How They Survive: 10 Strategies for Cardiac Arrest

Your system may be quite good at cardiac arrest. If you attended the opening ceremonies of the Cardiac Arrest Survival Summit Tuesday in Seattle, you still may have left feeling like a slacker.

A series of kickoff speakers culminating with Freddy Lippert, CEO of the elite system in Copenhagen, Denmark, provided an expansive overview of the whys, hows, and how-to-do-it-wells of improving cardiac arrest survival and ideas to be elaborated upon over the rest of the week. He presented the Global Resuscitation Alliance’s 10 best-practice programs for better outcomes and summarized the notable improvements seen in Denmark.

Almost 20 years ago, Denmark’s 30-day survival rate for out-of-hospital cardiac arrest was just 3%, and its bystander CPR rate just 19%. Among their efforts to improve, leaders visited Seattle and its Resuscitation Academy. That helped define the following 10 measures:

1.  A cardiac arrest registry: In Denmark it’s been part of electronic patient charts since 2016.
2. Telephone CPR: Artificial intelligence has improved call-takers’ recognition.
3. High-performance CPR: Video calls are now being used to coach bystander CPR.
4. Rapid dispatch: The first mention of a critical symptom triggers dispatch of the closest ambulance, even while the caller is providing more information.
5. Measurement of professional resuscitation: Defibrillator data is reviewed, and individualized feedback and low-dose, high-frequency training are provided.
6. AED training for first and likely responders (e.g., police, security guards, etc.).
7. Smart technology: This includes a national AED network mapped for dispatchers and widespread use of the HeartRunner app. Denmark has 75,000 registered citizen HeartRunner responders, only a quarter of which are healthcare professionals but 97% of whom are CPR-trained. They respond not only to public arrests but also private residences; recent data suggest they’re beating ambulance crews to victims around 40% of the time.
8. Mandatory CPR and AED training in schools and the community: CPR is even required to get a driver’s license.
9. Work toward accountability: The community gets regular reports of key metrics.
10. A culture of excellence: This is ] hard to measure, but when EMS providers recognize sincere, mission-driven leadership, the GRA notes, they respond and contribute to a positive culture.

By 2018, Lippert concluded, his country’s bystander CPR rate was an impressive 78%, and its 30-day OHCA survival had increased to 16% for all arrests and 46% for witnessed ventricular fibrillation.

Two Lives Saved

Preceding Lippert on stage was Seattle resuscitation luminary Mickey Eisenberg, MD, PhD, director of medical quality improvement for King County EMS and a professor of emergency medicine at the University of Washington. Eisenberg reviewed the storied history of cardiac resuscitation in Seattle and pioneering work of physicians like Leonard Cobb and Michael Copass, and he credited continuous efforts to improve care in King County for saving more than 7,500 lives since their initial work. He emphasized there were two primary interventions that can have significant impact on OHCA survival: telephone CPR, which allows all victims to receive bystander CPR; and high-performance CPR as defined by measures like team management/scene choreography, compression quality, and minimizing hands-off-chest time. In Seattle pauses can’t exceed 10 seconds, even for intubation.

Earlier Jennifer Hayes, resuscitation coordinator at CHOC Children’s (the Children’s Hospital of Orange County) in Southern California, recounted her own cardiac arrest while pregnant. Hayes’ husband heard her fall; a neighboring police officer appeared to help with compressions; and EMS arrived quickly, all contributing to her rescue. When doctors determined the cause to be eclampsia, an emergency c-section produced son Micah 10 weeks early, at 3.5 lbs.

Ongoing problems ultimately sent Hayes home with a wearable external defibrillator. Micah spent 71 days in the NICU before joining her. Both are now fine, though Hayes has endured some common survivor anxieties. “High-quality resuscitation,” she told attendees, holding an enthusiastic Micah, now 2, “saved two lives.”

Additionally, local sports medicine physician Jonathan Drezner, MD, interviewed sports executive Tod Leiweke, now CEO of Seattle’s new NHL team and previously CEO of its NFL Seahawks and MLS Sounders. A decade ago the pair created the Heart of Seattle program that put AEDs in every public school.

Drezner described discovering the deficit and having no luck addressing it with school system leaders. When he enlisted Leiweke, then with the Seahawks, they became much more responsive, and 130 AEDs were placed. Two months later, Drezner noted, one was used to save a life.

Leiweke vowed cardiac arrest survival would continue to be a cause with the city’s new hockey team.

John Erich is the senior editor of EMS World.