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Heart attack

Report: Cardiac arrest kills many, often ignored

Karen Weintraub, Special to USA TODAY

Cardiac arrest is America's third-largest killer, but is too often ignored, an expert panel concluded Tuesday.

Timothy Williams leads a heart surgery team at Bon Secours Health System St. Francis Downtown Hospital in Greenville, S.C.

A new report from the Institute of Medicine found that too few people know the signs of cardiac arrest or what to do about it, and that too little is known about the condition, which kills more than 500,000 Americans a year.

Most people are more familiar with a heat attack, in which the heart muscle is deprived of blood, causing chest pain and shortness of breath. A heart attack patient usually can describe his or her agony and is brought to a hospital for immediate treatment.

With cardiac arrest, by contrast, the heart's rhythm gets dangerously out of whack, interrupting blood flow to the brain. The person usually collapses and is unable to speak. They need CPR before they reach the hospital to have any chance of survival or recovery, said Robert Graham, chairman of the 18-person Institute of Medicine Panel, which produced the report Strategies to Improve Cardiac Arrest Survival: A Time to Act.

"You have less than 10 minutes before changes in the brain become almost irreversible," he said.

Less than 10% of those who suffer cardiac arrest in the community survive to leave the hospital, previous research has shown, though success rates in a few places, including Seattle, are as high as 64%.

The difference there, Graham said, is a well-trained public and emergency system that responds rapidly with three crucial steps: calling 911; starting chest compressions to deliver blood to the person's brain; and obtaining a nearby automated external defibrillator (AED) and beginning defibrillation while waiting for an ambulance.

A campaign by the American Heart Association has led 24 states to require that high school students train in such CPR treatments, with one more, New York, possibly joining that list later this summer.

Research into the basic biology of cardiac arrest is also essential, the panel said, as is a deeper understanding of the risk factors that might predict who is going to develop the condition.

A simple stress test indicates whether someone is at high risk for a heart attack, but there is no comparable test to suggest when someone is in danger of cardiac arrest, Graham said.

More work is also needed to distinguish between people who are likely to die regardless of medical treatment, and those who could go on to have a high quality of life if they survive cardiac arrest, said Bruce Lindsay, section head for cardiac electrophysiology at the Cleveland Clinic.

Overall, Lindsay said he thinks the new report does a good job of calling attention to a crucial and under-appreciated health issue.

"There's room for improvement in how we deliver care all the way from the public through the medical system," he said.

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