Prediction and Prevention of Sudden Cardiac Arrest

Prediction and prevention of sudden cardiac arrest (SCA) remains one of the great challenges of contemporary cardiology. As the most common cause of death in the United States, SCA accounts for an estimated 350 000 deaths annually and represents a leading cause of disability and healthcare costs.1,2 Early cardiopulmonary resuscitation and defibrillation are essential steps in resuscitation of individuals with the life-threatening ventricular arrhythmias that most commonly cause SCA.3–10 In an effort to improve survival from cardiac arrest, public access to defibrillation (PAD) programs have promoted the chain-of-survival concept with sequential steps in the prehospital phase that result in improved survival.11 These interventions include rapid access to emergency medical services by calling 911, cardiopulmonary resuscitation (CPR), defibrillation when indicated, and initiation of advanced medical care.11 Survival depends directly on the time to defibrillation, and early defibrillation has emerged as the most important intervention, with survival decreasing by 10% with each minute of delay in defibrillation.12,13Articles pp 1374 and 1380 A confluence of multiple factors over the last several years has resulted in the coming of age of PAD programs. Among these is the recognition that incorporation of the automated external defibrillator (AED) into the chain of survival shortens time to definitive therapy and improves survival.3–13 Good Samaritan laws, passed in all 50 states, are supplemented by the federal Cardiac Arrest Survival Act and provide broad-based legal immunity for those purchasing or using an AED.14 At the same, there has been a growing recognition that not providing access to an AED as a prudent measure of public protection may subject one to liability in public locations.14 Finally, a substantial body of robust clinical data, including multiple prospective randomized trials and a meta-analysis, support incorporation of the AED into PAD programs.2–13Interest …