“Improving Cardiac Arrest Patient Survival in Georgia”
Each year, approximately 300,000 people in the United States suffer a cardiac arrest. Known in the medical community as an out-of-hospital cardiac arrest (OHCA), survival rates have hovered around 8 percent for the last 30 years. When a group of health leaders in Atlanta considered the possibility of installing public-access automatic defibrillators (AEDs) throughout the city to help improve survival rates in 2003, they quickly recognized that their inability to track the progress of OHCA patient outcomes through the medical system — from the ambulance to the hospital to the moment of discharge — would make it impossible to assess the effectiveness of such an investment. Dr. Bryan McNally, Associate Professor of Emergency Medicine at Emory University, worked with Atlanta hospitals, emergency medical technicians, medical software providers, a network of medical experts, and the Centers for Disease Control and Prevention in Atlanta to develop the Cardiac Arrest Registry to Enhance Survival (CARES) — the first database to track key details for OHCAs. Dr. McNally and partners worked closely with Dr. Greg Mears, who had led the development of the National EMS Information System (NEMSIS), to select indicators that would allow the team to track the outcomes of their efforts and to ensure that the data they were collecting was compatible with the nationwide NEMSIS system. They agreed to track survival rate, bystander CPR rate, the rate of AED use, and total transition time between 911 dispatchers and EMS responders, among other indicators, to assess the timeliness and quality of care patients were receiving throughout the response pipeline. The first-year results of the CARES pilot program clearly showed Atlanta’s poor performance in saving the lives of cardiac arrest victims and provided a baseline from which to make improvements. This data contributed to a greater understanding of the barriers that patients and health professionals encountered that led to OHCA fatalities. It also improved collaboration among citizens, emergency responders, and hospital staff, resulting in increased survival rates and support for future funding considerations.