Initiative Boosts Cardiac Arrest Survival in Ariz.


SAN DIEGO —The dismal survival rate of out-of-hospital cardiac arrest—only 5%-10%—varies from region to region, according to a database study.

“I don't think the public really thinks about or understands that you have a 500% better chance of survival if you collapse in one city than another,” Dr. Ben Bobrow said at the meeting.

“I believe that making cardiac arrest a reportable illness would help improve survival rates,” he noted. “Why shouldn't people in the community know what their survival rates are? [It is] similar to knowing what the crime rates are,” said Dr. Bobrow, medical director of the Bureau of Emergency Medical Services and Trauma System for the Arizona Department of Health Services, Phoenix.

In 2004, Dr. Bobrow led an effort to regionalize the state's cardiac arrest care by collecting and analyzing data from first care reports of out-of-hospital cardiac arrest (OHCA) patients on whom resuscitation was attempted in the field (Prehosp. Emerg. Care 2008;12:381-7). Data for the effort, known as the Save Hearts in Arizona Registry and Education (SHARE) program, were initially obtained voluntarily from 35 EMS agencies and are now obtained from more than 80 EMS agencies (

Dr. Bobrow found that between Jan. 1, 2005, and April 1, 2006, 1,484 cases of OHCA were reported by the 35 departments, of which 1,104 were of presumed cardiac etiology occurring prior to arrival of EMS. Only 37 (3.4%) of 1,076 OHCA patients survived to hospital discharge. Bystander CPR had a positive effect on survival (odds ratio of 3.0), yet was provided only 25% of the time.

Because there were so few OHCA survivors, the SHARE program's directors decided to modify the state's OHCA protocol based on current evidence, and to track the results closely.

The program's directors adopted a multipronged strategy that was disseminated to the state's EMS agencies: training EMS dispatchers to provide chest compression–only instructions to 911 callers; advocating for chest compression–only CPR to increase the likelihood that bystanders will provide CPR; increasing the odds of early defibrillation by establishing a more structured public-access defibrillation program; enabling minimally interrupted cardiac resuscitation by EMS providers; and a creating a statewide system of cardiac receiving centers where patients would get guideline-based postarrest care such as therapeutic hypothermia.

One of the main changes was the shift from conventional CPR (with breaths) to chest compression–only CPR (without mouth to mouth). “There's a lot of data to show that even brief, 10-second interruptions in chest compressions are enough to decrease the chance of successful defibrillation,” Dr. Bobrow said.

The program used a series of public service announcements to educate citizens in Arizona about how to perform chest compression–only CPR. The state also partnered with the American Heart Association to launch a hands-only CPR campaign (

At the AHA's 2009 Resuscitation Science Symposium, the SHARE team presented data showing that the overall incidence of bystander CPR rose from 25% to 40% after the program, while the overall incidence of hands-only CPR rose from 16% to 77%.

“This really simple intervention of bystander chest compression–only CPR was incredibly powerful,” Dr. Bobrow remarked. “Survival was significantly better for OHCA victims if they received chest compression–only CPR than no CPR or conventional CPR.”

Evaluation of the initial 1,500 OHCA cases in the state revealed that the rate of survival to discharge for the subset of patients with a witnessed collapse and ventricular fibrillation upon EMS arrival increased significantly, from 20.3% to 39.5%, after centers earned a CRC designation. The all-rhythm survival rate to hospital discharge also rose significantly, from 10.1% to 20.1%.

Disclosures: Dr. Bobrow disclosed that he has received funding from the National Institutes of Health, the American Heart Association, and the Medtronic Foundation.

'This really simple intervention of bystander chest compression–only CPR was incredibly powerful.'


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