The CPR Problem

Here are the facts. According to the American Heart Association:

  • CPR within the first 2 minutes of sudden cardiac arrest can double or triple a victim’s chance of survival.
  • Only 32% of the time do victims of cardiac arrest receive bystander CPR.
  • Less than 8% of out-of-hospital cardiac arrest patients survive. (today’s chance of survival)
  • There are nearly 383,000 out-of-hospital sudden cardiac arrests per year (88% occur “at home”)

Based on these statistics (and some rough math…very rough math), 30,640 people survive out-of-hospital cardiac arrest each year (8% of 383,000). If CPR is delivered promptly, we can save an additional 30,640 to 61,280 people per year (“double or triple a victim’s chance of survival”), for a total of up to 91,920 saves (8% * 3 = 24% of 383,000 = 91,920).

This is great, so what’s the problem?

In a best case scenario, we’re saving UP TO 24% of victims. This is assuming quality CPR is delivered and that bystanders act. Of course, there are likely many other factors and assumptions in play that I’m omitting for purposes of simplicity.

As we know, studies have indicated that there is a 10% decrease in survivability for every 1 minute that passes after cardiac arrest. Some studies indicate a 90% chance of survival if defibrillation is delivered within the first  minute! (note: while unrealistic to assume AEDs could be applied within 1 minute of all SCA victims, just for fun, 90% of 383,000 is 344,700, over a quarter-million more saves than CPR alone).

Additionally, the AHA states that they train 12 million people annually. While prices for CPR training services vary tremendously, from “free” training donated by a fire department to high rates charged in expensive cities like New York or San Francisco, a (very rough) rate of $50/person “feels” like a reasonable mean (see our rates for drop in training).

$50 per person * 12,000,000 people = $600,000,000 dollars spent by the market in AHA training alone. The Red Cross, NSC, and other training organizations/curriculums add to this total.

Average price of an AED? Looking at the prices found on publicly available sites and leaders like www.aedsuperstore.com, $1,300 is a solid ballpark figure.

$600,000,000 spent on CPR training divided by $1,300 per AED = 461,538 AED units (if all funds were to be spent on deploying AEDs instead of providing CPR training services).

So the question (after all of this statistically-flawed math and these incongruous assumptions), would adding 461,538 new AED units to the United States market each year save more lives than the 30,640 lives we’re saving today? Perhaps it would. Perhaps it wouldn’t. But I can’t help but think that the ratio of dollars-spent-on-CPR-to-dollars-spent-on-AEDs has to adjust if we truly want to change the save rates in the United States. After all, CPR is just buying time for an AED to arrive….

A word of caution: I’ve completely over-simplified these figures and made horrible comparisons. In no way are we advocating for less CPR training. In fact, one of the most important aspects of CPR training is that we’re able to train the public in how to recognize the signs and symptoms of SCA and when to grab an AED. The point of this exercise is merely to think out of the box and look at extreme methods of possibly saving more lives. That is, are there better, more effective, ways to use today’s dollars? Let us know your thoughts, where we’re right, where we’re wrong, and if you have better solutions.

 

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