Implementation Strategies to Improve Survival Outcomes after Out-of-Hospital Cardiac Arrest: Global Challenges and Disparities.

Out-of-hospital cardiac arrest (OHCA) is a major global public health problem, contributing to high mortality and morbidity. There is significant variability in OHCA incidence and survival rates across different countries and communities and in various geographical locations, even within the same country. Cardiopulmonary resuscitation (CPR) knowledge and skills are critical to achieving better survival outcomes during OHCA. Community CPR training rates vary widely from country to country. Most low-middle-income countries (LMICs) lack an organized prehospital care system and are relatively far from the acceptable standards recommended for better outcomes by international organizations. Several factors contribute to disparities in outcomes during the management of OHCA in a given community in any country. The key challenges are lack of OHCA awareness, community CPR training, well-trained medical personnel, first responders, essential emergency equipment, high-quality emergency medical services (EMS) and funding, as well as access to and provision of timely, evidence-based emergency cardiac care. It is important to understand the structure of a given geographical community before planning and implementing a sustainable program to enhance outcomes during OHCA globally. There is a need for ground-level research and surveillance to improve outcomes from OHCA. Addressing these challenges and disparities is critical in improving survival outcomes after OHCA.