Chances of survival due to CPR vary by city

by Ashley LaBounty
edited by Kim Theodore

Survival rates after cardiac arrest vary remarkably across the country because of underused modern treatment improvements in practice, such as extra corporeal membrane oxygenation.



According to a recent article in The New York Times, “In the United States, there are roughly 350,000 resuscitation attempts outside hospitals each year, with average survival rates of 5 to 10 percent.” However, in areas like Seattle and King County of Washington, survival rates improved by 22 percent in the past seven years to 19.9 percent.

The improvements in these areas came from better training for E.M.S. providers, continually measuring the care they provide and spreading awareness of cardiac arrest and that it is treatable, so citizens can provide bystander CPR quickly.

Dr. Graham Nichol, professor of medicine at the University of Washington, said, “If Seattle’s innovations could be implemented nationwide for out-of-hospital cardiac arrests, as many as 30,000 lives annually could be saved.”

The problem with CPR administration, however, is that it takes patience and training to perform 100 to 120 compressions per minute, with each one being about five centimeters deep.

Studies have found that compressions are often interrupted for too long due to resuscitators checking for a pulse, which starves the internal organs of oxygen.

“You should only be feeling for a pulse for 10 seconds, while people fumble around trying to feel a pulse for one minute or more,” said Dr. Stephan Mayer, the director of neurocritical care at the Mount Sinai Health System.

The other problem with CPR administration is that medical care workers give up too soon. CPR administration is usually performed for only 15 to 20 minutes, but studies show that longer attempts of up to an hour lead to better survival rates.

There are other alternative options to CPR, including an extra corporeal membrane oxygenation (ECMO), which is a procedure where blood is taken from the patient in cardiac arrest through a catheter placed in the central vein, circulated through an oxygen filter, and then the oxygenated blood is returned to the body. This procedure is more widely used in other countries such as Japan and South Korea.

“They routinely bring people back to life who would remain dead here,” said Dr. Sam Parnia, the director of resuscitation research at Stony Brook Hospital.

After a patient’s circulation is restored, certain interventions must happen to prevent further injury to the body and brain. These interventions include avoiding toxic amounts of oxygen, maintaining a normal level of carbon dioxide, high blood pressure, and sometimes a cardiac catheterization procedure.

To ensure and improve survival rate, every five years the American Heart Association releases resuscitation guidelines in the journal circulation based on the composition of the latest research. The newest update, which was published on October 15, emphasizes the importance of bystander CPR, and doctors forming integrated systems in the chain of survival.

The goal of the association is to double survival rates nationwide to 16 percent by 2020.

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