UAB researchers aim to improve cardiac-arrest-survival rates

The survival rate for people who suffer out-of-hospital cardiac arrest in the United States is dismal — around 5 percent — say researchers at the University of Alabama at Birmingham. But in the greater Birmingham area, the survival rate has doubled since UAB researchers joined the Resuscitation Outcomes Consortium, a federally funded research effort in 10 U.S. and Canadian cities aimed in part at improving cardiac-arrest-survival rates.

There are 300,000 cardiac arrests in the United States each year. In 2006, when UAB joined the ROC study, only five of 269 patients with cardiac arrest treated in the greater Birmingham area survived — some 3 percent. In 2010, 6 percent, or 28 of 430 treated survived.

"I think we can reach much higher," said Henry Wang, M.D., an associate professor in the Department of Emergency Medicine at UAB and co-principal investigator of the ROC trial. "In the ROC consortium, the average is about 8 percent. The top of the class, Seattle and Pittsburgh, are at 16 percent. They have worked tirelessly for 20 years to come up with the perfect fusion between EMS care, bystander care and excellent hospital care."

Wang says it begins with bystanders quickly calling 9-1-1 and providing good quality CPR.

"One of our missing ingredients in Birmingham is our low rate of bystander CPR," Wang said. "We know from our ROC studies that only 15 percent of our cases of cardiac arrest receive bystander CPR. In Seattle and other communities, it's more than 50 percent."

Doug Markham owes his life to bystander CPR. Three bystanders, in fact. The Books-a-Million executive went into cardiac arrest during a business meeting one afternoon in June 2011. As the cry of "Does anyone know CPR" flew around the office, three co-workers stepped up. For 13 minutes, the three took turns keeping Doug's heart going until EMS crews arrived. One of the three, Spencer Simpson, had only learned CPR a few months earlier, as he prepared for the birth of his first child.

"We learned infant CPR, but they also taught us adult CPR," said Simpson. "I thought my baby was a good reason to learn CPR, but I never dreamed I'd have another great reason, a really important reason in Doug, to learn it."

There was another person in the office who knew CPR — Markham himself. The military reservist and Boy Scout leader has been CPR-trained for more than 40 years.

"I've known it since I was a boy and never had the opportunity to use it. And here one of the people working on me had just learned it for the first time only a few months before. If it wasn't for those fellow associates who knew CPR, I wouldn't be sitting here today."

The second arm in improving cardiac arrest survival is the EMS response. Wang says there are nine EMS agencies in the greater Birmingham area participating in the ROC.

"Any time you introduce major research into a community, medical care naturally improves," he said. "You begin to measure your parameters, you begin to understand how care is delivered and that provides information upon which you can act to improve care."

The ROC EMS crews are equipped with new cardiac monitors that measure CPR performance, and let the provider know if they are doing too few or too many chest compressions or taking too many breaks. The next step will be to turn a smart phone into a cardiac monitor. Wang says the technology exists — with real-time feedback on CPR quality.

"It wouldn't surprise me if in the next five to 10 years, smart phones will have this capability to provide state-of-the-art lifesaving information."

The paramedics who responded to Doug Markham's cardiac arrest are ROC participants. Wes Ward and Kevin Pilgreen, of Rescue 15, Birmingham Fire and Rescue, spent another 16 minutes on CPR and advanced life-support on Markham upon their arrival, and they shocked his heart five times before he was stable enough for transport to UAB.

The hospital is the final piece of the puzzle. Once the heart is restarted, proper post-arrest care is essential. Wang says new therapies such as therapeutic hypothermia are helping to minimize damage done to the brain during a cardiac-arrest episode. While the reasons are unclear, medicine has long known that the rapid return of blood to the brain following successful resuscitation carries with it the potential for additional damage to brain cells. Chilling the body to 32 degrees Celsius (89.6 Fahrenheit) for a period of 24 hours has a neuro-protective effect.

Markham spent 10 days in the hospital. He was back at work in three weeks, although he admits that not quite a year later he's still not back to full strength. But he knows he's one of the lucky few.

"Things that were important in my life aren't so important anymore," he says. "Personal achievement doesn't mean much to me at all anymore. Family, friends, co-workers — they all mean a lot more to me now than they did before."

"Our work in Birmingham is not done," said Wang. "We aspire to reach 16 percent, and I think 20 percent is possible. I have absolute confidence that one day Birmingham will be known for being at the top of the cardiac arrest survival chain in the entire United States."