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I'm Rob Logan, Ph.D. senior staff National Library of Medicine substituting this week for Donald Lindberg, M.D, the Director of the U.S. National of Medicine.

Here is what's new this week in MedlinePlus.

To listen to Dr. Lindberg's comments, click here

A recent study in the Journal of the American Medical Association reports the chances to survive an out-of-the-hospital cardiac arrest in North America may depend on where you live and a community's commitment to improving emergency care.

In one of the first, comprehensive, international studies, cardiac arrest survival rates varied significantly across ten sites in the U.S. and Canada. The chances of surviving a cardiac arrest were the best in Seattle and were the worst for study sites in Alabama.

The study followed 20,520 cardiac arrest cases in 10 sites from May 2006 to April 2007. The population base surrounding the 10 sites was about 21.4 million.

Patients who lived in Seattle, Iowa, Portland (OR), and Vancouver (BC) had a better chance of surviving cardiac arrest. While the overall percent of patients who survived to hospital discharge was about 4.4 percent, survival rates ranged from about six to eight percent in the aforementioned areas.

Patients who lived in Alabama, Dallas, Ottawa, Pittsburgh, and Toronto had a worse chance of surviving cardiac arrest. While the overall percent of patients who survived to hospital discharge was about 4.4 percent, survival rates ranged from one to 3.3 percent in the aforementioned areas.

Survival rates improved everywhere if emergency medical teams provided resuscitation, and overall, 21 percent of patients who received help for ventricular fibrillation and cardiac arrest survived to hospital discharge.

It should be noted that the survival rates in Alabama (which had the lowest survival rates among the participating sites) may be better than in many areas throughout North America. The study's thirteen authors explain some medical centers in Alabama are part of a Resuscitation Outcomes Consortium, which is a pioneer, clinical research network dedicated to evaluating the treatment of patients with a life-threatening injury and to improve treatment outcomes.

So, the consortium is among the first to keep track of all cardiac arrests treated by emergency medical services provider within their service area. As an accompanying editorial explains, most communities and medical centers do not assess aggregate cardiac arrest survival rates, which may contribute to less urgency to improve emergency medical services.

Drs. Arthur Sanders and Karl Kern write and we quote… '…physicians and the public should demand data on survival from cardiac arrest from every community. Publications and organizations should use these survival data when rating cities for livability and health indices….' (end of quote).

Some other strategies to improve cardiac arrest survival rates mentioned by the site study's authors include: public education about how to recognize and help others during a cardiac arrest, as well as a well-organized emergency medical service (where emergency medical technicians and paramedics are well trained and supervised by other health care providers).

Incidentally, the impetus for an improved response is cardiac arrest is treatable if responses, such as defibrillation, occur within minutes -- and if emergency responders believe they have the ability and authority to intervene aggressively.

Among the study's limitations, the study sites' populations are not necessarily representative of all of N. America.

Yet, the study adds to mounting evidence that caring for cardiac arrest is a national, civic, and neighborhood challenge. In February, we reported a New England Journal of Medicine study found it may be better to have a cardiac arrest outside of (rather than within) a hospital. While the New England Journal of Medicine study focused on response timing instead of survival rates, both studies suggest the prospects for cardiac arrest patients (in-or-out of a hospital) leave room for improvement.

A third study, recently published in the Archives of Internal Medicine, suggests low income Americans do not get to a hospital (or treatment) as quickly as other persons after a heart attack.

MedlinePlus.gov's cardiac arrest health topic page explains a cardiac arrest can occur when the heart's rhythms become abnormal. The heart can beat too fast, too slow, or can stop. Besides a heart attack and arrhythmia, other causes of cardiac arrest include: electrocution, drowning, choking, infection, trauma, and drug overdose.

Defibrillators establish a normal contraction rhythm in a heart that is not beating properly. Defibrillators, which are about the size of a car battery, deliver an electronic shock to the heart.

To find MedlinePlus.'gov's cardiac arrest health topic page, simply type 'cardiac arrest' in the search box on MedlinePlus' home page. Then, click on 'cardiac arrest (National Library of Medicine).'

Among the options on this page include information on: the latest pertinent clinical trials, the latest research findings from leading medical journals, links to support organizations, and some information specifically for children with cardiac arrest.

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