Incidence of and Survival from Sudden Cardiac Arrest Vincent N Mosesso, Jr, MD Professor of Emergency Medicine University of Pittsburgh School of Medicine
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
300,000 Americans suffer OOHCA yearly 600-1000 Americans will suffer OOHCA today High morbidity and mortality - ~50% never make it to the hospital
Incidence-the mystery AHA Heart and Stroke Facts 2009-236,000-325,000 MMWR - 460,000 Problem: - Not a reportable disease for CDC - Not categorized by national public health agencies
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 2004 155,000 (0.5/1000) - Treated by EMS, composite analysis - VF 60,000
Sudden cardiac death: a public health crisis 250000 200000 150000 100000 50000 0 Annual incidence House fire Prostate cancer Breast cancer Car accidents Sudden cardiac arrest
The faces of sudden death http://kenheart.org/html/memorials.html
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 0.5-1 / 1,000 Risk of SCD increases 10-50 x with exertion
Sudden deaths by sport Maron BJ, JAMA, 1996
Prediction & Prevention
Presenting rhythm EMS studies report decreasing incidence/frequency VF No. of Cases 400 350 300 250 200 150 100 50 0 1970 1972 1974 1976 1978 1980 1982 1984 1986 Year 1988 Cobb L, Fahrenbruch CE, Olsufka M, Copass M. Changing Incidence of Out-of-Hospital Ventricular Fibrillation, 1980-2000. JAMA 288(23):3008-3013, 2002. 1990 1992 1994 1996 1998 2000 Public access defibrillation trials show higher rate North American PAD Trial 60%
VF as initial arrest rhythm PAD-based studies: high and constant 100 80 60 40 VF 20 0 Casinos PAD Airlines Federal
Median survival = 8.4%
Langhelle - 4 cities in Norway
Survival for OOH-VF 100 Cardiac-rehabilitation programs, electrophysiology laboratories Survival (%) 80 60 40 PAD programs 20 Home, after EMS response to 911 request 0 1 2-7 8-15 Estimated Time from Collapse to Defibrillator Shock (minutes) Weaver WD et al. NEJM 2002; 347:1223
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
Some unfortunate facts Bystander CPR 31% Bystander AED 2%
Strategies to improve survival Prevention Pre-resuscitation (Preparedness) Resuscitation Post-resuscitation
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
The faces of sudden death http://kenheart.org/html/memorials.html