Why rates of ROSC from cardiac arrest remain so low

There have been lots of efforts to improve out-of-hospital cardiac arrest survival, but we have had little success

It’s hard to imagine what life was like prior to the 1950s, from a field care viewpoint. Back then, if someone experienced sudden cardiac arrest (SCA) in the field, it was considered a terminal event. SCA patients were taken to funeral homes, not hospitals. In most circumstances, there was no emphasis on understanding what happened or why. That began to change when closed heart massage, which became known as CPR, artificial ventilations and portable cardiac defibrillators began making their appearance on the medical landscape in the middle of the 20th century. With television shows like “Emergency!” hitting the airways, the public perception of SCA shifted to the possibility of being “saved” by modern medicine.

By the 1980s, the pendulum swung the other way. With shows like “Rescue 911” showing scenes of successful rescues every week, now everyone could be resuscitated, walk out of a hospital and be reunited joyfully with their family and loved ones. The hero status of EMS providers grew even larger, even while funding for EMS services were being cut and the system became increasingly fragmented. Cowboy medicine was rampant and no one really cared about evidence-based medicine.

So, it should come as no surprise that ROSC rates continue to be dismal across this country. Think about it: we have spent a great deal of money, time and effort to increase the chances of cardiac arrest survival. Many cities and regions have built their entire EMS system around the response time standard of eight minutes or less, so that trained providers and equipment can get to the SCA patient within the “save” window (unless you’re a Calif. department that is unable to document the recertification for personnel).

Yet while a few, isolated places in the country are showing real progress in resuscitation, most do not. The average survival rate from out-of-hospital cardiac arrest is 6 percent. That’s a pretty poor showing for 60 years of so-called progress.

Moreover, we know what works: bystander participation, high quality CPR, early defibrillation are the foundational blocks of resuscitation. Maintaining perfusion within a few seconds of cardiovascular collapse is mandatory; defibrillation is the definitive intervention for ventricular fibrillation. Lots of great studies demonstrate this trifecta of emergency cardiac care.

It’s time to hold up our mirror and take a good look at what we do at our local level. Do you not only advocate for state of the art emergency care, but actually do something about it? Pit crew CPR, high quality compressions, teaching the public how to perform  compression-only CPR, pushing for public-access AEDs - each is a component of cardiac resuscitation. Which of these does your system do? If it’s few or none, it shouldn’t be a surprise that the resuscitation rate continues to be dismal.

We need to do a better job in meeting the expectation of greater results.

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