You’re unlikely to survive cardiac arrest. How Tarrant County wants to change that
Rodrigo Perez peels the pretend electrode pads from their backing, like he’s removing a giant sticker.
He places the electrode stickers on a dummy’s chest, one above and to the left of the dummy’s heart, and one below and to the right of the heart, just like his instructor showed him.
Rodrigo, 13, waits for the fake Automated External Defibrillator, or AED, to give the appropriate amount of shocks to his “patient.” Then, he begins chest compressions.
Rodrigo, a seventh-grader in the Hurst-Euless-Bedford school district, is learning how to save a life. Rodrigo and his dad José Perez joined about 30 students, some with their parents, on a school night in October to practice CPR and how to use an AED.
The school district, which educates about 23,000 students in the Fort Worth suburbs, is on its way to making CPR a skill that every student learns at least once a year starting in fifth grade.
The school district is joining other community leaders and groups across Tarrant County to find ways to improve the county’s survival rate for cardiac arrests. Cardiac arrest occurs when a person’s heart stops beating unexpectedly, which in turn stops blood flow to the heart and other organs.
“Almost all (cardiac arrests) come out of the blue and are unexpected,” said Dr. Tom Aufderheide, a professor of emergency medicine at the Medical College of Wisconsin. Cardiac arrest can affect anyone, and there are no warning signs before it strikes, he said.
In addition to striking without warning, cardiac arrests are almost always fatal.
A person’s likelihood of surviving cardiac arrest is directly tied to how quickly they get treatment, meaning that the sooner a bystander calls 911, begins CPR, and uses an AED, the greater chance that person has to survive.
Survival varies by community: In some parts of the country, bystander CPR is common, AEDs are easy to find, and those who experience cardiac arrest have a better shot at leaving the hospital alive.
Tarrant County is not one of those communities. But the H-E-B school district and others are trying to change that. Tarrant County is one of three counties throughout the U.S. participating in a pilot program with the American Heart Association to improve cardiac arrest survival rates.
“We know that some of the most important things in cardiac arrest survival are bystander CPR, AED use, and dispatcher-guided CPR,” said Matt Zavadsky, a Fort Worth-based consultant in emergency medical services who is helping to lead the pilot project. Dispatcher-guided CPR is when someone calls 911 and gets instructions on how to save a life from the dispatcher on the other end of the line.
The pilot program is bringing together the American Heart Association, local school districts, hospitals, police departments, emergency responders and more to help more people survive cardiac arrest in Tarrant County.
What’s the difference between a cardiac arrest and a heart attack, anyways?
Although people often confuse the two, cardiac arrests and heart attacks are very different, said Dr. Audrey Blewer, an assistant professor of community health and nursing at Duke University. Although both affect the heart, a heart attack affects the “plumbing” of the human body, while cardiac arrest is an electrical issue, Blewer said.
During a heart attack, blood flow to the heart is blocked, which can cause injury or death to part of the heart. But although blood flow is blocked, the heart itself continues to beat. A heart attack victim can be alert and conscious while in the midst of the attack. Heart attack victims will also usually have symptoms, like chest pains.
During a cardiac arrest, however, the heart simply stops beating, meaning there is no blood flow to the heart, brain, or other organs.
Someone who has suffered a cardiac arrest will likely collapse suddenly, and stop breathing or moving.
When Rodrigo and his dad learned how to perform CPR by pushing fast and hard on the center of the chest, they were learning how to keep blood flowing to the heart after it had stopped beating. In effect, someone performing CPR is manually pumping blood through the body.
This manual pumping increases the amount of time that the heart can receive a shock from an AED, after which it will hopefully start beating again on its own, Aufderheide said.
One reason that survival rates for cardiac arrest are so dismal is because relatively few U.S. adults know how to perform CPR and use an AED. Blewer and Aufderheide said that CPR and AED use can double survival rates.
How can we respond to cardiac arrest more quickly?
At a recent meeting of the Tarrant County coalition, Zavadsky, the consultant helping to lead the project and the former Chief Transformation Officer of MedStar, started the meeting the way most meetings with the American Heart Association start.
“There is an AED in the front office,” Zavadsky said. He assigned one person to go get the AED, and a second to call 911 should someone go into cardiac arrest.
It is considerations like these that the coalition hope will become more commonplace at schools, businesses, and community spaces throughout Tarrant County.
More than 350,000 people have a cardiac arrest outside of a hospital setting every year. Of those people, most die: 89% of people who suffer an out-of-hospital cardiac arrest do not survive, according to data from 2023. But this rate varies widely depending on the community. In King County, the county Seattle is located in, almost half of all people who have a cardiac arrest survive, among cardiac arrests witnessed by another person according to data from 2023.
In Tarrant County, the survival rate is 5.6%, Zavadsky said. The coalition wants to be on par with King County, which would mean improving the current rate substantially.
To make that progress, the coalition is in the process of identifying its goals. One area of focus for the group is education, with the H-E-B school district setting an example for other districts to follow. Currently, Texas state law requires every student to be CPR certified to graduate high school. The coalition would like to see more schools and districts follow the lead of H-E-B’s school district, which is providing more frequent CPR training so that students learn CPR multiple times throughout their school career. H-E-B also a more robust emergency response plan known as a Cardiac Emergency Response Plan.
The group also wants to identify more defibrillators throughout Tarrant County. Knowing where a defibrillator is in a business — like if it’s in the checkout of aisle 3 at a Target or on the wall outside the women’s restroom in an office — can be the difference between life or death. When a 911 call operator knows where a defibrillator is, they can direct someone to the life-saving device immediately.
But only a fraction of all defibrillators are actually registered with the local emergency services system, as is required by law. MedStar, which provides emergency medical services for about a dozen cities in Tarrant County, has about 300 defibrillators registered in its system. The total number of devices could be 10 times that, Zavadsky said.
Aufderheide, who is also the director of the Resuscitation Research Center, applauded the coalition’s goals.
“All of the steps that this group is implementing have strong science behind them,” he said. “They work.”
This story was originally published January 23, 2025 at 6:00 AM.
