Multistate 5-Year Initiative to Improve Care for Out-of-Hospital Cardiac Arrest: Primary Results From the HeartRescue Project

J Am Heart Assoc. 2017 Sep 22;6(9):e005716. doi: 10.1161/JAHA.117.005716.


Background: The HeartRescue Project is a multistate public health initiative focused on establishing statewide out-of-hospital cardiac arrest (OHCA) systems of care to improve case capture and OHCA care in the community, by emergency medical services (EMS), and at hospital level.

Methods and results: From 2011 to 2015 in the 5 original HeartRescue states, all adults with EMS-treated OHCA due to a presumed cardiac cause were included. In an adult population of 32.8 million, a total of 64 988 OHCAs-including 10 046 patients with a bystander-witnessed OHCA with a shockable rhythm-were treated by 330 EMS agencies. From 2011 to 2015, the case-capture rate for all-rhythm OHCA increased from an estimated 39.0% (n=6762) to 89.2% (n=16 103; P<0.001 for trend). Overall survival to hospital discharge was 11.4% for all rhythms and 34.0% in the subgroup with bystander-witnessed OHCA with a shockable rhythm. We observed modest temporal increases in bystander cardiopulmonary resuscitation (41.8-43.5%, P<0.001 for trend) and bystander automated external defibrillator application (3.2-5.6%, P<0.001 for trend) in the all-rhythm group, although there were no temporal changes in survival. There were marked all-rhythm survival differences across the 5 states (8.0-16.1%, P<0.001) and across participating EMS agencies (2.7-26.5%, P<0.001).

Conclusions: In the initial 5 years, the HeartRescue Project developed a population-based OHCA registry and improved statewide case-capture rates and some processes of care, although there were no early temporal changes in survival. The observed survival variation across states and EMS systems presents a future challenge to elucidate the characteristics of high-performing systems with the goal of improving OHCA care and survival.

Keywords: automated external defibrillator; cardiac arrest; cardiopumonary resuscitation; public health initiative; quality improvement.

Publication types

  • Multicenter Study
  • Observational Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Cardiopulmonary Resuscitation* / adverse effects
  • Cardiopulmonary Resuscitation* / mortality
  • Cardiopulmonary Resuscitation* / trends
  • Defibrillators
  • Electric Countershock* / adverse effects
  • Electric Countershock* / instrumentation
  • Electric Countershock* / mortality
  • Electric Countershock* / trends
  • Emergency Medical Services* / trends
  • Female
  • Healthcare Disparities
  • Hospital Mortality
  • Humans
  • Male
  • Middle Aged
  • Out-of-Hospital Cardiac Arrest / diagnosis
  • Out-of-Hospital Cardiac Arrest / mortality
  • Out-of-Hospital Cardiac Arrest / therapy*
  • Patient Discharge
  • Process Assessment, Health Care* / trends
  • Program Evaluation
  • Prospective Studies
  • Quality Improvement* / trends
  • Quality Indicators, Health Care* / trends
  • Registries
  • Time Factors
  • Treatment Outcome
  • United States