U.S. Cardiac Arrest Survival Rates Around 6 Percent for Those Occurring Outside of a Hospital;

New IOM Report Recommends Strategies to Improve Survival Rates


WASHINGTON – Cardiac arrest strikes almost 600,000 people each year, killing the vast majority of those individuals, says a new report from the Institute of Medicine.  Every year in the U.S., approximately 395,000 cases of cardiac arrest occur outside of a hospital setting, in which less than 6 percent survive.  Approximately 200,000 cardiac arrests occur each year in hospitals, and 24 percent of those patients survive.  Estimates suggest that cardiac arrest is the third leading cause of death in the U.S. behind cancer and heart disease.


Following a cardiac arrest, each minute without treatment decreases the likelihood of surviving without disability, and survival rates depend greatly on where the cardiac arrest occurs, said the committee that carried out the study and wrote the report.  In addition, there are wide variations in survival rates among communities and hospitals across the U.S.  The committee recommended a series of strategies and actions to improve survival and quality of life following cardiac arrest.


“Cardiac arrest survival rates are unacceptably low,” said Robert Graham, chair of the study committee and director of the national program office for Aligning Forces for Quality at George Washington University, Washington, D.C.  “Although breakthroughs in understanding and treating cardiac arrest are promising, the ability to deliver timely interventions and high-quality care is inconsistent.  Cardiac arrest treatment is a community issue, requiring a wide range of people to be prepared to act, including bystanders, family members, first responders, emergency medical personnel, and health care providers.”


Although the terms are often used interchangeably, cardiac arrest is different and medically distinct from a heart attack.  A heart attack occurs when blood flow to an area of the heart is blocked by a narrowed or completely obstructed coronary artery, resulting in damage of heart muscle.  Heart attack symptoms may include pain, dizziness, and shortness of breath, among others.  Cardiac arrest results from a disturbance in the electrical activity of the heart that causes it to stop beating.  The electrical disturbance can occur suddenly due to a heart attack, severe imbalance of electrolytes, or an inherited genetic mutation that predisposes to electric abnormalities. Symptoms include an almost instantaneous loss of consciousness.  The treatment goal for a cardiac arrest is to facilitate the return of circulation and restore the electric rhythm, while for a heart attack, it is to reopen blocked arteries and restore blood flow.


Wide disparities in cardiac arrest outcomes have been documented -- many due to variations in patient demographics and health status, geographic chacteristics, and system-level factors affecting the quality and availability of care, such as rates of CPR knowledge among bystanders.  For example, the committee found that more than 8 out of 10 cardiac arrests occur in a home setting, and 46 percent of in-home cardiac arrests are witnessed by another person.  In addition, one study found that survival rates of cardiac arrests that occurred outside the hospital ranged from 7.7 percent to 39.9 percent across 10 North American sites.  Risk-adjusted survival rates for cardiac arrests that occur in the hospital also vary 10.3 percent between bottom- and top-decile hospitals.      


Effective treatment for cardiac arrest demands an immediate response from an individual to recognize cardiac arrest, call 911, start CPR, and use an automated external defibrillator (AED), the committee said.  Decreasing the time between cardiac arrest onset and the first chest compression is critical.  The likelihood of surviving decreases by 10 percent with every passing minute between collapse and return of spontaneous circulation, although new research offers hope in extending this time.


Although evidence indicates that bystander CPR and AED use can significantly improve survival and outcomes from cardiac arrest, each year less than 3 percent of the U.S. population receives CPR training, leaving many bystanders unprepared to respond to cardiac arrest.  Furthermore, EMS systems vary in capacities and resources to respond to complex medical needs, such as cardiac arrests.  National EMS-system oversight contributes to fragmentation and lack of coordination and planning in response to cardiac arrest, but some communities have demonstrated that focused leadership and accountability can overcome these barriers, the committee said.  Educating and training EMS providers to administer “high-performance CPR” -- which emphasizes team-related factors such as communication and collaboration to attain high-quality CPR -- and provide dispatcher-assisted CPR can help increase the likelihood of positive outcomes. 


To improve survival and quality of life following cardiac arrest, the committee recommended several actions:

·         Establish a national registry of cardiac arrest to monitor performance, identify problems, and track progress.

·         Educate and train the public on how to recognize cardiac arrest, contact emergency responders, administer CPR, and use AEDs, as well as facilitate state and local education departments to include CPR and AED training as middle- and high-school graduation requirements. 

·         Enhance performance of EMS systems with emphasis on dispatcher-assisted CPR and high-performance CPR.

·         Develop strategies to improve systems of care within hospital settings, including setting national accreditation standards related to cardiac arrest for hospitals and health care systems.

·         Adopt continuous quality improvement programs for cardiac arrest to promote accountability, encourage training and continued competency, and facilitate performance comparisons within hospitals and EMS and health care systems.

·         Expand research in cardiac arrest resuscitation and promote innovative technologies and treatments.

·         Create a national cardiac arrest collaborative to unify the field and identify common goals.


“There are complex challenges and barriers to successfully treat cardiac arrests, both in communities and hospitals,” said Victor Dzau, president of the Institute of Medicine.  “However, if existing and developing capabilities are leveraged, the system of cardiac arrest response can be strengthened throughout the U.S.” 


The study was sponsored by the American Heart Association; American Red Cross; American College of Cardiology; Centers for Disease Control and Prevention; National Institutes of Health, and the U.S. Department of Veterans Affairs.  Established in 1970 under the charter of the National Academy of Sciences, the Institute of Medicine provides independent, objective, evidence-based advice to policymakers, health professionals, the private sector, and the public.  The National Academy of Sciences, National Academy of Engineering, Institute of Medicine, and National Research Council make up the National Academies.  A committee roster follows.



Jennifer Walsh, Senior Media Relations Officer

Chelsea Dickson, Media Relations Associate

Office of News and Public Information

202-334-2138; e-mail

Twitter: @NAS_news and @NASciences

Pre-publication copies of Strategies to Improve Cardiac Arrest Survival: A Time to Act are available from the National Academies Press on the Internet at or by calling 202-334-3313 or 1-800-624-6242. Reporters may obtain a copy from the Office of News and Public Information (contacts listed above).

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Board on Health Sciences Policy


Committee on the Treatment of Cardiac Arrest: Current Status and Future Directions


Robert Graham, M.D. (chair)


Aligning Forces for Quality; and

Research Professor

Milken Institute School of Public Health

George Washington University

Washington, D.C.


Mickey Eisenberg, M.D., Ph.D., M.P.H. (vice chair)

Medical Program Director

King County Emergency Medical Services

University of Washington Medical Center



Dianne Atkins, M.D.

Professor of Pediatrics and Cardiology

Carver College of Medicine

University of Iowa

Iowa City


Tom P. Aufderheide, M.D., M.S., FACEP, FACC, FAHA

Professor and Associate Chair of Research Affairs

Department of Emergency Medicine

Medical College of Wisconsin



Lance B. Becker, M.D.

Professor of Emergency Medicine;

Division Chief, Emergency Critical Care; and

Director, Center for Resuscitation Science

University of Pennsylvania Health System



Bentley Bobrow, M.D., FACEP

Professor of Emergency Medicine

University of Arizona College of Medicine



Nisha Chandra-Strobos, M.D.

Chief of the Bayview Division of Cardiology; and

Professor of Medicine

Johns Hopkins Bayview Medical Center



Marina Del Rios, M.D.

Assistant Professor

Health Disparities Research

University of Illinois



Al Hallstrom, Ph.D.

Emeritus Professor

Department of Biostatistics

University of Washington



Daniel B. Kramer, M.D., M.P.H.

Assistant Professor of Medicine

Institute of Aging Research

Harvard Medical School



Roger J. Lewis, M.D., Ph.D.


Department of Emergency Medicine

Harbor-UCLA Medical Center; and


David Geffen School of Medicine

University of California

Los Angeles


David Markenson, M.D., MBA. FAAP, FCCM, FACEP

Chief Medical Officer

Sky Ridge Medical Center



Raina Merchant, M.D.

Assistant Professor of Emergency Medicine; and

Associate Faculty Program Director

Robert Wood Johnson Clinical Scholars Program

University of Pennsylvania



Robert Myerburg, M.D.

Professor of Medicine and Physiology

Division of Cardiology

Leonard Miller School of Medicine

University of Miami



Brahmajee K. Nallamothu, M.D.

Associate Professor

Division of Cardiovascular Diseases

Ann Arbor VA Medical Center

University of Michigan

Ann Arbor


Robin Newhouse, RN, Ph.D., RN, NEA-BC, FAAN

Chair and Professor of Organizational Systems and Adult Health

University of Maryland School of Nursing



Ralph L. Sacco, M.D., M.S., FAHA, FAAN

Olemberg Professor of Neurology, Public Health Sciences, Human Genetics, and Neurosurgery

Leonard Miller School of Medicine

University of Miami



Arthur B. Sanders, M.D.


Department of Emergency Medicine

University of Arizona College of Medicine



Clyde W. Yancy, M.D., M.Sc., FACC, FAHA, MACP

Magerstadt Professor of Medicine; and

Chief of Division of Cardiology

Feinberg School of Medicine

Northwestern University

Northwestern Memorial Hospital





Margaret McCoy, J.D., M.P.H.

Study Director