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

Published

Journal Article

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.

Full Text

Duke Authors

Cited Authors

  • van Diepen, S; Girotra, S; Abella, BS; Becker, LB; Bobrow, BJ; Chan, PS; Fahrenbruch, C; Granger, CB; Jollis, JG; McNally, B; White, L; Yannopoulos, D; Rea, TD

Published Date

  • September 22, 2017

Published In

Volume / Issue

  • 6 / 9

PubMed ID

  • 28939711

Pubmed Central ID

  • 28939711

Electronic International Standard Serial Number (EISSN)

  • 2047-9980

International Standard Serial Number (ISSN)

  • 2047-9980

Digital Object Identifier (DOI)

  • 10.1161/JAHA.117.005716

Language

  • eng