Strategies to Increase Cardiac Arrest Survival Rates: National Academy of Medicine Recommendations

cardiac arrest
cardiac arrest
A committee of experts aims to increase widespread cardiac arrest survival rates through public awareness, enhanced EMS capabilities, and the creation of a national cardiac arrest collaborative.

More than 600 000 people in the United States experience cardiac arrest each year. Current survival rates hover at ≤6% for individuals outside of hospital settings and ≤24% for those in hospital care, making cardiac arrest the third leading cause of death in the United States, according to a report from the National Academy of Medicine (NAM).

A NAM-convened committee of experts, led by Robert Graham, MD, director of the Robert Wood Johnson Foundation’s Aligning Forces for Quality program, recognized that while breakthroughs in treatment of cardiac arrest are promising, “cardiac arrest survival rates are unacceptably low […] The ability to deliver timely interventions and high-quality care is inconsistent. Cardiac arrest treatment is a community issue, requiring a wide range of people to be prepared to act.”

The study, sponsored by multiple health organizations, including the American Heart Association, American College of Cardiology, and National Institutes of Health, among others, reports that only 3% of people in the United States receive annual CPR training, compared with 95% of people in Norway and 80% of people in Germany.

The study estimates at least 1600 people in the United States suffer cardiac arrest daily; in many communities—minority and low-income communities in particular—the survival rate is placed at ≤10%. Timely intervention is imperative, as each minute without treatment decreases the likelihood of survival, with good neurologic and functional outcomes.

The study also notes that “effective treatments for specific types of cardiac arrest are widely available and could reduce deaths and disability if they were more efficiently implemented.”

To encourage this implementation, researchers recommend public education campaigns, stress the importance of preparation, and acknowledge that “the resuscitation field has a public identity crisis […] The public often equates cardiac arrest with a heart attack, but cardiac arrests outside of hospitals […] rarely have early warning signs.”

The NAM committee has made the following recommendations to improve response and limit the range of negative effects that cardiac arrest can have on both the length and quality of a person’s life:

  • Recommendation 1: Establish a national cardiac arrest registry.
  • Recommendation 2: Foster a culture of action through public awareness and training.
  • Recommendation 3: Enhance the capabilities and performance of EMS systems
  • Recommendation 4: Set national accreditation standards related to cardiac arrest for hospitals and healthcare systems.
  • Recommendation 5: Adopt continuous quality improvement programs.
  • Recommendation 6: Accelerate research on pathophysiology, new therapies, and translation of science for cardiac arrest.
  • Recommendation 7: Accelerate research on the evaluation and adoption of cardiac arrest therapies.
  • Recommendation 8: Create a National Cardiac Arrest Collaborative.

Cardiac arrest remains a treatable medical event, the committee emphasized. Effective response requires the timely action of the public, EMS systems, healthcare systems, researchers, and professional, educational, and advocacy organizations.


  1. Graham R, McCoy MA, and Schultz AM, (Eds.). (2015). Strategies to Improve Cardiac Arrest Survival: A Time To Act. Washington, D.C.: The National Academies Press.
  2. Jacob JA. Health Agencies Update: Recommendations to Improve Cardiac Arrest Survival. JAMA. 2015;314(8):761