DALLAS, Jan. 14, 2010 — Many more people could survive out-of-hospital cardiac arrest (OOHCA) if regional systems of cardiac resuscitation care were established, according to a policy statement published in Circulation: Journal of the American Heart Association.

View the full statement - Regional Systems of Care for Out-of-Hospital Cardiac Arrest at http://circ.ahajournals.org/cgi/reprint/CIR.0b013e3181cdb7db

In addition, the statement proposes establishing specialized cardiac resuscitation centers in hospitals similar to the regional stroke, heart attack and trauma centers that already exist.

About 295,000 people in the United States are treated for OOHCA each year. If deaths due to OOHCA were separated from deaths due to other cardiovascular causes, it would be the third-leading cause of death, according to the statement.

“Currently, survival rates after cardiac arrest vary by as much as 500 percent from city to city, largely because many regions lack a well coordinated approach to treating people who suffer out-of-hospital cardiac arrest,” said Graham Nichol, MD, MPH, lead author of the policy statement, professor of medicine at the University of Washington in Seattle and director of the University of Washington-Harborview Center for Prehospital Emergency Care.

In areas that have implemented systems of care, such as Seattle and King County, Wash., as many as 40 percent of people who have ventricular fibrillation survive to hospital discharge, compared with an average survival-to-discharge rate of 7.9 percent for emergency medical services (EMS)-treated cardiac arrest throughout North America, according to the statement.

“The American Heart Association Emergency Cardiovascular Care Programs and other organizations have invested considerable time, effort and resources in developing and disseminating evidence-based resuscitation guidelines and training materials to improve the outcome of OOHCA,” the authors wrote.

Despite these efforts, it has been difficult to detect an increased success rate in cardiac resuscitation over time, they said.

“In contrast, regional systems of care have had a significant impact on outcomes for people who suffer life-threatening traumatic injury or heart attack,” Nichol said. “It is time to do for people who suffer cardiac arrest what we did for people who suffer heart attack or trauma.”

Key treatments and strategies to care for patients after cardiac arrest include:

* therapeutic hypothermia
* coronary angiography and percutaneous coronary intervention (PCI)
* early stabilization of blood circulation and vital signs
* ability to manage re-arrest
* reliable estimation of survival (especially considering the effects of therapeutic hypothermia – such as delay in resuming normal brain function and blood chemistry)
* electrophysiology studies prior to discharge and treatment of patients with lethal arrhythmias

“These interventions are complex or require special experience and expertise to ensure their success,” wrote the statement authors. “Cardiac resuscitation centers could develop expertise in using these interventions, contribute to research and knowledge of their effectiveness, and function as training centers for post-cardiac arrest care.”

The proposed essential elements of regional systems of care for OOHCA are:

* medical direction for EMS and hospital to work together in developing a plan
* external certification (not self-designation)
* field triage of patients with return of spontaneous circulation to route appropriate patients for angioplasty
* plan for and treatment of re-arrest
* continuous quality improvement plan to monitor, report and set goals to improve outcomes
* reimbursement plan for participation

“What can and should be done in each region depends on what barriers that community currently faces,” Nichol said. “This may include more CPR training for lay people and EMS personnel, or increasing the availability of in-hospital treatments such as PCI or hypothermia.”

“Individuals also need to be part of these regional efforts. People need to know how to recognize and respond to cardiac arrest. If someone is unconscious and not breathing normally, call 9-1-1 immediately and perform CPR until medical help arrives.”