A consensus statement from the American Heart Association Cardiac Arrest Survival summit was published Monday in the online version of Circulation.
At first glance, there doesn’t appear to be any earth shattering news. A consensus statement looks at as much evidence as possible and creates a list of “best practices” or recommendations to solve a problem or address an issue.
In this case, the writing group took a look at the wide variability of survival from out-of-hospital cardiac arrest (OHCA), and surmised that the differences were too great to be attributed solely to patient demographics.
It is likely that, based on the evidence, there are steps that response systems can implement that can improve rates of survival in many communities.
We already know that community-based responders are essential in the chain of survival.
I and others have advocated for stronger involvement of EMS in training the public on its role of recognizing cardiac arrest, calling 911 and starting CPR.
The consensus paper also calls for strong dispatch protocols that provide “just in time,” over-the-phone training in chest compressions; highly trained EMS providers who are well experienced in resuscitation; and a multidisciplinary approach to post-resuscitation care in the hospital, including therapeutic hypothermia.
In other words, the chain of survival has to be strong at every link, or it will have challenges in achieving higher rates of survival.
The statement also recognizes that, in order for a system to evolve, it has to overcome challenges that are economically and politically based.
As a rule, people dread change; we are most comfortable with the status quo. Yet, in the case of cardiac arrest, not making substantive, long-lasting changes in an average system will continue to promote mediocre outcomes. Thought “champions” have to push tirelessly to make a system more responsive to its community needs.
No doubt, there are a lot of pretty big items in the statement that would need to be addressed in improving outcomes, but they’re not terribly expensive, nor unreasonable in effort. It’s more about changing the mindset that a system can improve its performance, and that it’s worth doing so.
