Skip main navigation

Abstract

Every 10 years, the American Heart Association (AHA) Emergency Cardiovascular Care Committee establishes goals to improve survival from cardiac arrest. These goals align with broader AHA Impact Goals and support the AHA’s advocacy efforts and strategic investments in research, education, clinical care, and quality improvement programs. This scientific statement focuses on 2030 AHA emergency cardiovascular care priorities, with a specific focus on bystander cardiopulmonary resuscitation, early defibrillation, and neurologically intact survival. This scientific statement also includes aspirational goals, such as establishing cardiac arrest as a reportable disease and mandating reporting of standardized outcomes from different sources; advancing recognition of and knowledge about cardiac arrest; improving dispatch system response, availability, and access to resuscitation training in multiple settings and at multiple time points; improving availability, access, and affordability of defibrillators; providing a focus on early defibrillation, in-hospital programs, and establishing champions for debriefing and review of cardiac arrest events; and expanding measures to track outcomes beyond survival. The ability to track and report data from these broader aspirational targets will potentially require expansion of existing data sets, development of new data sets, and enhanced integration of technology to collect process and outcome data, as well as partnerships of the AHA with national, state, and local organizations. The COVID-19 (coronavirus disease 2019) pandemic, disparities in COVID-19 outcomes for historically excluded racial and ethnic groups, and the longstanding disparities in cardiac arrest treatment and outcomes for Black and Hispanic or Latino populations also contributed to an explicit focus and target on equity for the AHA Emergency Cardiovascular Care 2030 Impact Goals.

In 2010, the American Heart Association (AHA) Emergency Cardiovascular Care (ECC) Committee identified specific goals focused on increasing survival from cardiac arrest. Targets for 2020 included training 20 million people per year, doubling bystander response, and doubling out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest (IHCA) survival. Whereas substantial improvements have been achieved over the past decade toward these goals,1 cardiac arrest remains a major public health problem and the leading cause of death and morbidity in the United States.2

The 2010 goals provided a road map for key strategic areas of focus for improving cardiac arrest outcomes.3 Furthermore, these priorities are used by the ECC Committee for strategic planning and for ECC organizational aims to make meaningful advancements in creating an ecosystem of training, response, action, and follow-through for the public and for health care professionals.

This scientific statement identifies key strategic targets for improving cardiac arrest outcomes by 2030. These priorities were developed through an iterative process led by the AHA ECC Committee. The ECC Committee has >300 volunteers and consists of 3 subcommittees (Science, Education, and Systems of Care), in addition to the Pediatrics Emphasis Group. Members of these committees are leading resuscitation experts representing several disciplines (eg, emergency medicine, medicine, critical care, neurology, pediatrics, surgery, behavioral science) and professional backgrounds (eg, physicians, nurses, paramedics, respiratory technicians, educators), as well as cardiac arrest survivors. Each committee identified target areas in a 2-day, face-to-face meeting with cross-committee discussions. A refined list of target areas and metrics was then reviewed in-depth within committees and presented to the ECC Committee. The list was further refined over a series of meetings across all subcommittees and the Pediatrics Emphasis Group. Table 1 shows targets across adult and pediatric groups with an approximate 10% to 20% proposed increase in survival goals. Each section also includes action strategies that can be advanced by national, state, and local organizations and through partnerships with the AHA and other stakeholders (Figure 1).

Table 1. American Heart Association Emergency Cardiovascular Care Committee 2030 Impact Goals

AreaGoalEquity
BCPR (adult >18 y)Increase the rate of BCPR to >50% (2020 CARES: 40.2%)*The targeted goal rate in underrepresented groups (by sex, gender, race, or ethnicity, as well as other historically underrepresented groups), and in communities with low socioeconomic status, should at least be equal to that of the general population. The targeted population includes residential and public settings and excludes nursing homes.
AED application (adult >18 y)Increase the proportion of individuals with OHCA in a public setting who have an AED applied before the arrival of EMS to >20% (2020 CARES: 9%)The targeted goal rate in underrepresented groups (by sex, gender, race, or ethnicity, as well as other historically underrepresented groups), and in communities with low socioeconomic status, should at least be equal to that of the general population.
Survival after OHCA (adult and pediatric)Increase survival to hospital discharge with good neurologic outcome (CPC 1 or 2) after OHCA, as follows:
Adult (>18 y): to >8% at home or residence (2020 CARES: 6.1%); to >19% in public settings (2020 CARES: 15.7%)
Pediatric (<1 y): to >6% after an initial arrest at home or residence (2020 CARES: 5.3%)
Pediatric (1–12 y): to >12% in public setting (2020 CARES: 10.9%); to >11.5% after an initial arrest at home or residence (2020 CARES: 10.5%); to >21% in public setting (2020 CARES: 19.2%)
Pediatric (13–18 y): to >17.5% after an initial arrest at home or residence (2020 CARES: 16%); to >33% in public setting (2020 CARES: 30%)
The targeted goal rate in underrepresented groups (by sex, gender, race, or ethnicity, as well as other historically underrepresented groups), and in communities with low socioeconomic status, should at least be equal to that of the general population.
Survival after IHCAIncrease survival to hospital discharge with good neurologic outcome (CPC 1 or 2) after IHCA, as follows:
Adult: to >24% (2020 GWTG-R: 16%)
Pediatric: to >45% (2015–2019 GWTG-R: 34%–42%)
The targeted goal rate in underrepresented groups (by sex, gender, race, or ethnicity, as well as other historically underrepresented groups), and in communities with low socioeconomic status, should at least be equal to that of the general population.

AED indicates automated external defibrillator; BCPR, bystander cardiopulmonary resuscitation; CARES, Cardiac Arrest Registry to Enhance Survival; CPC, Cerebral Performance Category; EMS, emergency medical services; GWTG-R, Get With the Guidelines–Resuscitation; IHCA, in-hospital cardiac arrest; and OHCA, out-of-hospital cardiac arrest.

* Excludes nursing home events.

Figure 1.

Figure 1. Key stakeholders for advancing American Heart Association efforts to improve cardiac arrest outcomes by 2030. EMS indicates emergency medical services.

The target areas and metrics listed in Table 1 were developed on the basis of data that are accessible in currently available, robustly managed, longitudinal national databases that report information specifically about OHCA and IHCA. Our committee recognized that advancing process and outcome measures in cardiac arrest will require expansion of these databases or development of new data repositories to include additional information about the multitude of factors that affect cardiac arrest incidence, treatment, and outcomes. In addition to a consistent funding source and governing organization, robust tracking of these measures would require that the data are consistently available, accessible, of high integrity, valid, able to be risk-stratified, and measurable across populations. Table 2 includes aspirational goals for cardiac arrest process and outcome measures that would ideally be available in national databases before or by 2030 to provide greater granularity in tracking and improving the range of factors that affect cardiac arrest. This broader list of targets and populations would enable better benchmarking and broader understanding of where resources should be allocated for improving cardiac arrest outcomes. The AHA is well-positioned to support coordinating existing and future resources and partners to enable data collection and reporting of the areas of focus in the aspirational goals, with a goal of this information being available by 2030.

Table 2. Areas of Focus, Action Strategies, and Aspirational Targets: A Vision for an Optimized Resuscitation Ecosystem in 2030

Areas of focus for aspirational goalsAction strategiesAspirational targets
Equity, disparities, and racism
 Establishment of cardiac arrest as a reportable disease that must include information about age, sex, gender, race, ethnicity, and socioeconomic dataDevelop uniformity of the definition of cardiac arrest; connections between EHR and data from sources such as surveillance systems, public health databases, and EMS; and a robust infrastructure for collecting, validating, and reporting data at local, state, and national levels.All cardiac arrests are reliably reported in a publicly available national database, with accurate information about age, sex, gender, race, ethnicity, and socioeconomic data.
 Screening and preventionProvide resources to support universal screening for and prevention of cardiovascular disease for individuals and communities.Access to screening and preventive resources is available throughout the life cycle for all individuals and communities.
 Resuscitation training materialsDevelop, test, and implement strategies to overcome bias and structural and systemic racism in BLS, ACLS, PBLS, and PALS training materials.Resuscitation training materials are equitable and free of bias and racism.
 Disparities in cardiac arrest care and outcomesSupport research and advocacy to understand needs of high-risk communities and strategies to reduce disparities in care and outcomes.
Implement focused efforts and reporting of outcomes to reduce inequities in prehospital and hospital interventions.
Ensure equitable access to resources for care after cardiac arrest and recovery for patients and their families and caregivers.
Build and support partnerships between AHA and other resuscitation-focused organizations and community and stakeholder organizations to address and eliminate disparities.
Deploy and incentivize interventions and implementation programs with demonstrated success at eliminating disparities in cardiac arrest care and outcomes.
Disparities in cardiac arrest care and outcomes are identified and eliminated.
 Citizen preparedness and access to resources for effective response to cardiac arrestPrioritize citizen preparedness, training, and AED access in all communities, with a particular focus on high-risk communities.
Encourage donors and philanthropic organizations to support resuscitation resources (ie, CPR & First Aid Anywhere Training Kit, Adult & Child CPR Anytime Kit, and Infant CPR Anytime Kit purchases; sponsored community CPR events; CPR trainings; AED placement) in all communities, with a particular focus on high-risk communities.
Every community has optimized citizen preparedness and access to resources for effective response to cardiac arrest.
 Partnerships, advocacy, and engagementOrganize focused efforts by the AHA to identify community and academic partners to engage in ongoing activities to discuss, design, and implement community-based activities to improve cardiac arrest survival rates.
Hold AHA-initiated meetings for public and private entities to come together to discuss how to address health inequities in cardiac arrest survival and how to increase survival rates collaboratively in an equitable, just, and timely manner.
Schedule annual assemblies of the AHA and other resuscitation-focused organizations specifically to address strategies to reduce disparities and improve survival rates.
CPR and AEDs
 Recognition and responseEstablish infrastructure to support approaches such as campaigns to increase awareness, universal access to training and evaluation of competency, readily available just-in-time training, and universally accessible devices and technology to help with identifying arrest and providing chest compressions and defibrillation.
Provide novel training, approaches, and increased resources to support response and willingness to address cardiac arrest in any location (ie, hospital, public setting, home).
Support development and testing of technologies to identify first responders for OHCA (eg, PulsePoint).
Secure increased access to AEDs for early defibrillation.
Ensure that every person knows how to recognize cardiac arrest and to respond (eg, call 9-1-1, begin CPR, apply AED) within 1 min.
Ensure that 100% of individuals in cardiac arrest receive high-quality CPR within 1 min and AED application within 2 min.
 Early detection of unwitnessed and unmonitored cardiac arrestSupport development and testing of technologies (eg, wearables) to improve early detection of unmonitored or unwitnessed SCA.Realize 50% reduction of unwitnessed and unmonitored cardiac arrests.
 CPR qualityImprove quality of CPR delivered (eg, using feedback devices).Ensure that all CPR delivered is of high quality.
 Telecommunicator CPRSecure universal deployment of telecommunicator CPR for all dispatch systems and data about quality and outcomes.Confirm that 100% of EMS systems have telecommunicator CPR and that it is provided by dispatch in 100% of relevant cases within 1 min.
 CPR and AED trainingOrganize broad deployment of CPR and AED training at multiple time points and settings (eg, elementary school, high school graduation, DMV encounters, job training, community centers, recreation centers, gyms, religious organizations, supermarkets) and in multimodal delivery systems (eg, in-person, Internet, smartphone applications, text, telephone) to increase population-wide awareness, competence, and willingness to perform.
Supply resources (eg, local, state, federal) for population-wide exposure to training, mandates for training at different life intervals, and likely novel personalized delivery modes and training approaches that are easily accessible, just-in-time available, and affordable.
Ensure that every person (>9 y of age) has received CPR and AED training at different life intervals, through a multitude of venues, and in an accessible, affordable format.
Establish CPR training as a requirement for high school graduation.
Reach 100% of states requiring CPR training in schools (CPR training in school is required in 38 states as of February 2023).
 AED accessAdapt AED design to include features such as location (eg, geomapping capabilities); portability; and integration with existing devices (eg, phones), emergency dispatch systems, and cardiac arrest databases, at a substantially lower price.Ensure that adapted AEDs are accessible within 1 min in every community.
 AED registriesDevelop robust, sustainable, and functional AED registries to facilitate measurement and optimization of AED placement, access during an emergency, and centralized coordination of deployment.Establish that every AED and use of the AED is trackable in an accessible registry.
 Research and policy to accelerate CPR delivery and AED useSupport research into novel approaches for increasing CPR delivery.
Support development and implementation of research into novel approaches for improved access to early defibrillation for those who experience OHCA in residential settings (eg, community responder models, personal-access defibrillators, unmanned aerial vehicles).
Develop forums (eg, summits, task forces, hackathons) to enhance collaboration between health care stakeholders and industry in the development of novel technologies, solutions, and strategies to address known barriers to early defibrillation.
Realize a 10% increase in resuscitation research and tracking of how this research affects CPR delivery and AED use.
In-hospital cardiac arrest
 Early recognition and effective response to patients with acute physiologic declineProvide improved monitoring for all hospitalized patients.
Confirm that systems are in place to triage high-risk patients to hospital wards with monitoring (eg, telemetry, ICU).
Triage 100% of patients to the correct inpatient location with appropriate monitoring.
Provide a timely response (within 2 min) to all patients with acute physiologic decline to reduce likelihood of IHCA.
 Response to IHCAConfirm availability of monitoring and a team to respond promptly to all cardiac arrest events.
Create and validate a post–cardiac arrest checklist for adult and pediatric patients.
Ensure that every eligible patient receives evidence-based high-quality care after cardiac arrest.
Provide high-quality CPR within 1 min and defibrillator application within 2 min in 100% of IHCA cases regardless of time of day, day of week, or hospital area.
 Review of IHCA for quality improvementEstablish infrastructure to review every cardiac arrest case (eg, just-in-time) through debriefing sessions (eg, integration of device data, chart review, and audiovisual recordings of the event) and provide frequent committee review and feedback.
Ensure that every hospital has at least 1 dynamic resuscitation champion and a leadership culture that prioritizes IHCA as a reflection of care excellence.
Ensure that every cardiac arrest case is evaluated routinely and team members receive feedback, and the effects of the review and feedback process are tracked over time.
Survival improvement
 Expansion of outcome measures beyond survivalExpand upon care after cardiac arrest to include measures assessing quality of life and functional outcomes after hospital discharge.
Initiate standardized reporting of survival outcomes for registries and in clinical trials (eg, COSCA, P-COSCA), in scientific journals (eg, annual AHA Statistical Update, all publications reporting on arrest outcomes), and in the lay press.
Expand cardiac arrest outcomes measures beyond CPC and neurologic outcomes and track, collect, and report (eg, in registries, scientific publications) outcomes measures for every cardiac arrest survivor.
 SurvivorshipHave survivor communities and support groups for patients, families, caregivers, and responders available and accessible.
Provide information about possible physical and emotional effects after cardiac arrest and survivorship, along with available resources, to all survivors of cardiac arrest, families, and caregivers after hospital discharge.
Provide care after cardiac arrest to survivors and their support systems to support their physical and psychologic needs.
Measurement and tracking
 Centers of excellenceExpand existing criteria and measurement for cardiac arrest centers of excellence.
Create a recognition or designation program to highlight centers of excellence and encourage regionalization of care.
Ensure that centers of excellence are accessible in every geographic region.
 Cardiac arrest process and outcome measures for prehospital systems (eg, EMS), in-hospital systems, and posthospital systems (eg, rehabilitation)Develop prehospital, in-hospital, and posthospital standardized process and outcome measures that can be collected in existing or new registries for tracking, reporting, and response.
Regularly report demographic data on disparities in incidence, treatment, and outcomes in SCA in all communities and high-risk communities in scientific publications (eg, annual AHA Statistical Update) and the lay press.
Ensure that data regarding cardiac arrest process and outcome measures are standardized; available for every arrest; and able to be collected, reported, and responded to.
 Resuscitation databasesIncrease funding, incentives, and mandates from federal and state partners for comprehensive national, state, and local data collection and reporting as well as quality improvement activities.
Increase EMS and hospital membership in registries (eg, GWTG-R, CARES) to optimize geographic and demographic reach.
Expand existing registries or create new ones to expand reach and capture additional data (eg, OHCA post-ROSC variables, such as WLST and ICD implantation, long-term survivorship, functional measures, quality-of-life data, and outcomes after hospital discharge).
Support reporting of outcomes in clinical trials in alignment with resuscitation initiatives (eg, COSCA, P-COSCA).
Have the AHA convene relevant stakeholders to evaluate resource and infrastructure needs to expand existing registries or create new ones to expand uptake and data fields.
Require all EMS agencies to submit OHCA data to a national registry and receive feedback.
Stipulate for all hospitals to submit resuscitation data to a national registry and receive feedback.
 Acceleration of resuscitation researchIncrease resuscitation science grant funding with a focus on translational and implementation science to identify and disseminate best practices from high-performing EMS agencies and hospitals.
Support development and implementation of research into novel approaches for improved access to early defibrillation for individuals who experience OHCA in residential settings (eg, community responder models, personal-access defibrillators, unmanned aerial vehicles).
Increase resuscitation science grant funding by 10% (eg, AHA, NIH, foundations).

ACLS indicates advanced cardiovascular life support; AED, automated external defibrillator; AHA, American Heart Association; BLS, basic life support; CARES, Cardiac Arrest Registry to Enhance Survival; COSCA, Core Outcome Set After Cardiac Arrest; CPR, cardiopulmonary resuscitation; DMV, Department of Motor Vehicles; EMS, emergency medical services; GWTG-R, Get With the Guidelines–Resuscitation; ICD, implantable cardioverter defibrillator; ICU, intensive care unit; IHCA, in-hospital cardiac arrest; NIH, National Institutes of Health; OHCA, out-of-hospital cardiac arrest; PALS, pediatric advanced life support; PBLS, pediatric basic life support; P-COSCA, Pediatric Core Outcome Set After Cardiac Arrest; ROSC, return of spontaneous circulation; SCA, sudden cardiac arrest; and WLST, withdrawal of life-sustaining therapy.

ALIGNING WITH THE AHA 2024 GOAL

An explicit focus of the AHA ECC 2030 priorities is alignment with the AHA 2024 Impact Goal.4 This specific goal is as follows: “Every person deserves the opportunity for a full, healthy life. As champions for health equity, by 2024, the AHA will advance cardiovascular health for all, including identifying and removing barriers to health care access and quality.”4

The AHA ECC 2030 Impact Goals (Table 1) directly align with this organizational goal, with a focus on health equity and ensuring that cardiac arrest survival and access to care is equitable for all.

2020: COVID-19 AND EQUITY

The confluence of 2 events in 2020 shaped the time horizon and overarching focus of the 2030 priorities. First, the global COVID-19 (coronavirus disease 2019) pandemic has been a major driver of morbidity and mortality across health conditions, and its effects on cardiac arrest outcomes have been substantial and devastating.5–7 The practice of resuscitation has been severely affected (eg, delays and limitations in resuscitation attempts and variability in the implementation of postresuscitation care).8 Resuscitation guidelines have been continually updated to be responsive to these shifts.8,9

Health care professionals had to consider their own risk of contracting COVID-19 in performing all resuscitations and invasive procedures.10–12 Health care systems had to balance caring for critically ill patients with and without COVID-19, ensuring that health care staff had adequate personal protective equipment and in parallel avoiding COVID-19 transmission to patients with medical emergencies not related to COVID-19 or in need of routine medical care. The COVID-19 pandemic fractured health care systems’ capacity to care for patients with conditions not related to COVID-19, with substantial consequences. Early identification of cardiovascular emergencies was challenged when outpatient medical care was moved from in-person clinic settings to telehealth and nonurgent clinic appointments were rescheduled or cancelled. As shelter-in-place orders were adopted by municipalities experiencing COVID-19 surges, emergency medical services (EMS) systems identified a decrease in calls for cardiovascular emergencies and an increase in patients’ refusal of transport.13,14 These factors are important contributors to the excess number of cases of OHCA.15,16 Whereas COVID-19 has had global repercussions, there are substantial disparities in how hospitals were affected by the COVID-19 pandemic because of the tiered nature of the US health care system, a structure that affects the quality of care received by patients from historically underrepresented racial and ethnic groups.16–21 The long-term effect that COVID-19 and its sequelae will have on cardiac arrest outcomes and resuscitation remains unknown, but the contribution of hospital-level differences in care and outcomes will need to be further examined. These priorities for the next decade are therefore identified to account for the substantial uncertainty in resuscitation practices and outcomes.

The AHA ECC 2030 priorities were also shaped by a nationwide awakening to the systemic racism present in the United States, highlighted by the murder of George Floyd, and others, by police officers and the visibility of the Black Lives Matter movement. The COVID-19 pandemic also exposed vulnerabilities and biases within the health care system that predated the pandemic and have detrimental effects on how health care systems operate and how health outcomes are affected.18,22 In addition, the pandemic has led to renewed focus on structural racism being identified as a public health crisis.19 Overall, the effects of the COVID-19 pandemic have resulted in an unparalleled loss of life, numbering in the millions. These deaths have disproportionately affected Black, Hispanic or Latino, and Indigenous communities and exacerbated health inequities.20,23,24

Inequities in workplace safety, technology literacy, language concordance, and access to health care contributed to disproportionate rates of COVID-19 infections, hospitalizations, and deaths in Black, Hispanic or Latino, and other historically excluded people.25–27 These factors have also been contributors to increased incidence of and lower survival after cardiac arrest in the same communities.16,28 Considering the substantial disparities (eg, race, ethnicity, sex, gender) that exist in bystander cardiopulmonary resuscitation (BCPR) rates and cardiac arrest outcomes, the writing group and the ECC Committee identified equity as a key focus for evaluating BCPR rates, automated external defibrillator (AED) use, and cardiac arrest outcomes over time.

PRIORITY AREA: EQUITY, DISPARITIES, RACISM

Disparities in Care and Outcomes

Cardiac arrest incidence and survival rates vary, depending on factors such as location, race, and ethnicity.29–33 Black and Hispanic or Latino individuals have a higher incidence of cardiac arrest and a lower chance of surviving with functional neurologic outcome compared with White individuals.34,35 The incidence of OHCA increases and the likelihood of survival decreases among individuals in lower-income populations.36–41 BCPR can double to triple chances of survival, but it is less frequently provided to people who have an OHCA in neighborhoods that are predominantly Black, Hispanic or Latino, or low-income.42–44 Previous reports also support that BCPR may be provided less frequently to women who have experienced cardiac arrest.45–47 Outcomes after a cardiac arrest also vary widely by hospital, with studies showing that hospitals that provide care for predominantly Black and low-income populations report lower survival rates compared with those that serve higher-income and predominantly White populations.48 Disparities in rates of cardiac catheterization and provision of targeted temperature management have been identified as potential reasons for sex- or race-related disparities in neurologically favorable survival after cardiac arrest.49–52

Racism and Root Causes for Disparities

The underlying causes of disparities in the incidence, treatment, survival, and long-term outcomes of cardiac arrest are complex. The higher incidence and lower survival rates of cardiac arrest in Black, Hispanic or Latino, and other historically excluded people are largely a consequence of structural racism. Defined as the “totality of ways in which societies foster racial discrimination, through mutually reinforcing inequitable systems (eg, housing, education, employment, earnings, benefits, credit, media, health care, criminal justice) that in turn reinforce discriminatory beliefs, values, and distribution of resources,” structural racism reinforces and perpetuates health inequities.53

Rates of cardiovascular disease vary by race and ethnicity,2 which may lead to the higher incidence rates of cardiac arrest in individuals who are Black, Hispanic or Latino, or from other underrepresented groups; however, unequal access to preventive health services and screening, delays in diagnosis and treatment, lack of neighborhood-level resources, and unequal access to cardiopulmonary resuscitation (CPR) and AED training opportunities also contribute to worse cardiac arrest outcomes in these populations.54–61 Inequitable educational and employment opportunities and inequitable distribution of health care infrastructure and services lead to shorter life expectancies in people in some under-resourced zip codes compared with their neighbors a few miles away.62–64 Despite national cardiac arrest treatment guidelines, not all patients receive evidence-based therapies or care, with people from historically underrepresented racial, ethnic, sex, or gender groups at particularly high risk for undertreatment.50,52,65–69 In accordance, the AHA and the AHA ECC Committee have included identifying and removing barriers to health equity in their Impact Goals and priorities.4,70

To eliminate disparities in cardiac arrest incidence, treatment, and survival, it is imperative to describe and measure how interpersonal, structural, and institutional biases negatively affect the health of historically underrepresented racial and ethnic groups, rural communities, and low-income communities. There is an opportunity to save more lives by prioritizing equitable delivery of lifesaving interventions throughout the Chain of Survival (Figure 2) and including equitable outcomes as a metric of success. This approach also aligns with the AHA’s focus on promoting strategies for addressing structural racism across multiple domains: advocacy, quality improvement, leadership, human resources and business operations, and science (Figure 3).

Figure 2.

Figure 2. Chain of Survival: adult and pediatric out-of-hospital cardiac arrest. CPR indicates cardiopulmonary resuscitation. Reprinted from Merchant et al70a with permission. Copyright © 2020 American Heart Association, Inc.

Figure 3.

Figure 3. AHA strategies for addressing structural racism. AHA indicates American Heart Association. Reprinted from Churchwell et al18 with permission. Copyright © 2020 American Heart Association, Inc.

Target Priority and Included Populations

In alignment with the AHA’s 2024 goals,4 and in consideration of the persistent disparities in cardiac arrest recognition, treatment, and survival on the basis of race, ethnicity, income, sex, gender, or geographic location (ie, urban, rural), the ECC Committee has included a 2030 Target Priority to eliminate disparities in BCPR, AED use, and survival. The targeted goal rate of BCPR, AED use, and survival in all historically underrepresented groups and communities (eg, owing to sex, gender, race, ethnicity, or socioeconomic status) should at least be equal to that of the general population.

Action Strategies

Action strategies to address disparities (Table 2) need to be centered around identifying barriers to the links of the AHA Chain of Survival to implement targeted plans to strengthen those links. One barrier to tracking progress in outcomes over time is that cardiac arrest is not identified as a reportable condition. Another barrier to achieving health equity is lack of data on underrepresented groups (eg, Indigenous people, Asian individuals). Inconsistency exists in how sex, race, ethnicity, and socioeconomic status data are obtained and reported. Studies may report these data by geographic designation because obtaining individual-level data can be challenging, and self-reporting may not be possible in the setting of cardiac arrest.71–73

Addressing the disproportionate burden of cardiac arrest incidence in lower-income and historically underrepresented racial and ethnic groups should start at the societal level, with prevention and screening to identify people at risk of cardiovascular disease or cardiac arrest. Resuscitation training materials could raise awareness of inequities by including information for end users about historical and current disparities in practice and outcomes for historically underrepresented groups (eg, owing to race, ethnicity, sex, gender, or socioeconomic status). Moreover, strategies to increase community response must address structural barriers to activating EMS response, such as language competency and mistrust of first responders.74 Individuals trained in basic and advanced life support must recognize and address implicit structural and systemic bias to reduce inequities in EMS and hospital interventions. In addition, there is a need for equal access to resources for care and recovery after cardiac arrest.

PRIORITY AREA: BCPR

OHCA is associated with low survival, but early CPR and early defibrillation can improve outcomes.75,76 Approximately 70% of cardiac arrests occur outside of the hospital setting, where the link for early CPR in the AHA Chain of Survival often lies in the hands of lay rescuers. BCPR has been shown in multiple studies to improve OHCA survival and can double or triple the odds of survival in OHCA.37,38,77,78 BCPR is only performed in an estimated 40% of US individuals in cardiac arrest, with lower rates in Black, Hispanic or Latino, and other historically underrepresented racial and ethnic groups.38,40 People living in primarily low-income neighborhoods or in neighborhoods with predominantly Black or Hispanic or Latino residents are more likely to have OHCA and are less likely to receive BCPR.41,42 For example, in a study79 using the CARES database (Cardiac Arrest Registry to Enhance Survival), Hispanic or Latino residents of Los Angeles received BCPR at approximately half the rate of White residents. Contributing factors to low rates of BCPR include limited access to knowledge about training, fear of making a mistake, fear of disease transmission (which has increased since the onset of the COVID-19 pandemic), and liability concerns.74,80,81 Language barriers and associated challenges attributable to limited English-language proficiency in 9-1-1 callers during dispatcher-identified cardiac arrest are also associated with less frequent BCPR, as well as delays in both cardiac arrest recognition and implementation of telephone-assisted CPR.66,82,83

Annual rates of CPR training in the United States vary widely across communities, with counties located in the South and those with higher proportions of rural areas, higher proportions of Black and Hispanic or Latino residents, or lower median household incomes having lower rates of CPR training than other communities.55,84

Previous work has focused on community-based programs to increase knowledge awareness and action in neighborhoods.85–87 One such program was highlighted in a study of 2 cities in Texas, which demonstrated how a geographically targeted CPR training strategy tailored to neighborhood population characteristics may be effective in reducing disparities in BCPR for OHCA.56 High-risk neighborhoods (ie, neighborhoods comprising predominantly low-income residents and historically underrepresented ethnic and racial groups) can be identified and CPR training targeted in neighborhoods in which it is most likely to be needed.39,40,43,44,58 Incentives and support for new training modalities and digital platforms, such as virtual training, Resuscitation Quality Improvement programs, and CPR kiosks, may be able to enhance CPR education and response.88,89 Recognizing the importance of community involvement in a cardiac arrest program and developing a CPR training program that takes into consideration the uniqueness of each community’s barriers and opportunities can help support implementation of targeted programs focused on education90 and increasing awareness. Training programs should not only include the mechanics of BCPR but also address community concerns regarding accessing emergency services and preventing disease transmission, especially in the context of the COVID-19 pandemic. Continued focus on CPR training as a requirement for high school graduation or in other settings, such as when obtaining a driver’s license, represent additional strategies for increasing training.91 Targeted efforts focused on high-risk communities have the potential to improve overall BCPR rates while reducing health disparities in the prevention, recognition, and treatment of cardiac arrest.

Target Priority and Included Populations

The ECC 2030 Target Priority is to increase the rate of BCPR to >50% (versus the 2020 CARES goal of 40.2%) by the end of 2030. The targeted goal rate in underrepresented groups (by sex, gender, race, or ethnicity, as well as other historically underrepresented groups), and in communities with low socioeconomic status, should at least be equal to that of the general population.

Action Strategies

Action strategies to improve BCPR (Table 2) must address barriers to CPR training and performance, include more robust data collection to improve outcomes, and identify and target training in broader settings (eg, requirement for high school graduation) and communities of highest need to reduce disparities and increase rates of BCPR in all neighborhoods, regardless of race, ethnicity, geography, or socioeconomic status.

PRIORITY AREA: EARLY ACCESS DEFIBRILLATION FOR OHCA

Ventricular fibrillation and pulseless ventricular tachycardia are amenable to defibrillation but deteriorate to nonshockable rhythms over time. The probability of survival from cardiac arrest decreases for every minute defibrillation is delayed.92,93 Early defibrillation in conjunction with chest compressions is associated with markedly improved survival for people who experience cardiac arrest.94,95 The median time from 9-1-1 call to scene arrival for EMS responding to OHCA is >6 minutes in North America, even in dense urban settings.96 Given these system limitations, use of AEDs as soon as possible by people at the scene is a critical component of the Chain of Survival and a key strategy to optimize outcomes after OHCA. Most contemporary AEDs provide prompts to guide users through the process of CPR, with some even providing real-time feedback on quality.

Despite the proliferation of public-access defibrillation programs, many barriers to early defibrillation for individuals in cardiac arrest remain.97 Overall, fewer than 10% of people in cardiac arrest have an AED applied before EMS arrival.95,96 AEDs are more likely to be used in public settings compared with private residential settings (15.3% versus 1.3%).98 This is a critical issue because ≈80% of all OHCAs occur in a residential setting.95 Although shockable rhythms are observed less often in cardiac arrests in residential locations, the potential population health benefit of early detection and defibrillation for OHCA occurring in residential settings could be substantial.99 A specific focus on early defibrillation (and not just public-access defibrillation) would enable a broader focus on defibrillation across multiple settings where cardiac arrest occurs and substantial improvements in outcomes could occur with targeted strategies in these nonpublic areas (eg, home, offices, clubs, industrial areas).

Access to AEDs and early defibrillation is not uniform.100–106 AEDs require a substantial upfront investment to acquire and install the equipment. There are also costs associated with training potential users and ongoing maintenance. Evidence suggests that there are fewer public-access AEDs in low-income neighborhoods compared with higher-income neighborhoods.107 AEDs are used less often during cardiac arrests occurring in neighborhoods with lower socioeconomic status.108 Women who experience OHCA in a public location are less likely than men to receive bystander AED use.109 Hispanic or Latino residents were reported to be less likely than White or Black residents to have received AED training.59 Future work is required to understand the systemic and contextual factors contributing to inequity in access to early defibrillation so that effective, targeted solutions can be implemented.

Target Priority and Included Populations

The ECC 2030 Target Priority is to increase the proportion of individuals with OHCA who have an AED applied before the arrival of EMS in a public setting to 20% (versus the 2020 CARES goal of 9.0%). The targeted goal rate in underrepresented groups (by sex, gender, race, or ethnicity, as well as other historically underrepresented groups), and in communities with low socioeconomic status, should at least be equal to that of the general population.

Action Strategies

Action strategies to increase early defibrillation (Table 2) focus on improving AED awareness and competency, removing barriers to immediate access and retrieval during an emergency, and supporting the implementation and study of innovative technologies and strategies for early defibrillation in OHCA. Although some overlap may exist, the strategies for improving access to early defibrillation for OHCA will differ for public and residential settings (where most OHCAs occur). To make substantial improvements in early defibrillation for those who experience OHCA in a residential setting, a rethinking of the public-access defibrillation model is required and may require specific targets and strategies. Innovative technology facilitating the development of lightweight, compact, consumer-grade AEDs could support a new paradigm of personal-access defibrillation, whereby devices are easily and regularly carried like cell phones or worn like watches. New vectors of AED delivery, including AED-equipped community volunteers dispatched in parallel with professional responders and unmanned aerial vehicles equipped with AEDs, offer new approaches requiring evaluation.110,111

PRIORITY AREA: IMPROVE SURVIVAL

Cardiac Arrest Outcomes

From 2000 to 2010, there was notable improvement in survival rates for both IHCA and OHCA. For IHCA, risk-adjusted rates of survival to discharge increased from 13.7% to 22.3%, with parallel improvements in survival for shockable cardiac arrest rhythms (<30% in 2000 to ≈40% in 2010) and nonshockable cardiac arrest rhythms (7%–10% in 2010–2011 to 11%–13% in 2009–2010).112 A similar pattern was observed for OHCA, with overall rates of survival to discharge increasing from 5.7% in 2005 to 2006 to 8.3% in 2012, with parallel improvements in both rhythm types. More recently, IHCA survival has improved to ≈24% in 2016 to 2019, and OHCA survival has improved to ≈10%.113

A unique challenge that has emerged is the effect of the COVID-19 pandemic on cardiac arrest response and survival outcomes. Initial analyses from the CARES and Get With the Guidelines–Resuscitation (GWTG-R) registries have detected dramatic decreases in OHCA and IHCA survival.6,114,115 It will be critical to reassess the 2030 survival targets described in this article on the basis of whether survival rates rebound to prepandemic levels in the near future.

Most efforts at improving cardiac arrest survival have focused on acute resuscitation management, whether inside or outside the hospital. GWTG-R has developed an awards recognition infrastructure to elevate hospitals with superior process-of-care adherence when the patient is pulseless (ie, in timely defibrillation for shockable arrest rhythms or timely administration of epinephrine for nonshockable arrest rhythms).116

For OHCA, efforts focused on increasing rates of BCPR, EMS response time, and widespread deployment of AEDs has made, and will continue to make, substantial inroads in improving acute resuscitation response and ultimately survival.117 Additional work on identifying best practices in postresuscitation care will be critical, especially as research into early percutaneous interventions, extracorporeal cardiopulmonary resuscitation, targeted temperature management and fever avoidance, and other strategies evolves.118 A recognition program for high-performing EMS agencies with the highest rates of survival to hospital admission in an entity such as CARES may catalyze innovations and quality improvement in prehospital care. In addition, identifying best practices for OHCA at top-performing EMS agencies that care for predominantly Black or Hispanic or Latino individuals and for IHCA at hospitals that care for predominantly Black or Hispanic or Latino patients, as well as how these sites overcame barriers unique to these communities, is a health equity priority to begin narrowing the race and ethnicity gaps in survival outcomes.

Because variability exists in CPR training, provision, and outcomes by sex and gender, there is an important need to focus on strategies to address inequities in this realm.46,47

Previous work has focused primarily on survival and neurologic outcomes, but functional outcomes and longer-term outcomes after hospital discharge also need to be addressed. Existing reporting recommendations (eg, the COSCA [Core Outcome Set After Cardiac Arrest] and P-COSCA [Pediatric COSCA] initiatives) could be required for reporting trial outcomes to further support how data from clinical trials are incorporated in future Impact Goals.119,120 An important focus for 2030 will be uniformly reported data from clinical trials, registries, and infrastructure to collect and track longer-term outcomes of cardiac arrest survivors with a focus on survivorship, quality of life, and physical and psychosocial wellbeing.

Target Priority and Included Populations

The ECC 2030 Target Priority is to increase survival to hospital discharge with good neurologic outcome (Cerebral Performance Category 1 or 2) after OHCA in a residential or public setting, as follows:

  • In adults: >12% (2020 CARES, 7.1%)

  • In children <1 year of age: to 6% after an initial arrest at home or residence (2020 CARES, 5.3%) and to 12% in a public setting (2020 CARES, 10.9%)

  • In children 1 to 12 years of age: to 11.5% after an initial arrest at home or residence (2020 CARES, 10.5%) and to 21% in a public setting (2020 CARES, 19.2%)

  • In children 13 to 18 years of age: to 17.5% after an initial arrest at home or residence (2020 CARES, 16%) and to 33% in a public setting (2020 CARES, 30%)

The ECC 2030 Target Priority is to increase survival to hospital discharge with good neurologic outcome (Cerebral Performance Category 1 or 2) after IHCA, as follows:

  • In adults: >24% (2020 GWTG-R, 16%)

  • In children: >45% (2015–2019 GWTG-R, 34%–42%)

The AHA ECC 2030 Impact Goals rate in underrepresented groups (by sex, gender, race, or ethnicity, as well as other historically underrepresented groups), and in communities with low socioeconomic status, should at least be equal to that of the general population.

Action Strategies

Action strategies to address improving survival after cardiac arrest (Table 2) can be centered around approaches to detect decompensating patients early, improve data collection and registries to add to our current understanding of risks and outcomes, and provide optimal care after cardiac arrest, with a focus on survivorship and quality of life after hospital discharge. Early detection of clinical decompensation with early warning scores in the inpatient setting could theoretically improve outcomes; although, thus far, data have been inconclusive. The many different scoring systems use different definitions of end points, use different algorithms of data analysis, and have undergone different validation, which make comparing scores and implementing processes challenging.121–123 In both the inpatient and out-of-hospital setting, process optimization (eg, decreasing time to defibrillation or epinephrine administration, increasing BCPR rates, expanding public-access AEDs) are all integral to improving survival.

By identifying hospital systems, EMS agencies, and communities that achieve excellent outcomes, subsequent qualitative investigation can begin to reveal how their outcomes differ.124,125 This work will be incumbent upon increased funding and resource allocation at multiple levels for resuscitation science.

PRIORITY AREA: MEASUREMENT AND TRACKING

The key to quality improvement is measurement, tracking, and assessment of how specific interventions affect health outcomes. The 2 main registries in this regard are CARES126 and GWTG-R.127 CARES is used primarily to capture dispatcher, prehospital, and hospital data on OHCA, whereas GWTG-R is primarily used for IHCA, and participants can access their own data and benchmark for quality improvement purposes. CARES releases a summary annual report. GWTG-R data are primarily shared through periodic research publications, an annual report of each hospital’s risk-standardized survival rate for IHCA, and an awards program for benchmarking resuscitation processes of care. The 2020 CARES data included 1741 EMS agencies and 1962 hospitals with a catchment area representing ≈44% of the US population (143.5 million people). In 2020, 127 376 treated OHCAs were included with a crude incidence of 88.8 treated arrests per 100 000 population. Unpublished CARES data on cardiac arrest differences by age, race, ethnicity, and sex are presented in Tables 3 and 4 (personal communication, Dr Bryan McNally, Principal Investigator for CARES, January 2023).

Table 3. Differences in Bystander Interventions and Survival After OHCA by Race, Ethnicity, and Sex, Adult (Age >18 Years), CARES, 2021

GroupsNontraumatic cause survival rates, overall survival to hospital dischargeBystander intervention rates
CPR*Public AED use
Total12 996/143 284 (9.1)43 048/107 782 (39.9)1704/16 747 (10.2)
 American Indian/Alaska Native38/510 (7.5)161/411 (39.2)8/88 (9.1)
 Asian318/3572 (8.9)1199/2828 (42.4)33/386 (8.5)
 Black/African American2471/30 805 (8.0)7288/22 011 (33.1)282/3247 (8.7)
 Hispanic or Latino996/12 134 (8.2)3640/9520 (38.2)119/1584 (7.5)
 Native Hawaiian/Pacific Islander72/772 (9.3)299/621 (48.1)4/84 (4.8)
 White7101/72 073 (9.9)22 760/54 269 (41.9)975/8376 (11.6)
 Unknown2000/23 418 (8.5)7701/18 122 (42.5)283/2982 (9.5)
Male8413/89 743 (9.4)27 909/69 480 (40.2)1384/13 115 (10.6)
 American Indian/Alaska Native23/284 (8.1)91/232 (39.2)5/56 (8.9)
 Asian238/2207 (10.8)738/1773 (41.6)26/308 (8.4)
 Black/African American1399/17 376 (8.1)4156/12 729 (32.6)213/2418 (8.8)
 Hispanic or Latino678/7998 (8.5)2437/6458 (37.7)104/1301 (8.0)
 Native Hawaiian/Pacific Islander44/482 (9.1)197/399 (49.4)3/65 (4.6)
 White4704/46 362 (10.1)15 202/35 999 (42.2)809/6627 (12.2)
 Unknown1327/15 034 (8.8)5088/11 890 (42.8)224/2340 (9.6)
Female4578/53 496 (8.6)15,129/38 270 (39.5)320/3628 (8.8)
 American Indian/Alaska Native15/226 (6.6)70/179 (39.1)3/32 (9.4)
 Asian80/1363 (5.9)459/1053 (43.6)7/78 (9.0)
 Black/African American1071/13 419 (8.0)3132/9276 (33.8)69/829 (8.3)
 Hispanic/Latina317/4133 (7.7)1202/3060 (39.3)15/283 (5.3)
 Native Hawaiian/Pacific Islander28/290 (9.7)102/222 (45.9)1/19 (5.3)
 White2394/25 694 (9.3)7555/18 259 (41.4)166/1747 (9.5)
 Unknown673/8371 (8.0)2609/6221 (41.9)59/640 (9.2)

Values are n/N (%).

OHCA indicates out-of-hospital cardiac arrest.

* Bystander cardiopulmonary resuscitation (CPR) rate excludes 9-1-1 responder witnessed, nursing home, and health care facility arrests.

† Public automated external defibrillator (AED) use rate excludes 9-1-1 responder witnessed, home or residence, nursing home, and health care facility arrests.

‡ Sex missing for 45 individuals.

Source: Personal communication, Dr Bryan McNally, Principal Investigator for Cardiac Arrest Registry to Enhance Survival (CARES), January 2023. Used with permission.

Table 4. Differences in Bystander Interventions and Survival After OHCA by Race, Ethnicity, and Sex, Pediatric (Age ≤18 Years), CARES, 2021

GroupsAge <1 y*Age 1–12 yAge 13–18 y
Nontraumatic cause survival rates, overall survival to hospital dischargeBystander intervention ratesNontraumatic cause survival rates, overall survival to hospital dischargeBystander intervention ratesNontraumatic cause survival rates, overall survival to hospital dischargeBystander intervention rates
CPRPublic AED useCPRPublic AED useCPRPublic AED use
Total§388/6499 (6.0)2872/6227 (46.1)8/410 (2.0)634/4205 (15.0)2003/3876 (51.7)43/561 (7.7)544/2959 (18.4)1325/2700 (49.1)96/548 (17.5)
 American Indian/Alaska Native3/31 (9.7)13/31 (41.9)0/3 (0.0)4/16 (25.0)9/16 (56.2)0/4 (0.0)2/13 (15.4)7/12 (58.3)0/5 (0.0)
 Asian12/115 (10.4)46/100 (46.0)0/9 (0.0)9/88 (10.2)44/80 (55.0)1/17 (5.9)16/61 (26.2)34/53 (64.2)3/9 (33.3)
 Black/African American120/2380 (5.0)923/2296 (40.2)0/113 (0.0)165/1348 (12.2)530/1231 (43.1)15/191 (7.9)108/738 (14.6)257/652 (39.4)30/155 (19.4)
 Hispanic or Latino34/647 (5.3)254/616 (41.2)0/47 (0.0)91/549 (16.6)231/500 (46.2)7/65 (10.8)79/437 (18.1)176/404 (43.6)11/74 (14.9)
 Native Hawaiian/Pacific Islander1/43 (2.3)16/42 (38.1)0/2 (0.0)4/31 (12.9)18/30 (60.0)0/6 (0.0)5/22 (22.7)11/22 (50.0)3/6 (50.0)
 White149/2065 (7.2)1029/1973 (52.2)5/154 (3.2)217/1391 (15.6)790/1297 (60.9)14/156 (9.0)237/1153 (20.6)587/1065 (55.1)35/187 (18.7)
 Unknown69/1218 (5.7)591/1169 (50.6)3/82 (3.7)144/782 (18.4)381/722 (52.8)6/122 (4.9)97/535 (18.1)253/492 (51.4)14/112 (12.5)
Male266/3735 (7.1)1657/3585 (46.2)4/240 (1.7)388/2445 (15.9)1174/2246 (52.3)24/343 (7.0)373/1863 (20.0)847/1725 (49.1)71/407 (17.4)
 American Indian/Alaska Native2/15 (13.3)9/15 (60.0)0/2 (0.0)3/9 (33.3)4/9 (44.4)0/3 (0.0)1/9 (11.1)4/8 (50.0)0/4 (0.0)
 Asian9/65 (13.8)26/58 (44.8)0/5 (0.0)7/50 (14.0)26/45 (57.8)0/10 (0.0)11/37 (29.7)20/33 (60.6)2/8 (25.0)
 Black/African American79/1335 (5.9)508/1292 (39.3)0/60 (0.0)99/760 (13.0)282/681 (41.4)7/111 (6.3)85/474 (17.9)168/420 (40.0)24/124 (19.4)
 Hispanic or Latino25/374 (6.7)148/356 (41.6)0/25 (0.0)50/308 (16.2)132/280 (47.1)5/45 (11.1)53/279 (19.0)112/261 (42.9)6/55 (10.9)
 Native Hawaiian/Pacific Islander0/28 (0.0)10/27 (37.0)0/2 (0.0)3/15 (20.0)8/14 (57.1)0/3 (0.0)2/12 (16.7)6/12 (50.0)2/4 (50.0)
 White109/1226 (8.9)618/1176 (52.6)1/94 (1.1)132/813 (16.2)482/760 (63.4)7/93 (7.5)155/723 (21.4)373/679 (54.9)27/131 (20.6)
 Unknown42/692 (6.1)338/661 (51.1)3/52 (5.8)94/490 (19.2)240/457 (52.5)5/78 (6.4)66/329 (20.1)164/312 (52.6)10/81 (12.3)
Female122/2759 (4.4)1214/2637 (46.0)4/169 (2.4)246/1760 (14.0)829/1630 (50.9)19/218 (8.7)171/1096 (15.6)478/975 (49.0)25/141 (17.7)
 American Indian/Alaska Native1/16 (6.2)4/16 (25.0)0/1 (0.0)1/7 (14.3)5/7 (71.4)0/1 (0.0)1/4 (25.0)3/4 (75.0)0/1 (0.0)
 Asian3/49 (6.1)19/41 (46.3)0/4 (0.0)2/38 (5.3)18/35 (51.4)1/7 (14.3)5/24 (20.8)14/20 (70.0)1/1 (100.0)
 Black/African American41/1045 (3.9)415/1004 (41.3)0/53 (0.0)66/588 (11.2)248/550 (45.1)8/80 (10.0)23/264 (8.7)89/232 (38.4)6/31 (19.4)
 Hispanic or Latina9/272 (3.3)106/259 (40.9)0/22 (0.0)41/241 (17.0)99/220 (45.0)2/20 (10.0)26/158 (16.5)64/143 (44.8)5/19 (26.3)
 Native Hawaiian/Pacific Islander1/15 (6.7)6/15 (40.0)0/0 (0.0)1/16 (6.2)10/16 (62.5)0/3 (0.0)3/10 (30.0)5/10 (50.0)1/2 (50.0)
 White40/838 (4.8)411/796 (51.6)4/60 (6.7)85/578 (14.7)308/537 (57.4)7/63 (11.1)82/430 (19.1)214/386 (55.4)8/56 (14.3)
 Unknown27/524 (5.2)253/506 (50.0)0/29 (0.0)50/292 (17.1)141/265 (53.2)1/44 (2.3)31/206 (15.0)89/180 (49.4)4/31 (12.9)

Values are n/N (%).

OHCA indicates out-of-hospital cardiac arrest.

* Stillborn neonates and perinatal newborns born without signs of life are excluded.

† Bystander cardiopulmonary resuscitation (CPR) rate excludes 9-1-1 responder witnessed, nursing home, and health care facility arrests.

‡ Public automated external defibrillator (AED) use rate excludes 9-1-1 responder witnessed, home or residence, nursing home, and health care facility arrests.

§ Sex missing for 5 individuals (<1 y age category).

Source: Personal communication, Dr Bryan McNally, Principal Investigator for Cardiac Arrest Registry to Enhance Survival (CARES), January 2023. Used with permission.

An important challenge in achieving the AHA ECC 2030 Impact Goals is that nationally representative data are either incomplete or not publicly available at the national, state, and local levels. The specific metrics for tracking cardiac arrest process and outcome measures should also evolve as new data become available. Reports that are publicly available lack adequate granularity on analyses for purposes of health equity, especially as they pertain to geographic location and neighborhood-level characteristics. The ability to access these data at a community level will be key in planning and implementing interventions where they are most likely to have the greatest effect.

Major advances in cardiac arrest research are often driven by data. Results from clinical trials often drive major advances in cardiac arrest care and outcomes. However, inconsistencies exist in how data are reported from these studies, sometimes limiting their comparability or generalizability. Existing reporting recommendations (eg, COSCA and P-COSCA initiatives) should be required for reporting trials outcomes, which could further support how data from clinical trials are incorporated in future Impact Goals.119,120

A barrier to expansion of both CARES and GWTG-R is lack of funding. The registries are voluntary and supported by philanthropic sources (eg, the AHA) or by subscription fees by the participating agencies, states, or hospital systems. A more stable funding stream to cover costs for participating sites and statistical support will be essential to the continued success of capturing and providing feedback data for OHCA and IHCA.

In addition to increasing enrollment, the measures in these registries should be expanded to allow for tracking and measurement of aspirational areas of focus and targets (Table 2), or complementary registries should be resourced and implemented that allow for tracking these measures to achieve an optimized resuscitation ecosystem in the near future. Another barrier is that reporting on cardiac arrest incidence, process measures, and outcomes is not mandatory or incentivized. If cardiac arrest were classified as a reportable disease (eg, by the Council of State and Territorial Epidemiologists), uniform reporting by all states would be mandated. As an alternative, data collection and reporting could be incentivized by linking it to health care system certifications or reimbursement.

Collaboration across key stakeholder groups is also paramount to the success of this initiative. The Chain of Survival is uniquely dependent on multiple links, which require coordinated efforts from the community, dispatchers, prehospital health care professionals, health care systems, patients, and their caregivers to improve outcomes after cardiac arrest.

Action Strategies

The action strategies outlined in Table 2 address barriers to measurement and tracking of OHCA process measures, outcomes, and equity. These strategies require engagement and resources at the national, state, and local government levels, as well as participation of all stakeholders in the local systems of care, including members of the health care team, patients, and their families.

PEDIATRIC PERSPECTIVE

Whereas this document applies to the population at large, including children, there are some differences that warrant highlighting for the pediatric population. There are disparities in treatment and outcomes for children experiencing cardiac arrest.67,108,128,129 Naim et al130 reported that BCPR was provided in 46.5% of pediatric OHCA arrests and that an AED was not used in 82.6% of pediatric OHCAs, which is comparable to adult OHCA data.

Children who are the recipients of BCPR and who have placement of an AED in OHCA are far more likely to be White and from neighborhoods with higher education and income levels.108,129,130 Survival, however, does not seem to be different among races in both IHCA and OHCA.67,131 The investigators of these studies hypothesized that this may be attributable to both the expansion of pediatric insurance coverage and the broad reach of major academic hospitals in caring for pediatric patients. However, much of the difference in pediatric cases stems from the predominance of a respiratory cause of cardiac arrest. An alternative approach of compression-only CPR, suggested as an option for bystanders who witness OHCA, has not been shown to be as effective as conventional compressions with breaths in pediatric patients.124,130 This likely is because of the respiratory cause underlying many pediatric arrests and the need for rescue breaths. A large component of pediatric arrests occur in infants, at home, and are unwitnessed, likely associated with sudden infant death syndrome.124 A different approach is needed to improve these outcomes, with focus on prevention of known risk factors, research to clarify pathogenesis, and education and training in conventional CPR for families and caregivers of young children. A continued focus on rigorous data to guide pediatric resuscitation practices for OHCA and IHCA would also be beneficial.

CONCLUSIONS

These goals for 2030 were developed during an extraordinary time. Global events that occurred while the deliberations for this article were taking place included a worldwide pandemic responsible for >5.5 million deaths (as of January 2022), substantial economic stress throughout major segments of the business world, incidents leading to a sharp focus on racism and inequality, and the expectation that climate change will soon emerge as the largest global threat to human health, along with acutely worsening metrics on cardiovascular health and diminished survival rates in nearly every community. The authors debated all these issues in an attempt to provide goals that balanced the need to improve cardiovascular health and survival rates against the many ongoing additional pressing issues faced by our communities during a stressful period in our history.

The AHA ECC 2030 Impact Goals are intended to reflect our optimism for improvement grounded in a pragmatic foundation of what is realistic given current conditions and serve as an achievable road map for improved cardiovascular health and better survival rates in all communities. The themes presented harmonize with the new goals of the AHA to create a world where every person can lead a full, healthy life, and reflect our ongoing struggles to contain the COVID-19 pandemic. There is an increasing recognition of the need to provide more equitable care, identify disparities and structural inequity, and create better systems of care that will remove the ongoing inequitable systems that perpetuate disparities. New proposed metrics will allow us to document our progress in resolving disparities. We seek to extend the effects of the interventions that we know to be effective. Improving the rates of BCPR and advancing the coverage of AEDs to provide more rapid defibrillation serve as a foundation. Collecting critical data on important metrics such as rates of BCPR, use of AEDs, and survival rates allow us to delve into the issues causing disparities while improving care for everyone.

Working to achieve the AHA ECC 2030 Impact Goals will advance our response to cardiac arrest, engage all our communities in promoting better public health, and advance the goal of ensuring that all people lead the fullest and healthiest life possible.

ARTICLE INFORMATION

Footnotes

The American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest.

This statement was approved by the American Heart Association Science Advisory and Coordinating Committee on June 30, 2023, and the American Heart Association Executive Committee on September 18, 2023. A copy of the document is available at https://professional.heart.org/statements by using either “Search for Guidelines & Statements” or the “Browse by Topic” area. To purchase additional reprints, call 215-356-2721 or email

The American Heart Association requests that this document be cited as follows: Merchant RM, Becker LB, Brooks SC, Chan PS, Del Rios M, McBride ME, Neumar RW, Previdi JK, Uzendu A, Sasson C; on behalf of the American Heart Association. The American Heart Association Emergency Cardiovascular Care 2030 Impact Goals and call to action to improve cardiac arrest outcomes: a scientific statement from the American Heart Association. Circulation. 2024;149:e914–e933. doi: 10.1161/CIR.0000000000001196

The expert peer review of AHA-commissioned documents (eg, scientific statements, clinical practice guidelines, systematic reviews) is conducted by the AHA Office of Science Operations. For more on AHA statements and guidelines development, visit https://professional.heart.org/statements. Select the “Guidelines & Statements” drop-down menu, then click “Publication Development.”

Permissions: Multiple copies, modification, alteration, enhancement, and distribution of this document are not permitted without the express permission of the American Heart Association. Instructions for obtaining permission are located at https://www.heart.org/permissions. A link to the “Copyright Permissions Request Form” appears in the second paragraph (https://www.heart.org/en/about-us/statements-and-policies/copyright-request-form).

Circulation is available at www.ahajournals.org/journal/circ

REFERENCES

  • 1. American Heart Association. About CPR & ECC.Accessed October 18, 2022. https://cpr.heart.org/en/resources/about-cpr-and-eccGoogle Scholar
  • 2. Virani SS, Alonso A, Aparicio HJ, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Cheng S, Delling FN, et al; on behalf of the American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics: 2021 update: a report from the American Heart Association.Circulation. 2021; 143:e254–e743. doi: 10.1161/CIR.0000000000000950LinkGoogle Scholar
  • 3. Neumar RW. Doubling cardiac arrest survival by 2020: achieving the American Heart Association Impact Goal.Circulation. 2016; 134:2037–2039. doi: 10.1161/CIRCULATIONAHA.116.025819LinkGoogle Scholar
  • 4. Lloyd-Jones DM, Elkind M, Albert MA. American Heart Association’s 2024 Impact Goal: every person deserves the opportunity for a full, healthy life.Circulation. 2021; 144:e277–e279. doi: 10.1161/CIRCULATIONAHA.121.057617LinkGoogle Scholar
  • 5. Scquizzato T, D’Amico F, Rocchi M, Saracino M, Stella F, Landoni G, Zangrillo A. Impact of COVID-19 pandemic on out-of-hospital cardiac arrest system-of-care: a systematic review and meta-analysis.Prehosp Emerg Care. 2021; 1:1–12. doi: 10.1080/10903127.2021.1967535CrossrefGoogle Scholar
  • 6. Chan PS, Girotra S, Tang Y, Al-Araji R, Nallamothu BK, McNally B. Outcomes for out-of-hospital cardiac arrest in the United States during the coronavirus disease 2019 pandemic.JAMA Cardiol. 2021; 6:296–303. doi: 10.1001/jamacardio.2020.6210CrossrefMedlineGoogle Scholar
  • 7. Borkowska MJ, Jaguszewski MJ, Koda M, Gasecka A, Szarpak A, Gilis-Malinowska N, Safiejko K, Szarpak L, Filipiak KJ, Smereka J. Impact of coronavirus disease 2019 on out-of-hospital cardiac arrest survival rate: a systematic review with meta-analysis.J Clin Med. 2021; 10:1209. doi: 10.3390/jcm10061209CrossrefMedlineGoogle Scholar
  • 8. Hsu A, Sasson C, Kudenchuk PJ, Atkins DL, Aziz K, Becker LB, Berg RA, Bhanji F, Bradley SM, Brooks SC, et al. 2021 Interim guidance to health care providers for basic and advanced cardiac life support in adults, children, and neonates with suspected or confirmed COVID-19.Circ Cardiovasc Qual Outcomes. 2021; 14:e008396. doi: 10.1161/CIRCOUTCOMES.121.008396LinkGoogle Scholar
  • 9. Atkins DL, Sasson C, Hsu A, Aziz K, Becker LB, Berg RA, Bhanji F, Bradley SM, Brooks SC, Chan M, et al; on behalf of the Emergency Cardiovascular Care Committee and Get With the Guidelines–Resuscitation, Adult and Pediatric Task Forces of the American Heart Association. 2022 Interim guidance to health care providers for basic and advanced cardiac life support in adults, children, and neonates with suspected or confirmed COVID-19: from the Emergency Cardiovascular Care Committee and Get With The Guidelines–Resuscitation adult and pediatric task forces of the American Heart Association in collaboration with the American Academy of Pediatrics, American Association for Respiratory Care, the Society of Critical Care Anesthesiologists, and American Society of Anesthesiologists.Circ Cardiovasc Qual Outcomes. 2022; 15:e008900. doi: 10.1161/CIRCOUTCOMES.122.008900LinkGoogle Scholar
  • 10. Ramzy M, Montrief T, Gottlieb M, Brady WJ, Singh M, Long B. COVID-19 cardiac arrest management: a review for emergency clinicians.Am J Emerg Med. 2020; 38:2693–2702. doi: 10.1016/j.ajem.2020.08.011CrossrefMedlineGoogle Scholar
  • 11. Barnicle R, Bracey A, Zahid B, Davic A, Weingart S. Prioritising intubator safety in a pandemic: the details matter.Emerg Med J. 2021; 38:217–219. doi: 10.1136/emermed-2020-210362CrossrefMedlineGoogle Scholar
  • 12. Weissman DN, de Perio MA, Radonovich LJ. COVID-19 and risks posed to personnel during endotracheal intubation.JAMA. 2020; 323:2027–2028. doi: 10.1001/jama.2020.6627CrossrefMedlineGoogle Scholar
  • 13. Jeffery MM, D’Onofrio G, Paek H, Platts-Mills TF, Soares WE, Hoppe JA, Genes N, Nath B, Melnick ER. Trends in emergency department visits and hospital admissions in health care systems in 5 states in the first months of the COVID-19 pandemic in the US.JAMA Intern Med. 2020; 180:1328–1333. doi: 10.1001/jamainternmed.2020.3288CrossrefMedlineGoogle Scholar
  • 14. Sun C, Dyer S, Salvia J, Segal L, Levi R. Worse cardiac arrest outcomes during the COVID-19 pandemic in Boston can be attributed to patient reluctance to seek care.Health Aff (Millwood). 2021; 40:886–895. doi: 10.1377/hlthaff.2021.00250CrossrefMedlineGoogle Scholar
  • 15. Teoh SE, Masuda Y, Tan DJH, Liu N, Morrison LJ, Ong MEH, Blewer AL, Ho AFW. Impact of the COVID-19 pandemic on the epidemiology of out-of-hospital cardiac arrest: a systematic review and meta-analysis.Ann Intensive Care. 2021; 11:169. doi: 10.1186/s13613-021-00957-8CrossrefMedlineGoogle Scholar
  • 16. Lai PH, Lancet EA, Weiden MD, Webber MP, Zeig-Owens R, Hall CB, Prezant DJ. Characteristics associated with out-of-hospital cardiac arrests and resuscitations during the novel coronavirus disease 2019 pandemic in New York City.JAMA Cardiol. 2020; 5:1154–1163. doi: 10.1001/jamacardio.2020.2488CrossrefMedlineGoogle Scholar
  • 17. Kovach CP, Perman SM. Impact of the COVID-19 pandemic on cardiac arrest systems of care.Curr Opin Crit Care. 2021; 27:239–245. doi: 10.1097/MCC.0000000000000817CrossrefMedlineGoogle Scholar
  • 18. Churchwell K, Elkind MSV, Benjamin RM, Carson AP, Chang EK, Lawrence W, Mills A, Odom TM, Rodriguez CJ, Rodriguez F, et al; American Heart Association. Call to action: structural racism as a fundamental driver of health disparities: a presidential advisory from the American Heart Association.Circulation. 2020; 142:e454–e468. doi: 10.1161/CIR.0000000000000936LinkGoogle Scholar
  • 19. Laurencin CT, McClinton A. The COVID-19 pandemic: a call to action to identify and address racial and ethnic disparities.J Racial Ethn Health Disparities. 2020; 7:398–402. doi: 10.1007/s40615-020-00756-0CrossrefMedlineGoogle Scholar
  • 20. Huyser KR, Yang TC, Yellow Horse AJ. Indigenous peoples, concentrated disadvantage, and income inequality in New Mexico: a zip code–level investigation of spatially varying associations between socioeconomic disadvantages and confirmed COVID-19 cases.J Epidemiol Community Health. 2021; 75:1044–1049. doi: 10.1136/jech-2020-215055CrossrefMedlineGoogle Scholar
  • 21. Garcia MA, Homan PA, Garcia C, Brown TH. The color of COVID-19: structural racism and the disproportionate impact of the pandemic on older Black and Latinx adults.J Gerontol B Psychol Sci Soc Sci. 2021; 76:e75–e80. doi: 10.1093/geronb/gbaa114CrossrefMedlineGoogle Scholar
  • 22. Tan SB, deSouza P, Raifman M. Structural racism and COVID-19 in the USA: a county-level empirical analysis.J Racial Ethn Health Disparities. 2022; 9:236–246. doi: 10.1007/s40615-020-00948-8CrossrefMedlineGoogle Scholar
  • 23. Magesh S, John D, Li WT, Li Y, Mattingly-App A, Jain S, Chang EY, Ongkeko WM. Disparities in COVID-19 outcomes by race, ethnicity, and socioeconomic status: a systematic review and meta-analysis.JAMA Netw Open. 2021; 4:e2134147. doi: 10.1001/jamanetworkopen.2021.34147CrossrefMedlineGoogle Scholar
  • 24. Asch DA, Islam MN, Sheils NE, Chen Y, Doshi JA, Buresh J, Werner RM. Patient and hospital factors associated with differences in mortality rates among Black and White US Medicare beneficiaries hospitalized with COVID-19 infection.JAMA Netw Open. 2021; 4:e2112842. doi: 10.1001/jamanetworkopen.2021.12842CrossrefMedlineGoogle Scholar
  • 25. Bassett MT, Chen JT, Krieger N. Variation in racial/ethnic disparities in COVID-19 mortality by age in the United States: a cross-sectional study.PLoS Med. 2020; 17:e1003402. doi: 10.1371/journal.pmed.1003402CrossrefMedlineGoogle Scholar
  • 26. Xu JJ, Chen JT, Belin TR, Brookmeyer RS, Suchard MA, Ramirez CM. Racial and ethnic disparities in years of potential life lost attributable to COVID-19 in the United States: an analysis of 45 states and the District of Columbia.Int J Environ Res Public Health. 2021; 18:2921. doi: 10.3390/ijerph18062921CrossrefMedlineGoogle Scholar
  • 27. Rentsch CT, Kidwai-Khan F, Tate JP, Park LS, King JT, Skanderson M, Hauser RG, Schultze A, Jarvis CI, Holodniy M, et al. Patterns of COVID-19 testing and mortality by race and ethnicity among United States veterans: a nationwide cohort study.PLoS Med. 2020; 17:e1003379. doi: 10.1371/journal.pmed.1003379CrossrefMedlineGoogle Scholar
  • 28. Baldi E, Sechi GM, Mare C, Canevari F, Brancaglione A, Primi R, Klersy C, Palo A, Contri E, Ronchi V, et al; the Lombardia CARe researchers. COVID-19 kills at home: the close relationship between the epidemic and the increase of out-of-hospital cardiac arrests.Eur Heart J. 2020; 41:3045–3054. doi: 10.1093/eurheartj/ehaa508CrossrefMedlineGoogle Scholar
  • 29. Merchant RM, Yang L, Becker LB, Berg RA, Nadkarni V, Nichol G, Carr BG, Mitra N, Bradley SM, Abella BS, et al; American Heart Association Get With the Guidelines–Resuscitation Investigators. Variability in case-mix adjusted in-hospital cardiac arrest rates.Med Care. 2012; 50:124–130. doi: 10.1097/MLR.0b013e31822d5d17CrossrefMedlineGoogle Scholar
  • 30. Moller S, Wissenberg M, Starkopf L, Kragholm K, Hansen SM, Ringgren KB, Folke F, Andersen J, Malta Hansen C, Lippert F, et al. Socioeconomic disparities in prehospital factors and survival after out-of-hospital cardiac arrest.Heart. 2021; 107:627–634. doi: 10.1136/heartjnl-2020-317761CrossrefMedlineGoogle Scholar
  • 31. Kim LK, Looser P, Swaminathan RV, Horowitz J, Friedman O, Shin JH, Minutello RM, Bergman G, Singh H, Wong SC, et al. Sex-based disparities in incidence, treatment, and outcomes of cardiac arrest in the United States, 2003-2012.J Am Heart Assoc. 2016; 5:e003704. doi: 10.1161/JAHA.116.003704LinkGoogle Scholar
  • 32. Gaddam S, Singh S. Socioeconomic disparities in prehospital cardiac arrest outcomes: an analysis of the NEMSIS database.Am J Emerg Med. 2020; 38:2007–2010. doi: 10.1016/j.ajem.2020.06.045CrossrefMedlineGoogle Scholar
  • 33. Hsia RY, Huang D, Mann NC, Colwell C, Mercer MP, Dai M, Niedzwiecki MJ. A US national study of the association between income and ambulance response time in cardiac arrest.JAMA Netw Open. 2018; 1:e185202. doi: 10.1001/jamanetworkopen.2018.5202CrossrefMedlineGoogle Scholar
  • 34. Bosson N, Fang A, Kaji AH, Gausche-Hill M, French WJ, Shavelle D, Thomas JL, Niemann JT. Racial and ethnic differences in outcomes after out-of-hospital cardiac arrest: Hispanics and Blacks may fare worse than non-Hispanic Whites.Resuscitation. 2019; 137:29–34. doi: 10.1016/j.resuscitation.2019.01.038CrossrefMedlineGoogle Scholar
  • 35. Zhao D, Post WS, Blasco-Colmenares E, Cheng A, Zhang Y, Deo R, Pastor-Barriuso R, Michos ED, Sotoodehnia N, Guallar E. Racial differences in sudden cardiac death.Circulation. 2019; 139:1688–1697. doi: 10.1161/CIRCULATIONAHA.118.036553LinkGoogle Scholar
  • 36. Huebinger R, Vithalani V, Osborn L, Decker C, Jarvis J, Dickson R, Escott M, White L, Al-Araji R, Nikonowicz P, et al. Community disparities in out of hospital cardiac arrest care and outcomes in Texas.Resuscitation. 2021; 163:101–107. doi: 10.1016/j.resuscitation.2021.03.021CrossrefMedlineGoogle Scholar
  • 37. Herlitz J, Svensson L, Holmberg S, Angquist KA, Young M. Efficacy of bystander CPR: intervention by lay people and by health care professionals.Resuscitation. 2005; 66:291–295. doi: 10.1016/j.resuscitation.2005.04.003CrossrefMedlineGoogle Scholar
  • 38. McNally B, Robb R, Mehta M, Vellano K, Valderrama AL, Yoon PW, Sasson C, Crouch A, Perez AB, Merritt R, et al; Centers for Disease Control and Prevention. Out-of-hospital cardiac arrest surveillance: Cardiac Arrest Registry to Enhance Survival (CARES), United States, October 1, 2005–December 31, 2010.MMWR Surveill Summ. 2011; 60:1–19.MedlineGoogle Scholar
  • 39. Sasson C, Rogers MA, Dahl J, Kellermann AL. Predictors of survival from out-of-hospital cardiac arrest: a systematic review and meta-analysis.Circ Cardiovasc Qual Outcomes. 2010; 3:63–81. doi: 10.1161/CIRCOUTCOMES.109.889576LinkGoogle Scholar
  • 40. Sasson C, Keirns CC, Smith D, Sayre M, Macy M, Meurer W, McNally BF, Kellermann AL, Iwashyna TJ; CARES (Cardiac Arrest Registry to Enhance Survival) Study Group. Small area variations in out-of-hospital cardiac arrest: does the neighborhood matter?Ann Intern Med. 2010; 153:19–22. doi: 10.7326/0003-4819-153-1-201007060-00255CrossrefMedlineGoogle Scholar
  • 41. Becker LB, Han BH, Meyer PM, Wright FA, Rhodes KV, Smith DW, Barrett J. Racial differences in the incidence of cardiac arrest and subsequent survival: the CPR Chicago Project.N Engl J Med. 1993; 329:600–606. doi: 10.1056/NEJM199308263290902CrossrefMedlineGoogle Scholar
  • 42. Moon S, Bobrow BJ, Vadeboncoeur TF, Kortuem W, Kisakye M, Sasson C, Stolz U, Spaite DW. Disparities in bystander CPR provision and survival from out-of-hospital cardiac arrest according to neighborhood ethnicity.Am J Emerg Med. 2014; 32:1041–1045. doi: 10.1016/j.ajem.2014.06.019CrossrefMedlineGoogle Scholar
  • 43. Sasson C, Magid DJ, Haukoos JS. Neighborhood characteristics and bystander-initiated CPR.N Engl J Med. 2013; 368:391–392. doi: 10.1056/NEJMc1214188CrossrefMedlineGoogle Scholar
  • 44. Uber A, Sadler RC, Chassee T, Reynolds JC. Bystander cardiopulmonary resuscitation is clustered and associated with neighborhood socioeconomic characteristics: a geospatial analysis of Kent County, Michigan.Acad Emerg Med. 2017; 24:930–939. doi: 10.1111/acem.13222CrossrefMedlineGoogle Scholar
  • 45. Souers A, Zuver C, Rodriguez A, Van Dillen C, Hunter C, Papa L. Bystander CPR occurrences in out of hospital cardiac arrest between sexes.Resuscitation. 2021; 166:1–6. doi: 10.1016/j.resuscitation.2021.06.021CrossrefMedlineGoogle Scholar
  • 46. Mody P, Pandey A, Slutsky AS, Segar MW, Kiss A, Dorian P, Parsons J, Scales DC, Rac VE, Cheskes S, et al. Gender-based differences in outcomes among resuscitated patients with out-of-hospital cardiac arrest.Circulation. 2021; 143:641–649. doi: 10.1161/CIRCULATIONAHA.120.050427LinkGoogle Scholar
  • 47. Morrison LJ, Schmicker RH, Weisfeldt ML, Bigham BL, Berg RA, Topjian AA, Abramson BL, Atkins DL, Egan D, Sopko G, et al; Resuscitation Outcomes Consortium Investigators. Effect of gender on outcome of out of hospital cardiac arrest in the Resuscitation Outcomes Consortium.Resuscitation. 2016; 100:76–81. doi: 10.1016/j.resuscitation.2015.12.002CrossrefMedlineGoogle Scholar
  • 48. Merchant RM, Becker LB, Yang F, Groeneveld PW. Hospital racial composition: a neglected factor in cardiac arrest survival disparities.Am Heart J. 2011; 161:705–711. doi: 10.1016/j.ahj.2011.01.011CrossrefMedlineGoogle Scholar
  • 49. Vogelsong MA, May T, Agarwal S, Cronberg T, Dankiewicz J, Dupont A, Friberg H, Hand R, McPherson J, Mlynash M, et al. Influence of sex on survival, neurologic outcomes, and neurodiagnostic testing after out-of-hospital cardiac arrest.Resuscitation. 2021; 167:66–75. doi: 10.1016/j.resuscitation.2021.07.037CrossrefMedlineGoogle Scholar
  • 50. Morris NA, Mazzeffi M, McArdle P, May TL, Burke JF, Bradley SM, Agarwal S, Badjatia N, Perman SM; CARES Surveillance Group. Women receive less targeted temperature management than men following out-of-hospital cardiac arrest due to early care limitations: a study from the CARES Investigators.Resuscitation. 2021; 169:97–104. doi: 10.1016/j.resuscitation.2021.10.036CrossrefMedlineGoogle Scholar
  • 51. Morris NA, Mazzeffi M, McArdle P, May TL, Waldrop G, Perman SM, Burke JF, Bradley SM, Agarwal S, Figueroa JF, et al; CARES Surveillance Group. Hispanic/Latino-serving hospitals provide less targeted temperature management following out-of-hospital cardiac arrest.J Am Heart Assoc. 2021; 10:e017773. doi: 10.1161/JAHA.121.023934LinkGoogle Scholar
  • 52. Jacobs CS, Beers L, Park S, Scirica B, Henderson GV, Hsu L, Bevers M, Dworetzky BA, Lee JW. Racial and ethnic disparities in postcardiac arrest targeted temperature management outcomes.Crit Care Med. 2020; 48:56–63. doi: 10.1097/CCM.0000000000004001CrossrefMedlineGoogle Scholar
  • 53. Bailey ZD, Krieger N, Agenor M, Graves J, Linos N, Bassett MT. Structural racism and health inequities in the USA: evidence and interventions.Lancet. 2017; 389:1453–1463. doi: 10.1016/S0140-6736(17)30569-XCrossrefMedlineGoogle Scholar
  • 54. Andersen LW, Holmberg MJ, Granfeldt A, Lofgren B, Vellano K, McNally BF, Siegerink B, Kurth T, Donnino MW; CARES Surveillance Group. Neighborhood characteristics, bystander automated external defibrillator use, and patient outcomes in public out-of-hospital cardiac arrest.Resuscitation. 2018; 126:72–79. doi: 10.1016/j.resuscitation.2018.02.021CrossrefMedlineGoogle Scholar
  • 55. Blewer AL, Ibrahim SA, Leary M, Dutwin D, McNally B, Anderson ML, Morrison LJ, Aufderheide TP, Daya M, Idris AH, et al. Cardiopulmonary resuscitation training disparities in the United States.J Am Heart Assoc. 2017; 6:e006124. doi: 10.1161/JAHA.117.006124LinkGoogle Scholar
  • 56. Root ED, Gonzales L, Persse DE, Hinchey PR, McNally B, Sasson C. A tale of two cities: the role of neighborhood socioeconomic status in spatial clustering of bystander CPR in Austin and Houston.Resuscitation. 2013; 84:752–759. doi: 10.1016/j.resuscitation.2013.01.007CrossrefMedlineGoogle Scholar
  • 57. Sasson C, Keirns CC, Smith DM, Sayre MR, Macy ML, Meurer WJ, McNally BF, Kellermann AL, Iwashyna TJ. Examining the contextual effects of neighborhood on out-of-hospital cardiac arrest and the provision of bystander cardiopulmonary resuscitation.Resuscitation. 2011; 82:674–679. doi: 10.1016/j.resuscitation.2011.02.002CrossrefMedlineGoogle Scholar
  • 58. Sasson C, Magid DJ, Chan P, Root ED, McNally BF, Kellermann AL, Haukoos JS; CARES Surveillance Group. Association of neighborhood characteristics with bystander-initiated CPR.N Engl J Med. 2012; 367:1607–1615. doi: 10.1056/NEJMoa1110700CrossrefMedlineGoogle Scholar
  • 59. Owen DD, McGovern SK, Murray A, Leary M, Del Rios M, Merchant RM, Abella BS, Dutwin D, Blewer AL. Association of race and socioeconomic status with automatic external defibrillator training prevalence in the United States.Resuscitation. 2018; 127:100–104. doi: 10.1016/j.resuscitation.2018.03.037CrossrefMedlineGoogle Scholar
  • 60. Allan KS, Ray JG, Gozdyra P, Morrison LJ, Kiss A, Buick JE, Zhan CC, Dorian P; Rescu Investigators. High risk neighbourhoods: The effect of neighbourhood level factors on cardiac arrest incidence.Resuscitation. 2020; 149:100–108. doi: 10.1016/j.resuscitation.2020.02.002CrossrefMedlineGoogle Scholar
  • 61. Gul SS, Cohen SA, Becker TK, Huesgen K, Jones JM, Tyndall JA. Patient, neighborhood, and spatial determinants of out-of-hospital cardiac arrest outcomes throughout the Chain of Survival: a community-oriented multilevel analysis.Prehosp Emerg Care. 2020; 24:307–318. doi: 10.1080/10903127.2019.1640324CrossrefMedlineGoogle Scholar
  • 62. LeCounte ES, Swain GR. Life expectancy at birth in Milwaukee county: a zip code-level analysis.J Patient Cent Res Rev. 2017; 4:213–220. doi: 10.17294/2330-0698.1576CrossrefMedlineGoogle Scholar
  • 63. Venkataramani A, Daza S, Emanuel E. Association of social mobility with the income-related longevity gap in the United States: a cross-sectional, county-level study.JAMA Intern Med. 2020; 180:429–436. doi: 10.1001/jamainternmed.2019.6532CrossrefMedlineGoogle Scholar
  • 64. Franzini L, Spears W. Contributions of social context to inequalities in years of life lost to heart disease in Texas, USA.Soc Sci Med. 2003; 57:1847–1861. doi: 10.1016/s0277-9536(03)00018-2CrossrefMedlineGoogle Scholar
  • 65. Eapen ZJ, Peterson ED, Fonarow GC, Sanders GD, Yancy CW, Sears SF, Carlson MD, Curtis AB, Hall LL, Hayes DL, et al. Quality of care for sudden cardiac arrest: proposed steps to improve the translation of evidence into practice.Am Heart J. 2011; 162:222–231. doi: 10.1016/j.ahj.2011.04.021CrossrefMedlineGoogle Scholar
  • 66. Sanko S, Feng S, Lane C, Eckstein M. Comparison of emergency medical dispatch systems for performance of telecommunicator-assisted cardiopulmonary resuscitation among 9-1-1 callers with limited English proficiency.JAMA Netw Open. 2021; 4:e216827. doi: 10.1001/jamanetworkopen.2021.6827CrossrefMedlineGoogle Scholar
  • 67. Haskell SE, Girotra S, Zhou Y, Zimmerman MB, Del Rios M, Merchant RM, Atkins DL. Racial disparities in survival outcomes following pediatric in-hospital cardiac arrest.Resuscitation. 2021; 159:117–125. doi: 10.1016/j.resuscitation.2020.12.018CrossrefMedlineGoogle Scholar
  • 68. Blewer AL, Schmicker RH, Morrison LJ, Aufderheide TP, Daya M, Starks MA, May S, Idris AH, Callaway CW, Kudenchuk PJ, et al; Resuscitation Outcomes Consortium Investigators. Variation in bystander cardiopulmonary resuscitation delivery and subsequent survival from out-of-hospital cardiac arrest based on neighborhood-level ethnic characteristics.Circulation. 2020; 141:34–41. doi: 10.1161/CIRCULATIONAHA.119.041541LinkGoogle Scholar
  • 69. Blewer AL, McGovern SK, Schmicker RH, May S, Morrison LJ, Aufderheide TP, Daya M, Idris AH, Callaway CW, Kudenchuk PJ, et al; Resuscitation Outcomes Consortium (ROC) Investigators. Gender disparities among adult recipients of bystander cardiopulmonary resuscitation in the public.Circ Cardiovasc Qual Outcomes. 2018; 11:e004710. doi: 10.1161/CIRCOUTCOMES.118.004710LinkGoogle Scholar
  • 70. Angell SY, McConnell MV, Anderson CAM, Bibbins-Domingo K, Boyle DS, Capewell S, Ezzati M, de Ferranti S, Gaskin DJ, Goetzel RZ, et al. The American Heart Association 2030 Impact Goal: a presidential advisory from the American Heart Association.Circulation. 2020; 141:e120–e138. doi: 10.1161/CIR.0000000000000758LinkGoogle Scholar
  • 70a. Merchant RM, Topjian AA, Panchal AR, Cheng A, Aziz K, Berg KM, Lavonas EJ, Magid DJ; on behalf of the Adult Basic and Advanced Life Support, Pediatric Basic and Advanced Life Support, Neonatal Life Support, Resuscitation Education Science, and Systems of Care Writing Groups. Part 1: executive summary: 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care.Circulation. 2020; 142(suppl 2):S337–S357. 10.1161/CIR.0000000000000918LinkGoogle Scholar
  • 71. Chugh SS, Jui J, Gunson K, Stecker EC, John BT, Thompson B, Ilias N, Vickers C, Dogra V, Daya M, et al. Current burden of sudden cardiac death: multiple source surveillance versus retrospective death certificate-based review in a large US community.J Am Coll Cardiol. 2004; 44:1268–1275. doi: 10.1016/j.jacc.2004.06.029CrossrefMedlineGoogle Scholar
  • 72. Starks MA, Schmicker RH, Peterson ED, May S, Buick JE, Kudenchuk PJ, Drennan IR, Herren H, Jasti J, Sayre M, et al; Resuscitation Outcomes Consortium (ROC). Association of neighborhood demographics with out-of-hospital cardiac arrest treatment and outcomes: where you live may matter.JAMA Cardiol. 2017; 2:1110–1118. doi: 10.1001/jamacardio.2017.2671CrossrefMedlineGoogle Scholar
  • 73. Elliott MN, Fremont A, Morrison PA, Pantoja P, Lurie N. A new method for estimating race/ethnicity and associated disparities where administrative records lack self-reported race/ethnicity.Health Serv Res. 2008; 43:1722–1736. doi: 10.1111/j.1475-6773.2008.00854.xCrossrefMedlineGoogle Scholar
  • 74. Sasson C, Haukoos JS, Bond C, Rabe M, Colbert SH, King R, Sayre M, Heisler M. Barriers and facilitators to learning and performing cardiopulmonary resuscitation in neighborhoods with low bystander cardiopulmonary resuscitation prevalence and high rates of cardiac arrest in Columbus, OH.Circ Cardiovasc Qual Outcomes. 2013; 6:550–558. doi: 10.1161/CIRCOUTCOMES.111.000097LinkGoogle Scholar
  • 75. Kronick SL, Kurz MC, Lin S, Edelson DP, Berg RA, Billi JE, Cabanas JG, Cone DC, Diercks DB, Foster JJ, et al. Part 4: systems of care and continuous quality improvement: 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care.Circulation. 2015; 132:S397–S413. doi: 10.1161/CIR.0000000000000258LinkGoogle Scholar
  • 76. Hansen CM, Kragholm K, Granger CB, Pearson DA, Tyson C, Monk L, Corbett C, Nelson RD, Dupre ME, Fosbol EL, et al. The role of bystanders, first responders, and emergency medical service providers in timely defibrillation and related outcomes after out-of-hospital cardiac arrest: results from a statewide registry.Resuscitation. 2015; 96:303–309. doi: 10.1016/j.resuscitation.2015.09.002CrossrefMedlineGoogle Scholar
  • 77. Bobrow BJ, Spaite DW, Berg RA, Stolz U, Sanders AB, Kern KB, Vadeboncoeur TF, Clark LL, Gallagher JV, Stapczynski JS, et al. Chest compression-only CPR by lay rescuers and survival from out-of-hospital cardiac arrest.JAMA. 2010; 304:1447–1454. doi: 10.1001/jama.2010.1392CrossrefMedlineGoogle Scholar
  • 78. Cummins RO. Emergency medical services and sudden cardiac arrest: the “Chain of Survival” concept.Annu Rev Public Health. 1993; 14:313–333. doi: 10.1146/annurev.pu.14.050193.001525CrossrefMedlineGoogle Scholar
  • 79. Benson PC, Eckstein M, McClung CD, Henderson SO. Racial/ethnic differences in bystander CPR in Los Angeles, California.Ethn Dis. 2009; 19:401–406.MedlineGoogle Scholar
  • 80. Matsuyama T, Scapigliati A, Pellis T, Greif R, Iwami T. Willingness to perform bystander cardiopulmonary resuscitation: a scoping review.Resusc Plus. 2020; 4:100043. doi: 10.1016/j.resplu.2020.100043CrossrefMedlineGoogle Scholar
  • 81. Abella BS, Aufderheide TP, Eigel B, Hickey RW, Longstreth WT, Nadkarni V, Nichol G, Sayre MR, Sommargren CE, Hazinski MF; American Heart Association. Reducing barriers for implementation of bystander-initiated cardiopulmonary resuscitation: a scientific statement from the American Heart Association for healthcare providers, policymakers, and community leaders regarding the effectiveness of cardiopulmonary resuscitation.Circulation. 2008; 117:704–709. doi: 10.1161/CIRCULATIONAHA.107.188486LinkGoogle Scholar
  • 82. Nuno T, Bobrow BJ, Rogge-Miller KA, Panczyk M, Mullins T, Tormala W, Estrada A, Keim SM, Spaite DW. Disparities in telephone CPR access and timing during out-of-hospital cardiac arrest.Resuscitation. 2017; 115:11–16. doi: 10.1016/j.resuscitation.2017.03.028CrossrefMedlineGoogle Scholar
  • 83. Bradley SM, Fahrenbruch CE, Meischke H, Allen J, Bloomingdale M, Rea TD. Bystander CPR in out-of-hospital cardiac arrest: the role of limited English proficiency.Resuscitation. 2011; 82:680–684. doi: 10.1016/j.resuscitation.2011.02.006CrossrefMedlineGoogle Scholar
  • 84. Anderson ML, Cox M, Al-Khatib SM, Nichol G, Thomas KL, Chan PS, Saha-Chaudhuri P, Fosbol EL, Eigel B, Clendenen B, et al. Rates of cardiopulmonary resuscitation training in the United States.JAMA Intern Med. 2014; 174:194–201. doi: 10.1001/jamainternmed.2013.11320CrossrefMedlineGoogle Scholar
  • 85. Sasson C, Haukoos JS, Eigel B, Magid DJ. The HANDDS program: a systematic approach for addressing disparities in the provision of bystander cardiopulmonary resuscitation.Acad Emerg Med. 2014; 21:1042–1049. doi: 10.1111/acem.12455CrossrefMedlineGoogle Scholar
  • 86. Del Rios M, Han J, Cano A, Ramirez V, Morales G, Campbell TL, Hoek TV. Pay it forward: high school video-based instruction can disseminate CPR knowledge in priority neighborhoods.West J Emerg Med. 2018; 19:423–429. doi: 10.5811/westjem.2017.10.35108CrossrefMedlineGoogle Scholar
  • 87. Scapigliati A, Zace D, Matsuyama T, Pisapia L, Saviani M, Semeraro F, Ristagno G, Laurenti P, Bray JE, Greif R; on behalf of the International Liaison Committee on Resuscitation Education, Implementation, and Teams Task Force. Community initiatives to promote basic life support implementation: a scoping review.J Clin Med. 2021; 10:5719. doi: 10.3390/jcm10245719CrossrefMedlineGoogle Scholar
  • 88. Donoghue A, Heard D, Griffin R, Abbadessa MK, Gaines S, Je S, Hanna R, Erbayri J, Myers S, Niles D, et al. Longitudinal effect of high frequency training on CPR performance during simulated and actual pediatric cardiac arrest.Resusc Plus. 2021; 6:100117. doi: 10.1016/j.resplu.2021.100117CrossrefMedlineGoogle Scholar
  • 89. Heard DG, Andresen KH, Guthmiller KM, Lucas R, Heard KJ, Blewer AL, Abella BS, Gent LM, Sasson C. Hands-only cardiopulmonary resuscitation education: a comparison of on-screen with compression feedback, classroom, and video education.Ann Emerg Med. 2019; 73:599–609. doi: 10.1016/j.annemergmed.2018.09.026CrossrefMedlineGoogle Scholar
  • 90. Cheng A, Nadkarni VM, Mancini MB, Hunt EA, Sinz EH, Merchant RM, Donoghue A, Duff JP, Eppich W, Auerbach M, et al; on behalf of the American Heart Association Education Science Investigators; and on behalf of the American Heart Association Education Science and Programs Committee, Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation; Council on Cardiovascular and Stroke Nursing; and Council on Quality of Care and Outcomes Research. Resuscitation education science: educational strategies to improve outcomes from cardiac arrest: a scientific statement from the American Heart Association.Circulation. 2018; 138:e82–e122. doi: 10.1161/CIR.0000000000000583LinkGoogle Scholar
  • 91. Alexander TD, McGovern SK, Leary M, Abella BS, Blewer AL. Association of state-level CPR training initiatives with layperson CPR knowledge in the United States.Resuscitation. 2019; 140:9–15. doi: 10.1016/j.resuscitation.2019.04.037CrossrefMedlineGoogle Scholar
  • 92. Blom MT, Beesems SG, Homma PC, Zijlstra JA, Hulleman M, van Hoeijen DA, Bardai A, Tijssen JG, Tan HL, Koster RW. Improved survival after out-of-hospital cardiac arrest and use of automated external defibrillators.Circulation. 2014; 130:1868–1875. doi: 10.1161/CIRCULATIONAHA.114.010905LinkGoogle Scholar
  • 93. Drennan IR, Lin S, Thorpe KE, Morrison LJ. The effect of time to defibrillation and targeted temperature management on functional survival after out-of-hospital cardiac arrest.Resuscitation. 2014; 85:1623–1628. doi: 10.1016/j.resuscitation.2014.07.010CrossrefMedlineGoogle Scholar
  • 94. Pollack RA, Brown SP, Rea T, Aufderheide T, Barbic D, Buick JE, Christenson J, Idris AH, Jasti J, Kampp M, et al; ROC Investigators. Impact of bystander automated external defibrillator use on survival and functional outcomes in shockable observed public cardiac arrests.Circulation. 2018; 137:2104–2113. doi: 10.1161/CIRCULATIONAHA.117.030700LinkGoogle Scholar
  • 95. Weisfeldt ML, Sitlani CM, Ornato JP, Rea T, Aufderheide TP, Davis D, Dreyer J, Hess EP, Jui J, Maloney J, et al; ROC Investigators. Survival after application of automatic external defibrillators before arrival of the emergency medical system: evaluation in the resuscitation outcomes consortium population of 21 million.J Am Coll Cardiol. 2010; 55:1713–1720. doi: 10.1016/j.jacc.2009.11.077CrossrefMedlineGoogle Scholar
  • 96. Buick JE, Drennan IR, Scales DC, Brooks SC, Byers A, Cheskes S, Dainty KN, Feldman M, Verbeek PR, Zhan C, et al; Rescu Investigators. Improving temporal trends in survival and neurological outcomes after out-of-hospital cardiac arrest.Circ Cardiovasc Qual Outcomes. 2018; 11:e003561. doi: 10.1161/CIRCOUTCOMES.117.003561LinkGoogle Scholar
  • 97. Ringh M, Hollenberg J, Palsgaard-Moeller T, Svensson L, Rosenqvist M, Lippert FK, Wissenberg M, Malta Hansen C, Claesson A, Viereck S, et al; COSTA study group (research collaboration between Copenhagen, Oslo, Stockholm, and Amsterdam). The challenges and possibilities of public access defibrillation.J Intern Med. 2018; 283:238–256. doi: 10.1111/joim.12730CrossrefMedlineGoogle Scholar
  • 98. Hansen SM, Hansen CM, Folke F, Rajan S, Kragholm K, Ejlskov L, Gislason G, Kober L, Gerds TA, Hjortshoj S, et al. Bystander defibrillation for out-of-hospital cardiac arrest in public vs residential locations.JAMA Cardiol. 2017; 2:507–514. doi: 10.1001/jamacardio.2017.0008CrossrefMedlineGoogle Scholar
  • 99. Weisfeldt ML, Everson-Stewart S, Sitlani C, Rea T, Aufderheide TP, Atkins DL, Bigham B, Brooks SC, Foerster C, Gray R, et al; Resuscitation Outcomes Consortium Investigators. Ventricular tachyarrhythmias after cardiac arrest in public versus at home.N Engl J Med. 2011; 364:313–321. doi: 10.1056/NEJMoa1010663CrossrefMedlineGoogle Scholar
  • 100. Chrisinger BW, Grossestreuer AV, Laguna MC, Griffis HM, Branas CC, Wiebe DJ, Merchant RM. Characteristics of automated external defibrillator coverage in Philadelphia, PA, based on land use and estimated risk.Resuscitation. 2016; 109:9–15. doi: 10.1016/j.resuscitation.2016.09.021CrossrefMedlineGoogle Scholar
  • 101. Griffis HM, Band RA, Ruther M, Harhay M, Asch DA, Hershey JC, Hill S, Nadkarni L, Kilaru A, Branas CC, et al. Employment and residential characteristics in relation to automated external defibrillator locations.Am Heart J. 2016; 172:185–191. doi: 10.1016/j.ahj.2015.09.022CrossrefMedlineGoogle Scholar
  • 102. Kilaru AS, Leffer M, Perkner J, Sawyer KF, Jolley CE, Nadkarni LD, Shofer FS, Merchant RM. Use of automated external defibrillators in US federal buildings: implementation of the Federal Occupational Health public access defibrillation program.J Occup Environ Med. 2014; 56:86–91. doi: 10.1097/JOM.0000000000000042CrossrefMedlineGoogle Scholar
  • 103. Saberian S, Pendyala VS, Siebert VR, Himmel BA, Wigant RR, Knepp MD, Orcutt JW, Mungee S, Chan DP, Baman TS. Disparities regarding inadequate automated external defibrillator training and potential barriers to successful cardiac resuscitation in public school systems.Am J Cardiol. 2018; 122:1565–1569. 10.1016/j.amjcard.2018.07.015CrossrefMedlineGoogle Scholar
  • 104. Jadhav S, Gaddam S. Gender and location disparities in prehospital bystander AED usage.Resuscitation. 2021; 158:139–142. doi: 10.1016/j.resuscitation.2020.11.006CrossrefMedlineGoogle Scholar
  • 105. Kiyohara K, Katayama Y, Kitamura T, Kiguchi T, Matsuyama T, Ishida K, Sado J, Hirose T, Hayashida S, Nishiyama C, et al. Gender disparities in the application of public-access AED pads among OHCA patients in public locations.Resuscitation. 2020; 150:60–64. doi: 10.1016/j.resuscitation.2020.02.038CrossrefMedlineGoogle Scholar
  • 106. Thornton MD, Cicero MX, McCabe ME, Chen L. Automated external defibrillators in high schools: disparities persist despite legislation.Pediatr Emerg Care. 2020; 36:419–423. doi: 10.1097/PEC.0000000000001335CrossrefMedlineGoogle Scholar
  • 107. Leung KHB, Brooks SC, Clegg GR, Chan TCY. Socioeconomically equitable public defibrillator placement using mathematical optimization.Resuscitation. 2021; 166:14–20. doi: 10.1016/j.resuscitation.2021.07.002CrossrefMedlineGoogle Scholar
  • 108. Griffis H, Wu L, Naim MY, Bradley R, Tobin J, McNally B, Vellano K, Quan L, Markenson D, Rossano JW; CARES Surveillance Group. Characteristics and outcomes of AED use in pediatric cardiac arrest in public settings: the influence of neighborhood characteristics.Resuscitation. 2020; 146:126–131. doi: 10.1016/j.resuscitation.2019.09.038CrossrefMedlineGoogle Scholar
  • 109. Grunau B, Humphries K, Stenstrom R, Pennington S, Scheuermeyer F, van Diepen S, Awad E, Al Assil R, Kawano T, Brooks S, et al. Public access defibrillators: gender-based inequities in access and application.Resuscitation. 2020; 150:17–22. doi: 10.1016/j.resuscitation.2020.02.024CrossrefMedlineGoogle Scholar
  • 110. Claesson A, Backman A, Ringh M, Svensson L, Nordberg P, Djarv T, Hollenberg J. Time to delivery of an automated external defibrillator using a drone for simulated out-of-hospital cardiac arrests vs emergency medical services.JAMA. 2017; 317:2332–2334. doi: 10.1001/jama.2017.3957CrossrefMedlineGoogle Scholar
  • 111. Ringh M, Rosenqvist M, Hollenberg J, Jonsson M, Fredman D, Nordberg P, Jarnbert-Pettersson H, Hasselqvist-Ax I, Riva G, Svensson L. Mobile-phone dispatch of laypersons for CPR in out-of-hospital cardiac arrest.N Engl J Med. 2015; 372:2316–2325. doi: 10.1056/NEJMoa1406038CrossrefMedlineGoogle Scholar
  • 112. Girotra S, Nallamothu BK, Spertus JA, Li Y, Krumholz HM, Chan PS; American Heart Association Get with the Guidelines–Resuscitation Investigators. Trends in survival after in-hospital cardiac arrest.N Engl J Med. 2012; 367:1912–1920. doi: 10.1056/NEJMoa1109148CrossrefMedlineGoogle Scholar
  • 113. myCARES. CARES Summary Report: Demographic and Survival Characteristics of OHCA.Published April 14, 2021. Accessed March 3, 2023. https://mycares.net/sitepages/uploads/2021/2020%20Non-Traumatic%20National%20Summary%20Report.pdfGoogle Scholar
  • 114. Lim ZJ, Ponnapa Reddy M, Afroz A, Billah B, Shekar K, Subramaniam A. Incidence and outcome of out-of-hospital cardiac arrests in the COVID-19 era: a systematic review and meta-analysis.Resuscitation. 2020; 157:248–258. doi: 10.1016/j.resuscitation.2020.10.025CrossrefMedlineGoogle Scholar
  • 115. Fothergill RT, Smith AL, Wrigley F, Perkins GD. Out-of-hospital cardiac arrest in London during the COVID-19 pandemic.Resusc Plus. 2021; 5:100066. doi: 10.1016/j.resplu.2020.100066CrossrefMedlineGoogle Scholar
  • 116. American Heart Association. Get With The Guidelines–Resuscitation Recognition Criteria.Updated March 3, 2023. Accessed March 3, 2023. https://www.heart.org/en/professional/quality-improvement/get-with-the-guidelines/get-with-the-guidelines-resuscitation/get-with-the-guidelines-resuscitation-recognition-criteriaGoogle Scholar
  • 117. Blewer AL, Ho AFW, Shahidah N, White AE, Pek PP, Ng YY, Mao DR, Tiah L, Chia MY, Leong BS, et al. Impact of bystander-focused public health interventions on cardiopulmonary resuscitation and survival: a cohort study.Lancet Public Health. 2020; 5:e428–e436. doi: 10.1016/S2468-2667(20)30140-7CrossrefMedlineGoogle Scholar
  • 118. Dankiewicz J, Cronberg T, Lilja G, Jakobsen JC, Levin H, Ullen S, Rylander C, Wise MP, Oddo M, Cariou A, et al; TTM2 Trial Investigators. Hypothermia versus normothermia after out-of-hospital cardiac arrest.N Engl J Med. 2021; 384:2283–2294. doi: 10.1056/NEJMoa2100591CrossrefMedlineGoogle Scholar
  • 119. Topjian AA, Scholefield BR, Pinto NP, Fink EL, Buysse CMP, Haywood K, Maconochie I, Nadkarni VM, de Caen A, Escalante-Kanashiro R, et al. P-COSCA (Pediatric Core Outcome Set for Cardiac Arrest) in children: an advisory statement from the International Liaison Committee on Resuscitation.Circulation. 2020; 142:e246–e261. doi: 10.1161/CIR.0000000000000911LinkGoogle Scholar
  • 120. Haywood K, Whitehead L, Nadkarni VM, Achana F, Beesems S, Bottiger BW, Brooks A, Castrén M, Ong ME, Hazinski MF, et alon behalf of the COSCA Collaborators. COSCA (Core Outcome Set for Cardiac Arrest) in adults: an advisory statement from the International Liaison Committee on Resuscitation.Circulation. 2018; 137:e783–e801. 10.1161/CIR.0000000000000562LinkGoogle Scholar
  • 121. Fang AHS, Lim WT, Balakrishnan T. Early warning score validation methodologies and performance metrics: a systematic review.BMC Med Inform Decis Mak. 2020; 20:111. 10.1186/s12911-020-01144-8CrossrefMedlineGoogle Scholar
  • 122. Fu LH, Schwartz J, Moy A, Knaplund C, Kang MJ, Schnock KO, Garcia JP, Jia H, Dykes PC, Cato K, et al. Development and validation of early warning score system: a systematic literature review.J Biomed Inform. 2020; 105:103410. doi: 10.1016/j.jbi.2020.103410CrossrefMedlineGoogle Scholar
  • 123. Campbell V, Conway R, Carey K, Tran K, Visser A, Gifford S, McLanders M, Edelson D, Churpek M. Predicting clinical deterioration with Q-ADDS compared to NEWS, Between the Flags, and eCART track and trigger tools.Resuscitation. 2020; 153:28–34. doi: 10.1016/j.resuscitation.2020.05.027CrossrefMedlineGoogle Scholar
  • 124. Berger DA, Chen NW, Miller JB, Welch RD, Reynolds JC, Pribble JM, Swor DR; on behalf of the CARES Surveillance Group. Substantial variation exists in post-cardiac arrest outcomes across Michigan hospitals.Resuscitation. 2021; 159:97–104. 10.1016/j.resuscitation.2020.11.007CrossrefMedlineGoogle Scholar
  • 125. Kelham M, Jones TN, Rathod KS, Guttmann O, Proudfoot A, Rees P, Knight CJ, Ozkor M, Wragg A, Jain A, et al. An observational study assessing the impact of a cardiac arrest centre on patient outcomes after out-of-hospital cardiac arrest (OHCA).Eur Heart J Acute Cardiovasc Care. 2020; 9:S67–S73. doi: 10.1177/2048872620974606CrossrefMedlineGoogle Scholar
  • 126. McNally B, Stokes A, Crouch A, Kellermann AL; CARES Surveillance Group. CARES: Cardiac Arrest Registry to Enhance Survival.Ann Emerg Med. 2009; 54:674–683.e2. doi: 10.1016/j.annemergmed.2009.03.018CrossrefMedlineGoogle Scholar
  • 127. Peberdy MA, Kaye W, Ornato JP, Larkin GL, Nadkarni V, Mancini ME, Berg RA, Nichol G, Lane-Trultt T. Cardiopulmonary resuscitation of adults in the hospital: a report of 14720 cardiac arrests from the National Registry of Cardiopulmonary Resuscitation.Resuscitation. 2003; 58:297–308. doi: 10.1016/s0300-9572(03)00215-6CrossrefMedlineGoogle Scholar
  • 128. Esangbedo I, Yu P, Raymond T, Niles DE, Hanna R, Zhang X, Wolfe H, Griffis H, Nadkarni V; on behalf of the Pediatric Resuscitation Quality (pediRES-Q) Collaborative Investigators. Pediatric in-hospital CPR quality at night and on weekends.Resuscitation. 2020; 146:56–63. doi: 10.1016/j.resuscitation.2019.10.039CrossrefMedlineGoogle Scholar
  • 129. Naim MY, Griffis HM, Burke RV, McNally BF, Song L, Berg RA, Nadkarni VM, Vellano K, Markenson D, Bradley RN, et al. Race/ethnicity and neighborhood characteristics are associated with bystander cardiopulmonary resuscitation in pediatric out-of-hospital cardiac arrest in the United States: a study from CARES.J Am Heart Assoc. 2019; 8:e012637. doi: 10.1161/JAHA.119.012637LinkGoogle Scholar
  • 130. Naim MY, Burke RV, McNally BF, Song L, Griffis HM, Berg RA, Vellano K, Markenson D, Bradley RN, Rossano JW. Association of bystander cardiopulmonary resuscitation with overall and neurologically favorable survival after pediatric out-of-hospital cardiac arrest in the united states: a report from the Cardiac Arrest Registry to Enhance Survival surveillance registry.JAMA Pediatr. 2017; 171:133–141. doi: 10.1001/jamapediatrics.2016.3643CrossrefMedlineGoogle Scholar
  • 131. Jayaram N, McNally B, Tang F, Chan PS. Survival after out-of-hospital cardiac arrest in children.J Am Heart Assoc. 2015; 4:e002122. doi: 10.1161/JAHA.115.002122LinkGoogle Scholar

eLetters(0)

eLetters should relate to an article recently published in the journal and are not a forum for providing unpublished data. Comments are reviewed for appropriate use of tone and language. Comments are not peer-reviewed. Acceptable comments are posted to the journal website only. Comments are not published in an issue and are not indexed in PubMed. Comments should be no longer than 500 words and will only be posted online. References are limited to 10. Authors of the article cited in the comment will be invited to reply, as appropriate.

Comments and feedback on AHA/ASA Scientific Statements and Guidelines should be directed to the AHA/ASA Manuscript Oversight Committee via its Correspondence page.