Arizona increases cardiac arrest survival through centralized out-of-hospital care

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 - ambulance, EMS

Survival stats shot upward after a consortium in Arizona implemented statewide protocols to triage patients to the nearest cardiac care center as opposed to a hospital. The findings were published online July 23 in Annals of Emergency Medicine.

The triage protocol, implemented in 2008, called for emergency service teams to bring cardiac patients to the closest cardiac care facility as opposed to a hospital, provided that the cardiac center was less than 15 minutes further. Daniel W. Spaite, MD, of the University of Arizona in Tucson, and colleagues reviewed cardiac care center cases between 2007 and 2010 to analyze outcomes before and after the protocol was put into place.

They saw a 60 percent increase in the number of patients taken to certified cardiac care centers following the implementation of the triage protocol. All-rhythm survival rates increased from 8.9 percent before the protocol to 14.4 percent after. Cardiac care centers were able to increase their rates of providing certain types of care to cardiac patients: therapeutic hypothermia rates skyrocketed from 0 percent to 44 percent post-protocol and catheterization PCI rates nearly tripled, going from 11.7 percent to 30.7 percent over the course of the analysis.

Favorable neurological outcomes increased from 5.9 percent to 8.9 percent.

Patients with ventricular fibrillation or tachycardia not only saw increases in survival (from 21.4 percent to 39.2 percent), but also in favorable neurological survival (from 19.4 percent to 29.8 percent).

While the proportion of patients for whom spontaneous circulation returned remained approximately the same between the two time periods (25.3 percent before, 24.1 percent after), more interventions were able to do more good for patients.

"We knew lives would be saved if the hospitals implemented the latest cutting-edge guidelines for post-cardiac arrest care and we were able to get cardiac arrest patients to those hospitals, similar to what is done for Level 1 trauma patients," said Spaite in a press release. "Taking these patients directly to a hospital optimally prepared to treat cardiac arrest gave patients a better chance of survival and of preventing neurologic damage, a common result of these cardiac events."