Sudden Cardiac Arrest - improving survivability through awareness

12/04/19

Sudden Cardiac Arrest (SCA) affects approximately seven million people every year. Of those people, only 5-10% survive. SCA can strike at any time, to any person, of any age with no warning. Worryingly, 270 children die every year after suffering an SCA in school, in the UK, and 12 people under the age of 35 die every week.

CPR, defibrillators, initiatives and survival

As the average ambulance response time in the UK lies around eight minutes, and with survival chances decreasing by 10% for every minute that passes, the bystander plays the critical part in responding to SCA - chances of survival increase by 75% if a Defibrillator is used in the first few minutes after SCA.
 
In England, CPR is only undertaken by a bystander 40-50% of the time, which is significantly less than the comparable demographics of Norway (73%), Seattle (66%), and North Holland (60%), which have the considerably higher survival rates of 25%, 22% and 21%, respectively, compared to England's 7-8% (2011-2014 data).
 
The driving factors behind these improvements are awareness initiatives such as mass training events, mandatory training as part of driving license qualification3 and unlike the UK4, many EU countries have "Good Samaritan Laws" obliging bystanders to help those in need. In the case of the Netherlands, an individual could face three months imprisonment for not medically assisting persons in need.
 
Between 2000 and 2002, England's Department of Health placed 681 Public Access Defibrillators (PADs) in 110 public places and the trial confirmed that their placement can double the chance of surviving SCA. Worryingly, more recent data shows that bystander defibrillation only occurs in only 1.74% of Out of Hospital Cardiac Arrest (OHCA) cases, in the UK, and is most likely due to lack of confidence in the location and use of the devices.
 
Comparing this to community initiatives in the Netherlands, Public Access Defibrillator (PAD) schemes saw an increase in survival rate from 16.2% to 19.7%, and from 29.1% to 41.4% among those with initially shockable rhythms.

Lack of education, accessibility and poor maintenance can be costly

The ability of bystanders to perform CPR and operate PADs varies greatly across geographical regions, sometimes limited by their own abilities, the emergency services dispatchers or the access to the equipment itself.
 
One study in Iowa found that two years after the placement of PADs, none of the sites involved had successfully maintained the programme and faced critical issues like inaccessible equipment or expired batteries and pads making the initial initiative a failure.
 
Another study found that only 3.8 of OHCAs that occurred in Copenhagen, between 2011 and 2013, had a bystander use a PAD on the affected, although 15.1% occurred within 100m of an accessible PAD. Reasons for this included misinformation between the Emergency Service Dispatchers and the location of anPAD, too much time between the OHCA and the location of the PAD and the challenges faced by the dispatchers in identifying the OHCA.

Looking forward

In the age of technology, breakthroughs are being made in every sector. For PADs, the future looks promising with smarter PADs that send real-time maintenance reports via wifi, apps that locate nearby life-saving equipment via geolocation6 and easier means of communication allowing for public awareness campaigns.  The ability to respond to an SCA effectively looks to become easier over time.
 
Ultimately, though, what is needed is a multi-faceted approach. Better public awareness about CPR and PAD operation, annual refresher courses for first aiders, easier access to equipment and introducing CPR and PAD courses to citizens of all ages - following the example of countries that have introduced it to their primary and secondary school curricula.
 
If you're worried about how you'd react when facing an SCA, or just need that little information on the matter, click here to download our Guide to Defibrillators - How To Save a Life.
 
Prior knowledge can help you save a life.



 

A person suffering from Sudden Cardiac Arrest (SCA)

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