IOM reports 'unacceptable' disparities in cardiac arrest survival

Too many people die from cardiac arrest in the U.S. despite breakthroughs in the understanding and treatment of the condition, according to a report from the Institute of Medicine.

The authors suggest revamping the national strategy to standardize surveillance, coordination, data collection, public education and the sharing of best practices pertaining to the condition.

The ability to consistently deliver timely interventions and high-quality care to cardiac arrest patients has been “less than impressive,” said Dr. Robert Graham, chair of the 19-member multidisciplinary IOM committee on the treatment of cardiac arrest, in a preface to the report. The disparate survival rates across the nation have been “equally unacceptable,” he said.

An estimated 600,000 people experience cardiac arrest each year in the U.S. Nearly two-thirds of the events occur outside of the hospital, but less than 6% of patients survive when the arrests begin in that setting, compared with 24% of inpatients. The total annual aggregate cost of out-of-hospital cardiac arrest in the U.S. was $33 billion according to a 2014 study.

While heart attacks result from problems with circulation, cardiac arrest is an electrical issue that occurs when the heart malfunctions and unexpectedly stops beating. Effective treatments for specific types of cardiac arrest are widely available and could reduce deaths and disability if more efficiently implemented.

The report emphasizes strategies in six areas. These include: the creation of a national cardiac arrest registry; enhancing the performance of emergency medical systems; improving systems of care; promoting research and innovation; more extensive education of the public on how to do CPR and use defibrillators; and creation of a national collaborative to identify common goals to improve survival.

One of the most surprising findings is that no precision data exists to characterize the true impact of cardiac arrest in this country, most reported numbers are only estimates, said committee member, Dr. Lance Becker, an emergency physician from the University of Pennsylvania.

Current registries are “excellent starts, but not adequate,” he said, adding that national data is an essential missing element. “We need to measure the impact of our treatments and interventions so that we can really establish evidence-based practices that will save lives in every community.”

Though she is not on the committee, several studies coauthored by Dr. Monica Kleinman were cited in the report. Her research focuses on resuscitation quality, outcomes, regional differences and use of registries.

While there are pockets of the country where outcomes are significantly better than others and where systems of care work extremely well, “that's not a nationwide phenomenon,” said Kleinman, clinical director of the Medical-Surgical ICU & Critical Care Transport Program at Children's Hospital Boston and past chair of the American Heart Association's Emergency Cardiovascular Care Committee.

The single biggest potential for impact is to implement nationwide what has already been learned by “local champions” within those pockets. “It could change policy, it could change planning, it could literally change systems of care,” she said. “The potential to save more lives is absolutely there.”

The IOM report was requested by the American College of Cardiology, American Heart Association, American Red Cross, Centers for Disease Control and Prevention, the National Institutes of Health and the U.S. Department of Veterans Affairs to review factors affecting resuscitation research and to inform on what is needed to improve care.

“I will be the first to admit that this is an ambitious report, questioning many accepted norms and asking what conditions are necessary to advance the field an improve outcomes,” said Dr. Victor Dzau, a cardiologist and president of the IOM. The system of response to cardiac arrest in the U.S. can be strengthened if existing and developing capabilities are leveraged and stakeholders align, he said.