Abstract P145: Development of the Arizona Statewide Consortium of Cardiac Arrest Centers
Objective: AHA guidelines call for therapeutic hypothermia (TH) in patients who have return of spontaneous circulation (ROSC) but remain comatose after out-of-hospital cardiac arrest (OHCA) from ventricular fibrillation. In addition, early percutaneous intervention (PCI) and other post-arrest care may improve outcomes. Our objective is implementation of a statewide system of designated specialty Cardiac Arrest Centers (CACs), along with a prehospital protocol directing eligible patients to CACs, to increase the delivery of guideline-based therapies.
Methods: In 12/07 the Arizona Department of Health Services initiated a program of designating hospitals as CACs based upon ability to 1) administer TH, 2) perform 24/7 PCI, and 3) report accurate data. In addition, the State EMS Council approved a prehospital protocol. This established criteria allowing EMS personnel to bypass local hospitals to take comatose, ROSC patients to CACs, as long as the estimated increase in transport interval was no greater than 15 minutes. Here we report the preliminary process outcomes from the first six months of the program.
Results: Prior to initiating the consortium, only 1 of 61 acute care hospitals in Arizona routinely administered TH for comatose ROSC patients. In the first 6 months of program implementation (12/07–5/08), 14 hospitals met criteria and were designated as CACs. Since implementation, a total of 18 patients have received TH at 6 CACs. Between 10/17/04 and 4/1/08 there were 3,217 adult presumed cardiac OHCAs statewide, of which 636 (19.7%) had ROSC but remained comatose. Thus, we estimate that nearly 200 patients per year may have the potential to benefit from this program. Survival and neurological outcome data are currently being collected.
Conclusion: It is feasible for a state EMS Lead Agency to implement a statewide specialty hospital designation program and establish a prehospital bypass protocol directing appropriate patients to these centers. In Arizona, early results show an increased utilization of TH. In addition, the number of patients who may benefit from this system enhancement is significant. Our preliminary experience suggests that this approach may serve as a model for other states and large healthcare systems.