Boosting the Odds of Surviving Cardiac Arrest

Bryan McNally, MD, MPH; Arthur Kellermann, MD, MPH


August 21, 2006


This feature requires the newest version of Flash. You can download it here.

Want to improve your odds of surviving an out-of-hospital cardiac arrest 10-fold? Pick the right city.

Saving a cardiac arrest victim requires quick action -- prompt activation of 911, rapid provision of CPR, rapid defibrillation, and rapid access to definitive care. The American Heart Association calls this the "Chain of Survival.[1]"

Nearly every city and town provides each link in the chain, but this superficial consistency of approach masks huge disparities in outcome. Nationwide, survival rates of cardiac resuscitation vary by a factor of 10 or more.

In Seattle, for example, a victim observed to collapse from cardiac arrest has a 30% chance of survival to hospital discharge, but in Chicago, the same patient faces odds of only 3%.[2,3]


To succeed, each link in the "chain of survival" must occur quickly and efficiently, but in many US cities, swift delivery of care is hindered by fragmentation and lack of teamwork. Many cities don't even track their survival outcomes, so they don't know how well -- or how poorly -- they do.[4]

To improve treatment of cardiac arrest victims, Emory and the CDC has developed CARES, short for "Cardiac Arrest Registry to Enhance Survival." CARES is a simple but powerful database that allows cities to collect a small set of performance measures from 911, fire department first responders, and ambulances and link it with outcome data from hospitals.[5,6]

Business people understand the expression: "You manage what you measure." The same principle applies to healthcare. No one would accept 10-fold differences in operative mortality. Why should we accept 10-fold differences in cardiac arrest survival?

Every day, millions scan the paper to determine their favorite team's position in the major league standings. Someday, citizens may track, with equal interest, their city's performance at saving lives.

That's my opinion. I'm Dr. Bryan McNally, Assistant Professor of Emergency Medicine at Emory University.


Sign Up now for a free monthly email that brings you the top features from MedGenMed.

Readers are encouraged to respond to George Lundberg, MD, Editor of MedGenMed, for the editor's eyes only or for possible publication via email:


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.