Introduction
To
Sudden Cardiac Arrest
And
Automatic External Defibrillation

What is sudden cardiac arrest?

More aptly called sudden cardiac death, sudden cardiac arrest is a condition in which the heartbeat stops suddenly and unexpectedly. It is caused by life-threatening arrhythmias, abnormalities in the heart’s electrical system. The most common arrhythmia is ventricular fibrillation. In this condition, the heart beats so chaotically that it’s unable to pump blood to the body and brain.

The sudden cardiac arrest victim first loses his or her pulse, then consciousness, and finally the ability to breathe. Without immediate treatment, the victim almost always dies.


Sudden cardiac arrest vs. heart attacks

A sudden cardiac arrest is not the same thing as a heart attack, although a person suffering a heart attack is more likely to develop abnormal heart rhythms and sudden cardiac arrest. Here’s how they’re different:

• A heart attack is caused by blocked blood flow to the heart muscle so the muscle begins to die. Sudden cardiac arrest is caused by an abnormal heart rhythm.
• A heart attack is often preceded by chest, arm, upper abdomen, or jaw pain. Nausea and sweating are common. There is rarely a warning before sudden cardiac arrest.
• Heart attack patients usually remain conscious. Sudden cardiac arrest victims always lose consciousness.
  

The prevalence of sudden cardiac arrest

One of the leading causes of death among American adults, sudden cardiac arrest kills approximately 350,000 people a year, or approximately 1,000 people per day. Two out of every three deaths happen outside of the hospital.


Who’s at risk and where:

• Sudden cardiac arrest is unpredictable and can happen to anyone, anywhere—even to a child. Risk increases with age.
• Although pre-existing heart disease is a common cause of cardiac arrest, many victims have never had any heart problems.

Early defibrillation is the key to survival

The only effective way to treat cardiac arrest is with a defibrillator, a medical device that delivers an electrical current, or shock, through the chest to the heart. This shock—or countershock as it is sometimes called—interrupts the random electrical pulses of ventricular fibrillation and gives the heart a chance to start beating again in a normal rhythm. The process is called defibrillation.

If you’ve watched ER, or any other TV hospital show, you’ve probably seen a doctor or nurse successfully shocking a cardiac arrest victim back to life with a defibrillator. Unfortunately, in the real world, 95 percent of cardiac arrest victims die because they either don’t have access to defibrillation, or if they do, it’s delayed by 10 minutes or more.

That’s why the American Heart Association advocates for the widespread public use of AEDs. Early defibrillation could save up to 100,000 lives per year in America.



Survival odds:

Cardiac arrest is usually reversible if defibrillation occurs within the first few minutes after collapse. The sooner the shock is delivered, the better.

• As many as 50 percent of cardiac arrest victims could be resuscitated if they were defibrillated within seven minutes or less. In one study in Las Vegas, survival rates reached 70 percent. (Rapid Defibrillation by Nontraditional Responders: The Casino Project; T.D. Valenzula, et. al, Academic Emergency Medicine; May 1998, Vol. 5/No. 5, pg. 414.)
• Survival can be as high as 90 percent if a victim is defibrillated during the first minute after collapse.

Each minute defibrillation is delayed, the chance of a person surviving a cardiac arrest drops 10 percent—even if CPR is started immediately.

• If a sudden cardiac arrest victim isn’t defibrillated within 10 minutes, his or her chance of survival is less than 2 percent. The chance of survival will drop even further if CPR isn’t begun before the defibrillator arrives.
• If the heart isn’t restarted within the first four to six minutes after the arrest, the victim may sustain irreversible brain damage.
  

The Chain of Survival:

In 1990, the American Heart Association introduced a treatment model for victims of sudden cardiac arrest called the Chain of Survival. It outlines the specific sequence of events that need to happen for a victim to survive and recover from sudden cardiac arrest.

• Early Access. Someone suspects or determines the victim is in sudden cardiac arrest and calls for help.
• Early CPR. Someone trained in cardiopulmonary resuscitation keeps the victim’s blood flowing until defibrillation can begin.
• Early Defibrillation. Someone trained in defibrillation shocks the victim as quickly as possible.
• Early Advanced Care. Medical personnel provide advanced cardiac care which can include airway support, medications, and hospital services.

Studies show that the most critical link in the chain is defibrillation.

How an AED works:

An AED, or automated external defibrillator, is a portable and easy-to-use medical device designed especially for first responders with little training. A first responder is the one most likely to arrive first to the scene of a medical emergency.

An AED has a built-in computer that analyzes a victim’s heart rhythm and determines if it requires a shock. Unlike a manual defibrillator, an AED is simple to use because voice commands and screen messages guide the operator through the defibrillation process.



No medical background needed to use an AED:

AEDs are extremely intuitive and most people can learn to operate an AED with a few hours of training. In fact, the American Heart Association says “Learning to use and operate an AED is easier than learning to perform CPR.

How to use an AED:

A sophisticated medical device that’s simple to use, the AED leads the operator through the rescue process step by step.
Once the operator has confirmed the victim is unresponsive, not breathing, and has no pulse:

1.       The operator turns on the AED.

2.       The operator attaches the adhesive electrodes to the victim’s chest. The machine assesses and then interprets the victim’s heart rhythm.

3.       The operator follows the machine’s voice prompts and screen instructions.

If a shock is advised, the voice prompts will tell the operator to press the “SHOCK” button. The AED will not allow a shock to be given unless the victim needs it.

 

Why EMS and CPR are not enough:

Emergency medical service (Ambulance) professionals save many thousands of lives a year, but they could save even more if they weren’t impeded by the time it takes to reach a victim or a lack of equipment. Nothing could be truer when it comes to victims of sudden cardiac arrest.



EMS is sometimes delayed:

In some large metropolitan areas, the ambulance can’t even get to the scene of the attack in 10 minutes because of traffic. So, even if an emergency responder does have a defibrillator, the response time might not be fast enough to save the victim’s life.

"Even in the best EMS systems, it takes professional rescuers four to eight minutes to arrive at the scene," says Mary Fran Hazinski, R.N., M.S.N., chairperson of the American Heart Association’s ECC. "During these precious moments, the victims’ chances of survival are dwindling."

CPR cannot restart a heart:

Finally, CPR is an important link in the Chain of Survival, but it can’t save someone from sudden cardiac arrest. It buys a little bit of time for the victim, but only defibrillation has the potential to actually save the victim’s life.

Facts And Figures

 Sudden Cardiac Arrest

·               Up to 350,000 Americans die each year from Sudden Cardiac Arrest - that's almost 1000 per day.¹

·               Two out of every three deaths due to Sudden Cardiac Arrest occur before the victims even reach the hospital.⁷

·               Thousands could be saved - 300 people per day or more - if all the links in the Chain of Survival were strong - specifically if early defibrillation and automatic external defibrillators (AEDs) were available to all.⁴

·               The victim of Sudden Cardiac Arrest must receive a "life-saving" shock from a defibrillator within 10 minutes to restore a regular heart rhythm and save a life. For every minute that goes by without defibrillation, a cardiac arrest victim's chances of survival decrease by 10%. After 10 minutes without defibrillation, the chances of survival are practically nonexistent.¹

·               The chances of surviving sudden cardiac arrest in the US are less than 1 in 10.¹

·               In most cases, it's almost impossible to predict who will have a sudden cardiac arrest, or where and when it will happen.¹

·               Sudden Cardiac Arrest (SCA) has the most rapid onset of symptoms of any disease. Its onset is unpredictable and is indiscriminate with regard to gender or age.

·               Every two minutes someone in the United States dies of sudden cardiac arrest.¹

·               In cities where CPR training is widespread and EMS response is rapid, the survival rate from sudden cardiac arrest increased from 9% to 30% when AEDs were available to first responders (those likely to respond first to a medical emergency).⁴

·               The survival rate of those who have been saved from sudden cardiac death is good, with 80% alive one year later and 57% alive at five years.¹

Defibrillation - The Shock of Life

While all the links in the Chain of Survival must be strong, rapid defibrillation is the most important single factor in determining survival of sudden cardiac arrest.³

·               Early defibrillation - delivering an electrical current to the heart within the first few minutes after sudden cardiac arrest - can raise survival rates to 30 percent or higher.¹

·              Communities around the country have invested in the chain of survival by instituting ‘000’ and  training personnel. Yet, many of these communities have failed to provide enough defibrillators.¹

·             Dr. Joseph P. Ornato of the Medical College of Virginia said in a New York Times article: "Sending an emergency vehicle to a cardiac arrest without a defibrillator is like having policemen with guns but no bullets."¹

Automated External Defibrillators Are The Key

·               Few public gathering places have AEDs and only certain first responders are allowed to use AEDs by law.

·              AEDs are simple to use, walking the first responder through the process with easy-to-follow prompts. AEDs are programmed to only shock specific heart rhythms where a shock is necessary and WILL NOT shock inappropriate rhythms.

·              The majority of Sudden Cardiac Arrest victims are in ventricular fibrillation. The only treatment for ventricular fibrillation is defibrillation.

·               "Anyone who can learn CPR can learn to use AEDs," says Dr. Cummins, a pioneer in the treatment of out-of-hospital sudden cardiac arrest.¹

·              The American Heart Association estimates that 20,000 or more deaths could be prevented each year if AEDs were more widely available to first-line responders such as police officers and fire department personnel.¹

 


Is Your Community Prepared For SCA

By answering the following questions, you can determine whether your community is prepared to respond successfully to a sudden cardiac arrest. If you can answer "YES" to all of these questions, then your community is prepared. If not, you may want to explore how you can help prepare your community.

·               Is ‘000’ the emergency response number? If not it should be.

·                Are all first responders equipped with AEDs? (A first responder is one who is likely to arrive first in response to  

                 a medical emergency.) Ambulances? Firefighters? Police?

·                Are all first responders trained in the use of AEDs?

·                Do the laws in your community protect those who perform CPR and use AEDs in an attempt to save a life in an

                 emergency?

·                Are emergency first responders able to arrive on the scene of an emergency in 4-7 minutes?

·                Are CPR courses taught in your community?

·                Are most of the members in your community trained in CPR?

·                Are members of your community emergency response team trained in Advanced Cardiac Life Support?

 You Can Help Prepare Your Community

You could be the start of preparing your community to respond to Sudden Cardiac Arrest (SCA). Don't wait for someone else to take the lead. You could save the lives of your neighbors, family members and friends by acting now. Here are a few suggestions:

• Identify your community's weak links in the Chain of Survival. Cardiac survival depends on the entire chain. Having AEDs may not help if community members don't know to call the Ambulance. Your campaign could include establishing ‘000’ as your emergency response number, providing community-wide CPR training and equipping first responders with AEDs.
  
• Understand the facts about SCAand the Chain Of Survival. Develop an action plan and involve others in your community. This could include influential community members and decision makers.
  
• Ask your local Council and Emergency Services what they can do to help equip your community to respond to sudden cardiac arrest. Some may be willing to take on the cause and can raise public awareness. In addition, they may be able to get funding from local or state resources.
  
• Create public awareness and support. This can involve public speaking at community events and in schools, writing editorials, communicating with your Ambulance Service and talking with community leaders.
  
• Identify corporations and other organizations that may want to help strengthen the Chain of Survival in your community. They can help you secure donations, grants and sponsorships to provide AEDs and training.
• Train all  firefighters, police and other first responders.
  
• Make sure that early defibrillation programs operate with physician medical direction.
  
• Find out if the laws in your state are favorable to defibrillation and implementing the Chain of Survival. If not, write letters to city, state and federal representatives encouraging them to make changes in the name of saving lives