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Death is inevitable unless effective treatment is given promptly means

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That sentence, from the section on out-of-hospital cardiac arrest (OHCA), means the following:
Plain meaning: Once cardiac arrest happens outside a hospital, the person will almost certainly die unless someone starts effective resuscitation (CPR, defibrillation, advanced life support etc.) very quickly. Survival is the exception, not the rule, without rapid intervention.
Why:
  • In OHCA, cardiac output stops suddenly and completely - the heart is no longer pumping blood, so no oxygen reaches the brain or other vital organs.
  • Within seconds to a few minutes of this happening, brain injury begins, and without restoration of circulation, death follows inevitably - the natural course of untreated cardiac arrest is death.
  • "Virtually inevitable" (not "absolutely inevitable") acknowledges that a very small number of people can survive on their own (e.g., rare spontaneous recovery), but this is exceptional - for practical purposes, assume death will occur.
  • "Unless effective treatment is given promptly" specifies the one thing that changes the outcome: immediate, effective CPR (chest compressions maintaining forward flow of oxygenated blood) and rapid defibrillation/advanced care to correct the underlying cause (e.g., ventricular fibrillation) and restore spontaneous circulation. The key word is promptly - delay sharply reduces the chance of survival, since brain and organ damage accumulate every minute circulation is absent.
This is why OHCA is treated as a "time-critical" emergency: bystander CPR and early defibrillation (e.g., via public-access AEDs) within the first few minutes are what actually change a "virtually inevitable" death into a survivable event. This matches the textbook's later point that the basic principles of CPR are "to maintain forward flow of oxygenated blood, correct the causative factor, and restore spontaneous circulation."
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