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

• Type of Material: Article
• Authors: Sean van Diepen, University of Alberta; Saket Girotra, University of Iowa; Benjamin S. Abella, University of Pennsylvania; Lance B. Becker, Hofstra School of Medicine; Bentley J. Bobrow, University of Arizona; Paul S. Chan, University of Missouri‐Kansas; Carol Fahrenbruch, Public Health‐Seattle & King County; Christopher B. Granger, Duke Clinical Research Institute; James G. Jollis, Duke Clinical Research Institute; Bryan McNally, Emory University; Lindsay White, University of Washington; Demetris Yannopoulos, University of Minnesota; Thomas D. Rea, University of Washington
• Language: English
• Date: 2017-09-22
• Publisher: Wiley Open Access: Creative Commons Attribution Non-Commercial
• Publication Version: Final Published Version
• Copyright Statement: © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1161/JAHA.117.005716
• Title of Journal or Parent Work: Journal of the American Heart Association
• ISSN: 2047-9980
• Volume: 6
• Issue: 9
• Start Page: e005716
• End Page: e005716
• Grant/Funding Information: The HeartRescue Project was established with funding by the Medtronic Philanthropy.
• Keywords: Quality and outcomes; Ventricular fibrillation; Cardiopulmonary resuscitation and emergency cardiac care; public health initiative; cardiac arrest; Sudden cardiac death; automated external defibrillator; cardiopumonary resuscitation; quality improvement
• Research Categories: Health Sciences, General; Health Sciences, Medicine and Surgery; Health Sciences, Public Health

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.