The Cardiac Arrest Registry to Enhance Survival (CARES)

Each year, approximately 350,000 persons in the United States experience an out-of-hospital cardiac arrest (OHCA) or sudden death; approximately 90% of persons who experience an OHCA die. Despite decades of research, median reported rates of survival to hospital discharge are poor (10.4%) and have remained virtually unchanged for the past 30 years. Without a uniform and reliable method of data collection, communities cannot measure the effectiveness of their response systems, nor can they assess the impact of interventions designed to improve OHCA survival. Participation in an OHCA registry enables communities to compare patient populations, interventions, and outcomes with the goal of identifying opportunities to improve quality of care and ascertain whether resuscitation is provided according to evidence based guidelines. CARES was developed to help communities determine standard outcome measures for out-of-hospital cardiac arrest (OHCA) locally allowing for quality improvement efforts and benchmarking capability to improve care and increase survival.

Overall, the CARES program seeks to:

• Save more lives from OHCA
• Strengthen collaboration between 911 centers, first responders, emergency medical services (EMS) agencies and hospitals.
• Provide a simple, confidential process for assessing patient outcomes in compliance with HIPAA.
• Offer technical assistance (TA) to help community leaders identify and prioritize opportunities to improve EMS performance.
• Generate annual national and statewide reports for benchmarking capability.

CARES is a secure, Web-based data management system in which participating communities enter local data and generate their own reports. Communities can compare their EMS system performance to de-identified aggregate statistics at the local, state, or national level and discover promising practices that could improve emergency cardiac care.

Working Together to Improve Emergency Cardiac Care

The CARES system:

• Uses a secure Web database with restricted access for authorized users.
• Has software that collects and links data sources to create a single de-identified record for each OHCA event.
• Uses a simple, HIPAA-compliant methodology to protect confidentiality.
• Accepts a variety of input methods, such as uploaded data files or online data entry.
• Collects 9-1-1 computer-aided dispatch data for EMS response times.
• Allows longitudinal, internal benchmarking of key performance indicators.

Helping Communities Identify Opportunities for Improvement

CARES helps local EMS administrators and community leaders answer such questions as:

• Who is affected in my community?
• When and where are cardiac events happening?
• What parts of the system are working well?
• What parts of the system could work better?
• How can we improve emergency cardiac treatment?

Reaching Across the Nation

In 2004, the Centers for Disease Control and Prevention (CDC) collaborated with Emory University School of Medicine's Department of Emergency Medicine to develop CARES (Cardiac Arrest Registry to Enhance Survival), an OHCA surveillance registry to help communities increase survival rates. In 2005, Atlanta, Georgia was the first community to begin data collection with nearly 600 cases captured that year. At present, the registry now captures nearly the same number of cases every day. The program has since expanded to include 30 state-based registries and the District of Columbia, with community sites in 16 additional states. CARES represents a catchment area of more than 170 million people or approximately 51% of the US population. To date, the registry has captured over 820,000 records, with more than 2,300 EMS agencies and over 2,500 hospitals participating nationwide.

In 2011, CARES began expanding to statewide participation which allows enrollment of additional communities of different sizes and population densities to be included in the registry. In addition, state-level participation allows better communication and collaboration between state and local EMS providers.

In 2009, CARES began partnering internationally with the Pan Asian Resuscitation Outcomes Study (PAROS) which represents 13 Countries (Japan, South Korea, Malaysia, Singapore, Taiwan, Thailand, United Arab Emirates, China, Philippines, Indonesia, Vietnam, India and Pakistan). We have collaborated by sharing our software platform for data collection and reporting and technical expertise in an effort to implement a standard web-based platform for data collection and reporting for OHCA globally.

Saving Lives Through Improved Care and Prevention

CARES data are used to help communities benchmark and improve their performance for OHCA care. CARES allows participating communities to view their own statistics online confidentially and compare their performance to anonymous aggregated data at the local, regional, or national level. CARES automatically calculates local 911 response intervals, delivery rates for critical interventions (e.g., bystander CPR and public access defibrillation [PAD]), and community rates of survival and functional status at discharge, on the basis of each patient's CPC Scale. An annual report is provided to all participating communities that summarizes local results in comparison to regional and national benchmarks. Tracking performance longitudinally allows communities to better understand which elements of their care are working well and which elements need improvement. Reporting at the state and local levels can enable state and local public health and EMS agencies to coordinate their efforts to target improving emergency response for OHCA events which can lead to improvement in OHCA survival rates.