Bernd Böttiger | Board Director Science and Research, European Resuscitation Council (ERC)
Prof Böttiger* is Board Director Science and Research, European Resuscitation Council (ERC), co-author of the “Kids Save Lives” – Statement endorsed by the World Health Organisation (WHO). The statement highlights the importance of teaching CPR to all school children around the globe. The document reinforces the difference that early CPR can have on survival outcomes following sudden cardiac arrest (SCA), an issue that causes more than 2,000 deaths worldwide every day.
Earlier in the year, Bernd Böttiger, was the only-non American invited to speak at the US Institute of Medicine (IOM) Strategic Conference on Cardiac Arrest and CPR.
The Institute of Medicine (IOM) is part of the United States National Academies, and aims to provide unbiased, evidence-based, and authoritative information and advice concerning health and science policy to policy-makers, professionals, leaders in every sector of society, and the public at large. “The health arm of the National Academy of Sciences”. The New York Times calls the IOM the United States’ “most esteemed and authoritative adviser on issues of health and medicine, and its reports can transform medical thinking around the world. The IOM landmark report on patient safety, “To Err is Human” is mandatory reading for all of us.
The IOM released the report “Strategies to Improve Cardiac Arrest Survival: A Time to Act” on 30 June 2015. The report and strategic recommendations about cardiac arrest and CPR is available on www.iom.edu. Several important initiatives and ideas that are already implemented in parts of Europe have been adopted by the IOM, not least training of the lay public in elementary CPR.
The report outlines eight strategies for improving survival nationwide:
- Establishing a national and international cardiac arrest registry.
- Increasing public awareness and CPR training.
- Enhancing the capabilities and performance of emergency medical services systems.
- Setting national cardiac arrest accreditation standards for hospitals and healthcare systems.
- Adopting continuous quality improvement programmes. Research funding in resuscitation is far less than for other diseases that are just as common, such as cancer, cardiac diseases and strokes.
- Accelerating research on pathophysiology, new therapies and the translation of cardiac arrest science.
- Accelerating research on the evaluation and adoption of cardiac arrest therapies.
- Creating a national cardiac arrest collaborative.
Anaesthesiologists are the leading specialists in all of these fields confirming that our speciality is the very front of a socio-medical and society movement in patient care.
The report, which is featured in the leading American press and medical journals, states that “A national responsibility exists to significantly improve the likelihood of survival and favorable neurologic outcomes following a cardiac arrest”.
The third leading cause of death in industrialised nations
Sudden cardiac arrest without successful cardiopulmonary resuscitation (CPR) is the third leading cause of death in industrialised nations – and a very much underestimated health issue. Today, less than 10% of cardiac arrest patients survive in good conditions. Every year about 350,000 people die in Europe following sudden cardiac death with unsuccessful out-of-hospital CPR: 1,000 lives every day! Many of these lives could be saved if roadside CPR were carried out by bystanders. The response time by paramedics and physicians is 8-12 minutes and often longer however the brain already starts to die after 3-5 minutes without oxygen. 70% of all cardiac arrests are witnessed by lay bystanders who with the right training could take lifesaving action: cardiac compressions.Lay resuscitation rates throughout Europe differ greatly from less than 10% in some countries and to more than 80% in some parts of Norway.
We know from multiple activities in Denmark over a ten years period, that survival rates can be tripled by simply increasing lay resuscitation rates from 20 to more than 50%. Adult victims will already survive better if lay people perform thoracic compressions as there is still oxygen in the lungs and in the blood outside the brain. If Norwegian lay bystander CPR rates were replicated allover Europe, up to 100,000 lives would be saved a year. Four to five times more lives are lost every year due to out-of-hospital cardiac arrest than lives lost in road traffic accidents. Yet very little is invested into bystander CPR awareness campaigns and huge amounts of money is invested into road safety. Far smaller investment into public CPR awareness and education save many more lives.
“A Time to Act” – For Anaesthesiologists
Thanks to the billions invested in roads, education and vehicle safety, traffic accidents result in far fewer deaths today compared to decades ago. Similar investment and attention should now be turned to increasing survival and recovery without disability from cardiac arrest. Through the contribution of our specialty to leading studies and our participation in public awareness campaigns, anaesthesiologists across Europe and elsewhere are helping to improving rates of bystander CPR in their respective countries and improving the outcome of victims of cardiac arrest.
Actions that will have the biggest impact are: nationwide school children CPR training, telephone CPR, cardiac arrest registries and a change in legislation that not only requires the registration of deaths through traffic accidents but also mandatory registration of cardiac arrests and CPR.
Sudden cardiac arrest is one of the most important issues in healthcare. Preventing deaths by cardiac arrest and promoting CPR is a task every anaesthesiologist worldwide should be involved in! Resuscitation is and has always been an elementary area of anaesthesiology. Besides prevention, educating and training school children in lay CPR are the most effective actions to reduce preventable deaths – and anaesthesiologists are perfect educators. The message for the public is clear: successful CPR is perfectly easy; you can just do it, just pump! Laypeople can’t do anything wrong – the only mistake would be to do nothing. Without intervention before the arrival of the EMS, more than 90% of victims die.
Together and with many other specialists, medical societies, healthcare providers, teachers and politicians, we can easily save 100,000 additional lives every year in Europe, 274 lives every day, and one life every 5 minutes.
“It takes a society to save lives” – cardiac arrest is a community issue – anaesthesiologists can and should take the lead.
* Board Director Science and Research, European Resuscitation Council (ERC) Chairman, German Resuscitation Council (GRC) Member of the Board of the German Society of Anaesthesiology and Intensive Care Medicine (DGAI) Professor and Head of the Department of Anaesthesiology and Intensive Care Medicine University Hospital of Cologne