Perspective from Clifton W. Callaway, MD, PhD
July 01, 2015
4 min read
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IOM report calls for national cardiac arrest registry, more CPR training

Perspective from Clifton W. Callaway, MD, PhD
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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.