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Sudden Cardiac Arrest - Dr. Joseph Ornato
About 400,000-460,000 deaths occur per year in the U. S. from sudden cardiac arrest, mostly due to ventricular fibrillation. A majority of the events (79-84%) occur at home, and survival has been estimated to be as low as 5-8%. Survival is highly dependent on the time interval between collapsing to receiving initial defibrillation. Bystander CPR has also been found to be strongly associated with positive outcome. Dr. Ornato pointed out that the emergency medical service (EMS) system configurations vary widely across North America. Survival rate to hospital discharge from out of hospital cardiac arrest varied from 2-25% for all cardiac rhythms and 3-33% for ventricular fibrillation. Much of the variation is due to differences in definitions (especially problematic when establishing the denominator). He then described the Utstein CARDIA Arrest Guidelines, which aim to develop consensus on uniform reporting of data. The guidelines were recently revised to include updated variable definitions, revised cardiac arrest data collection form, more focus on collecting core time intervals, and emphasis on the need to have collection time synchronized. Some experts feel that the Utstein guidelines are limited by failing to include neurological outcomes as an essential component of all outcome studies on sudden cardiac arrest; they believe that once this is accomplished, using the Utstein template should be demanded by every editor to whom an article on resuscitation is submitted.
Dr. Ornato described the National Registry of CPR, a multi–facility registry sponsored by the American Heart Association. It uses an electronic database to capture resuscitation records, follows an in-hospital Utstein template and standardized data definitions, and thus allows aggregate data analysis across multiple centers (about 303 hospitals throughout the U.S. are participating). Resuscitations that started outside the hospital are excluded. He also showed a list of international surveillances. He concluded by saying that an organized national surveillance in the U.S. is needed.