Cardiac arrest kills ten times as many people as breast cancer, yet the library of research studying why it happens and how to improve the number of people who survive is outrageously small.
"Cardiac arrests remain a significant public health need worldwide, and the limited progress in improving poor survival in the U.S. and globally may be due to inadequate research," said leading researcher Shashank S. Sinha, M.D., M.Sc., from the University of Michigan. "We need to move the needle."
In a review of the medical literature surrounding cardiac arrest from the past twenty years, Sinha and colleagues found multiple trends in the research, both encouraging and discouraging. They evaluated over five thousand published medical journal articles and abstracts, but just 92 randomized clinical trials on the immediate treatment of cardiac arrest met the gold-standard needed to draw particular conclusions about the effectiveness of treatment options.
With just a few more than 64 thousand patients involved in high-standard cardiac arrest clinical trials in the past two decades, most of the best cardiac arrest research studies were conducted outside of the United States. That is less than five studies per year across the globe with published results, and researchers estimate that there are 25 to 86 times as many clinical trials published for heart failure, heart attack, and stroke.
"What we found in a nutshell was a striking paucity of randomized clinical trials relative to the burden of cardiac arrest in this country," said Sinha. "We estimate that only 2.5 such trials have been done for every 10,000 out-of-hospital cardiac arrests, and the number is even lower for in-hospital cardiac arrests." More than 535,000 cases of cardiac arrest occur each year in the United States, and only ten percent of people survive.
In addition to the disturbingly low number of studies done, the researchers saw that of those conducted, most tested drugs and devices rather than ways to improve the protocol surrounding cardiac arrest care by non-medical bystanders, EMTs, and hospital personnel. Overall, Sinha and his team found that cardiac arrest research lacked several key study avenues:
- Protocols for emergency care, post-arrest care, and studies of long-term survival and functional outcomes
- Records of patients following study; many trials did not follow patients long enough, and the researchers did not keep a record of what happened to survivors after they were discharged from the hospital or even after they saw the return of a normal heart rhythm after cardiac arrest
- Measuring outcomes of care like when patients return to work and what their quality of life is like
Fortunately, Sinha’s review was not completely negative. Some findings provided promise for the future of cardiac arrest research and care. For example, they saw that the pace of clinical arrest research trials seemed to increase in the past five years. Also, a recent guidelines update from the American Heart Association on cardiopulmonary resuscitation and emergency cardiac care also promising for the enhanced treatment of cardiac arrest. Regardless, Sinha and his team believe that studying immediate post-arrest care is of utmost importance, and there are many opportunities for research groups in the United States to lead to the charge in this realm.
Sinha’s study was recently published in the journal Circulation: Cardiovascular Quality and Outcomes.
Source: University of Michigan Health System