National Academy of Medicine Recommendations

National Academy of Medicine:
Improving Cardiac Arrest Outcomes

The National Academy of Medicine (formerly the Institute of Medicine) has a big role: providing advice on a variety of issues related to biomedical science, medicine, and health. The New York Times called NAM the country’s “most esteemed and authoritative adviser on issues of health and medicine, and its reports can transform medical thinking around the world.” One such report, Strategies to Improve Cardiac Arrest Survival, is considered a landmark document that includes eight strategic recommendations to help diminish barriers to successful cardiac arrest treatment and, as a result, improve what the IoM called “an unacceptably low survival rate.

“While breakthroughs in understanding and treatment are impressive, the ability to consistently deliver timely interventions and high-quality care is less than impressive,” according to the report. “The result is too many people dying from cardiac arrest. Based on recent estimates, more than 1,600 people suffer a cardiac arrest every day in the United States, defining an immense and sustained public health problem.”

Take Action: NAM’s 8 Strategic Recommendations

Create a nationwide
Cardiac Arrest Registry

This collaborative effort that includes state and local health departments, led by the Centers for Disease Control and Prevention, should collect cardiac arrest data—both out-of-hospital and in-hospital—to create a centralized database that not only improves federal and state accountability but also informs data-driven decisions that improve cardiac arrest outcomes. Data should be publicly available for a variety of reasons: to improve the general public’s knowledge of cardiac arrest treatments, to monitor the performance of medical services and healthcare systems (and make applicable improvements), and identify opportunities for proactive intervention, thereby reducing geographic, economic and other disparities that adversely affect survival rates.

Use training, improved awareness to encourage public action

Accessible medical assistance may not be readily available, which is why raising public awareness of both cardiac arrest symptoms and treatment is a critical part of improving outcomes. This collaborative effort should, according to the NAM, include entities like state and local departments of health and education and leading organizations in cardiac arrest response and treatment to deliver information and training to community groups, neighborhood organizations, employers, and professional organizations, among others. Training should include cardiopulmonary resuscitation (CPR) and automated external defibrillators (AED).

Develop protocols,
standards to improve
EMS performance

Consistency wherever possible is key to improving cardiac arrest response and results. The National Highway Traffic Safety Administration (the informal agency for EMS) should coordinate with other stakeholders to develop standard, dispatcher-assisted protocols, as well as educational standards that can be used across public safety points of contact. NAM also recommended establishing standardized CPR training curriculum, including definitions, that can become a foundational element of basic emergency medical technician training and certification.

Create national cardiac arrest
accreditation standards for
hospitals, health systems

Cardiac care can be improved and made more consistent with the creation of national accreditation standards that guide cardiac arrest care for both adult and pediatric patients. NAM recommended these standards be established by The Joint Commission in collaboration with the American Red Cross, the American Heart Association, hospital systems, hospitals, professional organizations and patient advocacy groups.

Implement formal, continuous quality improvement programs

NAM urged Emergency Medical Services systems, healthcare systems, and hospitals to “adopt formal, continuous quality improvement programs for cardiac arrest response.” These programs can have multi-faceted benefits: creating organization-specific accountability for specific, applicable cardiac arrest measures; help guide and implement core training to ensure EMS and hospital personnel are prepared to respond to adult and pediatric cardiac arrest patients; and create and share data for local, state and national quality improvements.

Support and prioritize research on cardiac arrest treatments

Research is a critical step in identifying new, effective cardiac arrest treatments. Just as collaboration is vital in many of the other recommendations, collaboration among several organizations—including the National Institutes of Health, the American Heart Association and the U.S. Department of Veterans Affairs, according to NAM—should be used to build a nationwide research infrastructure “that will support and accelerate innovative research on the causal mechanisms of onset, pathophysiology, treatment and outcomes of cardiac arrest,” according to NAM.

Prioritize and accelerate research on cardiac arrest therapies

Identifying cardiac arrest treatments is a key step, but equally important is the widespread adoption of best practices related to those treatments. NAM recommended collaboration between the National Institutes of Health, the U.S. Department of Veterans Affairs, the Agency for Healthcare Research and Quality and the Patient-Centered Outcomes Research Institute to prioritize research related to the identification and implementation of best practices; using innovative technologies to increase bystander knowledge of CPR and AED; and developing new strategies to ease the implementation of cardiac arrest treatments.

Create a national cardiac arrest collaborative

Guided by organizations and stakeholders such as the American Heart Association, the American Red Cross, the U.S. Department of Health and Human Services, other federal agencies, professional organizations and patient advocates, a nationwide cardiac arrest collaborative can play a key role in unifying the broader cardiac arrest field, helping to identify and work toward common goals that include improving cardiac arrest survival rates. Within the framework of the collaborative, a variety of proactive steps can be taken, including information exchange, working groups, action strategies, the creation of stakeholder toolkits and an annual collaborative meeting during which to discuss goals and monitor progress.

Read the full report for more information