Sudden Cardiac Arrests: A Shocking Response In Spain

Everyone knows someone who’s suffered a heart attack and the sober reality is that what is called Out of Hospital Cardiac Arrest (OHCA) is the third leading cause of death in Europe. Over 300,000 people suffer from an OHCA in Europe every year, yet only eight to ten per cent survive.

Surviving A Cardiac Arrest In Spain

Survival of a Sudden Cardiac Arrest (SCA) is almost wholly dependent upon what help is given and how quickly. The chances of survival after a Sudden Cardiac Arrest drop by ten per cent for every minute that passes and if the attack happens outside a hospital environment, even a fast ten-minute response time by an ambulance crew can be too late.

In research presented at the European Society of Cardiology’s (ESC) Congress this year, it was revealed that using a defibrillator on cardiac arrest victims significantly improves their 30-day survival rates, regardless of quick ambulance response times. Out of 7,471 adults who suffered a Sudden Cardiac Arrest outside the hospital, nearly 14 per cent received CPR from bystanders before an ambulance arrived and just over 83 per cent did not. Out of those who received intervention from bystanders, 44.5 per cent were still alive 30 days afterwards, whereas only 18.7 per cent of heart attack victims who received no CPR from bystanders were alive 30 days later.

The research shows how critical it is for a victim to receive help right away if they suffer a heart attack in public. The help available depends on two core things; firstly there being a bystander who recognises the signs of a Sudden Cardiac Arrest and knows how to perform CPR (Cardiopulmonary Resuscitation),  and secondly, there being an AED (Automated External Defibrillator) nearby. An AED is a portable device that can analyse the heart’s rhythm and deliver an electrical shock to restart the victim’s heart in the event of sudden cardiac arrest.

Number And Location Of AEDs in Spain

When viewed in the context of how critical the availability and use of AEDs is to save the lives of cardiac arrest victims, the status of the units in Spain, both in terms of numbers per 10,000 head of population and the legislation in place around them, is concerning.

The Spanish Government laid the foundations for the regulation of the presence of defibrillators in Royal Decree 365/2009, however, it was left up to each autonomous community to decide whether the installation of AEDs in public spaces should be mandatory or not and to decide on the regulations around usage.  This piecemeal approach has resulted in Spain having, at the last official count in 2021, in the region of 33,145 AED devices installed or an average of seven per 10,000 inhabitants, figures that are amongst the lowest in Europe. 

Currently, out of 17 autonomous communities, only six: the Basque Country, Catalonia, Andalucia, Asturias, the Canary Islands and Madrid have mandatory requirements for the installation of AEDs in public places such as shopping centres, airports, bus or train stations.  

There are an average of 30,000 Sudden Cardiac Arrests in Spain a year that happen outside hospitals and the survival rate of them is currently below 10 per cent. When that figure is compared with a survival rate of over 50 per cent in the USA where there is a very high presence of automated defibrillators, it’s clear that lack of AEDs in Spain is literally costing lives.

The Rules For Using An AED In Spain

Regulations around the use of AEDs where they exist also vary tremendously from region to region. At the strictest end of the legislative scale are autonomous communities that insist that the AED can only be used by doctors. A number of regions take a middle-ground position that, in addition to professionally trained medical personnel, people who have taken an official course and gained certification may use AEDs in a cardiac emergency. These courses can be up to nine weeks in length and the student is required to take a refresher course every one to three years, depending upon the region.

Some regions also allow untrained bystanders to use AEDs if a number of criteria have been met, such as being able to recognise the signs of a Sudden Cardiac Arrest and phoning for an ambulance on 112 before using the defibrillator. For foreign residents or visitors from other countries where the use of AEDs by the general public in a cardiac emergency is the norm, such strict regulations can be disconcerting, particularly when the penalty for using them can include criminal charges of manslaughter if the victim of the heart attack subsequently dies after a defibrillator is used.

Non-governmental organisations in Spain, such as the Spanish Heart Foundation (FEC), want to see legislation around the use of defibrillators outside hospitals updated and unified on a national level to get the number of units per 10,000 population increased and the use of them extended to the general public.

Four Signs Of Cardiac Arrest And Four Steps To Save A Life

Non-profit liveislife. eu promotes four simple steps to save the life of a Sudden Cardiac Arrest victim:

1. Recognise Sudden Cardiac Arrest
2. Call 112
3. Start CPR
4. Use AED

Recognise Sudden Cardiac Arrest:  There are four signs of a cardiac arrest:

1. Sudden collapse.
2. No pulse.
3. No breathing.
4. Loss of consciousness.

Start CPR. Place your hands on the centre of the chest and push hard and fast with an average of 100-120 compressions per minute. Keep repeating 30 compressions and then 2 rescue breaths.

Use AED. Use an automated external defibrillator (AED) to restart the heart.