Of the 1,000 Nova Scotians who suffer an out-of-hospital cardiac arrest each year, only about 6% (60) of them will survive.
On Tuesday members of the provincial Standing Committee on Health heard from experts about ways cardiac arrest outcomes in Nova Scotia could be improved.
It turns out bystanders can play a key role.
“The unfortunate reality is that the large majority of patients do not survive a cardiac arrest,” Dalhousie University professor and assistant dean of clinical research Dr. John Sapp told the committee.
Sapp, who’s also a practicing cardiologist at the QEII Health Sciences Centre, said when a cardiac arrest strikes, irreversible brain damage begins within about four minutes. After that, the survival rate drops by about 10% per minute.
Performing cardiopulmonary resuscitation (CPR) increases the chances of survival by ensuring the continuation of some blood flow. It can prolong the window long enough to prevent brain and organ damage in a patient until someone gets to them with a defibrillator.
A repeated refrain during Tuesday’s meeting was the importance of raising a generation of heroes — bystanders who recognize the signs of cardiac arrest, can perform CPR, and know how to use an automated external defibrillator (AED) while waiting for first responders to show up.
Sapp said if more people recognized the signs of cardiac arrest, knew how to perform CPR, and acted immediately, that stark survival statistic could change for the better.
“Calling EHS and doing CPR combined with an AED result in the best chance of survival and the best outcomes,” Sapp said.
“An effective response system depends upon us as a community to rescue one another, to provide that first aid until our specialists can get there.”
There was applause when Sapp acknowledged a Grade 3 student in the gallery along with the “hero” teacher who saved her life by performing CPR for seven and a half minutes after she collapsed and before first responders arrived.
Key to improving survival rates
Kathryn Rand, director of health policy and systems with Heart & Stroke Nova Scotia, told the committee that simply put, improving cardiac arrest outcomes means saving more lives. She described the difference between a heart attack and cardiac arrest.
“A heart attack is like a plumbing issue. It’s when the blood flow to the heart is slowed or blocked,” Rand said.
“A cardiac arrest is more like an electrical issue. It’s when it shuts off and stops beating. So not surprisingly, this is going to lead to death if it’s not treated immediately.”
Rand said cardiac arrest can happen to anyone of any age at any time or place without warning. Signs include sudden collapse, being unresponsive to touch or sound, and not breathing normally.
“The key to improving survival rates involves equipping Nova Scotians with the equipment needed to provide a layer of protection to cardiac arrest victims when an emergency strikes,” Rand said.
There were four highlights Rand wanted people to take from Tuesday’s presentation: their plan to create a generation of heroes by embedding CPR and AED education into schools; ensuring every Nova Scotian knows how to restart a heart; free AEDs that are moved from locked places to fully accessible outdoor cabinets and made available 24/7; and the need to invest in research.
Rand said Nova Scotia is also one of four provinces involved in a pilot CPR education project that will be rolled out at five sites. It will be geared towards students in Grades 7 to 9.
“It’s an immersive documentary engaging series that actually walks students through a teacher having a cardiac arrest, and then they do perform two minutes of CPR and you learn how to apply an AED,” she said, adding they’ve been working with the Department of Education to set it up.
Research findings from that project will help inform implementation of the program throughout the province.
“Research from other countries shows that cardiac arrest survival rate improves significantly when CPR and AED education is integrated into school programs,” Dr. Santokh Dhillon, Dalhousie University professor and IWK Children’s Heart Centre pediatric cardiologist/electrophysiologist said.
“We are less concerned about the type of education or training used as long as it is feasible, effective, and self-sustaining.”
Dhillon said much like learning most skills, the younger you start and the more you repeat it, the longer you’ll retain it.
“Children in general, they are very receptive, they learn quickly, and they act very swiftly,” Dhillon said.
‘The tool to save a life’
Mike Janczyszyn, an advanced care paramedic and the EHS AED Registry Program Coordinator, also addressed the committee. While the provincial registry is approaching 1,700 AEDs across the province, Janczyszyn said they know there are more out there. He urged people to ensure their AED is on the provincial registry.
Janczyszyn also said the awareness, promotion, and education piece will have the biggest impact on saving lives.
“Our goal and desire is to have AEDs become a normal feature of daily lives across the province in the same way that people see fire extinguishers, we want people to notice where they are so they can act quickly,” Janczyszyn said.
He added that while they’ve done “great things so far” with their partners, they need more help from Nova Scotians to get to where they want to be.
“Imagine a future where people survive cardiac arrest. Imagine the general public saving lives of all ages because they learn CPR. Imagine walking into every building that has an AED and knowing that there’s one easily accessible,” he said.
“Your co-worker, your family member, or your friend could potentially be saved within a moment’s notice. Imagine going for a bike ride in Victoria Park in Truro and seeing an AED right there in front of you and knowing that you have the tool to save a life if that were to happen right in front of you.”
Janczyszyn said Nova Scotians wanting to discover where AEDs are located in their communities can visit their website, which features CPR and AED-related information.
“The only caveat to that is it is a voluntary map, so I can tell you right now that there are some registered AEDs for us that would be linked up to the medical communications centre that are not exactly on that map due to it being a voluntary map,” he said.
Role of bystanders critical
Provincial medical director for Emergency Health Services (EHS) and Dalhousie University professor Dr. Andrew Travers echoed the comments of previous speakers. He said the importance of improving bystander awareness of what to do when someone collapses can’t be overstated.
“Even with the fastest EMS system in the world, we can’t get there in that first two minutes, three minutes, and four minutes, especially in rural and remote areas of the province,” Travers said.
“So it’s critical that regardless of how the health system is behaving, that people know what to do and how to do it and that begins by calling 911, following the directions that we give with telephone CPR. But even more importantly, having that community conversation of what can we do about knowing CPR and AED use.”
Travers said ambulances in Nova Scotia are “mini emergency departments” with a formulary of more than 50 medications compared with the 10 or 12 found in most EMS agencies in the country. He said while paramedics and those in small and large emergency departments “can do a lot,” the role of bystanders is critical.
“The odds of survival, despite everything we do as clinicians, pales compared to the odds of survival if a bystander knows what to do by doing chest compressions and accessing an AED,” Travers said.
Generation of heroes
Sapp said their research has shown that being in a rural area makes it more difficult to survive a cardiac arrest, but those chances can be improved.
“We do have to count on each other more when we’re not immediately next door to the hospital, we have to look after each other until help can get there, and that buys more time,” he said.
In his closing remarks, Sapp encouraged the committee to help them raise a generation of heroes, children who know what to do when tragedy is about to strike and can change the course.
“We’ve talked about a few interventions that we think are the low hanging fruit, relatively easy things that can make a big difference, and that is teaching our children how to provide first aid with CPR when it’s needed, increasing awareness, making AEDs more readily accessible,” Sapp said.
“They should be like a fire extinguisher. You walk in, you know where it is, and maybe you just file it in the back of your head. And finally, to support us in trying to do more research to provide better outcomes.”