of survival falls by 7-15%

for each minute of untreatedcardiac arrest

Early CPR alters this curve survivalincreases by 2-3 fold in some studies

Bottom line: public CPR matters!

CPR

Valenzuela et al, Circulation 1997


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Challenges to widespread CPR training and performance

Experience mismatch we train young

people who are unlikely to see victimsCosts of CPR courses; logisticsof finding a class

Aversion to mouth-to-mouthBreathing, especially for strangers

Fear of liability of performing CPR

Decay of CPR skills over time

Documents

Slides ROSC Lecture 1 Part 2