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Institute of Medicine Releases Recommendations to Increase Cardiac Arrest Survival Rates

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Everyone has a role in improving survival from cardiac arrest, including the general public, EMS and hospitals, national research and advocacy organizations, and Congress and other local, state and national government bodies. So says a new study from the Institute of Medicine (IOM) titled Strategies to Improve Cardiac Arrest Survival: A Time to Act.

In a press conference today at the IOM in Washington, D.C., members of the study committee discussed the impact of cardiac arrest and the eight specific recommendations included in the report.

“Cardiac arrest can strike anyone, anytime,” said Robert Graham, MD, a health policy researcher at the George Washington University and a chair of the study committee, which estimates that 600,000 people suffer from cardiac arrest each year. “The suddenness is one of the challenges that we have in responding appropriately and successfully to cardiac arrest.”

One of the committee’s recommendations is to enhance EMS systems—the report specifically recommends that the National Highway Traffic Safety Administration, home of the federal Office of EMS, join with other federal agencies and local, state, and private stakeholders to address EMS response to cardiac arrest. Specifically, the report recommends two areas of focus:

  • Develop standardized protocols for dispatcher-assisted CPR protocols and education standards;
  • Create a standardized definition and curriculum to train basic EMTs in high-performance CPR.

“EMS has an incredible opportunity to save lives from one of the leading causes of death today,” said Ben Bobrow, MD, a member of the study committee and a principle investigator with the HeartRescue Project in Arizona, where he serves as medical director for the state’s Bureau of EMS and Trauma Systems. “Over the past five years, by implementing simple and effective strategies such as telephone-CPR programs and high-performance CPR, the Heart Rescue Project has proven that EMS systems all across the U.S. can save many more lives from cardiac arrest by following the model of ‘measure and improve.’”

The study’s seven other recommendations include:

  • Establishing a national cardiac arrest registry;
  • Adopting quality improvement programs and assigning accountability and responsibility within agencies for measuring cardiac arrest outcomes and processes;
  • Encouraging a culture of action through public awareness and training, including requiring CPR training in middle schools and high schools;
  • Setting cardiac arrest-related national accreditation standards for hospitals and healthcare systems;
  • Funding and supporting research on the physiology and treatments of cardiac arrest as well as research on the evaluation and adoption of cardiac arrest therapies;
  • Creating a “National Cardiac Arrest Collaborative” to facilitate discussion and cooperation among researchers, industry, providers and patient advocates.

Creation of a national registry is the foundation for many of the other recommendations, said study committee member Lance Becker, MD, of the University of Pennsylvania. “Our first problem that the report enumerates is a problem with data,” Becker said during the presentation at the IOM. “We now know that we need data to characterize the true impact of cardiac arrest. One of the surprising findings is that we do not really have precision data on how many people die from cardiac arrest each year.”

That data, members of the committee suggested, is instrumental to the research and quality improvement that are needed to improve the system that responds to and treats cardiac arrest victims.

“Cardiac arrest, more than anything, requires a system response, that is a sequence of actions to optimize survival and functional outcomes,” said study committee member Tom Aufderheide, MD, of the Medical College of Wisconsin.

Committee members said the report, which is available at http://iom.edu/cardiacarrestsurvival, is just the start and that taking action will require collaboration and a unified effort among the stakeholders. They said some of the report’s sponsors, which included federal agencies as well as the American Heart Association, American Red Cross and American College of Cardiology, were already committing to take action.

“I think it’s a landmark report that’s going to make a big difference,” said Mary Newman, president of the Sudden Cardiac Arrest Foundation.

Several cardiac arrest survivors, including one high school student who was only 16 at the time of her arrest, attended the briefing and thanked the committee members.

“This report is really important,” cardiac arrest survivor David Belkin, of Bethesda, Md., said after the briefing during a conversation among the survivors. But what he and the others in the room acknowledged was that this was only the first step toward improving systems of care and lobbying government and industry to invest more to improve survival from cardiac arrest.

Michael Gerber, MPH, NRP, is an instructor, author and consultant in Washington, DC. He is also a paramedic with the Bethesda-Chevy Chase Rescue Squad and previously worked as an EMS supervisor for the Alexandria (VA) Fire Department. Gerber has experience as an EMS educator and quality management coordinator and has presented original research at state and national EMS conferences. Reach him at mgerber@redflashgroup.com.

 

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