Improving Sudden Cardiac Arrest Survival Rates in the U.S.: Interview with Nicholas J. Jouriles, MD, FACEP

Interview by Jodie Elrod
Interview by Jodie Elrod
A new survey completed by the American College of Emergency Physicians (ACEP) shows that 90 percent of emergency physicians believe that resuscitation practices in the United States are not very effective. In this interview, we speak with Dr. Jouriles, ACEP President, about the findings. When was the State of Resuscitation survey done? How many were surveyed? The State of Resuscitation survey was conducted in September 2008 by Saperstein Associates, Inc., an independent opinion research company. It was commissioned by the ACEP. There were 1,056 questionnaires completed by ACEP members. One finding from this survey showed that 90 percent of emergency physicians believe that resuscitation practices in the United States are not very effective. Were you surprised by these results? Why are these findings so significant? I am not surprised. The patients involved are, for all intents and purposes, dead, so most will not do well no matter what the intervention. All emergency physicians realize this, and we all count the miracles when we are successful in bringing someone back to life. Describe some of the other important findings from this survey. The most important finding is that most patients undergoing cardiopulmonary arrest die. This is well known in the medical community, but the American public is exposed to different, unrealistically better results in the media. Several emerging technologies are available for treating sudden cardiac arrest. Can you tell us about some of these therapies, such as CPR feedback devices? How do these technologies work, and how will they help improve survival? Yes, there are several new devices and practices being studied. CPR feedback devices offer immediate feedback to the provider to help optimize therapy. Another promising modality being tried is hypothermia, which is cooling the patient. Since the probability of successful resuscitation is low, any proven improvement will be a welcome addition to our treatment. What are some of the other ways that resuscitation practices can be improved upon? Some ways include early recognition of arrest, hopefully before it happens, and early initiation of treatment. Can you provide an example of a community or hospital where thorough resuscitation practices and/or a good PAD program is in place? All communities and hospitals do the best they can. Most have similar survival rates. The perennial leader amongst major metropolitan areas is King County in Seattle. Many years ago they started a program for bystander CPR based on teaching as many citizens as possible. They also involved the city's paramedics to have a quick response time. How does the U.S. differ from other countries in terms of resuscitation programs and practices? The medical care is similar but every country has a different overall system. As President Obama discusses health care reform, I urge him not to forget the emergency care system. It saves lives every day, yet is woefully underfunded and has not been mentioned among all the campaign rhetoric. In 2008 the American College of Emergency Physicians celebrated its 40th anniversary. Tell us about the ACEP, including information about membership and future goals. ACEP is the oldest and largest emergency medicine organization in the world. We represent the needs of our 27,000 members on behalf of the 120 million patients we treat every year. ACEP wants quality and affordable emergency care to be available at all times and all locations for every American. What efforts might the ACEP be making in 2009 to help improve resuscitation for SCA victims? ACEP supports our members who do resuscitation research. We publicize their findings and educate our members.