Abstract 204: The Adoption of Multiple Best Practices to Improve Out-of-Hospital Cardiac Arrest in Salt Lake City, Utah
BACKGROUND: Survival from out-of-hospital cardiac arrest has remained unchanged over the last 30 years in the United States, with the exception of survival in a few high-performance EMS systems. We hypothesized that the implementation of several best practices from such EMS systems would result in improved survival in our community.
METHODS: In September 2011, the Salt Lake City Fire Department (SLCFD) implemented a 2010 AHA-based protocol for reducing hands-off time and improving CPR quality, including use of CPR-filtering technology to reduce pauses for rhythm analysis, real-time CPR feedback, intra-arrest chilled saline, team resuscitation based on a pit crew model, impedance threshold device CPR, and post-incident audit and feedback of all cardiac arrests by the medical director. Outcomes were collected from each receiving hospital, and Cerebral Performance Category (CPC) was used to estimate neurologic outcome. A CPC 1 or 2 was considered neurologically-intact. We evaluated performance prior to and following protocol implementation.
RESULTS: Between July 31, 2008 and October 1, 2011, there were 418 arrests with 25 neurologically-intact survivors (6%). Following implementation of the new protocol, there were 375 arrests with 58 neurologically-intact survivors (15%). The univariate odds ratio (OR) for neurologically-intact survival associated with protocol implementation was 2.9 (95% CI 1.8-4.7, p<0.0001). When controlling for Utstein factors (TABLE), the adjusted OR was 2.5 (95% CI 1.4-4.4, p=0.001).
CONCLUSIONS: A multifaceted approach to OOHCA resuscitation, based on best practices from optimized EMS systems, led to improved neurologically-intact survival in our system.
Author Disclosures: S. Youngquist: Speakers Bureau; Modest; Physio-Control. Consultant/Advisory Board; Modest; Keytechnic. C. Burk: None. D. Reilly: None. C. Baldwin: None.
- © 2014 by American Heart Association, Inc.