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About 220,000 people a year die of coronary heart disease without being hospitalized. That's about half of all deaths from CHD --- more than 600 Americans each day. Most of these are sudden deaths caused by cardiac arrest. Other factors besides heart disease and heart attack can cause cardiac arrest. They include respiratory arrest, electrocution, drowning, choking or trauma. Cardiac arrest can also occur without any known cause.

Brain death and permanent death start to occur in just four to six minutes after someone experiences cardiac arrest. Cardiac arrest can be reversed in most victims if it's treated within a few minutes with an electric shock to the heart to restore a normal heartbeat. This process is called defibrillation. A victim's chances of survival are reduced by 7--10 percent with every minute that passes. Few attempts at resuscitation succeed after 10 minutes.

No statistics are available for the exact number of cardiac arrests that occur each year. However, it's estimated that more than 95 percent of cardiac arrest victims die before reaching the hospital. In cities where defibrillation is provided within five to seven minutes, the survival rate from cardiac arrest is as high as 49 percent.

Early CPR and rapid defibrillation combined with early advanced care can result in high long-term survival rates for witnessed cardiac arrest. In one case, automated external defibrillators (AEDs) were mounted one minute apart in plain view at Chicago's O'Hare and Midway Airports in June 1999. In the first 10 months, 14 cardiac arrests occurred with 12 of the 14 victims in ventricular fibrillation. Nine of the 14 victims (64 percent) were revived with an AED and had no brain damage.

If every community could achieve a 20 percent cardiac arrest survival rate, an estimated 45,000--50,000 people could be saved each year from CHD alone. The American Heart Association urges the public to be prepared for cardiac emergencies:

" Know the warning signs of cardiac arrest. During cardiac arrest, a victim loses consciousness, stops normal breathing and loses pulse and blood pressure.

" Call 9-1-1 immediately to access the emergency medical system if you see any cardiac arrest warning signs.

" Give cardiopulmonary resuscitation (CPR) to help keep the cardiac arrest victim alive until emergency help arrives. CPR keeps blood flowing to the heart and brain until defibrillation can be administered.

Death from cardiac arrest is not inevitable. If more people react quickly by calling 9-1-1 and performing CPR, more lives can be saved.