Outpatient cardiac arrest is one of the biggest challenges to public health. It happens suddenly, often without warning, at home, on the street, in the workplace, in a stadium or in a public place. And then a race against time begins.
In Europe, the annual incidence of out-of-hospital cardiac arrests treated by pre-hospital emergency care services is currently estimated at around 55 per 100,000 inhabitants. About seven out of ten occur in private spaces. Despite the advancement of emergency medicine, survival remains low and varies significantly between European countries.
The crucial element is that in cardiac arrest time is not measured in hours, but in minutes.
The person next to the victim can be the first and perhaps most important link in the chain of survival. Quick identification of cardiac arrest, immediate call to emergency services, initiation of cardiopulmonary resuscitation (CPR) and, when available, use of an automated external defibrillator (AED) can change the outcome.
The new European Resuscitation Council (ERC) guidelines for 2025 place early CPR and early defibrillation at the core of the chain of survival.
To save more lives, data is needed
In order to be able to improve the treatment of outpatient cardiac arrest, it is necessary to have a systematic recording of cases.
Cardiac arrest registries allow health authorities and researchers to know how many arrests occur, where they are most often recorded, how quickly CPR starts, how often a defibrillator is used, and how quickly emergency services respond.
Equally important is the recording of the return of spontaneous circulation, survival and neurological status of patients after cardiac arrest.
These figures allow for the comparison of different urgent care systems and help identify weaknesses, delays, and practices that can improve the chances of survival.
Systematic data collection is therefore a key tool for creating more effective systems for the treatment of cardiac arrest.
Can technology give us the minutes we lose?
The response coming from several European countries is particularly interesting.
Alert systems via mobile phone applications can, as soon as the operations center receives a call about a possible cardiac arrest, identify trained volunteers or health professionals who are nearby.
The so-called first responders are notified on their mobile phones and can reach the patient, start CPR or look for the nearest AED, while the ambulance is already on the way.
It is no longer an experimental idea. The European Resuscitation Council's guidelines for 2025 emphasize organized first responders programs, which are activated by emergency centers and linked to registers of available defibrillators.
In this way, an attempt is made to fill one of the most critical gaps in the treatment of cardiac arrest: the time between the arrival of the ambulance.
Defibrillators arriving with drones
Even more impressive is the use of drones to transport defibrillators.
In real-world conditions in Sweden, drones carrying AEDs arrived before the ambulance in two-thirds of the incidents in which arrival times could be compared, saving more than three minutes on average.
In a cardiac arrest, three minutes is not just time. It can be the difference between maintaining blood supply to the brain and causing irreversible damage.
The ability to transport a defibrillator within a few minutes is particularly important in areas where ambulance response times are longer or where access is more difficult.
Can a smartwatch recognize cardiac arrest?
At the same time, the technology that many people already wear on their wrist is also evolving.
Modern smartwatches can record heart rate and, in some models, perform electrocardiogram recording.
The investigation is now going one step further. Data have been published on algorithms that can detect pulse loss through smartwatch sensors, while experimental systems have linked circulatory arrest detection to the automatic activation of an emergency aid network.
This technology is still under evaluation and is not a substitute for human recognition of cardiac arrest or emergency care services.
It does, however, point in a direction in which mobile devices could in the future help to drastically reduce the time until emergency services are notified.
From spectator to rescuer
No technology, however, can replace the informed citizen.
Training more people in CPR, the widespread availability of automatic external defibrillators, the systematic recording of their location and the creation of networks of trained first responders can decisively strengthen the chain of survival.
Equally important is the existence of organized systems for recording incidents, so that the competent services know where there are weaknesses and which interventions have a real effect.
Outpatient cardiac arrest can occur anywhere and in front of any of us.
At that moment, one does not need to be a doctor to help save a life.
He needs to recognize that something is wrong. Call for help immediately. Start CPR. And, if available, use the defibrillator.
Because in cardiac arrest, the first rescuer can be the person next to us.
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