Incidence of and Survival from Sudden Cardiac Arrest
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1 Incidence of and Survival from Sudden Cardiac Arrest Vincent N Mosesso, Jr, MD Professor of Emergency Medicine University of Pittsburgh School of Medicine
2 Disclosures Employer: University of Pittsburgh / UPMC Advisory Board, OxySure, Inc, Fresno, TX Speaker Honorarium, Biotronik Corp Medical Director, Sudden Cardiac Arrest Association, Washington, DC Medical Director, Advanced Medical Life Support Program, National Assn of EMTs
3
4 300,000 Americans suffer OOHCA yearly Americans will suffer OOHCA today High morbidity and mortality - ~50% never make it to the hospital
5 Incidence-the mystery AHA Heart and Stroke Facts , ,000 MMWR - 460,000 Problem: - Not a reportable disease for CDC - Not categorized by national public health agencies
6 Examples of reported incidence Myerburg 1997 (review): 300,000 Masstricht area 1997: 280,000 (1/1000) Cobb 2002 (extrapolation): 184,000 (0.9/1000) - Treated by EMS, age >20 years Rea 2004 (age 50-79): 1.89/1000-6/1000 with heart disease; 0.8/1000 without Rea ,000 (0.5/1000) - Treated by EMS, composite analysis - VF 60,000
7 Sudden cardiac death: a public health crisis Annual incidence House fire Prostate cancer Breast cancer Car accidents Sudden cardiac arrest
8 The faces of sudden death
9 SCD in athletes Competitive athletes - 25 million youths - 4 million HS - 400,000 college - 40,000 pro Risk of death - HS/college women: 1 / 769,000 - HS / college men: 1 / 133,000 - College men: 1.45 / 100,000 Risk of SCD in age >40 about / 1,000 Risk of SCD increases x with exertion
10 Sudden deaths by sport Maron BJ, JAMA, 1996
11 Prediction & Prevention
12
13 Presenting rhythm EMS studies report decreasing incidence/frequency VF No. of Cases Year 1988 Cobb L, Fahrenbruch CE, Olsufka M, Copass M. Changing Incidence of Out-of-Hospital Ventricular Fibrillation, JAMA 288(23): , Public access defibrillation trials show higher rate North American PAD Trial 60%
14 VF as initial arrest rhythm PAD-based studies: high and constant VF 20 0 Casinos PAD Airlines Federal
15 Median survival = 8.4%
16 Langhelle - 4 cities in Norway
17 Survival for OOH-VF 100 Cardiac-rehabilitation programs, electrophysiology laboratories Survival (%) PAD programs 20 Home, after EMS response to 911 request Estimated Time from Collapse to Defibrillator Shock (minutes) Weaver WD et al. NEJM 2002; 347:1223
18 Factors affecting survival Time to CPR - Quality of CPR Time to defibrillation - Timing of defibrillation EMS response time - Especially if no bystander care Post-resuscitation care - Hypothermia
19 Some unfortunate facts Bystander CPR 31% Bystander AED 2%
20 Strategies to improve survival Prevention Pre-resuscitation (Preparedness) Resuscitation Post-resuscitation
21 SCA remains a leading cause of death SCA can strike anyone regardless of age, gender, race, fitness, and known health Ventricular fibrillation is still common Survival rates remain low and vary significantly based on locality
22 The faces of sudden death
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