Guideline-Based Cardiac Resuscitation Systems of Care
Guideline-Based Cardiac Resuscitation Systems of Care
Background There is large and significant regional variation in out-of-hospital cardiac arrest (OHCA), and despite advances in treatment, survival remains low. The American Heart Association has called for the creation of integrated cardiac resuscitation systems of care capable of measuring and improving evidence-based care from bystanders through to hospital discharge.
Methods The HeartRescue Project was initiated in 2010 by the Medtronic Foundation in collaboration with 5 academic medical centers and American Medical Response. The HeartRescue Project aims to develop regional cardiac resuscitation systems of care that will implement guideline-based best practice bystander, prehospital, and hospital care with standardized data reporting linked to outcomes. The primary goal is to improve collective OHCA survival by 50% over 5 years.
Results The total population in the 5 participating states is 41.1 million. At baseline, the HeartRescue Project covers approximately 26.1 million people (63.6%) and has engaged 767 emergency medical services agencies and 269 hospitals. Data will be collected for quality improvement, to inform provider feedback, and serve to define effective strategies to improve cardiac arrest care.
Conclusion The HeartRescue Project is the largest public health initiative of its kind focused entirely on cardiac arrest outcomes. The project is designed to significantly improve OHCA survival by implementing and measuring model systems of care for cardiac resuscitation.
Out-of-hospital cardiac arrest (OHCA) affects an estimated 380,000 people per year in the United States. Unfortunately, a recent report has suggested that the overall rate of survival to hospital discharge has remained low despite advances in both prehospital and hospital cardiac arrest care. Another report has suggested that survival is approximately 8%. Despite this poor prognosis overall, a 5-fold regional variation in OHCA survival has been reported in North America. This disparity presents an opportunity to identify best practices from high-performing communities and expand implementation and integration of community-, prehospital-, and hospital-based interventions to improve care and patient outcomes.
One potential approach to addressing regional outcome disparities might involve the regionalization of postcardiac arrest care. The creation of regional care systems has led to important improvements in the care of other time-sensitive medical conditions, such as trauma and ST-elevation myocardial infarction (STEMI), through the timely and consistent application of evidence-based care by experienced providers. A recent American Heart Association scientific statement called for the development of regional systems of care designed to coordinate, standardize, and measure OHCA patient care from emergency medical services (EMS) to designated resuscitation centers capable of providing integrated multidisciplinary postarrest care. This statement also stressed the adoption of evidence-based practices at each stage of care aimed at improving OHCA survival rates nationally. Moreover, the need for a national surveillance system capable of benchmarking outcomes and setting quality improvement standards at each step of OHCA care has been recommended by the American Heart Association but has yet to be established.
Abstract and Introduction
Abstract
Background There is large and significant regional variation in out-of-hospital cardiac arrest (OHCA), and despite advances in treatment, survival remains low. The American Heart Association has called for the creation of integrated cardiac resuscitation systems of care capable of measuring and improving evidence-based care from bystanders through to hospital discharge.
Methods The HeartRescue Project was initiated in 2010 by the Medtronic Foundation in collaboration with 5 academic medical centers and American Medical Response. The HeartRescue Project aims to develop regional cardiac resuscitation systems of care that will implement guideline-based best practice bystander, prehospital, and hospital care with standardized data reporting linked to outcomes. The primary goal is to improve collective OHCA survival by 50% over 5 years.
Results The total population in the 5 participating states is 41.1 million. At baseline, the HeartRescue Project covers approximately 26.1 million people (63.6%) and has engaged 767 emergency medical services agencies and 269 hospitals. Data will be collected for quality improvement, to inform provider feedback, and serve to define effective strategies to improve cardiac arrest care.
Conclusion The HeartRescue Project is the largest public health initiative of its kind focused entirely on cardiac arrest outcomes. The project is designed to significantly improve OHCA survival by implementing and measuring model systems of care for cardiac resuscitation.
Introduction
Out-of-hospital cardiac arrest (OHCA) affects an estimated 380,000 people per year in the United States. Unfortunately, a recent report has suggested that the overall rate of survival to hospital discharge has remained low despite advances in both prehospital and hospital cardiac arrest care. Another report has suggested that survival is approximately 8%. Despite this poor prognosis overall, a 5-fold regional variation in OHCA survival has been reported in North America. This disparity presents an opportunity to identify best practices from high-performing communities and expand implementation and integration of community-, prehospital-, and hospital-based interventions to improve care and patient outcomes.
One potential approach to addressing regional outcome disparities might involve the regionalization of postcardiac arrest care. The creation of regional care systems has led to important improvements in the care of other time-sensitive medical conditions, such as trauma and ST-elevation myocardial infarction (STEMI), through the timely and consistent application of evidence-based care by experienced providers. A recent American Heart Association scientific statement called for the development of regional systems of care designed to coordinate, standardize, and measure OHCA patient care from emergency medical services (EMS) to designated resuscitation centers capable of providing integrated multidisciplinary postarrest care. This statement also stressed the adoption of evidence-based practices at each stage of care aimed at improving OHCA survival rates nationally. Moreover, the need for a national surveillance system capable of benchmarking outcomes and setting quality improvement standards at each step of OHCA care has been recommended by the American Heart Association but has yet to be established.
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