By Ben Sherwood
The Survivors Club
June 26, 2009

Every twenty seconds, a heart attack strikes someone in America, killing five hundred thousand a year. That's fifty-seven deaths every hour, almost one per minute. In the United States and many nations, it's the leading cause of death among adults over age forty.

The most lethal kind of heart problem--called sudden cardiac arrest (SCA) --occurs when your ticker's electrical system goes haywire and stops pumping blood to the rest of your body. SCA accounts for an estimated 325,000 deaths every year in the US and -- according to news accounts -- it appears to have killed Michael Jackson.

1. What's the difference between heart attack and cardiac arrest?

It's important to note that a heart attack is different from cardiac arrest. A heart attack or myocardial infarction is a blockage of your heart's plumbing while cardiac arrest is an electrical problem with your heartbeat, according to the Heart Rhythm Foundation. The difference is critical: Cardiac arrest is typically much more dangerous than heart attack.

2. What are your odds of surviving cardiac arrest?

In major cities in North America, your chances range between three to nine percent depending in large part on the quality of the emergency response system. In communities with the best emergency response like Seattle, the salvage rate tops out at 16 percent. Put bluntly, even in the best cities in America, 85 to 95 percent of cardiac arrest victims simply don't make it.

Consider the Jackson case: It took paramedics three minutes and 17 seconds to respond to the 9-1-1 call from Jackson's home. His personal physician was already in the house performing CPR, according to the Los Angeles Times. Jackson wasn't breathing and never regained consciousness. Paramedics treated Jackson for 42 minutes, transporting him to UCLA Medical Center, where he was pronounced dead.

3. Who survives cardiac arrest?

So who actually survives cardiac arrest? People like Thurman Austin. The sixty-three-year-old textile worker from China Grove, North Carolina, was gambling at the Stardust Casino in Las Vegas when he collapsed, banged his head on a dollar slot machine, and hit the floor. He didn't even know his wife, Gwen, in the next seat had just won nearly three hundred dollars. Within minutes, security guards arrived with one of the casino's new defibrillators and shocked his heart back into normal rhythm. It was July 1, 1997. "I hit the jackpot that day," he says. Yes, he did.

4. What's the "best place" to suffer cardiac arrest?

Believe it or not, casinos are among the safest places in the world for a heart attack or cardiac arrest, according to the New England Journal of Medicine. The reason has nothing to do with Lady Luck, says Dr. Bryan Bledsoe, a former paramedic and emergency physician who teaches at the University of Nevada-Las Vegas and writes textbooks for emergency caregivers. Survival depends on how fast you're defibrillated and receive chest compressions. If you get the first jolt within one minute, your chances are around 90 percent, but they drop 10 percent every sixty seconds.

Incredibly, the salvage rate on the Vegas Strip is now 53 percent. Even in most hospitals, your odds aren't as good.

5. Why is a Las Vegas Casino the best place?

The answer begins with the alarming fact that two to three times more people suffer cardiac arrest in Las Vegas than other cities of similar size. The reason: Vegas Syndrome. Older tourists keel over because of too much eating, drinking, partying, smoking, exhaustion, and stress from gambling. Indeed, paramedics in Clark County, Nevada, found themselves responding to so many fatal cardiac arrest calls in casinos that they urgently needed a solution. In 1997, they began persuading casino owners to buy automated external defibrillators (AEDs) and to install them like fire extinguishers in public places. They also started training casino workers in CPR and defibrillation. (Note: The story of cardiac arrest in Vegas is told wonderfully in a Wall Street Journal piece in January 2006 by Kevin Helliker.)

With security cameras and guards always on the lookout for cheaters and troublemakers, virtually everyone is under constant surveillance. That means if a visitor drops, someone notices quickly. If you keel over at the MGM Mirage, for instance, a trained staffer with a defibrillator will be standing over you in just 2.8 minutes. Even if you're in a hospital, the response rate isn't always so fast. And that can make the difference between hitting the jackpot and losing everything.

That's a big reason why airports, ball parks, libraries and other public places are installing more and more defibrillators. They save lives. Indeed, the AED program at O'Hare and Midway airports in Chicago has showed a salvage rate of 64 percent, good news for travelers and even better odds the Vegas strip.

6. Should I buy a defibrillator for my home?

Sudden cardiac arrest strikes around 125,000 Americans every year in their homes and 40,000 in public places not including hospitals.  The survival rate of people suffering cardiac arrest at home is around two percent.  So should you own a home defibrillator? The answer: If you can afford one - they cost between $1,000 and $2,000 -- there's no harm having one around.  But the evidence suggests they don't increase overall survival.

According to the first study of home defibrillators involving 7,000 heart attack survivors, the devices definitely help, but so can CPR and at a much lower cost.  Defibrillators definitely save lives, but very few people were stricken at home, and CPR by spouses turned out to be just as useful.  "Access to a home AED did not significantly improve survival," the study concluded.

The doctor who conducted the home defibrillator study admits to owning four himself.  Dr. Gust Bardy of the Seattle Institute of Cardiac Research once used a public AED to revive a person in a Denver airport. "I managed to defibrillate the patient and still make my connection," he said.

Bottom line: Learn CPR or brush up on your CPR skills.  Click here for more from the Red Cross on CPR and first aid classes.

Update: From news accounts Friday morning, it appears possible that Jackson suffered from respiratory arrest induced by drugs (or a drug overdose). Respiratory arrest means your breathing stops and it usually coincides with or triggers cardiac arrest. We'll know more after the autopsy.)