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J Am Heart Assoc. 2017 Sep 22;6(9). pii: e005716. doi: 10.1161/JAHA.117.005716.

Multistate 5-Year Initiative to Improve Care for Out-of-Hospital Cardiac Arrest: Primary Results From the HeartRescue Project.

Author information

1
Department of Critical Care and Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada sv9@ualberta.ca.
2
Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA.
3
Center for Resuscitation Science, University of Pennsylvania, Philadelphia, PA.
4
Hofstra School of Medicine, Hempstead, NY.
5
University of Arizona, Phoenix, AZ.
6
Saint Luke's Mid America Heart Institute and University of Missouri-Kansas, Kansas City, MO.
7
Division of Emergency Services, Public Health-Seattle & King County, Seattle, WA.
8
Duke Clinical Research Institute, Durham, NC.
9
Emory University School of Medicine, Atlanta, GA.
10
University of Washington, Seattle, WA.
11
University of Minnesota, Duluth, MN.

Abstract

BACKGROUND:

The HeartRescue Project is a multistate public health initiative focused on establishing statewide out-of-hospital cardiac arrest (OHCA) systems of care to improve case capture and OHCA care in the community, by emergency medical services (EMS), and at hospital level.

METHODS AND RESULTS:

From 2011 to 2015 in the 5 original HeartRescue states, all adults with EMS-treated OHCA due to a presumed cardiac cause were included. In an adult population of 32.8 million, a total of 64 988 OHCAs-including 10 046 patients with a bystander-witnessed OHCA with a shockable rhythm-were treated by 330 EMS agencies. From 2011 to 2015, the case-capture rate for all-rhythm OHCA increased from an estimated 39.0% (n=6762) to 89.2% (n=16 103; P<0.001 for trend). Overall survival to hospital discharge was 11.4% for all rhythms and 34.0% in the subgroup with bystander-witnessed OHCA with a shockable rhythm. We observed modest temporal increases in bystander cardiopulmonary resuscitation (41.8-43.5%, P<0.001 for trend) and bystander automated external defibrillator application (3.2-5.6%, P<0.001 for trend) in the all-rhythm group, although there were no temporal changes in survival. There were marked all-rhythm survival differences across the 5 states (8.0-16.1%, P<0.001) and across participating EMS agencies (2.7-26.5%, P<0.001).

CONCLUSIONS:

In the initial 5 years, the HeartRescue Project developed a population-based OHCA registry and improved statewide case-capture rates and some processes of care, although there were no early temporal changes in survival. The observed survival variation across states and EMS systems presents a future challenge to elucidate the characteristics of high-performing systems with the goal of improving OHCA care and survival.

KEYWORDS:

automated external defibrillator; cardiac arrest; cardiopumonary resuscitation; public health initiative; quality improvement

PMID:
28939711
PMCID:
PMC5634254
DOI:
10.1161/JAHA.117.005716
[Indexed for MEDLINE]
Free PMC Article

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