Latest News

CARES/PAROS Meeting

We will be hosting a CARES/PAROS (Pan-Asian Resuscitation Outcomes Study) meeting at the 2017 NAEMSP conference in New Orleans, LA on Tuesday, January 24th from 7:30-8:30am. The meeting will be held at the Hyatt Regency New Orleans in the "Celestin G" Room.

2017 NAEMSP conference in New Orleans, LA
http://www.naemsp.org/pages/annual-meeting.aspx


Association Of Bystander CPR With Survival After Pediatric OHCA

A peer-reviewed article utilizing CARES data entitled "Association of Bystander Cardiopulmonary Resuscitation With Overall and Neurologically Favorable Survival After Pediatric Out-of-Hospital Cardiac Arrest in the United States" was published today in JAMA Pediatrics. Dr. Maryam Naim was awarded the 2015 "Cardiovascular Disease in the Young Outstanding Research Award in Pediatric Cardiology" for this work. The abstract and PubMed link can be found below.

Importance:  There are few data on the prevalence or outcome of bystander cardiopulmonary resuscitation (BCPR) in children 18 years and younger.

Objective:  To characterize BCPR in pediatric out-of-hospital cardiac arrests (OHCAs).

Design, Setting, and Participants:  This analysis of the Cardiac Arrest Registry to Enhance Survival database investigated nontraumatic OHCAs in children 18 years and younger from January 2013 through December 2015.

Exposures:  Bystander CPR, which included conventional CPR and compression-only CPR.

Main Outcomes and Measures:  Overall survival and neurologically favorable survival, defined as a Cerebral Performance Category score of 1 or 2, at the time of hospital discharge.

Results:  Of the 3900 children younger than 18 years with OHCA, 2317 (59.4%) were infants, 2346 (60.2%) were female, and 3595 (92.2%) had nonshockable rhythms. Bystander CPR was performed on 1814 children (46.5%) and was more common for white children (687 of 1221 [56.3%]) compared with African American children (447 of 1134 [39.4%]) and Hispanic children (197 of 455 [43.3%]) (P < .001). Overall survival and neurologically favorable survival were 11.3% (440 of 3900) and 9.1% (354 of 3900), respectively. On multivariable analysis, BCPR was independently associated with improved overall survival (adjusted proportion, 13.2%; 95% CI, 11.81-14.58; adjusted odds ratio, 1.57; 95% CI, 1.25-1.96) and neurologically favorable survival (adjusted proportion, 10.3%; 95% CI, 9.10-11.54; adjusted odds ratio, 1.50; 95% CI, 1.21-1.98) compared with no BCPR (overall survival: adjusted proportion, 9.5%; 95% CI, 8.28-10.69; neurologically favorable survival: adjusted proportion, 7.59%; 95% CI, 6.50-8.68). For those with data on type of BCPR, 697 of 1411 (49.4%) received conventional CPR and 714 of 1411 (50.6%) received compression-only CPR. On multivariable analysis, only conventional CPR (adjusted proportion, 12.89%; 95% CI, 10.69-15.09; adjusted odds ratio, 2.06; 95% CI, 1.51-2.79) was associated with improved neurologically favorable survival compared with no BCPR (adjusted proportion, 9.59%; 95% CI, 6.45-8.61). There was a significant interaction of BCPR with age. Among infants, conventional BCPR was associated with improved overall survival and neurologically favorable survival while compression-only CPR had similar outcomes to no BCPR.

Conclusions and Relevance:  Bystander CPR is associated with improved outcomes in pediatric OHCAs. Improving the provision of BCPR in minority communities and increasing the use of conventional BCPR may improve outcomes for children with OHCA.

PubMed link
https://www.ncbi.nlm.nih.gov/pubmed/27837587


NASEMSO Resolution in Support of CARES

CARES presented a registry update to state medical directors, data managers, and electronic Patient Care Record (ePCR) vendor contacts at the National Association of State EMS Officials Conference in Albuquerque, New Mexico on September 19th. An update was provided on current state and site participation, 2016-2017 focus states, ePCR extraction processes, and program collaboration with HeartRescue. As a result of the discussion, NASEMSO membership approved an official resolution supporting and encouraging participation in CARES, which will be very valuable to program recruitment and ePCR vendor engagement. CARES continues to strive towards establishing relationships with stakeholders for expanded state and site participation in the registry.

If you are interested in joining the CARES State network or HeartRescue US Consortium, please contact Monica Rajdev (mmehta5@emory.edu) or Dr. Thomas Rea (rea123@uw.edu), respectively.

NASEMSO Resolution 2016:
https://www.dropbox.com/s/u0p6vrdtyzjv5ix/NASEMSO-CARES%202016.pdf?dl=0


CARES Educational Webinar 2016

We would like to thank Dr. Kruger and Dr. Martin for their recent presentation entitled "Prehospital Cardiac Catheterization Lab Activation for Witnessed Ventricular Fibrillation Cardiac Arrest." The webinar covered the success of the novel system implemented in Lincoln, Nebraska which has since drastically improved their OHCA survival rate. At the end of the webinar the audience asked great questions about the challenges as well as solutions for emulating similar systems in their own communities. 

For those who could not join or are interested in distributing the webinar to their department, please see below for links to the recording and slide deck.

The full recording can be accessed at the link below:
https://www.dropbox.com/s/zkr5a6fgpddwxy9/CARES%20educational%20webinar%202016.mp4?dl=0

The slide deck can be accessed at the link below:
https://www.dropbox.com/s/7tfl88vywgces1v/CARES%20educational%20webinar%20deck%202016.pdf?dl=0


ReSS Travel Stipends

The Council on Cardiopulmonary, Critical Care, Perioperative & Resuscitation (3CPR) proudly sponsors Emergency Medical Services Travel Stipends to attend ReSS and/or Scientific Sessions 2016, taking place November 12-16 in New Orleans, Louisiana. The Council invites you to apply by August 10, 2016.

These grants will be awarded to encourage and support the efforts of EMS chiefs, educators and other non-physician EMS leadership and encourage them to participate in council and AHA activities such as the Resuscitation Science Symposium Nov. 12-14.

These stipends provide travel funding to the AHA's Resuscitation Science Symposium (ReSS), as well as complimentary registration for non-physician EMS personnel who have a strong interest in cardiac arrest, CPR and resuscitation care.

Additional information regarding eligibility and the application process can be found at the following link:
http://professional.heart.org/professional/ProfessionalMembership/ScientificCouncils/UCM_322209_Travel-Stipends-to-AHA-Scientific-Sessions.jsp


Implementation of a Regional Telephone CPR Program and Outcomes After OHCA

We are excited to share a recent publication by Dr. Ben Bobrow et al. that examines the association between Telephone CPR (T-CPR), bystander CPR rates, and OHCA outcomes.

ABSTRACT:
Importance: Bystander cardiopulmonary resuscitation (CPR) significantly improves survival from out-of-hospital cardiac arrest but is provided in less than half of events on average. Telephone CPR (TCPR) can significantly increase bystander CPR rates and improve clinical outcomes.

Objective: To investigate the effect of a TCPR bundle of care on TCPR process measures and outcomes.

Design, Setting, and Participants: A prospective, before-after, observational study of adult patients with out-of-hospital cardiac arrest not receiving bystander CPR before the 9-1-1 call between October 1, 2010, and September 30, 2013.

Interventions: A TCPR program, including guideline-based protocols, telecommunicator training, data collection, and feedback, in 2 regional dispatch centers servicing metropolitan Phoenix, Arizona. Audio recordings of out-of-hospital cardiac arrest calls were audited and linked with emergency medical services and hospital outcome data.

Main Outcomes and Measures: Survival to hospital discharge and functional outcome at hospital discharge.

Results: There were 2334 out-of-hospital cardiac arrests (798 phase 1 [P1] and 1536 phase 2 [P2]) in the study group; 64% (1499) were male, and the median age was 63 years (age range, 9-101 years; interquartile range, 51-75 years). Provision of TCPR increased from 43.5% in P1 to 52.8% in P2 (P < .001), yielding an increase of 9.3% (95% CI, 4.9%-13.8%). The median time to first chest compression decreased from 256 seconds in P1 to 212 seconds in P2 (P < .001). All rhythm survival was significantly higher in P2 (184 of 1536 [12.0%]) compared with P1 (73 of 798 [9.1%]), with an adjusted odds ratio (aOR) of 1.47 (95% CI, 1.08-2.02; P = .02) in a logistic regression model and an adjusted difference in absolute survival rates (adjusted rate difference) of 3.1% (95% CI, 1.5%-4.9%). Survival for patients with a shockable initial rhythm significantly improved in P2 (107 of 306 [35.0%]) compared with P1 (42 of 170 [24.7%]), with an aOR of 1.70 (95% CI, 1.09-2.65; P = .02) and an adjusted rate difference of 9.6% (95% CI, 4.8%-14.4%). The rate of favorable functional outcome was significantly higher in P2 (127 of 1536 [8.3%]; 95% CI, 6.9%-9.8%) than in P1 (45 of 798 [5.6%]; 95% CI, 4.1%-7.5%), with an aOR of 1.68 (95% CI, 1.13-2.48; P = .01) and an adjusted rate difference of 2.7% (95% CI, 1.3%-4.4%).

Conclusions and Relevance: Implementation of a guideline-based TCPR bundle of care was independently associated with significant improvements in the provision and timeliness of TCPR, survival to hospital discharge, and survival with favorable functional outcome.

The full article can be accessed at the link below:
http://cardiology.jamanetwork.com/article.aspx?articleid=2518761


CARES 2015 Video Metrics

We are excited to present you with a summary video on 2015 metrics. This video includes participation statistics of the program along with National Report summary data. We hope you enjoy this informative presentation. Thank you for your continued CARES support and participation!

CARES 2015 Video Metrics
https://youtu.be/_70sHfUeLGQ


Statewide Initiatives Improve Outcomes for Patients Who Undergo Cardiac Arrest at Home

According to a study by DCRI (Duke Clinical Research Institute) researchers, North Carolina's statewide effort to promote bystander CPR and first-responder defibrillation improved outcomes for patients who suffered cardiac arrest in their homes. The study was led by Christopher Fordyce, MD and was presented at the annual Scientific Sessions of the American College of Cardiology in Chicago this month.

The full story can be accessed here:
https://www.dcri.org/research/news/dcri-news-2016/acc-2016-statewide-initiatives



Regional Variation in OHCA Survival in the U.S.

A peer-reviewed article utilizing CARES data entitled "Regional Variation in Out-of-Hospital Cardiac Arrest Survival in the United States" was recently published in Circulation. The abstract and PubMed link can be found below.

BACKGROUND:
Although previous studies have shown marked variation in out-of-hospital cardiac arrest survival across U.S. regions, factors underlying this survival variation remain incompletely explained.
METHODS AND RESULTS:
Using data from the Cardiac Arrest Registry to Enhance Survival, we identified 96,662 adult patients with out-of-hospital cardiac in 132 U.S. counties. We used hierarchical regression models to examine county-level variation in rates of survival and survival with functional recovery (defined as Cerebral Performance Category score of 1 or 2) and examined the contribution of demographics, cardiac arrest characteristics, bystander cardiopulmonary resuscitation (CPR), automated external defibrillator (AED) use, and county-level socio-demographic factors in survival variation across counties. A total of 9317 (9.6%) patients survived to discharge, and 7176 (7.4%) achieved functional recovery. At a county-level, there was marked variation in rates of survival to discharge (range: 3.4%-22.0%, median odds ratio [MOR] 1.40, 95% CI 1.32-1.46) and survival with functional recovery (range: 0.8%-21.0%, MOR 1.53, 95% CI 1.43-1.62). County-level rates of bystander CPR and AED use were positively correlated with both outcomes (P<0.0001 for all). Patient demographic and cardiac arrest characteristics explained 4.8% and 27.7% of the county-level variation in survival, respectively. Additional adjustment of bystander CPR and AED explained 41% of the survival variation, and this increased to 50.4% after adjustment of county-level socio-demographic factors. Similar findings were noted in analyses of survival with functional recovery.
CONCLUSIONS:
Although out-of-hospital cardiac arrest survival varies significantly across U.S. counties, a substantial proportion of the variation is due to differences in bystander response across communities.

PubMed link:
http://www.ncbi.nlm.nih.gov/pubmed/27081119



New Publication in JAHA Utilizing CARES Data

We are excited to share a recent publication by Dr. Paul Chan et al. that utilized CARES data:

"Long-Term Outcomes Among Elderly Survivors of Out-of-Hospital Cardiac Arrest" was published in the Journal of the American Heart Association. This open-access article is accessible at http://jaha.ahajournals.org/content/5/3/e002924.full.pdf+html.

Thank you for your continued participation in CARES, which helps further knowledge in the field of resuscitative science.

Best,
The CARES Team

The article can be accessed here:
http://jaha.ahajournals.org/content/5/3/e002924.full.pdf+html




Dispatcher Assisted CPR Case

Below is a link to short video which demonstrates how dispatcher assisted CPR positively impacted the life of someone who is having an out of hospital cardiac arrest.

CARES participants can request access to a Dispatcher Assisted CPR module within CARES. For more details please visit the CARES webpage at https://mycares.net/sitepages/dispatchtraining.jsp .

The dispatcher assisted CPR case can be accessed here:
https://www.dropbox.com/s/cr3hjfbriwme0v6/Dispatch Assisted CPR case Edwin Huang NSLD.mp4?dl=0

More information regarding the Dispatcher Assisted CPR module within CARES can be accessed here:
https://mycares.net/sitepages/dispatchtraining.jsp



Survival After OHCA in Children

A peer-reviewed article utilizing CARES data entitled "Survival After Out-of-Hospital Cardiac Arrest in Children" was recently published in Journal of the American Heart Association. The abstract and direct access link can be found below.

Background: Little is known about survival after out‐of‐hospital cardiac arrest (OHCA) in children. We examined whether OHCA survival in children differs by age, sex, and race, as well as recent survival trends.
Methods and Results: Within the prospective Cardiac Arrest Registry to Enhance Survival (CARES), we identified children (age <18 years) with an OHCA from October 2005 to December 2013. Survival to hospital discharge by age (categorized as infants [0 to 1 year], younger children [2 to 7 years], older children [8 to 12 years], and teenagers [13 to 17 years]), sex, and race was assessed using modified Poisson regression. Additionally, we assessed whether survival has improved over 3 time periods: 2005-2007, 2008-2010, and 2011-2013. Of 1980 children with an OHCA, 429 (21.7%) were infants, 952 (48.1%) younger children, 276 (13.9%) older children, and 323 (16.3%) teenagers. Fifty‐nine percent of the study population was male and 31.8% of black race. Overall, 162 (8.2%) children survived to hospital discharge. After multivariable adjustment, infants (rate ratio: 0.56; 95% CI: 0.35, 0.90) and younger children (rate ratio: 0.42; 95% CI: 0.27, 0.65) were less likely to survive compared with teenagers. In contrast, there were no differences in survival by sex or race. Finally, there were no temporal trends in survival across the study periods (P=0.21).
Conclusions: In a large, national registry, we found no evidence for racial or sex differences in survival among children with OHCA, but survival was lower in younger age groups. Unlike in adults with OHCA, survival rates in children have not improved in recent years.

Direct Access link:
http://jaha.ahajournals.org/content/4/10/e002122.full#abstract-1


Early Coronary Angiography and Survival After OHCA

A peer-reviewed article utilizing CARES data entitled "Early Coronary Angiography and Survival After Out-of-Hospital Cardiac Arrest" was recently published in Circulation: Cardiovascular Intervention. The abstract and PubMed link can be found below.

BACKGROUND: Although out-of-hospital cardiac arrest is common because of acute myocardial infarction, it is unknown whether early coronary angiography is associated with improved survival in these patients.
METHODS AND RESULTS: Using data from the Cardiac Arrest Registry to Enhance Survival (CARES), we identified 4029 adult patients admitted to 374 hospitals after successful resuscitation from out-of-hospital cardiac arrest because of ventricular fibrillation, pulseless ventricular tachycardia, or unknown shockable rhythm between January 2010 and December 2013. Early coronary angiography (occurring within one calendar day of cardiac arrest) was performed in 1953 (48.5%) patients, of whom 1253 (64.2%) received coronary revascularization. Patients who underwent early coronary angiography were younger (59.9 versus 62.0 years); more likely to be men (78.1% versus 64.3%), have a witnessed arrest (84.6% versus 77.4%), and have ST-segment-elevation myocardial infarction (32.7% versus 7.9%); and less likely to have known cardiovascular disease (22.8% versus 35.0%), diabetes mellitus (11.0% versus 17.0%), and renal disease (1.8% versus 5.8%; P<0.01 for all comparisons). In analysis of 1312 propensity score-matched pairs, early coronary angiography was associated with higher odds of survival to discharge (odds ratio 1.52 [95% confidence interval 1.28-1.80]; P<0.0001) and survival with favorable neurological outcome (odds ratio 1.47 [95% confidence interval 1.25-1.71]; P<0.0001). Further adjustment for coronary revascularization in our models significantly attenuated both odds ratios, suggesting that revascularization was a key mediator of the survival benefit.
CONCLUSIONS: Among initial survivors of out-of-hospital cardiac arrest caused by VF or pulseless VT, we found early coronary angiography was associated with higher odds of survival to discharge and favorable neurological outcome.

PubMed link:
http://www.ncbi.nlm.nih.gov/pubmed/26453686

A corresponding editorial, "How Much is Enough", can be viewed at:
http://circinterventions.ahajournals.org/content/8/10/e003075.extract?sid=5bf1457f-4f05-43b2-82d8-ec9e12ded50b


Community and Telephone CPR Workshop at ECCU

Open to call-takers, dispatchers, community CPR trainers, and lay people who
want to learn Telephone-CPR, the pre-conference workshop promises an interactive learning
experience. It provides insight through hands-on CPR practice, 9-1-1 audio
recordings, small-group discussion, and interviews with a survivor, her rescuer
and the call-taker who provided T-CPR instructions.

When: December 7, 2015, 8am-12pm
Where: Manchester Grand Hyatt, San Diego, CA
Who: Helge Myklebust & Tonje Birkenes (Laerdal Medical) and Dr. Ben Bobrow & Micah Panczyk (Arizona Dept. of Health Services)

For more information, please call 602-364-2846.

To register, visit:
https://www.citizencpr.com/ehome/108317/conference/?&


IOM Report recommends national registry for OHCA

A new report from the Institute of Medicine (IOM) recommends the establishment of a national registry to track out-of-hospital cardiac arrests (OHCA), while boosting involvement in teaching bystander CPR (cardiopulmonary resuscitation) to communities. The report highlights that "A national responsibility exists to improve the likelihood of survival and favorable neurologic outcomes following a cardiac arrest. This will require immediate changes in cardiac arrest reporting, research, training, and treatment."

The CARES Program is an OHCA registry that has the potential to serve as the recognized registry for the US. CARES, established through a collaborative effort between Emory and the Centers for Disease Control and Prevention (CDC), began in 2004 and has since expanded both nationally and internationally. Currently more than 800 EMS agencies and over 1,300 hospitals in 36 states representing a population footprint of 80 million people participate in the program

"CARES has been able to track improvements in survival and bystander interventions amongst participating communities over time. Our ultimate goal of the program is to serve as a standard platform for quality assurance efforts and improve survival from OHCA," says Bryan McNally, MD, MPH, Executive Director of CARES and Associate Professor of Emergency Medicine at Emory University School of Medicine.

McNally goes on to say, "We are excited to see that the IOM has recognized the importance of having a national registry for OHCA. We believe CARES is well positioned to be the registry for the US as we currently cover approximately 25% of the US population and have approximately 200,000 cardiac arrest events in the registry."

Currently, CARES is funded by the American Red Cross, American Heart Association, Medtronic Foundation and ZOLL Corporation. These partners have supported the concept of CARES as a national registry and emphasized the importance of promoting bystander interventions such as CPR and AED use.

According to McNally, registry data suggests survival rates from OHCA are trending in the right direction. With numerous states participating in CARES, and now the IOM supporting a national registry, we hope this message continues to reach more communities to promote participation in the registry and benefit even more cardiac arrest patients.

The full IOM report can be accessed via the following link:
http://www.iom.edu/Reports/2015/Strategies-to-Improve-Cardiac-Arrest-Survival.aspx

The CARES commissioned paper on the public health burden of cardiac arrest can be accessed via the following link:
http://iom.edu/~/media/Files/Report%20Files/2015/CARES.pdf

A recording of the report release webcast is available at:
http://iom.edu/Activities/PublicHealth/TreatmentofCardiacArrest/2015-June-30.aspx



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