October is Sudden Cardiac Arrest (SCA) Awareness Month. In Northern America, more than 300,000 people are affected every year by out-of-hospital SCA, which occurs when the heart no longer beats properly. According to the American Heart Association, about 92% of SCA victims die before reaching the hospital.
Survivability of SCA is dependent on the length of time between SCA and chest compressions that allow blood flow to the heart and brain. This can be accomplished by non-medical personnel using Cardiopulmonary Resuscitation (CPR), known as “bystander CPR”, which can provide lifesaving treatment for a victim of SCA until medical personnel arrive.
In Denmark, the rate of patients who received bystander CPR in 2001 was 21.1%. The country embarked on a national initiative to improve SCA survivability. This initiative included increased training of residents as early as elementary school. Instructional kits were provided, and learning CPR was required in order to receive a driver’s license. The percent of patients who received bystander CPR increased from 2001 to 2010 to 44.9%.
In addition to the increased education of the general population about CPR, changes were made to improve care provided after SCA by hospitals and emergency medical services. According to a study in the Journal of the American Medical Association, these changes together have improved the survivability of all stages after SCA. From 2001 to 2010 in Denmark, cardiac arrest patients arriving at a hospital alive increased from 7.9% to 21.8%. In addition, 30-day and 1-year survival also increased, from 3.5% to 10.8% and 2.9% to 10.2%, respectively.
Denmark’s initiative hopes to lessen the reluctance bystanders may have to perform CPR due to lack of training. In addition, the American Heart Association recommended in 2008 that laypersons perform compression-only CPR (no breaths) if they are unable or unwilling to provide rescue breaths. This may have also decreased the reluctance of bystanders to perform CPR due to concerns about spread of disease, or feeling uncomfortable giving rescue breaths.
Providing additional training to emergency medicine providers can also improve survivability. Another recent study by the University of Arizona has found that improving the quality and effectiveness of CPR performed by emergency medicine providers improved survival rates. In the study, rescuers were provided real-time feedback as to the quality of the CPR being provided, as well as training that emphasized a team approach. Before these interventions, 26% of SCA victims survived to hospital discharge. After the interventions, 56% of victims survived to discharge.
Although CPR dates back to 1740, improvements in availability and quality are still being found that can increase survivability of SCA victims. Because of the importance in quick and effective action, the importance of action by non-medically-trained bystanders to the survival rate after SCA provides strong support for layperson CPR training.
To view the Outline and Cause Map including the cause-and-effect of the improvements to survival rate in Denmark as a result of interventions and improvements, please click “Download PDF” above.