Leading resuscitation experts collaborate to improve SCA survival rates.
Initiated and funded by the Medtronic Foundation, the HeartRescue project is designed to improve how SCA is recognized, treated and measured in the United States.
What is the role of HeartRescue Partners?
The HeartRescue Project begins with a shared belief that SCA is a treatable condition. Working in select geographies, HeartRescue Partners and their partner agencies will work to improve SCA survival rates by expanding and replicating successful city and county out-of-hospital cardiac arrest response programs to statewide levels. Within their geographies, Partners will:
- Develop an integrated community response to SCA
- Coordinate public and professional education and training efforts
- Introduce and apply best-practice treatments to the general public, first responders (police/fire), emergency medical services (EMS) and hospitals
- Implement a common, systemic method of measuring performance and outcomes of SCA
Measurement of results is an essential element of the HeartRescue Project. A system can implement all the best practices in the world, but we won't know it is working unless performance and outcomes including survival rates are measured. We can also gain better perspectives on SCA prevalence.
- Currently, there are no national standards for SCA performance and outcomes. HeartRescue Partners are utilizing the CARES registry as a common set of data elements used to measure performance and outcomes. More information on OHCA (out-of-hospital cardiac arrest) data collection can be found here.
- There are an estimated 382,800 OHCA events treated by EMS in the United States each year.1
- The best survival statistics available today indicate that in communities that measure their survival rates, roughly 10% of OHCA victims survive2; this is known as the “overall” survival rate.
- Survival in communities that are not measuring is likely half of that rate. Because only a handful of communities currently measure SCA survival2,3 across most of the United States, the national overall survival rate is likely much less than 10%.
- Survival for EMS treated, bystander witnessed, ventricular fibrillation (VF) OHCA in the US is around 30% in communities that measure.
- Patients who present in ventricular fibrillation, particularly those who are EMS-treated, bystander-witnessed, and in ventricular fibrillation have the best chance of survival among all cardiac arrest victims. Survival rates for this group of SCA victims often serve as a sentinel measure for the effectiveness of a community's system of care.
- There is wide variability in EMS-treated, bystander witnessed, VF OHCA survival rates across the country, ranging from 7.7% to 39.9%3.
While every community has a unique set of circumstances that may not allow for the commitment of resources that top-performing systems may have, similar results can be achieved.
Focusing on best practices does not mean cookie-cutter solutions. Incremental steps can be taken, starting with a number of possibilities including:
- Measuring OHCA at the basic level (e.g. ventricular fibrillation witnessed arrests)
- Improving CPR at the EMS level (e.g., implementing high performance CPR education at the EMT level)
- Implementing public-based CPR/AED education programs
- Providing 911 dispatchers with SCA recognition training and bystander CPR instructions
It should be no surprise that any community SCA response effort needs visionary leaders committed to system improvement. Any efforts should start by gaining buy-in and enthusiasm from top community leaders. Leaders fulfill the following functions:
- Motivate and educate other key leaders
- Set strategic goals for activities to be undertaken
- Align efforts within the organization to achieve those goals
- Provide resources for the creation, spread, and sustainability of effective systems
- Remove obstacles to improvements for clinicians and staff
- Require adherence to known practices that will promote patient safety
There is a correlation between the overall performance of an EMS system and SCA survival rates.
- The attributes of collaboration and measurement which contribute to good SCA outcomes also contribute to better EMS care in general
- Collaboration that’s required to improve SCA survival rates means connections between pre-hospital and hospital are strong, which has positive implications for the entire system
- Undertaking an effort to improve SCA outcomes can have a positive effect on the entire EMS system, in terms of building relationships, cultural changes, and an emphasis on performance and quality improvement
1. Roger VL, Go AS, Lloyd-Jones DM, et al. Heart disease and stroke statistics--2012 update: a report from the American Heart Association. Circulation. Jan 3 2012;125(1):e2-e220.
2. McNally B, Robb R, Mehta M, et al. Out-of-hospital cardiac arrest surveillance --- Cardiac Arrest Registry to Enhance Survival (CARES), United States, October 1, 2005--December 31, 2010. MMWR. Surveillance summaries : Morbidity and mortality weekly report. Surveillance summaries / CDC. Jul 29 2011;60(8):1-19.
3. Nichol G, Thomas E, Callaway CW, et al. Regional variation in out-of-hospital cardiac arrest incidence and outcome. JAMA : the journal of the American Medical Association. Sep 24 2008;300(12):1423-1431.
What Makes the HeartRescue Project Unique?
The HeartRescue Project approach builds on decades of best practices at the bystander, prehospital and hospital level, combining them under one program in order to expand geographic reach. Key elements include:
- Publicly stated/measurable goals (a 50-percent increase in survival rates over five years in funded geographies)
- A common set of data elements used to measure performance and outcomes
- State-based reach, to include every size of community
- Highly collaborative environment, bringing together leaders, influencers, and hundreds of stakeholders in each state
- A focus on incremental system quality improvement via demonstrable, data-driven evidence
- A commitment to sharing information and publishing results