Cardiac arrest recoveries are great stories, but they’re rare. We can fix that | Expert Opinion
Only in about 40% of the cases where CPR is needed do people actually receive it. This helps to explain why only 1 in 10 people, on average, survives.
A few weeks ago, I saw that Marine Corps Gen. Eric Smith returned to full active duty after experiencing cardiac arrest and a subsequent surgery to fix a congenital heart defect. He survived the initial cardiac arrest in October because people saw him collapse and immediately performed CPR while 911 was called. Before that, news outlets covered the cardiac arrest of football player Damar Hamlin, who received prompt CPR and experienced a great recovery.
These are great examples of resuscitation success, but I can tell you that, unfortunately, these stories are not very common.
After a heart attack, every minute someone doesn’t receive CPR drops their chance of survival by 10%. After 10 minutes, with no CPR, there’s pretty much no coming back.
Unfortunately, only in about 40% of the cases where CPR is needed do people actually receive it. These breaks in the “chain of survival” help to explain why only 1 in 10 people, on average, survives cardiac arrest.
As an emergency medicine doctor, low rates of CPR put us at a significant disadvantage when we try to save someone’s life. I’ve been doing this job for more than 18 years, and the number of patients who survive cardiac arrest has remained stubbornly low for decades, even longer than my time as a physician.
However, I think we can actually make a change in those numbers, and a leading scientific group within the American Heart Association thinks it can be done by 2030. Simply, we need more people ready and willing to save a life, like those who stepped in quickly for Smith and Hamlin.
People experience cardiac arrest everywhere, so “bystander” CPR is vitally important. As soon as someone does chest compressions, the chances immediately increase that the person whose heart stopped will live.
For bystanders, the instructions are straightforward: call 911, place your hands in the middle of the chest and push hard and fast. The 1977 Bee Gees’ song “Staying Alive” is the right speed for delivering chest compressions. CPR training is becoming more widely accessible — via online courses, in-person courses, and mobile apps with just-in-time instructions — but there is still a significant gap in moving from teaching CPR to people actually receiving it in an emergency.
Racial inequities add to the tragedy of our dismal cardiac arrest survival rates. Black and Hispanic people are roughly 37% less likely to receive CPR from bystanders when they experience cardiac arrest at home when compared to white individuals (45%) and less likely to receive CPR in public locations (45% for Black and Hispanic individuals and 60% for white individuals). And these disparities contribute to significant differences in who lives and who dies following cardiac arrest.
Every 10 years, the American Heart Association’s Emergency Cardiovascular Care Committee sets new goals to provide guidance on how to improve survival. As a scientist who studies how to improve cardiac arrest outcomes, I worked with a team to help formulate the goals this time. We developed a broad list of ways we can improve outcomes from the community to the hospital and back to the community. A key area of focus is providing more CPR training to a wide variety of people. The more people who are trained and feel confident in giving CPR, the more likely one of them will be around when someone’s heart stops.
[CPR training is offered through the American Red Cross, American Heart Association, and other local organizations. You can look up options near you here: atlas.heart.org/home]
The goals we’ve set aim to push the rate of CPR administered to cardiac arrest patients past 50%, which we believe can translate to doubling the rate of survival.
Some immediate next steps are to lean into what we know is effective: Increasing rates of bystander CPR through targeted outreach, increasing training that’s convenient and accessible to the public, expanding coverage and use of automatic external defibrillators (AEDs), and ensuring that we are using state-of-the-art approaches to data collection and tracking with a goal of equitable care for all.
Our current goal of going from 10 to 20% in survival rates may not seem exciting at first glance. But when you consider that 350,000 people have cardiac arrest outside of a hospital each year, that means that 35,000 more people will have a higher likelihood of going home. That’s 35,000 more people seeing their families, hugging their children, and returning to their communities and living their lives again.
As someone who has regularly witnessed what happens when someone’s heart never starts beating again, I’m committed to ensuring we give everyone the best chance at surviving cardiac arrest. I think we all can be.
Raina Merchant is a professor of Emergency Medicine at Penn Medicine.