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Sept. 23, 2008 -- If your heart stops beating, you're five times more likely to die in certain parts of the U.S. and Canada than in others.
Your odds are worst if you live in Alabama, where only 3% of cardiac arrest patients treated by emergency responders survive to hospital discharge.
That's five times worse odds than in Seattle, where EMT treatment prevents cardiac arrest death 16.3% of the time.
"We were surprised by how large the differences were between regions," study leader Graham Nichol, MD, MPH, of the University of Washington, Seattle, says in a news release.
If you don't live in Alabama, there's no cause for celebration. Only 4.6% of people in North America who suffer cardiac arrest survive. A little more than?half of the patients are treated by emergency responders, which increases the odds of survival to 8.4%.
The findings come from a study of 20,520 people who suffered cardiac arrests from May 2006 through April 2007 in 10 large areas of the U.S. and Canada.
Some 15,000 deaths would be prevented every year if the rest of North America improved to Seattle's level, Nichol and colleagues calculate.
Cardiac arrest occurs when the heart stops beating effectively. It's different from a heart attack, in which blood flow to the heart is blocked?(although a heart attack can trigger cardiac arrest).
CPR -- cardiopulmonary resuscitation -- can save the life of a person in cardiac arrest. So can prompt treatment with an automated external defibrillator or AED, now available in many public places.
But survival depends on several factors. It depends on prompt assistance from emergency responders, bystanders trained in CPR, defibrillator availability, emergency responders having advanced life support capabilities, and the very best hospital care.
In an editorial accompanying the study, University of Arizona researchers Arthur B. Sanders, MD, and Karl B. Kern, MD, call for more resources for local emergency medical services, saying "It's time to recognize the importance of EMS systems to the health of a community."
"Each community needs to examine how well it is treating cardiac arrest," Nichol says. "It may get better results by training the public to recognize and respond to medical emergencies, by improving the local organized emergency response, or by improving hospital care for these patients."
Sanders and Kern note that too few cardiac arrest patients get aggressive treatment from EMS responders. They call for a review of resuscitation rules in light of recent improvements in resuscitation science.
It's not just survival that differed across the continent. For example, for every 100,000 residents, Dallas has 159 cardiac arrests; but Portland has just 77.5.
Out-of-hospital cardiac arrest is fatal 96.9% of the time in Alabama and 91.8% of the time in Seattle.
Here are the survival rates for EMS-treated, out-of-hospital cardiac arrest in 10 areas in the Nichol study:
The study will continue through 2010. The Nichol team's report and the Sanders/Kern editorial appear in the Sept. 24 issue of The Journal of the American Medical Association.