Public Health Initiatives Can Improve Outcomes for Out-of-Hospital Cardiac Arrest

Approximately 400,000 people in the United States suffer from out-of-hospital cardiac arrest (OHCA) each year, with less than 10% surviving through hospital discharge. The majority of these OHCAs occur at home and those who suffer from home OHCAs are 4 to 5 times less likely to survive than those who experience an OHCA in a public location.

The difference in outcomes may be, in part, due to different patient circumstances, such as greater comorbidities; longer delay of cardiopulmonary resuscitation (CPR) initiation and emergency medical services (EMS) arrival; lower probability of a witnessed arrest; and lower frequency shockable initial rhythms.

A study published in JAMA Cardiology described temporal trends in bystander CPR and first- responder defibrillation for home and public OHCAs to answer the question of whether or not public health initiatives improve prehospital efforts and outcomes for patients with OCHA.

“Little is known about the influence of comprehensive public health initiatives according to out-of-hospital cardiac arrest location, particularly at home, where resuscitation efforts and outcome have been historically poor,” wrote the authors.

The authors of the study reviewed 8269 patients who had experienced OHCAs and were resuscitated between January 1, 2010, and December 31, 2014, from 16 counties in North Carolina. The data was taken from the Cardiac Arrest Registry to Enhance Survival (CARES).

The 8269 patients in the study were organized by home versus public OHCA with 5602 OHCAs occurring at home and 2667 occurring in public locations. The median age among home OHCA patients was 64 and 62.2% were male. The median age among public OHCA patients was 68 and 61.5% were male.

An OHCA was presumed to be of cardiac cause unless it was known to have happened due to trauma, drowning, respiratory causes, electrocution, drug overdose, presumed poisoning or intoxication, asphyxia, exsanguinations, or any other non-cardiac cause. All EMS agencies had 2-tiered response systems, with responders equipped with automated external defibrillators (AEDs).

In 2010, the HeartRescueProject in North Carolina launched a statewide, multifaceted quality improvement program that included intervention for community members, EMS personnel, first responders, and hospital administrators and staff. Initiatives included chest compression-only training offered for community members at municipal events and to patients with cardiovascular disease and their families before hospital discharge, and school staff receiving AED training.

The rate of bystander-initiated CPR significantly increased at home and in public, rates of defibrillation by first responders significantly increased at home but not in public, rates of bystander CPR and EMS defibrillation did not increase dramatically at home but did in public, and the combined effort of bystander CPR and first responder defibrillation significantly increased at home but not in public.

“In summary, we found that after public health initiatives, more patients received bystander CPR and first-responder defibrillation, which was associated with increased rates of survival at home and in public,” the authors concluded. “Adopting some of these public health initiatives may likely be helpful for communities aiming to improve outcomes of OHCA.”