The World Restart a Heart (WRAH) initiative starts on October 16, 2018

The World Restart a Heart (WRAH) initiative starts on October 16, 2018

  • Issue 75

B.W. Böttiger, Cologne, Germany

“All citizens of the world can save a life”. With these words, the International Liaison Committee on Resuscitation (ILCOR) – and with the support from the European Society of Anaesthesiology (ESA) and many other organizations in Europe and worldwide – is launching the first global initiative – World Restart a Heart (WRAH) – to increase public awareness and therefore the rates of bystander cardiopulmonary resuscitation (CPR) for victims of cardiac arrest ( ILCOR has just published an article on its “World Restart a Heart (WRAH)” initiative.1

Anaesthesiologists – together with many other specialists, societies, healthcare providers, teachers, and politicians – can save 100,000 additional lives every year in Europe, and more than 300,000 lives worldwide. This can be reached by increasing lay bystander cardiopulmonary resuscitation (CPR) rates.

Cardiac arrest is a community issue, and CPR is a key competence of and a central topic for anaesthesiologists. Therefore, anaesthesiologists can be very active and increase visibility for our specialty in the public with school children and lay people education in CPR. An excellent possibility is to participate in the “World Restart a Heart Day” – October 16, the “World Anaesthesia Day”. This year, the motto of the first WRAH is “All citizens in the world can save a life”.

Sudden out-of-hospital cardiac arrest (OHCA) with unsuccessful cardiopulmonary resuscitation (CPR) is the third leading cause of death in industrialised nations.2After OHCA, the overall survival rates are 2–10%.2–5In Europe and in the US together, 700,000 people die of OHCA every year. The same applies to all other industrialised regions of the world. Many of these lives could be saved if more lay people provided immediate CPR.2

In most of the cases, it takes too long for the emergency services to arrive on the scene after the victim’s collapse. Thus, the most effective way to increase survival and favourable outcome in cardiac arrest by two- to four-fold is early CPR by lay bystanders and by “first responders”.1,3,4Lay bystander resuscitation rates, however, differ significantly across the world, ranging from 5% to 80%. If all countries could have high lay bystander resuscitation rates, this would help to save hundreds of thousands of lives every year.1,3In order to achieve this goal, all seven ILCOR councils (American Heart Association, European Resuscitation Council, Heart and Stroke Foundation of Canada, Australian and New Zealand Committee on Resuscitation, Resuscitation Council of Southern Africa, InterAmerican Heart Foundation, and Resuscitation Council of Asia) have agreed to participate in WRAH 2018. Following our first attempt in 2012 in Europe, where we were able to get signatures from 400 Members of the European Parliament for a “European Restart a Heart“ day, we are now going worldwide. Besides education of schoolchildren in CPR (“KIDS SAVE LIVES”),6many other initiatives have already been developed in different parts of the world. We are keen for the WRAH initiative to be as inclusive as possible, and that it should happen every year on 16 October – the World Anaesthesia Day – or as close to that day as possible.1Besides recommending CPR training for children and adults, it is hoped that a unified global message will enable our policy makers to take action to address the inequalities in patient survival around the world.

This topic is unique and positive in all aspects. All information about WRAH (e.g., activities, partners, etc.) are presented on the ILCOR webpage For further information, the full actual WRAH article can be found at: Please feel free to distribute this LINK and article further.

With the WRAH initiative (Figure 1), anaesthesiologists in Europe and beyond will help to improve the survival rate of people with OHCA by a factor of two- to four-fold. With this easy and common approach, we can save 300,000 additional lives worldwide every year, nearly a thousand every day, and nearly one life every minute – and we can and will positively increase visibility for our specialty in the public.

Figure 1: The logo of the World Restart a Heart (WRAH) initiative can and should be used for free by all participating in the WRAH campaign in Europe and by all associated activities around the world.

Already existing information, videos, presentations, curricula, and concepts on lay resuscitation initiatives and school children education in resuscitation can be found at the following web pages, and they all can be used for initiatives and campaigns by anaesthesiologists:–M



  1. Böttiger BW, Lockey A, Aickin R, et al. Resuscitation2018;128:188-90.
  2. Writing Group Members, Mozaffarian D, Benjamin EJ, Go AS, et al. Circulation2016;133:447-54.
  3. Kragholm K, Wissenberg M, Mortensen RN, et al. N Engl J Med2017;376:1737-47.
  4. Ong MEH, Perkins GD, Cariou A. Lancet2018;391:980-8.
  5. Myat A, Song KJ, Rea T. Lancet2018;391:970-9.
  6. Böttiger BW, Bossaert LL, Castrén M, et al. Resuscitation 2016;105;A1–3.

Co-authors:A. Lockey, Halifax, UK; R. Aickin, Auckland, New Zealand;M. Castren, Helsinki, Finland; A. de Caen, Edmonton, Canada;R. Escalante, Lima, Peru; K.B. Kern, Tucson, Arizona, USA;S.H. Lim, Singapore;V. Nadkarni, Philadelphia, Pennsylvania, USA; R.W. Neumar, Ann Arbor, Michigan, USA; J.P. Nolan, Bath, UK;D. Stanton, Netcare, South Africa; T.-L. Wang, Taiwan;G.D. Perkins, Coventry, UK.