Resuscitation Center Designation: Recommendations for Emergency Medical Services Practices

Abstract

Regionalization of medical resources by designating specialty receiving centers, such as trauma and stroke centers, within emergency medical services (EMS) systems is intended to ensure the highest-quality patient care in the most efficient and fiscally responsible fashion. Significant advances in the past decade such as induction of therapeutic hypothermia following resuscitation from cardiac arrest and a time-driven, algorithmic approach to management of septic patients have created compelling arguments for similar designation for specialized resuscitative interventions. Resuscitation of critically ill patients is both labor- and resource-intensive. It can significantly interrupt emergency department (ED) patient throughput. In addition, clinical progress in developing resuscitation techniques is often dependent on the presence of a strong research infrastructure to generate and validate new therapies. It is not feasible for many hospitals to make the commitment to care for large numbers of critically ill patients and the accompanying investigational activities, whether in the prehospital, ED, or inpatient arena. Because of this, the question of whether EMS systems should designate specific hospitals as "resuscitation centers" has now come center stage. Just as EMS systems currently delineate criteria and monitor compliance for trauma, ST-elevation myocardial infarction (STEMI), and stroke centers, strong logic now exists to develop similar standards for resuscitation facilities. Accordingly, this discussion reviews the current applicable trends in resuscitation science and presents a rationale for resuscitation center designation within EMS systems. Potential barriers to the establishment of such centers are discussed and strategies to overcome them are proposed.

Emergency department factors associated with survival after sudden cardiac arrest

“…[14][15][16] Efforts to regionalize cardiac arrest care are underway, and a credentialing system for CRCs was recently released by the AHA. [41][42][43][44] Our data, showing worse outcomes at high volume centers, suggest that volume alone is an inadequate criterion by which to designate centers that should preferentially care for patients with sudden cardiac arrest. Future efforts should focus on better understanding the relative importance of the many components of a system of care for cardiac arrest.…”

The US Emergency Care System: Meeting Everyday Acute Care Needs While Being Ready For Disasters

“…These specialty referral networks have evolved as regions recognize the inefficiency of providing highly specialized services at every hospital. 15 The past decade has seen an increase in the types of services being touted as emergency specialty care, with centers to treat stroke, 16 ST-segment-elevation myocardial infarction, 17 and postcardiac arrest 18 emerging as some of the newest specialty care centers.…”

Survival and Neurologic Outcomes of Out-of-Hospital Cardiac Arrest Patients Who Were Transferred after Return of Spontaneous Circulation for Integrated Post-Cardiac Arrest Syndrome Care: The Another Feasibility of the Cardiac Arrest Center

“…Despite TH being emphasized, the medical community has been slow to adopt TH in the hospital environment (5, 6). This may be due to some barriers, such as a lack of knowledge about TH, financial barriers, and logistic barriers (6, 7). Thus, it is difficult to perform systematic post-cardiac arrest care including TH in all hospitals.…”