The Institute of Medicine, a division of the National Academies of Sciences, recently conducted a meeting in Seattle to continue its preliminary work on the status of cardiac arrest outcomes in the U.S. and opportunities for improvement. (Click here for report.)
As part of that meeting, IOM cardiac arrest committee member Ben Bobrow, MD, of the Arizona Department of Health Services, moderated a panel on the public’s experience with cardiac arrest. Mary Newman, MS, of the Sudden Cardiac Arrest Foundation, was among the invited speakers. She was asked to discuss the Foundation’s education, advocacy, and community building initiatives, and the public’s perception of sudden cardiac arrest and its prevention and treatment.
After highlighting Sudden Cardiac Arrest Foundation initiatives, Newman presented a summary of several national public awareness surveys about sudden cardiac arrest, which are outlined below.
National Public Awareness Surveys
Catalyst Research & Communications Survey, 2000
This cross-sectional telephone survey of a stratified random sample of 1,000 adults found that:
- A majority of respondents have taken a CPR class, mostly due to work or school requirements
- Most say they are willing to give CPR to help both known victims and strangers
- Most say they are willing to use an AED to help both known victims and strangers.
The primary reasons for hesitating to help were:
- Fear of doing the wrong thing
- Fear of hurting the victim
- Belief that others might do better
- Lack of training
- Lack of confidence
- Expiration of certification cards
- Unfamiliarty with AEDs.
Notably, fear of disease transmission and legal liability risks were non-issues at that time.
Sudden Cardiac Arrest Coalition, 2007
This survey of 800 likely voters, commissioned by the SCA Coalition, found that:
- Most respondents think SCA is the same as a heart attack
- When asked what action they associate with SCA, the most common response was “I don’t know.”
Nevertheless, most respondents:
- Favor a campaign to raise awareness about SCA
- Favor widespread deployment of AEDs
- Would support federal funding for support SCA research and educational initiatives
- Are concerned that they or a family member could have a sudden cardiac arrest in the next five years.
American Heart Association/ Harris Interactive, 2008
This survey of 1,132 U.S. residents > 18-years-old found most people:
- Say they are confident that they know what actions to take in a medical emergency
- Say they are familiar with CPR
- Recognize an AED as something that administers an electrical shock to restore a normal heartbeat.
Heart Rhythm Society, 2012
This survey, conducted three years after the launch of public awareness campaign contrasting heart attack with cardiac arrest, found most people:
- Do not know the difference between heart attack and sudden cardiac arrest
- Underestimate the seriousness of cardiac arrest
- Think sudden cardiac arrest is a type of heart attack.
CardioReady/ Harris Interactive, 2013
This national omnibus survey of a representative sample of 2,000 individuals > 18-years-old, found:
- Most respondents believe other causes of death (motor vehicle accidents, stroke, breast cancer, firearms) claim more lives than sudden cardiac arrest
- Few people understand AEDs should be used within three minutes of collapse
- Nevertheless, most people expect AEDs to be readily available in airports, fitness clubs, stadiums, schools, shopping malls, factories and manufacturing facilities, hotels, office buildings, theaters and concert halls.
Nine Common Myths
Based this and other research, Newman stated there are nine common public perception myths:
- SCA is rare
- SCA is the same as a heart attack
- SCA only happens to the elderly
- SCA only happens to people with a history of heart problems
- SCA cannot be prevented
- Victims are better off waiting for professional help to arrive
- AEDs can hurt people by shocking them inappropriately
- Nothing could have been done (It was a "massive heart attack")
- Everyone survives (The Hollywood Myth).
She countered these myths by stating the following facts:
- SCA affects more than 1,000 people a day in the U.S.
- SCA is different from a heart attack
- SCA happens to people of all ages, even the young
- SCA is often the first sign of a heart condition
- Heart screenings can often detect people at risk
- AEDs will not shock anyone unless shocks are needed to restore a normal heart rhythm
- Immediate bystander intervention can mean the difference between life and death
- Bystanders can call 911, start CPR and use the nearest AED to help save lives
- About 10% of out-of-hospital cardiac arrest victims survive, but survival rates of 40% and higher have been achieved.
Key Barriers to Bystander Intervention
An extensive body of literature provides insight into barriers to bystander intervention in medical emergencies. Based on this research, the surveys described above, and other insights, Newman highlighted several key obstacles to bystander intervention in cases of sudden cardiac arrest, which are outlined below.
Why People Are Reluctant to Give CPR
- Fear of doing the wrong thing
- Lack of training
- Fear of forgetting training
- Belief that one must be currently certified in CPR to provide CPR
- Belief that someone else could do a better job
- Legal liability concerns
Why People Are Reluctant to Use AEDs
- Fear that the AED will shock someone who does not need to be shocked
- Inadequate deployment of AEDs
- Inability to find an AED when it is needed
- Belief that AEDs are meant to be used by professional responders only
- Antiquated, inaccurate labels stating the devices are intended "For use by trained rescuers only"
- Lack of training
- Legal liability concerns.
What Survivors Would Like Us to Know: Insights from a Growing Patient Population
Research presented by Kelly Sawyer, MD, a survivor and emergency physician at the William Beaumont School of Medicine, and colleagues, at a Sudden Cardiac Arrest Foundation session during the Emergency Cardiovascular Care Update in June suggest:
- Common experiences of survivors include memory loss, anxiety, depression, guilt, re-establishing a routine, getting back to school/ work, trouble sleeping, trouble visiting the place where SCA occurred, fear of an ICD shock, fear that an ICD will not shock, fear associated with not having an ICD
- The medical community needs to help survivors and their loved ones deal with the psycho-social aftermath of survival from SCA. Most survivors receive little or no mental health information or counseling during their hospital stay or upon discharge. Support groups and resources for survivors and caregivers are needed.
Any recommendations from the IOM Committee on Cardiac Arrest should take the perspectives of survivors into consideration.
In conclusion, Newman recommended the following measures:
- Make OHCA a reportable condition
- Make CPR-AED education a requirement for high school graduation in all states to help create a new generation of rescuers who are ready, willing and able to help in cases of sudden cardiac arrest
- Make dispatcher-CPR coaching universally available
- Take into consideration the wisdom, insights, and needs of sudden cardiac arrest survivors
- Advance public awareness campaigns that feature these key messages:
- SCA is the leading cause of death in the U.S.
- SCA is not the same as a heart attack
- Survival depends largely on immediate bystander action with CPR and AEDs
- CPR involves pressing hard and fast on the center of the chest
- AEDs are safe and effective for use by laypersons
- Good Samaritan laws protect people who try to help others
- The worst thing to do is to do nothing.
To see Newman's presentation, click here.