The problem of cardiac arrest in the community

Out-of-hospital cardiac arrests constitute 350,000 cases yearly in the United States and 60,000 in the United Kingdom. Prompt resuscitation (CPR) by lay persons and fast defibrillation by paramedics have had epidemiologic consequences on both sides of the Atlantic. In Seattle there are 20.6 and in Brighton 10.0 long-term life-saves yearly per 100,000 persons. In Piedmont Virginia, coronary deaths fell 16% for persons 30-69 years old and 25% for those of all ages; prehospital life-saves accounted for 23% and 8% of each respective reduction. Since CPR by lay persons now triples the long-term survival rate when coupled with prehospital defibrillation, favorable benefit-to-cost ratios can be effected by adding advanced life support and citizen CPR to an extant ambulance system. Meticulous direct and indirect medical control by the physician assures the highest quality of CPR and early cardiac care (ECC). Diagnostic procedures like electro-provocation identify high-risk patients. Changes of behavior and diet, new drugs, new operations, and external and implantable automated devices reduce sudden deaths. In the future, automated defibrillation by first responders and trained lay persons (including members of families of high-risk patients) should increase the number of early survivors who become candidates for long-term therapy with drugs, operations, and devices.