Abstract 36: The Impact of a Statewide, Comprehensive System of Care on Survival From Out-of-Hospital Cardiac Arrest
Introduction: Optimal survival after out-of-hospital cardiac arrest (OHCA) depends on an integrated system of care ensuring implementation of all links in the chain of survival. However, creating such a system is a major challenge requiring intentional, systematic planning and integration of bystander care, EMS dispatch, prehospital care, hospital management, and accurate outcomes data.
Hypothesis: Survival is improved by a fully implemented, comprehensive, statewide system of OHCA care.
Methods: The state of Arizona implemented a multifaceted system of OHCA care which included the following: 2004 – a statewide Utstein-style reporting network; 2005 — an EMS quality improvement program endorsing minimally interrupted cardiac resuscitation (MICR) and a statewide bystander CPR program encouraging chest compression-only CPR (COCPR); 2007 — formal recognition of Cardiac Receiving Centers (CRCs); 2008 — allowing EMS bypass to CRCs and integration of the AHA Hands Only™ CPR program into the system. The program covers ∼ 80% of the state's 6.6 million diverse residents. This study evaluated survival-to-hospital discharge, rate of bystander CPR (including proportion of COCPR), rate of EMS use of MICR, proportion of OHCAs treated at CRCs, and the use of therapeutic hypothermia (TH). Statistical significance was determined by Chi square and test for trend.
Results: Annual rates for survival, bystander CPR/COCPR provision, EMS MICR use, CRC use, and TH use increased significantly over time from 2005 to 2009 (p<0.001, Table). In 2009, OHCA survival was: overall-11.3%, and witnessed VF/VT-31.0%.
Conclusions: It is feasible to implement major changes in OHCA care across widely diverse communities when local, regional, and state emergency healthcare jurisdictions partner to establish a comprehensive system of care. The development of such a statewide system has dramatically improved patient outcome in a setting where survival rates were previously abysmal.
- © 2010 by American Heart Association, Inc.