Hot Tip: Have Your Heart Attack In Seattle

What are your chances of surviving cardiac arrest outside a hospital setting? In a word, remote. But some doctors are turning that around, boosting survival rates to previously unthinkable levels. That's great news, right? Now for the bad news: your likelihood of being in that lucky group of survivors depends a great deal on where you live. "It's like real estate—location, location, location," says Dr. Arthur Sanders, a professor of emergency medicine at the University of Arizona's Sarver Heart Center.

That is the upshot of a study appearing this week in the Journal of the American Medical Association. Dr. Graham Nichol, director of the University of Washington's Center for Prehospital Emergency Care, surveyed the outcomes of cardiac arrest in 10 North American cities and states. Though outcomes for most medical procedures vary with factors like socioeconomic status, the differences in this study were even more pronounced than usual. Survival from site to site varied as much as fivefold. Patients in Seattle who were treated by emergency medical technicians (EMTs) pulled through in 16 percent of cases. In Alabama, they survived just 3 percent of the time.

And Alabamans are probably better off than people in many other states. That's because, like the other localities represented in the JAMA study, Alabama participates in a government-funded research network dedicated to improving outcomes after cardiac arrest. Cities outside that network—even places like New York City, with all its high-powered medical centers—appear to have lower survival rates, judging by studies from the 1990s. "Older studies from New York, Chicago, Detroit and Los Angeles found overall survival rates of just 1-2 percent," says Sanders, who wrote an editorial in JAMA to accompany Nichol's paper.

What's Seattle doing that other cities aren't? The JAMA study didn't analyze public-health policies. But Nichol, who happens to live and work in Seattle, says one crucial difference lies in the simple fact that the city tracks outcomes of cardiac-arrest cases. Most cities do not—and therefore have no basis on which to judge their performance or measure improvements.
Second, it has an exceptionally well-organized EMS system. Emergency-medical technicians and paramedics are not only experienced and well trained, but also monitored by physicians on a daily basis to make sure they're doing everything in the best way possible. This daily oversight is not common in other cities, and the organization and efficiency of EMS systems can vary widely. Some are run by hospitals—others, by fire departments. In some towns, they're staffed by volunteers rather than paid professionals.

Finally, the public in Seattle is well informed about what to do in the case of such an emergency, thanks to a public-service campaign from the Seattle Fire Department that focuses on training the public to recognize and respond to cardiac arrest.

Wherever you are, the most crucial factor is rapid treatment. "Survival depends on how quickly you recognize the problem and respond—how quickly you start CPR, how quickly you provide a defibrillator and how quickly you cool the patient to protect the brain," Nichol says. Chances of survival can decrease by as much as 10 percent a minute, so there's no time to waste. Well-organized EMS systems are crucial. So are readily accessible defibrillators and bystanders who will perform CPR.