Abstract P36: Statewide Network of Cardiac Arrest Centers Improves Survival From Out of Hospital Cardiac Arrest
Objectives: Implementation of a statewide system of designated Cardiac Arrest Centers (CACs), along with a prehospital EMS bypass 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
provide AHA guideline post-arrest therapy,
perform 24/7 PCI,
report accurate data.
In addition, the State EMS Council approved a prehospital protocol that established criteria allowing EMS personnel to bypass local hospitals to take comatose, ROSC patients to CACs, provided the increase in transport interval was no greater than 15 minutes. Patients admitted to CACs were evaluated utilizing a standardized data collection tool and statistical analysis was performed with Fisher’s exact test.
Results: In the first 18 months of program implementation, an EMS bypass protocol was approved and 20 hospitals were designated as CACs (serving 49.1% of the state population). Since implementation, a total of 380 patients have been transported by EMS to CACs where 73 patients have received TH (83% of eligible). Use of TH has increased from 3.4% to 19.5% (p<0.0001). Of the patients receiving TH at cardiac arrest centers, 54.5% survived to hospital discharge. Furthermore, all rhythm OHCA survival to discharge has increased from 10.9% to 17.7% (p=0.013). For patients with a witnessed arrest and an initial monitored rhythm of ventricular fibrillation, survival to discharge increased from 20.3% to 42.4% (p=0.019). Bypass effectiveness, neurological recovery, PCI utilization, time to cooling, organ donation rates, STEMI and ICD rates are being analyzed.
Conclusions: It is feasible 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 and increased survival to discharge.