injury. A Japanese cardiac arrest registry of 10,000 patients with OHCA transported to critical cardiac care hospitals showed improved 1‐month survival compared with those patients transported to hospitals without specialized cardiac facilities [126]. Compared with historical controls, survival to hospital discharge in the Take Heart America Program, a regionalized system of cardiac arrest care in Minnesota, improved from 8.5% to 19%. The difference was a dramatic improvement in survival after admission to intensive care from 24% to 51% [127]. This program seeks to optimize prehospital care, including EMS and community training, while establishing transport and treatment protocols with three dedicated cardiac arrest centers providing therapeutic hypothermia, interventional coronary artery evaluation and treatment, and electrophysiological evaluation. However, analysis of CARES data has not revealed a similar relationship between survival or neurological outcome and the presence of a coronary catheterization laboratory or the volume of patients received [128].
Quality Improvement Program
A prerequisite for improving cardiac arrest resuscitation quality is the collection of performance and quality data. EMS medical directors should implement quality inspection and assurance programs to ensure the delivery of high‐quality cardiac arrest care. Commonly collected cardiac arrest quality data include treatment intervals such as the activation interval, response interval, patient access interval, and call‐to‐first defibrillation interval. Another important measure is CPR performance. Monitors now permit the EMS medical director to evaluate the depth, rate, and interruptions of chest compressions delivered throughout the entire episode [129,130].
The Utstein style for reporting cardiac arrest data provides some common denominators for comparing resuscitation rates among various systems [131]. EMS services should adopt standardized data collection methods that allow for uniform reporting and benchmarking capability.
Summary
Improving survival from OHCA requires a comprehensive community systems approach. No single component, including EMS, can improve cardiac arrest survival independently. EMS agencies must assume a leadership role in promoting, developing, and implementing this systems‐based approach.
References
1 1 De Maio VJ, Stiell IG, Wells GA, Spaite DW. Optimal defibrillation response intervals for maximum out‐of‐hospital cardiac arrest survival rates. Ann Emerg Med. 2003; 42:242–50.
2 2 Stiell IG, Wells GA, Field B, et al. Advanced cardiac life support in out‐of‐hospital cardiac arrest. N Engl J Med. 2004; 351(7):647–56.
3 3 Weisfeldt M. Bystanders save lives with CPR and automated external defibrillators. In: American Heart Scientific Sessions 2007. November 6, 2007; Orlando, FL; 2007.
4 4 McNally B, Robb R, Mehta M, et al. Out‐of‐hospital cardiac arrest surveillance, CardiacArrest Registry Enhance Survival (CARES), United States, October 1, 2005‐December 31, 2010. MMWR Surveill Summ. 2011; 60:1–19.
5 5 American Heart Association. 2001 Heart and Stroke Statistical Update. Dallas, TX: American Heart Association, 2000.
6 6 Cardiac Arrest Registry to Enhance Survival, 2019 Annual Report. Available at: https://mycares.net/sitepages/uploads/2020/2019_flipbook/index.html?page=39. Accessed February 12, 2021.
7 7 McNally B, Stokes A, Crouch A, Kellermann AL; CARES Surveillance Group. CARES – Cardiac Arrest Registry to Enhance Survival. Ann Emerg Med. 2009; 54:674–83.
8 8 Ong ME, Shin SD, Tanaka H, et al. Pan‐Asian Resuscitation Outcomes Study (PAROS): rationale, methodology, and implementation. Acad Emerg Med. 2011; 18:890–7.
9 9 Rosamund W, Flegal K, Furie K, et al. Heart Disease and Stroke Statistics—2008 Update. Circulation. 2008; 117:e25–e146.
10 10 Zheng ZJ, Croft JB, Giles WH, Mensah GA. Sudden cardiac death in the United States, 1989 to 1998. Circulation. 2001; 104:2158–63.
11 11 Nichol G, Rumsfeld J, Eigel B, et al. Essential features of designating out‐of‐hospital cardiac arrest as a reportable event. A scientific statement from the American Heart Association Emergency Cardiovascular Care Committee; Council on Cardiopulmonary, Perioperative, and Critical Care; Council on Cardiovascular Nursing; Council on Clinical Cardiology; and Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation. 2008; 117:2299–308.
12 12 Coute RA, Nathanson BH, Panchal AR, et al. Disability‐adjusted life years following adult out‐of‐hospital cardiac arrest in the United States. Circ Cardiovasc Qual Outcomes. 2019; 12(3):e004677.
13 13 Callaway CW, Hostler D, Doshi AA, et al. Usefulness of vasopressin administered with epinephrine during out‐of‐hospital cardiac arrest. Am J Cardiol. 2006; 98:1316–21.
14 14 Eisenberg MS, Horwood BT, Cummins RO, Reynolds Haertle R, Hearne TR. Cardiac arrest and resuscitation: a tale of 29 cities. Ann Emerg Med. 1990; 19:179–86.
15 15 Mitchell RG, Guly UM, Rainer TH, Robertson CE. Paramedic activities, drug administration and survival from out of hospital cardiac arrest. Resuscitation. 2000; 43:95–100.
16 16 Mosesso VN Jr, Davis EA, Auble TE, Paris PM, Yealy DM. Use of automated external defibrillators by police officers for treatment of out‐of‐hospital cardiac arrest. Ann Emerg Med. 1998; 32:200–7.
17 17 Schaffer WA, Cobb LA. Recurrent ventricular fibrillation and modes of death in survivors of out‐of‐hospital ventricular fibrillation. N Engl J Med. 1975; 293:259–62.
18 18 Yusuf S, Venkatesh G, Teo KK. Critical review of the approaches to the prevention of sudden death. Am J Cardiol. 1993; 72:51–8F.
19 19 Bunch TJ, White RD, Friedman PA, Kottke TE, Wu LA, Packer DL. Trends in treated ventricular fibrillation out‐of‐hospital cardiac arrest: a 17‐year population‐based study. Heart Rhythm. 2004; 1:255–9.
20 20 Cobb LA, Fahrenbruch CE, Olsufka M, Copass MK. Changing incidence of out‐of‐hospital ventricular fibrillation, 1980–2000. JAMA. 2002; 288:3008–13.
21 21 Polentini MS, Pirrallo RG, McGill W. The changing incidence of ventricular fibrillation in Milwaukee, Wisconsin (1992–2002). Prehosp Emerg Care. 2006; 10:52–60.
22 22 Youngquist ST, Kaji AH, Niemann JT. Beta‐blocker use and the changing epidemiology of out‐of‐hospital cardiac arrest rhythms. Resuscitation. 2008; 76:376–80.
23 23 Hallstrom AP, Ornato JP, Weisfeldt M, et al. Public‐access defibrillation and survival after out‐of‐hospital cardiac arrest. N Engl J Med. 2004; 351:637–46.
24 24 Valenzuela TD, Roe DJ, Nichol G, Clark LL, Spaite DW, Hardman RG. Outcomes of rapid defibrillation by security officers after cardiac arrest in casinos. N Engl J Med. 2000; 343:1206–9.
25 25 Cummins RO, Chamberlain DA, Abramson NS, et al. Recommended guidelines for uniform reporting of data from out‐of‐hospital cardiac arrest: the Utstein Style. Task Force of the American Heart Association, the European Resuscitation Council, the Heart and Stroke Foundation of Canada, and the Australian Resuscitation Council. Ann Emerg Med. 1991; 20:861–74.
26 26 Nichol G, Stiell IG, Hebert P, Wells GA, Vandemheen K, Laupacis A. What is the quality of life for survivors of cardiac arrest? A prospective study. Acad Emerg Med. 1999; 6:95–102.
27 27 Nichol G, Stiell IG, Laupacis A, Pham B, De Maio VJ, Wells GA. A cumulative meta‐analysis of the effectiveness of defibrillator‐capable emergency medical services for victims of out‐of‐hospital cardiac arrest. Ann Emerg Med. 1999; 34:517–25.
28 28 Callaway CW. Improving neurologic outcomes after out‐of‐hospital cardiac arrest. Prehosp Emerg Care. 1997; 1:45–57.
29 29 Nichol G, Thomas E, Callaway CW, et al. Regional variation in out‐of‐hospital cardiac arrest incidence and outcome. JAMA. 2008; 300:1423–31.
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