Doubling down on a crucial piece of the
cardiac arrest resuscitation puzzle
By Bentley J. Bobrow, MD
As much as EMS systems focus on delivering rapid, high-quality resus- citation, cardiac arrest survival continues to be a long shot in most communities.
More than 350,000 people a year experience cardiac arrest outside of a hospital and
despite enormous advances in resuscitation
science, on average only 12% survive. 1
A major factor responsible for the overall
poor survival rate is the fact that most cardiac
arrest victims still don’t receive bystander CPR.
This key bystander intervention, if performed
immediately, can double or even triple a person’s chance of survival.
The longer it takes between the time someone collapses and the initiation of CPR—and
subsequent arrival of trained emergency medical responders—the lower the odds of survival.
Trained emergency responders are already
focused on achieving the fastest response possible and doing high-performance CPR, but
it’s time to double down on another crucial
piece of the survival puzzle: those critical minutes before EMS arrive on scene. Because 70%
of all out-of-hospital cardiac arrests occur in
the home, 2 the focus must be on transforming
bystanders (e.g., friends or relatives who witness
the event) into lifesaving lay rescuers.
To increase survival rates, the probability
that bystanders will step up and take immediate action must be dramatically increased. This
means many more people in communities must
be able and willing to immediately identify
cardiac arrest, dial 9-1-1, locate an automated
external defibrillator (AED), and start rapid,
forceful, uninterrupted CPR without delay.
The American Heart Association (AHA)
and the American Red Cross, the two leading CPR training organizations, already train
approximately 20 million and 2. 3 million people, respectively, each year.
As impressive and important as these numbers are, it’s still not enough to assure that someone will be on-hand and ready to intervene
when cardiac arrest occurs.
Despite ongoing campaigns that strongly
encourage more people to get CPR-trained,
including the far more user-friendly “
hands-only” version of CPR, we still have a long way
to go toward maximizing cardiac arrest survival.
Cardiac arrest impacts too many lives to be
ignored. We must employ multiple strategies
simultaneously. We not only need more trained
lifesaving bystanders, we also need to train
the next generation of lifesaving bystanders.
Part of the answer to solving this puzzle lies
in recognizing that CPR training is a crucial
life skill that everyone must possess. As such,
CPR must become part of American education similar to, for example, the “three Rs”—
reading, writing and arithmetic.
Training high school students is a particularly efficient way to increase the number of
bystander rescuers. Several studies have shown
that students can quickly become proficient in
CPR, even with brief video-based and skills
training. 3, 4 This means that, in less time than
the average TV program, high school students
can learn CPR and save someone’s life.
Teaching CPR to high school students results
in communities saturated with trained bystanders, not just in any given year, but generation
after generation. Over time, this will change
mindsets and culture around CPR and profoundly increase the number of trained young
adults everywhere. Ultimately, it will increase
the probability that if a parent, sibling, grandparent or co-worker experiences cardiac arrest,
someone nearby will be able and willing to save
a life by calling 9-1-1, then starting and continuing CPR until emergency personnel arrive.
The AHA has embraced this approach with
the launch of its CPR in Schools campaign. This
nationwide advocacy effort began in 2011 with
the aim of legislating mandatory CPR training
for high school students in every state.
The AHA has worked tirelessly with its
local affiliates and other stakeholders (e.g., first
responders, doctors’ associations, public health
Figure 1: American Heart Association map showing states
requiring the teaching of CPR in schools (in red)