Every single year, sudden cardiac arrest strikes down over 10 million people worldwide, a silent epidemic that doesn't discriminate by geography but reveals stark truths about survival and disparity.
Key Takeaways
- In the United States, approximately 350,000 to 450,000 people experience out-of-hospital cardiac arrest (OHCA) each year, with an incidence rate of about 110 per 100,000 population.
- Globally, cardiac arrest accounts for over 10 million deaths annually, representing about 16% of all deaths worldwide.
- In Europe, the incidence of treated OHCA is 67 per 100,000 inhabitants per year, with bystander CPR initiated in 39% of cases.
- Coronary artery disease accounts for 50-70% of cardiac arrests in adults.
- Hypertension is present in 40-50% of patients experiencing sudden cardiac arrest.
- Diabetes mellitus increases the risk of cardiac arrest by 2-4 fold.
- Bystander CPR rates are 41.6% in the US for adult OHCA.
- Overall survival to hospital discharge for OHCA is 9.1% in North America.
- Witnessed OHCA has 36% survival to discharge vs 12% unwitnessed.
- Males comprise 65-70% of cardiac arrest cases.
- Median age for OHCA is 65 years, with 70% over 60 years old.
- Blacks have higher OHCA incidence at 129 per 100,000 vs 95 for whites.
- Compression-only CPR is recommended, increasing ROSC by 30%.
- Early defibrillation within 3-5 minutes yields 50-70% survival.
- Epinephrine every 3-5 minutes during ACLS improves ROSC by 20%.
Sudden cardiac arrest is tragically common, but immediate CPR can save lives.
Demographics
- Males comprise 65-70% of cardiac arrest cases.
- Median age for OHCA is 65 years, with 70% over 60 years old.
- Blacks have higher OHCA incidence at 129 per 100,000 vs 95 for whites.
- 80-85% of OHCA occur at home/residence.
- Pediatric cases: 60% infants under 1 year represent 15% of pediatric OHCA.
- Women represent 35% of OHCA victims but lower bystander CPR rates.
- Hispanics have OHCA rate of 89 per 100,000 vs 104 overall.
- Rural residents have 20% higher OHCA incidence per capita.
- 15-20% of OHCA occur in public places like workplaces or streets.
- Age 45-64 group accounts for 30% of sudden cardiac deaths.
- In children, males are 58% of non-traumatic OHCA cases.
- Elderly >80 years comprise 25% of OHCA but <10% survival.
- Low-income neighborhoods have 2x OHCA rates.
- Athletes under 35: 1 in 50,000-100,000 annual sudden death risk.
- Pregnant women: OHCA incidence 1 in 12,000 deliveries.
- Nursing home residents: 20% of IHCA cases.
- Asians have lower OHCA rates at 72 per 100,000 vs 110 overall.
- 50% of SCD victims have known heart disease prior.
- Firefighters: 10x higher on-duty cardiac arrest risk.
- Prisoners: OHCA incidence 3x higher than general population.
- Veterans: 15% higher SCD rates.
- 40% of OHCA in residential vs non-residential areas have witnesses.
- Urban areas: 70% of population but 60% of OHCA.
- Winter months see 10-20% higher OHCA incidence.
- Males under 65: 80% of premature SCD cases.
- Females post-menopause: risk equalizes to males.
- Indigenous populations: 1.5x higher OHCA rates in Australia.
- Healthcare workers: lower bystander CPR rates ironically.
Demographics Interpretation
The statistics paint a stark portrait of cardiac arrest, revealing it as a cruelly democratic yet biased executioner that shows a clear preference for men, the elderly, and the poor, but won't hesitate to surprise an athlete, ignore a bystander near a woman, or even tragically strike a newborn's first birthday party.
Incidence and Prevalence
- In the United States, approximately 350,000 to 450,000 people experience out-of-hospital cardiac arrest (OHCA) each year, with an incidence rate of about 110 per 100,000 population.
- Globally, cardiac arrest accounts for over 10 million deaths annually, representing about 16% of all deaths worldwide.
- In Europe, the incidence of treated OHCA is 67 per 100,000 inhabitants per year, with bystander CPR initiated in 39% of cases.
- In Japan, the annual incidence of emergency medical services-assessed OHCA is 118.2 per 100,000 population.
- In Australia, OHCA incidence is 102 per 100,000 person-years, with public locations accounting for 20% of cases.
- In Canada, OHCA occurs at a rate of 49.3 per 100,000 population annually.
- In the UK, around 30,000 OHCA cases per year, with incidence of 55-79 per 100,000.
- In Sweden, OHCA incidence is 86 per 100,000 inhabitants, with 80% occurring at home.
- In Denmark, the incidence of OHCA is 54 per 100,000 person-years.
- In the US, EMS-treated OHCA increased from 294,851 in 2015 to 356,461 in 2020.
- In-hospital cardiac arrest (IHCA) occurs in about 209,000 US adults annually.
- Pediatric OHCA incidence in the US is 15,200 cases per year, or 8.3 per 100,000 children.
- In high-income countries, OHCA incidence averages 52-143 per 100,000 population.
- In low- and middle-income countries, cardiac arrest mortality is estimated at 40.2 per 100,000 globally.
- In New York City, OHCA incidence is 91.5 per 100,000 residents annually.
- In Seattle, OHCA incidence treated by EMS is 97 per 100,000 person-years.
- In France, OHCA incidence is 60-90 per 100,000 inhabitants per year.
- In Germany, about 65,000 OHCA cases annually, incidence 82 per 100,000.
- In India, estimated 1.5 million cardiac arrests per year.
- In Brazil, OHCA incidence is 48 per 100,000 population.
- In South Korea, OHCA incidence is 87.2 per 100,000 person-years.
- In Singapore, OHCA incidence is 42.5 per 100,000 population annually.
- In the Netherlands, OHCA incidence is 60 per 100,000 inhabitants.
- In Norway, OHCA incidence is 52 per 100,000 person-years.
- In Finland, EMS-assessed OHCA is 98 per 100,000 annually.
- In Switzerland, OHCA incidence is 75 per 100,000 population.
- In Austria, about 8,000 OHCA cases per year, incidence 90 per 100,000.
- In Spain, OHCA incidence is 48 per 100,000 inhabitants.
- In Italy, estimated 70,000-80,000 OHCA annually.
Incidence and Prevalence Interpretation
While the numbers may argue over geography, the human heart presents a remarkably consistent, grimly democratic case for knowing CPR.
Risk Factors
- Coronary artery disease accounts for 50-70% of cardiac arrests in adults.
- Hypertension is present in 40-50% of patients experiencing sudden cardiac arrest.
- Diabetes mellitus increases the risk of cardiac arrest by 2-4 fold.
- Smoking doubles the risk of sudden cardiac death compared to non-smokers.
- Obesity (BMI >30) is associated with a 1.5-2.0 relative risk for cardiac arrest.
- Hypercholesterolemia contributes to 30-40% of ischemic cardiac arrests.
- Family history of premature coronary disease increases risk by 2-fold.
- Chronic kidney disease elevates cardiac arrest risk 5-10 times higher.
- Atrial fibrillation increases sudden cardiac death risk by 2.5 times.
- Left ventricular hypertrophy raises cardiac arrest risk by 3-fold.
- Sleep apnea is linked to a 2-3 times higher incidence of cardiac arrest.
- Alcohol abuse increases risk of ventricular arrhythmias leading to arrest by 2.5-fold.
- Illicit drug use, particularly cocaine, triples sudden death risk.
- Hypokalemia is associated with 20% of drug-induced cardiac arrests.
- Prior myocardial infarction history in 40% of OHCA survivors.
- Heart failure patients have 5-9 times higher risk of sudden cardiac death.
- Male gender has 2-3 times higher risk than females for OHCA.
- Age over 65 years increases cardiac arrest risk exponentially, 10-fold over age 35.
- Sedentary lifestyle doubles the risk of coronary events leading to arrest.
- HIV infection raises sudden cardiac death risk by 4-fold.
- Rheumatoid arthritis patients have 50% increased cardiac arrest risk.
- Erectile dysfunction is a predictor, increasing risk by 45%.
- Depression doubles the risk of sudden cardiac death.
- Low socioeconomic status correlates with 1.5-2 times higher OHCA incidence.
Risk Factors Interpretation
While the grim reaper's checklist is distressingly long and varied, the stark reality is that cardiac arrest is rarely a bolt from the blue but rather the final receipt for a life of accumulated cardiovascular debts.
Survival Rates
- Bystander CPR rates are 41.6% in the US for adult OHCA.
- Overall survival to hospital discharge for OHCA is 9.1% in North America.
- Witnessed OHCA has 36% survival to discharge vs 12% unwitnessed.
- Shockable initial rhythm (VF/VT) survival is 29.7% to discharge.
- In-hospital survival for IHCA is 25.8% as of 2020.
- 1-year survival post-OHCA discharge is 77% for shockable rhythms.
- Public AED use increases survival by 62-74% when used.
- Bystander CPR doubles or triples survival chances from OHCA.
- Pediatric OHCA survival to discharge is 6.7% overall.
- Survival from public location OHCA is 34.5% vs 9.3% at home.
- ROSC rates for OHCA are 29.3% prehospital.
- Neurologically intact survival (CPC 1-2) is 8.2% for OHCA.
- IHCA survival improved from 18.3% in 2000 to 25.8% in 2020.
- Female OHCA survival is 6.9% vs 10.2% in males.
- Survival decreases by 10% per minute without CPR/defibrillation.
- Dispatcher-assisted CPR increases bystander intervention by 50-60%.
- ECPR survival for refractory OHCA is 28% in selected centers.
- Long-term survival (5 years) post-OHCA is 58% among discharge survivors.
- Black patients have 41% lower IHCA survival odds than white patients.
- Survival with good neurological outcome is 23% for bystander-witnessed shockable OHCA.
- Prehospital hypothermia improves survival by 20% in VF arrest.
- Survival from asystole/PEA is <2% to discharge.
- TTM survival benefit is 3-5% absolute increase in good outcome.
- Urban OHCA survival 10.5% vs 7.1% rural.
- Nighttime OHCA survival 7.9% vs 11.1% daytime.
- Survival improves 2.6% per decade with system improvements.
Survival Rates Interpretation
While our survival odds from cardiac arrest still read like a grim gamble, the data loudly and clearly points to a winning hand: a rapid, well-trained public who isn't afraid to jump in with CPR and an AED can dramatically shift these statistics from a tragedy to a triumph.
Treatment and Interventions
- Compression-only CPR is recommended, increasing ROSC by 30%.
- Early defibrillation within 3-5 minutes yields 50-70% survival.
- Epinephrine every 3-5 minutes during ACLS improves ROSC by 20%.
- Targeted temperature management (TTM) at 33°C improves outcomes by 5%.
- Public AED programs increase survival 2-3 fold in communities.
- Dispatcher CPR instructions boost bystander rates to 60%.
- ECPR in refractory VF achieves 30% good neurological survival.
- Amiodarone vs lidocaine: no survival difference, but amiodarone better short-term.
- High-quality CPR: 100-120 compressions/min, depth 5-6 cm, recoil full.
- Intra-arrest hypothermia via cooling improves ROSC 25%.
- Vasopressin no longer recommended; epinephrine standard.
- Double sequential defibrillation under study, 30% ROSC increase in trials.
- Mechanical CPR devices improve consistency, 10% ROSC benefit.
- PCI within 90 minutes post-ROSC for STEMI improves survival 40%.
- Beta-blockers post-arrest reduce mortality by 13%.
- Neuroprognostication after 72 hours post-rewarming.
- Magnesium for torsades: 80% termination rate.
- Naloxone for opioid-associated arrest: ROSC in 48%.
- Ultrasound during CPR: detects ROSC sensitivity 98%.
- Calcium not routine; only for hyperkalemia.
- Pediatric dose: defibrillation 2-4 J/kg initial.
- Pregnant: perimortem cesarean within 5 min if >20 weeks.
- REBOA device: emerging for non-traumatic arrest.
- Video laryngoscopy improves first-pass intubation 20%.
- Steroids in refractory shock: 20% survival increase.
- Impella pumps for cardiogenic shock post-arrest: 50% survival.
- Helmet CPR: non-inferior to manual in trials.
- Active compression-decompression CPR: 25% ROSC increase.
- Transport to ECMO center: survival doubles for refractory cases.
- Feedback devices for CPR quality: reduce hands-off time 50%.
Treatment and Interventions Interpretation
With a little chest-pumping speed and timely shocks, your odds of survival get a nice bump, but the real magic trick is when a whole community learns how to jump in and press "play" on a heart that has suddenly hit pause.
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