Measuring Process and Outcome Variables is Critical for Improving Quality of Care for Out-of-Hospital Cardiac Arrest Victims.
Knowing your community’s survival rate, and some of the details such as the percentage of cases for which bystander CPR was provided, is necessary to begin planning effective improvement strategies.
Currently the most useful method of measuring is participation in the Cardiac Arrest Registry for Enhanced Survival (CARES).
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If an EMS system is not able to participate in CARES the system, they can collect their own basic registry data. However, the devil is in the details. It is important to ensure that all the appropriate cases should be included and to include essential elements in the correct format.
Measurement is Key to Success
Every EMS system should measure, evaluate and report its SCA survival rate
to the community annually.
EMS systems with the resources to do so should maintain more comprehensive data registries to better inform their quality initiatives. Maintaining an ongoing, accurate and complete registry for SCA QI requires a minimum of one dedicated person per 1,000,000 population dedicated to the task.
Why is measurement essential to success?
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 survive 2; 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 survival 2,3 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
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.