PITTSBURGH, PA--The American Heart Association (AHA) recently released its Heart Disease and Stroke Statistics—2014 Update, published in Circulation online in December and in print in January. The section on non-traumatic out-of-hospital cardiac arrest (OHCA), an abrupt and unexpected pulseless condition, is based largely on information derived from an ongoing registry from the Resuscitation Outcomes Consortium (ROC) multi-center clinical trial. According to the AHA, the incidence of OHCA in adults and youth is best characterized by ROC unpublished data from July 23, 2013.
The 2014 update suggests that more than 1,000 people suffer non-traumatic cardiac arrest outside hospitals—including about 26 children—each day in the U.S. Overall survival rates are approximately 10 percent. Among young victims, the survival rate is about five percent.
Highlights of the report follow.
Out-of-Hospital Cardiac Arrest: Adults
Incidence
- Each year, 424,000 people experience non-traumatic OHCA assessed by emergency medical services (EMS) personnel.
- Approximately 60 percent of OHCA victims are treated by EMS.
- Twenty-five percent of OHCA victims treated by EMS have no symptoms before the onset of arrest.
- Among EMS-treated OHCA cases, 23 percent have an initial rhythm of ventricular fibrillation (VF) or ventricular tachycardia (VT). As such, they could respond well to treatment with an automated external defibrillator (AED).
Risk Factors
- The age-adjusted incidence of OHCA is higher among blacks and Hispanics than among whites.
- Prior heart disease (heart attack or heart failure) is a major risk factor for cardiac arrest.
- A family history of cardiac arrest in a parent, sibling, or offspring is associated with a two-fold increase in risk of cardiac arrest.
Aftermath
- Survival to hospital discharge after EMS-treated non-traumatic cardiac arrest with any first recorded rhythm is 10.4 percent.
- Survival after bystander-witnessed VF is 31.7 percent.
- Among people who survive to hospital discharge, five-year survival is better among those who received angioplasty compared with their counterparts (78.7 vs. 54.4 percent) and among those who receive therapeutic hypothermia compared with their counterparts (77.5 vs. 60 percent).
- Survival rates are higher among those who receive chest compressions alone (10.2 percent) vs. chest compressions and rescue breathing (8.5 percent).
- Rates of survival to 30 days after hospital discharge are more than twice as poor for blacks as for whites. Survival among Hispanics are also lower than among whites.
Out-of-Hospital Cardiac Arrest: Youth
Incidence
- Each year, an estimated 9,500 children (<18 years old) experience EMS-assessed non-traumatic OHCA in the U.S., and of these, 7,700 children are treated by EMS.
- Among older athletes (17-24 years old), the incidence of non-traumatic OHCA tends to be higher among blacks compared with whites, and among males compared with females.
Aftermath
- Survival to hospital discharge after EMS-treated non-traumatic cardiac arrest among youth (<18 years old) is 5.4 percent. There are an estimated 7,000 fatalities in children each year.
- Of cardiovascular deaths that occurred in young athletes (<18 years old), 29 percent occurred in blacks, 54 percent in high school students, and 82 percent with physical exertion during competition or training.
Summary compiled by Mary M. Newman, MS, Sudden Cardiac Arrest Foundation
SOURCE: Go AS, Mozaffarian D, Roger VL, et al. Circulation. 2013;129:e28-e292.