Regional Systems of Care for Out-of-Hospital Cardiac Arrest

Abstract

Abstract-Out-of-hospital cardiac arrest continues to be an important public health problem, with large and important regional variations in outcomes. Survival rates vary widely among patients treated with out-of-hospital cardiac arrest by emergency medical services and among patients transported to the hospital after return of spontaneous circulation. Most regions lack a well-coordinated approach to post-cardiac arrest care. Effective hospital-based interventions for out-of-hospital cardiac arrest exist but are used infrequently. Barriers to implementation of these interventions include lack of knowledge, experience, personnel, resources, and infrastructure. A well-defined relationship between an increased volume of patients or procedures and better outcomes among individual providers and hospitals has been observed for several other clinical disorders. Regional systems of care have improved provider experience and patient outcomes for those with ST-elevation myocardial infarction and life-threatening traumatic injury. This statement describes the rationale for regional systems of care for patients resuscitated from cardiac arrest and the preliminary recommended elements of such systems. Many more people could potentially survive out-of-hospital cardiac arrest if regional systems of cardiac resuscitation were established. A national process is necessary to develop and implement evidence-based guidelines for such systems that must include standards for the categorization, verification, and designation of components of such systems. The time to do so is now. (Circulation. 2010;121:709-729.)Key Words: AHA Scientific Statements Ⅲ emergency medicine Ⅲ cardiac arrestThe American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest.This statement was approved by the American Heart Association Advocacy Coordinating Committee on October 13, 2009, and by the American Heart Association Science Advisory and Coordinating Committee on October 30, 2010. A copy of the statement is available at http://www.americanheart.org/ presenter.jhtml?identifierϭ3003999 by selecting either the "topic list" link or the "chronological list" link (No. KB-0017). To purchase additional reprints, call 843-216-2533 or e-mail kelle.ramsay@wolterskluwer.com.The American Heart Association requests that this document be cited as follows: Nichol G, Aufderheide TP, Eigel B, Neumar RW, Lurie KG, Bufalino VJ, Callaway CW, Menon V, Bass RR, Abella BS, Sayre M, Dougherty CM, Racht EM, Kleinman ME, O'Connor RE, Reilly JP, Ossmann EW, Peterson E; on behalf of the American Heart Association Emergency Cardiovascular Care Committee; Council on Arteriosclerosis, Thrombosis, and Vascula...

Improvement in Care and Outcomes for Emergency Medical Service–Transported Patients With ST‐Elevation Myocardial Infarction (STEMI) With and Without Prehospital Cardiac Arrest: A Mission: Lifeline STEMI Accelerator Study

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“…Moreover, patients with STEMI with OHCA have previously been less likely to bypass the nearest non–percutaneous cardiac intervention (PCI) hospital to reach a cardiac center relative to patients with STEMI without OHCA 5. Accordingly, a policy statement from the American Heart Association stresses the need for regional systems of care for patients with OHCA with substantial overlap to the regional systems of care that are recommended for patients with STEMI 6. In addition to timely catheterization, patients with OHCA may also benefit from temperature management and other intensive care.…”

Glibenclamide Is Comparable to Target Temperature Management in Improving Survival and Neurological Outcome After Asphyxial Cardiac Arrest in Rats

“…Despite that, the efficacy of TTM on comatose adult patients whose initial rhythms are nonshockable requires further confirmation 5, 6. In addition, the adverse effects of hypothermia, the increased nursing labor, and costs for management of hypothermia are also issues of concern 7, 8. Overall, TTM is still underutilized 9.…”

Optimal Management of Shivering During Therapeutic Hypothermia After Cardiac Arrest

“…Brain injury is a common complication after cardiac arrest, resulting in increased morbidity and mortality 3 ; this injury is due to impaired cerebrovascular autoregulation, cerebral edema, and postischemic neurodegeneration. 2 Implementation of mild hypothermia (32ºC-34ºC) for 12 to 24 hours after a cardiac arrest has resulted in improved survival and neurological recovery. 2 Implementation of therapeutic hypothermia has its advantages, although complications are associated with its use.…”