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IOM report calls for national cardiac arrest registry, more CPR training
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The Institute of Medicine released a report recommending several actions to improve survival rates and quality of life after cardiac arrest, including establishing a national cardiac arrest registry and training more people in how to use CPR and automated external defibrillators.
According to the report, there are approximately 395,000 cases of out-of-hospital cardiac arrest in the United States annually, and the survival rate is less than 6%, whereas there are approximately 200,000 U.S. cases of in-hospital cardiac arrest per year, and the survival rate is 24%.
“The question is, why doesn’t cardiac arrest resonate with the public the same way as stroke and cancer do?” Victor J. Dzau, MD, president of the Institute of Medicine (IOM), said at a press conference. “Why aren’t the public and policymakers asking more questions about improving the care for cardiac arrest as a nation? There seems to be a lack of coordination and strategy and messaging between the resuscitation community, public health and clinical research programs, and general policymakers. The inherent complexity of responding to cardiac arrest does not make the task easier.”
Changes are needed because each minute without treatment decreases the odds for survival without disability, and survival rates depend heavily on where the cardiac arrest occurs, according to the report’s authors.
Cardiac arrest “requires a system of response,” Robert Graham, MD, chair of the committee that wrote the report and director of the national program office for Aligning Forces for Quality at George Washington University, Washington, D.C., said at the press conference. “There is a lot that we do not know about the basic epidemiology of cardiac arrest. … We need this new data and knowledge. To make the system work well, we need the leadership and accountability that are critically important to keep looking at how the system is functioning and how quality improvement efforts are actually taking effect.”
The committee issued eight sets of recommendations. It called for the CDC to establish a publicly reported and available national cardiac arrest registry “to help increase federal and state accountability for current system performance and promote actions to improve cardiac arrest outcomes.” As part of that system, state, territorial and local health departments should mandate tracking and reporting of all cardiac arrest events and publicly report the incidence and outcomes of cardiac arrest, the authors wrote.
The committee also strongly recommended that more efforts be made to promote public awareness of the signs, symptoms and treatment of cardiac arrest. This includes more public CPR and AED training “across the lifespan, creating a culture of action that prepares and motivates bystanders to respond immediately upon witnessing a cardiac arrest,” they wrote.
The report specifically recommended that state and local education departments partner with training organizations and public advocacy groups to promote and facilitate CPR and AED training as a graduation requirement for middle school and high school students, that employers provide CPR and AED training to their employees and maintain AEDs, and that local health departments partner with community organizations to expand CPR and AED for adults older than 65 years and their caregivers.
The committee also recommended that:
- The National Highway Traffic Safety Administration should coordinate with other agencies and organizations to enhance the capabilities and performance of emergency medical services systems.
- The Joint Commission in conjunction with other organizations including the American Red Cross and the American Heart Association should develop and implement national accreditation standards related to cardiac arrest for hospitals and health care systems.
- EMS systems, health care systems and hospitals should adopt formal continuous quality improvement programs for cardiac arrest response.
- The NIH, the AHA and the U.S. Department of Veterans Affairs should lead an effort to accelerate research on pathophysiology, new therapies and translation of science for cardiac arrest.
- The NIH and other organizations should prioritize health services research related to the identification, evaluation and adoption of best practices; the use of innovative technologies; and the development of new implementation strategies for cardiac arrest treatments.
- The AHA and the American Red Cross, in conjunction with other agencies and organizations, should establish a national cardiac arrest collaborative to “unify the cardiac arrest field, identify common goals and build momentum within the field to ultimately improve survival from cardiac arrest with good neurologic and functional outcomes.” – by Erik Swain
Disclosure: The study was sponsored by the AHA, the American Red Cross, the American College of Cardiology, the CDC, the NIH and the U.S. Department of Veterans Affairs.
Perspective
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Clifton W. Callaway, MD, PhD
The IOM report is very exciting and highlights four distinct messages. One is that there are disparities in how resuscitation is delivered. The report calls for us to develop national statistics in a national database to get a handle on the scope of the problem of sudden cardiac arrest. No. 2, there is a call to action for citizens to take action, learn CPR and be able to take care of each other. No. 3, the report points out that to deliver better care to patients with cardiac arrest, we need to improve all our systems: emergency response through the 911 system, EMS systems, and hospitals. No. 4, there is a call for more focused efforts to do research both to create new treatments and to improve the delivery of known therapies for this situation.
Everything that is called for is congruent with the AHA’s organizational mission. In terms of databases, the AHA has sponsored for many years efforts like Get With the Guidelines and AHA has provided support for research databases such as the Cardiac Arrest Registry to Enhance Survival (CARES) and the Resuscitation Outcomes Consortium (ROC) Epistry. The AHA is ready to partner with any national database to gather more detailed statistics. There is a commitment of up to $5 million over the next few years to help with the infrastructure and relationships that might be necessary to create that kind of database. We already are providing a great deal of teaching to the community, including videos and courses on hands-only CPR, public service announcements and videos related to CPR and awareness about Good Samaritan laws. The association is going to continue and redouble its efforts there. We’re very interested in improving systems of care. Get With the Guidelines and other databases are examples of quality improvement efforts that the AHA has used to help hospitals identify processes for improvement. Finally, we are very committed to creating research networks. The AHA, in light of this report, commits to finding philanthropic support for research networks to do basic and clinical research that will develop and test therapies to improve the care of people with cardiac arrest.
The report highlights one of the largest killers of Americans today that not every American is aware of. I hope it’s an opportunity for people to realize that this is a potentially treatable condition for which we can deliver known treatments and improve survival.
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