Claire Dawson
Out-of-hospital cardiac arrest (OHCA) is a major public health problem, claiming the lives of nearly 350,000 people in the United States each year, according to the American Heart Association (AHA). The survival rate for OHCA cases has improved but is still low, with only about 10% of those who experience these events surviving. To address this issue, the NHLBI has launched initiatives such as the Resuscitation Outcomes Consortium (ROC) and RACE-CARS (Randomized Cluster Evaluation of Cardiac Arrest Systems), focusing on resuscitation research and community-based interventions to improve survival rates.
| Characteristics | Values |
|---|---|
| Number of out-of-hospital cardiac arrests (OHCA) annually in the U.S. | 356,000+ |
| Number of out-of-hospital cardiac arrests (OHCA) daily in the U.S. | 1,000 |
| Survival rate after EMS-treated OHCA | 9-11% |
| Survival rate with good functional status | 7% |
| States with higher rates of bystander AED use | Alaska, Minnesota, Nebraska, North Carolina, Oregon, Pennsylvania, Utah, and Washington |
| Bystander or layperson involvement in resuscitation efforts | 50% |
| OHCA occurrence by gender | 60% men, 37% women |
| OHCA occurrence by race | 57% Black, 26% White, 12% Hispanic, 2% Asian |
| OHCA occurrence by age group | Increased among adults aged 26-45 and 56-65 years, decreased among those aged >75 years |
| Mean age of OHCA patients in Chicago | 62.7 years |
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What You'll Learn
Survival rates
Out-of-hospital cardiac arrest (OHCA) has a low survival rate of 5–10%. This figure has, however, nearly doubled since 2000. The survival rate for 2021 was 9.1% for all EMS-treated non-traumatic OHCA cardiac arrests. The one-year survival rate is 10%.
The location of OHCA is a significant factor in survival rates. They occur most often in homes/residences (72–73.4%), followed by public settings (16.3–30%), and nursing homes (10.3%). Cardiac arrest victims in rural or remote regions often face unique challenges due to their distance from major hospitals and lack of access to life-saving equipment.
CPR can double or triple the chances of survival from an OHCA if administered immediately. However, only about 40% of people who experience an OHCA get the immediate help they need before professional help arrives. Bystander CPR rates are 40.2% according to 2023 data, while they were 55% in the period from 2010 to 2020. AED use by bystanders is also low, at 9% in 2020, though some states have higher rates, such as Alaska (9.7%), Nebraska (16.3%), and Washington (10.9%).
Research has shown that high-quality CPR significantly impacts survival outcomes, both inside and outside the hospital. Survival chances decrease by 10% for every minute that immediate CPR and use of an AED are delayed.
Machine learning models have been developed to aid in predicting survival and neurological outcomes in OHCA patients, which has the potential to improve clinical management in emergency rooms.
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Locations
Out-of-hospital cardiac arrest (OHCA) is a major public health problem in the United States, with approximately 1,000 cases assessed by emergency medical services each day. The American Heart Association (AHA) estimates that there are more than 356,000 OHCAs annually in the US, with nearly 90% of them proving fatal. This figure has increased from previous years, with 21,070 adult OHCAs recorded in Chicago between 2014 and 2015.
Most OHCAs occur at home, but they also frequently happen in public places. The survival rate for OHCA cases has improved and is nearly double what it was in 2000, but it still remains low, with only about 10% of those who experience these events surviving. This rate varies across the country, with higher survival rates in the Midwest and South compared to the Northeast.
The Resuscitation Outcomes Consortium (ROC), a network of 10 medical centers in the US and Canada, has played a key role in improving survival rates by focusing on resuscitation research. Other initiatives, such as the NHLBI's RACE-CARS trial in North Carolina, aim to improve survival through targeted community-based interventions, including strategies to achieve faster access to CPR and increase the use of defibrillators by bystanders.
In addition to these efforts, the importance of CPR training for both professionals and laypeople has been highlighted. Bystanders or laypersons currently get involved in resuscitation efforts only half of the time. Having more strategically located defibrillation machines and increasing public awareness of the risk of cardiac arrest and knowledge of how to intervene as a bystander could also help reduce the high mortality rate associated with OHCA.
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Bystander interventions
Out-of-hospital cardiac arrest (OHCA) is a major public health problem, claiming the lives of nearly 350,000 people in the United States each year, according to the American Heart Association (AHA). The survival rate is low, with only about 10% of those who experience these events surviving. This means that nearly 90% of patients do not survive, leading to a significant loss of potential life.
- CPR Training: It is essential to have basic life support skills, such as cardiopulmonary resuscitation (CPR) training. CPR can be lifesaving during a cardiac arrest as it helps maintain blood circulation and oxygen supply to the brain and other vital organs. However, research shows that bystanders or laypersons only get involved in resuscitation efforts about half of the time. Therefore, increasing public awareness and encouraging more people to learn CPR can significantly impact the survival rates of OHCA.
- Defibrillator Use: Strategic placement of defibrillation machines in public places can improve access to life-saving equipment. In addition to having the machines easily accessible, bystanders should also be educated on how to use them effectively. Early defibrillation can significantly improve the chances of survival for individuals experiencing cardiac arrest.
- Emergency Response: Knowing how to respond in an emergency is crucial. Bystanders should be able to recognise the signs of cardiac arrest, such as loss of consciousness, chest pain, nausea, vomiting, or shortness of breath. If someone is displaying these symptoms, immediate action should be taken by calling emergency services (for example, dialling 911 in the US) and seeking help from trained professionals.
- Awareness and Education: Increasing public awareness about the risk of cardiac arrest and how to intervene as a bystander can help reduce associated mortality. Educational campaigns and initiatives can empower individuals to take action and improve the overall response to OHCA events. This includes understanding the importance of early CPR, defibrillator use, and seeking timely medical assistance.
- Community-Based Interventions: Implementing targeted community-based interventions, such as the RACE-CARS (Randomized Cluster Evaluation of Cardiac Arrest Systems) program, can improve survival rates. This involves testing a set of customised interventions in various urban and rural counties to achieve faster access to CPR and higher rates of defibrillator use by bystanders. These strategies aim to address the specific needs and challenges of different communities.
- Workplace Training: Cardiac arrests can also occur in the workplace, and it is important for employees to be prepared. However, half of all US workers cannot locate an AED (automated external defibrillator) at their workplace. Providing workplace safety training that includes CPR, first aid, and AED usage can empower employees to respond effectively to cardiac arrest emergencies and potentially save lives.
By empowering bystanders with the knowledge, skills, and resources to intervene during out-of-hospital cardiac arrests, we can significantly improve survival rates and reduce the impact of this public health crisis.
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Recovery
Out-of-hospital cardiac arrest (OHCA) is a serious medical emergency that can lead to death within minutes if left untreated. OHCA occurs when the heart's electrical system malfunctions, causing it to stop beating regularly. In the United States alone, over 356,000 people experience OHCA annually, with a survival rate of around 9.1% for those who receive emergency medical services (EMS) treatment.
While survival rates have improved over the years, recovering from OHCA is a challenging process that requires time and specialized care. Here is an overview of the recovery process:
Immediate Post-Resuscitation Care
After successful resuscitation, the primary goal of post-cardiac arrest care is to optimize cardio-cerebral recovery. This includes maintaining cardiac output and cerebral perfusion, optimizing systemic hemodynamics, and minimizing further injury. Advanced cardiac life support and neuroprotective strategies, such as therapeutic hypothermia, are often initiated to improve survival rates and neurological outcomes.
In-Hospital Management
During the hospital stay, a multidisciplinary team works together to stabilize the patient's cardiopulmonary status and prevent future cardiac events. This includes monitoring and treating complications such as kidney failure, liver failure, and long-term heart disease. An initial 12-lead ECG is obtained to assess for coronary artery occlusion, which is a leading cause of OHCA. Depending on the findings, reperfusion therapy, such as percutaneous coronary intervention or fibrinolytic therapy, may be considered.
Long-Term Recovery
Even after hospital discharge, survivors of OHCA may face ongoing challenges. Many require ongoing heart care and follow-up appointments to prevent another episode. Additionally, it is common for survivors to experience brain damage due to oxygen deprivation during the cardiac arrest. This can lead to issues such as ataxia, difficulty concentrating, swallowing problems, muscle weakness, and speech disorders. As a result, survivors often need help in regaining their previous skills and adapting to any new limitations.
While the recovery journey is demanding, advancements in medical science and emergency services have improved survival rates and outcomes. With proper post-resuscitation care, stabilization, and long-term support, survivors of OHCA can work towards maximizing their abilities and minimizing the risk of future episodes.
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Epidemiology
Out-of-hospital cardiac arrest (OHCA) is a major public health problem in the United States, affecting more than 350,000 people annually, with an estimated incidence of 356,461 cases or nearly 1,000 people each day. The survival rate for OHCA cases is low, with only about 10% of those who experience these events surviving. This rate has improved over the last decade and is nearly double what it was in 2000. However, the current rate still languishes at about 10%, according to the 2022 update by the American Heart Association.
OHCA can occur in both adults and children, although it typically affects adults. In Chicago, between 2014 and 2021, approximately 60% of OHCAs occurred among men, with a higher proportion among Black or African American adults (57%) compared to White adults (26%). The mean age of OHCA decreased from 64.7 years during 2014-2015 to 62.7 years during 2020-2021, with a larger decrease among Black men. The percentage of OHCAs increased over time among adults aged 26-45 and 56-65 years, while it decreased among those aged over 75 years.
Survival after OHCA is influenced by several factors, including the timely delivery of resuscitation efforts and access to medical care. Bystanders or laypersons get involved in resuscitation efforts only about half of the time, highlighting the importance of CPR training for both professionals and the general public. The use of automated external defibrillators (AEDs) by laypeople has been shown to improve survival rates, with higher rates of bystander AED use in certain states, such as Alaska, Minnesota, and Nebraska. However, in the workplace, only half of US workers can locate an AED, and this percentage is even lower in the hospitality industry (34%).
The Resuscitation Outcomes Consortium (ROC) and the Cardiac Arrest Registry to Enhance Survival (CARES) provide valuable data and insights to improve the understanding and management of OHCA. Additionally, the NHLBI has launched RACE-CARS (Randomized Cluster Evaluation of Cardiac Arrest Systems), a 7-year trial conducted in 50 urban and rural counties in North Carolina, to test targeted community-based interventions and improve survival rates. These efforts include strategies for faster access to CPR and increased bystander defibrillator use.
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Frequently asked questions
There are more than 356,000 OHCAs in the US annually, according to the American Heart Association.
Only about 10% of people who experience out-of-hospital cardiac arrests survive. Survival rates have improved, nearly doubling since 2000, but more needs to be done.
Approximately 1,000 out-of-hospital cardiac arrests are assessed by emergency medical services in the US each day.
The incidence of OHCA in children is 23,514. In a study of athletes, 43.8% of those with SCA during competitive sports survived to hospital discharge.
