ATLANTA, GA--The odds of surviving cardiac arrest may depend
on which part of town you call home and whether anyone in the neighborhood
comes to your rescue by attempting to perform cardiopulmonary resuscitation
(CPR), according to a first-of-its-kind study in the June issue of the Annals
of Internal Medicine.
The study found that certain neighborhoods in Fulton County,
Ga.─which includes Atlanta─have an incidence of cardiac arrest two to three
times higher than other parts of the county and fewer bystanders who attempt to
perform CPR. Surprisingly, these findings remained across time, meaning that,
year after year, residents of these neighborhoods were at the highest risk for
a cardiac arrest event, and had the lowest rates of bystander CPR in Fulton
County. These neighborhoods tend to have lower median household incomes, more
Black residents, and lower education levels.
"These findings have national public health indications.
They show that it is time to change our thinking on how and where we conduct
CPR training if we are ever going to change the dismal rate of survival from
cardiac arrest,” said Comilla Sasson, M.D., M.S., lead author of, "Small
Area Variations in Out-of-Hospital Cardiac Arrest: Does the Neighborhood
Matter?" who conducted the study as a Robert Wood Johnson Foundation
Clinical Scholar at the University of Michigan. “Nine out of 10 people die from
a cardiac arrest event. This number can and must change.”
In Fulton County, if rates of CPR performed by bystanders
were improved to the level achieved by the highest performing parts of the
county, an additional 355 people could receive CPR. This could save an
additional 15 lives each year in Fulton County alone.
CPR training often targets young, healthy volunteers who are
least likely to encounter an individual in cardiac arrest. However, using Sasson’s
method, a public health surveillance registry based on that of the CDC can be
used to design targeted interventions in the neighborhoods that need CPR
training the most. Boosting bystander CPR rates in the United States from the
current average of 27 percent to 56 percent could save an additional 1,500
lives per year.
An earlier study by Sasson in the 2009 journal Circulation
found that the nation's survival rate for out-of-hospital cardiac arrest has
been at a standstill at 7.6 percent for nearly 30 years. Because most
incidences of cardiac arrest occur outside a hospital and are often witnessed
by bystanders, efforts to improve survival should focus on the prompt delivery
of medical interventions such as the delivery of CPR.
“To improve cardiac survival rates that have been stagnant
for 30 years, CPR training should be more basic and available to the people who
are most likely to witness someone experiencing cardiac arrest,” Sasson said.
“Health care resources are extremely limited. To make improvements, we need to
understand where and how best to make change.”
For this study, researchers analyzed emergency medical
services (EMS) and 911 call data from the Cardiac Arrest Registry to Enhance
Survival Rates (CARES), which was used to identify areas with higher incidences
of cardiac arrest and low rates of bystander CPR. CARES is an EMS Web-based
registry for out-of-hospital cardiac arrests. Census information was used to
approximate neighborhoods. The study is believed to be the first to show
relative stability in the incidence of cardiac arrest within census tracts from
year to year.
The 30 U.S. cities that
constitute the CARES Study Group include Anchorage, Alaska; Austin, Texas; Boston, Mass.;
Columbus, Ohio; Denver, Colo.; Honolulu, Hawaii; Houston, Texas; San Diego,
Calif.; Sioux Falls, Idaho; and Wake County, N.C.