Cleveland Urged to Track Cardiac Survival Rate

With huge differences in cardiac arrest survival rates recorded across the country, pressure is growing on Cleveland and other communities to examine how patients fare and what can be done to save more lives.

The local American Heart Association president is pushing for Cleveland to join a national effort that would reveal for the first time how many here survive cardiac arrest outside hospitals. The national average is about 6 percent.

The Cardiac Arrest Registry to Enhance Survival is a program based in Atlanta and is supported by the U.S. Centers for Disease Control and Prevention. Organizers report that survival rates range from 2 percent to 35 percent in 35 communities that track cases. The rate in Cleveland is unknown, Emergency Medical Service officials said.

Sudden cardiac arrest kills more than 300,000 people every year in the United States, the heart association says. Most cases are caused by ventricular fibrillation, an electrical disturbance that throws off the rhythm of the heart's pumping chambers. Early CPR and defibrillation can restore normal rhythm.

Dr. Arie Blitz, a University Hospitals heart surgeon and president of the local heart association chapter, said the large survival gap is "embarrassing."

He wants local hospitals, politicians and EMS leaders to buy into the program. The registry is a secure Internet database that records dispatch data, EMS performance and patient outcomes.

The goal is to identify weak links in the so-called "chain of survival."

"We need to be able to track what happens to those patients," said Blitz, who came here two years ago from New Orleans.

"In a city with the reputation of Cleveland as far as medical care is involved, there's no reason we can't have the best results for out-of-hospital care as well."

The initiative has signed up 13 cities and plans to double participation in the next year, said Dr. Bryan McNally of Emory University, the project leader. Cincinnati and Columbus have joined the program.

"We're interested in seeing if Cleveland could be a site," said McNally.

"The goal is to make it a national registry."

Reporting outcomes alone will improve survival, said Blitz.

Cleveland has not tracked survival rates because hospitals have been reluctant to share information, EMS Commissioner Edward Eckart said.

Bill Ryan of the Center for Health Affairs, which represents Cleveland-area hospitals, disagreed. Ryan said hospital officials have not been asked for patient outcomes.

Asked if local hospitals would participate in the registry, Ryan said, "I think that kind of conversation is worth having."

Hospital outcomes are important because early CPR and defibrillation affect not just whether a heart restarts, but also whether a patient walks out of the hospital.

Some survivors are brain damaged from lack of heart-pumping blood flow. But doctors say new CPR standards adopted in the past two years have improved outcomes. The American Heart Association's revised guidelines emphasize hard and fast chest compressions, which keeps blood moving to the heart and brain.

Dr. David Keseg, Columbus EMS medical director, credits the new guidelines with doubling the city's survival rate to 12 percent. Columbus hospitals share data on outcomes, he said.

Keseg said the registry will allow the city to determine what factors make a difference in survival.

As an example, he said that if the average time to defibrillation is longer than ideal in a certain neighborhood, the city can address it.

The data may prompt cities to deploy more automated external defibrillators or step up public CPR training.

Bystander CPR, which can double chances of survival, is performed about 15 percent of the time in Cleveland, said Dr. Thomas Collins, Cleveland EMS medical director. That's well below the national average of around 27 percent.

Seattle is seen as a leader in cardiac-arrest survival rates, in part because of aggressive community CPR training.