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November 2017

Improving Outcomes After Out-of-Hospital Cardiac Arrest

Author Affiliations
  • 1Department of Emergency Medicine, University of Arizona, Tucson
  • 2Tucson Fire Department, Tucson, Arizona
  • 3Department of Emergency Medicine, University of New Mexico, Albuquerque
  • 4University of Washington-Harborview Center for Prehospital Emergency Care, Harborview Medical Center, Seattle
  • 5Department of Medicine, University of Washington, Seattle
JAMA Cardiol. 2017;2(11):1183-1184. doi:10.1001/jamacardio.2017.3472

Persevere and preserve yourself for better circumstances.


Cardiac arrest is the cessation of cardiac activity associated with unresponsiveness, no normal breathing, and no signs of circulation.1 Most out-of-hospital cardiac arrest (OHCA) occurs in residential settings, and arrest in a private location is associated with a worse outcome than that in a public location.2 For decades, outcomes after OHCA did not significantly improve in many communities.3 Multiple communities in large, geographically separate locations have recently reported that efforts to increase use of effective interventions in the field are associated with improved survival after cardiac arrest.4,5 In this issue of JAMA Cardiology, Fordyce et al6 extend these observations by demonstrating that implementation of multiple interventions is associated with significantly improved outcomes after arrest in residential as well as public locations and overall in North Carolina. These improvements were temporally associated with increased use of cardiopulmonary resuscitation (CPR) by bystanders as well as defibrillation by emergency medical services (EMS) professionals who were part of the organized medical response to the event. Enthusiasm for the demonstration of improved survival in North Carolina should be tempered by the observation that only 29.6% of counties in the study state were able to fully participate.6

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