AHA Renews Call for Increasing CPR Training

A unified effort by the public, educators and policymakers is needed to reduce deaths from sudden cardiac arrest by increasing the use and effectiveness of cardiopulmonary resuscitation (CPR), according to a statement from the American Heart Association. The statement, "Reducing barriers for implementation of bystander-initiated cardiopulmonary resuscitation," appears online in Circulation: Journal of the American Heart Association.

"Bystander cardiopulmonary resuscitation rates are woefully inadequate, resulting in an enormous missed opportunity to save lives from cardiac arrest," said Benjamin S. Abella, M.D., M.Phil., clinical research director for the Center for Resuscitation Science at the University of Pennsylvania in Philadelphia, and lead author of the statement.

Studies indicate that in many communities only 15 percent to 30 percent of out-of-hospital cardiac arrest victims receive bystander CPR before emergency medical services (EMS) personnel arrive at the scene. Considering that cardiac arrest survival falls an estimated seven percent to 10 percent for every minute without CPR, the low rate of bystander CPR has a big impact on outcomes, he explained.

Approximately 166,200 out-of-hospital sudden cardiac arrest deaths occur annually in the United States. Sudden cardiac arrest often results from an irregular heartbeat called ventricular fibrillation (VF) which causes the heart to quiver so that it cannot generate blood flow. Treatment of VF requires CPR to keep blood moving through the body until the patient's heart can be shocked to terminate the VF and allow the heart's pacemaker cells to establish a normal rhythm, AHA officials said.

In the last decade, automated external defibrillators (AEDs), portable defibrillation machines, have become increasingly common in public buildings such as casinos, airports and schools. However, Abella said defibrillation is only one of the four links in the Chain of Survival, a sequence of four actions that must occur quickly to help assure the best chances of survival.

The Chain of Survival requires:

  • early recognition of the emergency and phoning 911 for EMS.
  • early bystander CPR.
  • early delivery of a shock via a defibrillator if indicated.
  • early advanced life support and post-resuscitation care delivered by healthcare providers.

"Quick initiation of CPR, as well as providing high quality CPR, is crucial to survival," Abella said. "What's needed is a two-pronged approach: first, substantially increase the number of bystanders trained in CPR who then provide CPR during an actual emergency and second, improve the quality of training and actual CPR performance through measures of its effectiveness."

The statement identifies specific potential barriers to improving U.S. cardiac arrest survival rates including: fear of infectious disease, fear of litigation and fear of poor performance, all of which Abella said could be overcome with adequate education, training and public awareness.

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