Multistate 5-Year Initiative to Improve Care for Out-of-Hospital Cardiac Arrest

Primary Results From the HeartRescue Project

Sean van Diepen, Saket Girotra, Benjamin S. Abella, Lance B. Becker, Bentley J Bobrow, Paul S. Chan, Carol Fahrenbruch, Christopher B. Granger, James G. Jollis, Bryan McNally, Lindsay White, Demetris Yannopoulos, Thomas D. Rea

Research output: Contribution to journalArticle

17 Citations (Scopus)

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.

Original languageEnglish (US)
JournalJournal of the American Heart Association
Volume6
Issue number9
DOIs
StatePublished - Sep 22 2017

Fingerprint

Out-of-Hospital Cardiac Arrest
Emergency Medical Services
Survival
Defibrillators
Cardiopulmonary Resuscitation
Population
Registries
Public Health

Keywords

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

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Multistate 5-Year Initiative to Improve Care for Out-of-Hospital Cardiac Arrest : Primary Results From the HeartRescue Project. / van Diepen, Sean; Girotra, Saket; Abella, Benjamin S.; Becker, Lance B.; Bobrow, Bentley J; Chan, Paul S.; Fahrenbruch, Carol; Granger, Christopher B.; Jollis, James G.; McNally, Bryan; White, Lindsay; Yannopoulos, Demetris; Rea, Thomas D.

In: Journal of the American Heart Association, Vol. 6, No. 9, 22.09.2017.

Research output: Contribution to journalArticle

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 2017, 'Multistate 5-Year Initiative to Improve Care for Out-of-Hospital Cardiac Arrest: Primary Results From the HeartRescue Project', Journal of the American Heart Association, vol. 6, no. 9. https://doi.org/10.1161/JAHA.117.005716
van Diepen, Sean ; Girotra, Saket ; Abella, Benjamin S. ; Becker, Lance B. ; Bobrow, Bentley J ; Chan, Paul S. ; Fahrenbruch, Carol ; Granger, Christopher B. ; Jollis, James G. ; McNally, Bryan ; White, Lindsay ; Yannopoulos, Demetris ; Rea, Thomas D. / Multistate 5-Year Initiative to Improve Care for Out-of-Hospital Cardiac Arrest : Primary Results From the HeartRescue Project. In: Journal of the American Heart Association. 2017 ; Vol. 6, No. 9.
@article{763d6f334a4c4e66a1634b564435689a,
title = "Multistate 5-Year Initiative to Improve Care for Out-of-Hospital Cardiac Arrest: Primary Results From the HeartRescue Project",
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",
author = "{van Diepen}, Sean and Saket Girotra and Abella, {Benjamin S.} and Becker, {Lance B.} and Bobrow, {Bentley J} and Chan, {Paul S.} and Carol Fahrenbruch and Granger, {Christopher B.} and Jollis, {James G.} and Bryan McNally and Lindsay White and Demetris Yannopoulos and Rea, {Thomas D.}",
year = "2017",
month = "9",
day = "22",
doi = "10.1161/JAHA.117.005716",
language = "English (US)",
volume = "6",
journal = "Journal of the American Heart Association",
issn = "2047-9980",
publisher = "Wiley-Blackwell",
number = "9",

}

TY - JOUR

T1 - Multistate 5-Year Initiative to Improve Care for Out-of-Hospital Cardiac Arrest

T2 - Primary Results From the HeartRescue Project

AU - van Diepen, Sean

AU - Girotra, Saket

AU - Abella, Benjamin S.

AU - Becker, Lance B.

AU - Bobrow, Bentley J

AU - Chan, Paul S.

AU - Fahrenbruch, Carol

AU - Granger, Christopher B.

AU - Jollis, James G.

AU - McNally, Bryan

AU - White, Lindsay

AU - Yannopoulos, Demetris

AU - Rea, Thomas D.

PY - 2017/9/22

Y1 - 2017/9/22

N2 - 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.

AB - 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.

KW - automated external defibrillator

KW - cardiac arrest

KW - cardiopumonary resuscitation

KW - public health initiative

KW - quality improvement

UR - http://www.scopus.com/inward/record.url?scp=85044732056&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85044732056&partnerID=8YFLogxK

U2 - 10.1161/JAHA.117.005716

DO - 10.1161/JAHA.117.005716

M3 - Article

VL - 6

JO - Journal of the American Heart Association

JF - Journal of the American Heart Association

SN - 2047-9980

IS - 9

ER -