20
TORONTO — There is a huge variation in survival rates among people who receive emergency treatment after suffering cardiac arrest — and the overall prognosis is poor at best, a study of 10 Canadian and U.S. cities and regions has found.
A team of researchers from the two countries found that overall, less than eight per cent of people who were treated by emergency personnel for cardiac arrests in the home or elsewhere outside hospital were successfully revived.
Seattle had the best survival rate at 16 per cent, while Alabama had the lowest at three per cent. Toronto and the Ottawa region achieved about 5.5 per cent survival, while the third Canadian city in the study, Vancouver, recorded 10 per cent survival.
“The regional differences in our study are huge — 500 per cent — much greater than the regional differences in survival for patients who are hospitalized with stroke or heart attack,” lead author Dr. Graham Nichol of the University of Washington, said Tuesday from Seattle.
Related Articles
“Cardiac arrest is a treatable condition,” he said. “Everyone needs to work to be aware of and improve their response in the community. It's the third-leading cause of death [after other cardiovascular diseases and cancer] in either country, so if we can do that we can save a lot of lives.”
Cardiac arrest is not the same as a heart attack. It occurs when the heart suddenly stops beating and the person is no longer breathing, often because of disruption to normal heart contractions, also known as ventricular fibrillation. Eighty per cent of cardiac arrests occur in the home.
Mr. Nichol said the key to saving lives is a quick response by bystanders, who need to perform immediate CPR until paramedics or firefighters arrive to treat and transport the patient. But in far too many cases, CPR is not performed and by the time EMS personnel arrive with defibrillators to shock the heart and restore breathing, it is too late.
An estimated 200,000 to 300,000 Americans and Canadians suffer cardiac arrest each year outside of hospital, and as the study shows, only a small proportion survive.
Co-author Dr. Ian Stiell of the University of Ottawa said about 30,000 Canadians die each year from the sudden cardiac arrest.
Saving more lives means more residents need to be trained in and willing to perform CPR, said Dr. Stiell, noting that an earlier study showed that in only about 30 per cent of cases do bystanders jump in to perform CPR when a person collapses with cardiac arrest.
In Ontario, he said, the response among citizens is half that amount.
“It's the whole community response and that speaks to the chain of survival. It's not just the paramedics, it's how fast you can access 911, were there bystanders to do CPR, did fire get there first with a defibrillator and then finally the paramedics?”
Dr. Stiell said there are no national bodies in either Canada or the U.S. taking the lead on CPR training of residents. Most training is done at the community level, but that can be hit and miss, he said.
“There needs to be a higher awareness and perhaps some government agency to take responsibility, whether it be the city public health or the provincial government or federal government, to take responsibility as a goal to improve bystander CPR training strategies.”
The study is published in this week's Journal of the American Medical Association.
