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

Abstract

BackgroundThe 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 ResultsFrom 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).ConclusionsIn 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.

Survival From Out‐of‐Hospital Cardiac Arrest: Are We Beginning to See Progress?

“…Several important take‐away messages can come out of this report of Van Diepen and colleagues 2. First, the HeartRescue Project demonstrated successful creation of a true population‐based registry with multiple diverse stakeholders.…”

“…The article by Van Diepen and colleagues2 documents a successful first step in documenting OHCA case‐capture rate. The HeartRescue Project is now challenged to identify the characteristics of the high‐performing states and EMS systems that should be universally adopted to improve survival from OHCA.…”

“…The article by Van Diepen et al in this issue of JAHA-Journal of the American Heart Association reports on the first steps needed to fulfill many of the recommendations of the IOM report. 2 Van Diepen and colleagues 2 report data from the initial 5 years of the HeartRescue Project, a multistate public health initiative focused on establishing state-wide out-of-hospital cardiac arrest (OHCA) systems of care to improve case capture rate and ultimately use the derived data to improve OHCA care at the community, the emergency medical services (EMS), and hospital levels. The initial data from the HeartRescue Project, reported by the authors, represent the first step in achieving the IOM recommendations.…”

“…Several important take-away messages can come out of this report of Van Diepen and colleagues. 2 First, the HeartRescue Project demonstrated successful creation of a true population-based registry with multiple diverse stakeholders. These essential data can be collected by most communities as an important first step recommended by the IOM report, to allow benchmarking and improvement of care and survival of those with OHCA.…”

Does care at a cardiac arrest centre improve outcome after out-of-hospital cardiac arrest? — A systematic review

“…[1][2][3][4][5] Survival from OHCA ranges from 8-16.1%. [6] Measures to maximise favourable neurological outcomes are a research priority for both patients and clinicians. [7] Post-resuscitation care, including percutaneous coronary intervention (PCI) and targeted temperature measurement (TTM), is an important component to achieve good neurological outcome.…”