Surviving cardiac arrest should not depend on luck

Surviving sudden cardiac arrest depends largely on luck – and it shouldn’t be this way.

When cardiac arrest happens, every second counts. There are three things that need to be done as soon as possible to maximize chances of survival – calling 9-1-1, starting cardiopulmonary resuscitation (CPR) and using an automated external defibrillator (AED). CPR keeps blood flowing to vital organs while AEDs provide a small electrical shock to get the heart pumping again.

Unfortunately, surviving cardiac arrest in our communities today depends heavily on luck. Less than 50 per cent of those who experience cardiac arrest in the community receive bystander CPR and less than 3 per cent have an AED used prior to paramedics arriving on scene. As a scientist here at Queen’s University, my work is focused on testing new strategies and technologies to reduce our dependence on luck. Three projects inspire optimism.

The PulsePoint Respond app connects people trained in CPR with 9-1-1 services. Think of it like Uber for basic life support. In communities with this technology, people who are willing and able to do CPR are encouraged to download PulsePoint onto their mobile phones. When someone calls 9-1-1 for a cardiac arrest, the PulsePoint system automatically notifies all PulsePoint users within 400 metres of the incident location. A map guides users to the emergency and the nearest public access AED, providing an opportunity to start CPR and use an AED while emergency personnel are on the way. As of April 2023, PulsePoint has 908,000 active users across North America and has sent more than 1.6 million alerts for suspected cardiac arrest. With funding from the Canadian Institutes of Health Research, we partnered with the PulsePoint app developers to implement a clinical trial across British Columbia and in Winnipeg and Columbus, Ohio, that aims to randomize 552 cardiac arrest events and measure the effectiveness of this strategy.

Volunteers are sent to calls for cardiac arrests in their communities and will likely arrive before paramedics.

The Neighbours Saving Neighbours program targets rural communities with longer than average paramedic response times. Citizens in these communities become volunteers for the local paramedic service, are trained in CPR, and then equipped with AEDs. The volunteers are sent to calls for cardiac arrests in their communities and, given their proximity as neighbours, will likely arrive before paramedics. Our pilot study in Frontenac County, north of Kingston, Ont., will evaluate this strategy before we scale-up the program to other Canadian communities. With more than 100 people volunteering in the first two weeks after launch, we are well on our way to our target of 250 volunteers for the Frontenac pilot.

Finally, AED deployment is about to undergo a paradigm shift. AEDs are rarely owned and carried by individuals because of high cost and poor portability. Unfortunately, public access defibrillation, involving placement of AEDs in transit hubs, public buildings and other public settings has failed as a stand-alone strategy to ensure early defibrillation. Less than 3 per cent of people who experience a cardiac arrest have a public-access AED used on them.

New AED technology, however, is about to change all of this. CellAED is the world’s first personal-use AED. Weighing less than 300 grams and costing approximately one-tenth that of a conventional AED, CellAED is a more portable and affordable option that could significantly improve access to these life-saving devices by allowing them to be in every home, purse, or gym bag. The CellAED could do for cardiac safety what smoke detectors and home fire extinguishers did for fire safety in the 1980s. We might soon look back on public-access AEDs with the same sense of nostalgia we get when remembering the public telephone booth. CellAED has achieved regulatory approval to sell in more than 70 countries around the world including the United Kingdom, the European Union, Australia and New Zealand. The company is trying to get on the ground in North America sometime in 2024, but work is underway to gain Health Canada approval and add CellAED to Canada sooner to support the Neighbours Saving Neighbours program.

Leave luck to the casinos and games of chance. With innovations like PulsePoint Respond, Neighbours Saving Neighbours and the revolutionary CellAED, early bystander CPR and defibrillation can become more reliable links in the Chain of Survival for cardiac arrest. Perhaps in the not-too-distant future, we will witness these crucial components of our response becoming an expectation, rather than a mere wish.