University of Iowa Health Science Relations and
Richard Kerber, MD
Professor of Internal Medicine
First Published: 2000
Last Revised: January 2004
Peer Review Status: Internally Peer Reviewed

What's the first thing to do when you witness someone collapse from cardiac arrest? If the victim is unresponsive, call 911, then start CPR, says the American Heart Association.

"Experts agree that early defibrillation--an electric shock that returns the heartbeat to normal--is vital for survival." says Dr. Richard Kerber, professor of internal medicine at the University of Iowa College of Medicine and staff physician with UI Hospitals and Clinics. "But CPR continues to be key in emergency treatment of patients who have cardiac arrest.", and new findings suggest that 1-2 minutes of CPR prior to defibrillation enhances the likelyhood of resumption of circulation and survival.

Kerber was chairman of the Heart Association Emergency Cardiac Care Committee that developed a "chain of survival" designed to improve the survival rates of people who experience heart attacks. The links in the chain are: 1-early activation of the emergency medical system, which means calling 911 immediately; 2-early CPR; 3-early defibrillation; and 4-advanced cardiac life support.

When those four activities are carried out efficiently, the survival rate for patients can be as high as 30 percent to 40 percent. However, many U.S. communities do not have a 911 emergency phone system, and some ambulances do not carry a portable defibrillator.

"When those problems exist, the survival rate drops to below 2 percent," Kerber says. "Every community should ask these questions: Do we have a 911 system? Can we dispatch rescue units within one minute of receiving calls? Does the ambulance carry a defibrillator? Are ambulance personnel qualified and permitted to use a defibrillator? If the answer to any of these questions is 'No' the community needs to improve its approach to emergency cardiac care," Kerber says.

The average citizen remains an important link in the survival chain, Kerber adds. If you want to be a strong link, enroll in a CPR class. Call your local American Heart Association affiliate or the Red Cross for details.