ACC 2016: Statewide initiatives improve outcomes for patients who undergo cardiac arrest at home

April 3, 2016 – The percentage of patients surviving to discharge has increased since North Carolina launched the RACE CARS program.

A coordinated statewide effort to promote bystander CPR and first-responder defibrillation improved outcomes for patients who suffered cardiac arrest in their homes, according to a study by DCRI researchers.

The study, led by Christopher Fordyce, MD, (pictured) was presented Sunday at the annual Scientific Sessions of the American College of Cardiology in Chicago.

Outcomes for patients who experience cardiac arrest outside of a hospital are very poor: an Institute of Medicine report issued last year noted that less than 6 percent of people who experience a cardiac arrest outside the hospital survive their initial hospitalization. In North Carolina, the RACE CARS (Regional Approach to Cardiovascular Emergencies Cardiac Arrest Resuscitation System) program promotes the use of chest-compression CPR and automated external defibrillator use among bystanders and first responders.

christopher-fordyceEarlier studies have shown that the initiative has significantly improved survival rates for cardiac arrest patients. However, those studies did not specifically examine the effects of the initiative on patients who experience cardiac arrest in their homes—even though approximately 70 percent of out-of-hospital cardiac arrest occurs in the home.

To better understand how the initiative has affected at-home cardiac arrest outcomes, Fordyce and his colleagues examined patient data from the Cardiac Arrest Registry to Enhance Survival (CARES) registry. CARES allows participating communities and emergency management systems to submit data on out-of-hospital cardiac arrest. Using the registry, the DCRI researchers identified 8,269 cases of out-of-hospital cardiac arrest from 16 counties in North Carolina between 2010 and 2014. Of these patients, 5,602 (68 percent) experienced cardiac arrest in public while 2,667 patients (32 percent) went into arrest at home.

The proportion of patients receiving bystander CPR increased at home from 28.3 percent in 2010 to 41.3 percent in 2014. There was a corresponding increase in public bystander CPR (61.0 percent to 70.6 percent). First-responder defibrillation increased at home (42.2 percent to 50.8 percent) but not in public (33.1 percent to 37.8 percent).

More patients also survived to discharge; both those who went into arrest at home (5.7 percent to 8.1 percent) and in public (10.8 percent to 16.2 percent). A combination of bystander CPR and either first-responder defibrillation at home or bystander defibrillation in public was most strongly associated with age-and sex-adjusted survival rates.

“These findings demonstrate that North Carolina’s bystander CPR and first-responder defibrillation initiatives are having a strong impact on survival rates for the majority of patients who experience cardiac arrest in their homes,” Fordyce said.

In addition to Fordyce, the study’s Duke authors included Carolina M. Hansen, MD; Kristian Kragholm, MD; James G. Jollis, MD; Mayme L. Roettig RN, MSN; Matthew E. Dupre, PhD; ; Lisa Monk, RN; Clark Tyson, MS, NREMT-P; Monique L. Anderson, MD; and Christopher B. Granger, MD.