Wide disparities in cardiac arrest outcomes have been documented -- many due to variations in patient demographics and health status, geographic chacteristics, and system-level factors affecting the quality and availability of care, such as rates of CPR knowledge among bystanders. For example, the committee found that more than 8 out of 10 cardiac arrests occur in a home setting, and 46 percent of in-home cardiac arrests are witnessed by another person. In addition, one study found that survival rates of cardiac arrests that occurred outside the hospital ranged from 7.7 percent to 39.9 percent across 10 North American sites. Risk-adjusted survival rates for cardiac arrests that occur in the hospital also vary 10.3 percent between bottom- and top-decile hospitals.

Effective treatment for cardiac arrest demands an immediate response from an individual to recognize cardiac arrest, call 911, start CPR, and use an automated external defibrillator (AED), the committee said. Decreasing the time between cardiac arrest onset and the first chest compression is critical. The likelihood of surviving decreases by 10 percent with every passing minute between collapse and return of spontaneous circulation, although new research offers hope in extending this time.

Although evidence indicates that bystander CPR and AED use can significantly improve survival and outcomes from cardiac arrest, each year less than 3 percent of the U.S. population receives CPR training, leaving many bystanders unprepared to respond to cardiac arrest. Furthermore, EMS systems vary in capacities and resources to respond to complex medical needs, such as cardiac arrests. National EMS-system oversight contributes to fragmentation and lack of coordination and planning in response to cardiac arrest, but some communities have demonstrated that focused leadership and accountability can overcome these barriers, the committee said. Educating and training EMS providers to administer "high-performance CPR" -- which emphasizes team-related factors such as communication and collaboration to attain high-quality CPR -- and provide dispatcher-assisted CPR can help increase the likelihood of positive outcomes.

To improve survival and quality of life following cardiac arrest, the committee recommended several actions:

Establish a national registry of cardiac arrest to monitor performance, identify problems, and track progress.
Educate and train the public on how to recognize cardiac arrest, contact emergency responders, administer CPR, and use AEDs, as well as facilitate state and local education departments to include CPR and AED training as middle- and high-school graduation requirements.

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