b'CARES Annual Report 2019 | 17Using CARES Data to Influence Survivability in the Hospital Setting By Andrea Kiogima, MSN, RN, Chest Pain Coordinator at the University of Michigan Health, Wyoming, MI In early 2018, the finalized 2017 CARES National Reports were made available to individual EMS and hospital facilities. It was a time of discovery for the Metro Health-University of Michigan Health organization as survivability following an out-of-hospital cardiac arrest (OHCA) was not a subset of patients that had specifically been tracked.One metric that stood out was in-hospital mortality. This represents patients who experienced an OHCA, survived to hospital admission, but do not survive to discharge. At the time the data was first presented, the organization was faring worse than state and national averages at a 70% in-hospital mortality rate, while the state average was 66.4% and national average was 62.8%.It quickly drew the attention of the organizations leadership and interdisciplinary Chest Pain Committee. What we understood, without the ability to control, was the fact that our hospital remains the most rural of the three major health systems in our region (Grand Rapids area). Metro Health regionally serves a large span of rural West Michigan around Grand Rapids. Often, our cardiac arrest patients had longer distances in transport, adding precious minutes to a critical situation. However, there were other factors that Metro had control over, one of those being Emergency Department (ED) disposition. There was no identifiable or standardized decision-making process as to where the patient should go following their care in the ED. Often times, patients went emergently to the Cardiovascular Catheterization Lab (CCL) and other times to the Intensive Care Unit (ICU). This was subjectively determined by individual physicians, case-by-case.An article published in the Journal of the American College of Cardiology (JACC) in 2015 3offered an algorithm to provide guidance for the management of patients who have achieved return of spontaneous circulation (ROSC), but remain comatose. ST-elevation on a 12-lead electrocardiogram was a direct indication for emergent transfer to CCL. CCL versus ICU disposition should be based on a number of considerations as shown in the figure below. 3 Rab, T, Kern KB, Tamis-Holland JE, et al. Cardiac arrest: a treatment algorithm for emergent invasive cardiac procedures in the resuscitated comatose patient. J Am Coll Cardio 2015;66:62-73 (Figure 1 reproduced with permission)'