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September 25, 2018 Circulation. 2018;138:e272–e391. DOI: 10.1161/CIR.0000000000000549 e282

CLINICAL STATEMENTS AND GUIDELINES

on death certificate studies that required a code inclusive of ischemic heart disease. The 2017 update of cardiovascular statistics from the AHA estimated the total annual burden of outof-hospital cardiac arrest at 356 500.S2.2.2-44 An additional 209 000 in-hospital cardiac arrests occur annually.S2.2.2-45 Among the out-of-hospital cardiac arrest group, approximately 357 000 events trigger emergency rescue response, with 97% occurring in adults >18 years of age. The survival statistics for out-of-hospital cardiac arrest remain disappointing, with an estimated 10% overall survival rate.S2.2.2-44 Among the subgroup of 70% of out-of-hospital cardiac arrests that occur in the home, survival is 6%. The best reported outcomes are from locations with highly developed and publicly visible emergency rescue response, along with the com- bination of public location of cardiac arrest, bystander witnesses willing to provide CPR, first responders arriving quickly, shockable rhythm at initial contact, availability of automated external defibrillators (AEDs), and possibly a benefit from telecommunication-directed CPR.S2.2.2-46,S2.2.2-47 Survival to hospital discharge after inhospital cardiac arrests is estimated to be 24%.S2.2.2-48 In all settings, survival statistics appear to be better when rhythms recorded by responders are shockable (VF, pulseless VT), compared with pulseless electrical activity or asystole.S2.2.2-49 Although the apparent increase in the incidence of pulseless electrical activity or asystole could be due to the later arrival of medical care, the decrease in the incidence of shockable rhythm has also been attributed, in part, to improvements in diagnosis and treatment of structural heart disease.S2.2.2-40

Figure 1A. SCD incidence and total events.S2.2.2-1 EF indicates ejection fraction; and SCD, sudden cardiac death.

Figure 1B. SCD and clinical subsets.S2.2.2-1 SCD indicates sudden cardiac death.

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