A statewide system in Arizona for directing out-of-hospital cardiac arrest patients to 31 designated cardiac receiving center (CRC) hospitals that provide guideline-based post-arrest care more than doubled risk-adjusted rates of both survival and survival with good neurologic status. The impact of this system, with the voluntary participation of 120 emergency medical services (EMS) agencies and covering 80 percent of the state’s population, was recently reported in Annals of Emergency Medicine.1
“We believed lives would be saved if the hospitals implemented the guidelines for post-arrest care and if we were able to get arrest patients to those hospitals,” said lead author Daniel Spaite, MD, director of EMS Research Collaboration and endowed professor at The University of Arizona in Tucson. The project is a partnership between EMS agencies, hospitals, the Arizona Department of Health Services (ADHS), and The University of Arizona in which designated CRCs commit to 24-7 guideline-based provision of therapeutic hypothermia and coronary angiography and percutaneous coronary interventions (cath/PCI), along with a bundle of other interventions.
ADHS worked closely with hospitals on implementing the guidelines and becoming recognized as CRCs starting in 2007. Then the department established protocols directing EMS agencies to transport cardiac arrest patients to the designated centers. Researchers compared survival rates before and after systemwide intervention, with survival increasing by more than 60 percent by 2010 (with adjusted odds ratio of more than 2).