Each year, more than 350,000 cases of cardiac arrest - in which the heart suddenly malfunctions and stops beating properly - occur outside of a hospital setting in the United States.
In 2016, only about 12% of those victims survived.
The nationwide survival rate reflects the narrow window available to provide treatment and attempt to resuscitate cardiac arrest victim. According to a 2015 Institute of Medicine study, a victim's likelihood of surviving a cardiac arrest decreases by 10% each minute between the collapse and the return of spontaneous circulation, highlighting the importance of reducing the time between the onset of the cardiac event and first chest compression.
Hands-only CPR, pushing hard and fast in the center of the chest at a rate of 100 to 120 compressions per minute, has emerged as a recommended technique, especially for bystanders waiting for emergency personnel to arrive. The technique, which can help keep blood flowing to the brain and other vital organs, can actually double or triple a victim's chance of survival if performed within the first couple minutes, according to the American Heart Association.
Searching for CPR
Yet, only 46% of sudden cardiac arrest victims received bystander CPR in 2016. Studies found that 70% of Americans feel helpless to act during a cardiac emergency, with most citing a fear of hurting the victim or an inability to properly administer CPR. Those findings are underscored by the fact that each year less than 3% of the United States population receives CPR training, the Institute of Medicine report found.
In recent years, organizations across the country have launched new programs meant to increase awareness and improve both the survival rates from sudden cardiac arrest and the detection of conditions that lead to its onset. Many programs aim to educate and train people how to recognize and respond to a cardiac arrest, reiterating the critical warning signs, including sudden loss of responsiveness, and emphasizing two main steps: call 911, and push hard and fast in the center of the victim's chest.
In order to expand their reach and raise awareness, some organizations have implemented innovative approaches to education and training. For example, the Mobile CPR Project - one of the three organizations the Independence Blue Cross Foundation partnered with as part of its Healthy Hearts Initiative - travels to community organizations, such as schools and churches, across the Greater Philadelphia area to offer free CPR education and training.
Education Makes the Difference
Driven by increased awareness around sudden cardiac arrest and the use of hands-only CPR, the U.S. percentage of bystander CPR rose more than 6 percent from 2013 to 2016. That increase is mirrored by a steady rise in the national survival rate over the same four-year period, with the rate climbing from 9.5 to 12%. The higher rate marks a step closer to the American Heart Association's goal to improve the survival rate of out-of-hospital cardiac arrests to 16%.
Yet, despite the recent growth nationwide, the survival rate of cardiac arrest victims and percentage of bystanders who perform CPR significantly vary in communities across the country. For example, in Philadelphia, more than 1,100 died from sudden cardiac arrest in 2015. In those cases, the percentage of people who received bystander CPR was 20.3&- about half of the national average.
Studies have cited a variety of factors as reasons for the disparities in both survival rates and bystander CPR, including patient demographics and health status, geographic characteristics and system-level factors affecting the quality and availability of care, such as access to education and training. A 2016 report published in Emergency Medicine International, a peer-reviewed journal that covers all areas of emergency medicine, found a significant disparity in the survival rate of cardiac arrest victims living in low-income neighborhoods, as well as predominately African-American neighborhoods.
As part of its Healthy Hearts Initiative, which launched in November, the Independence Blue Cross Foundation aims to address the cardiovascular disparities in vulnerable and high-risk populations across Southeastern Pennsylvania by supporting primary and secondary prevention strategies, such as free CPR and automated external defibrillators (AED) education and training. The Foundation supports the CPR Ready Campaign, an initiative whose mission is to triple the current rate of bystander CPR in Philadelphia to 60%, and double the number of people knowledgeable about and willing to use an AED, when available. The Foundation also supports Simon's Fund, an organization that provides free heart screenings to children, advocates for legislation, hosts awareness events, and promotes research to better understand sudden cardiac arrest and death.
Experts say a heightened focus on CPR training and education in communities across the country could save as many as 30,000 lives annually. As organizations devote more and more resources to raising awareness about cardiac arrest, more people will be equipped with the knowledge about how to act in an emergency situation.
Lorina Marshall-Blake is President of the Independence Blue Cross Foundation