b'18RACE-CARS Grant Using CARES Registry Awarded by NIH By Chris Granger, MD, Principal Investigator, Director, Cardiac Care Unit, Duke University Medical Center North Carolina, as one of the longest standing state participants, has over a decade of CARES data from across the state. In 2020, Duke University was awarded a 7-year grant, called RACE-CARS (Regional Approaches to Cardiovascular EmergenciesCardiac ARreSt (RACE-CARS).RACE-CARS is a National Heart Lung & Blood Institute (NHLBI)-sponsored cluster-randomized trial to test the implementation of community interventions to improve survival for people with cardiac arrest in North Carolina.In addition to addressing a major public health issue, the trial is innovative in being imbedded in the CARES Registry describes Dr. Monique Starks, a member of the trial team.RACE-CARS is the first entirely registry-based trial in the United States, an approach that has been used to great advantage in conducting efficient clinical trials in Europe.CARES will be used to perform patient enrollment (with waiver of individual informed consent) and to collect all baseline characteristics and primary outcome data. This accomplishes two elusive goals in randomized trials: it makes the trial highly efficient, and it makes the trial highly representative and relevant since the entire eligible population is automatically enrolled.The premise for RACE-CARS is based on prior observations utilizing CARES data, showing substantial regional heterogeneity in care correlated with variations in outcomes. RACE-CARS will examine the effectiveness of a multifaceted intervention compared to usual care. The structured intervention program will consist of four major elements:comprehensive community training of lay people in CPR and defibrillator use optimized 911 EMS dispatch performance including recognition of possible cardiac arrest enhanced bystander initiation of CPR with 911 operator coaching improved first responder performance to achieve earlier use of defibrillators. If successful, these interventions would provide a roadmap for communities throughout the U.S. to improve patient outcomes from OHCA and save lives. Sixty-three counties across North Carolina have been randomized to intervention versus control. RACE-CARS will engage EMS agencies, community health centers, and local community groups. The primary objective of the RACE-CARS trial is to improve survival to hospital discharge with good neurologic function by one third, increasing the rate from approximately 9% currently to 12%. In addition, quality of life and neurological functional status will be assessed at 6 and 12 months.The trial team includes Clark Tyson and Lisa Monk, as well as Drs. Jollis, Granger, Starks, Al-Khalidi, and Mark at Duke University. We are excited to have the opportunity to do a major NHLBI trial with CARES as the data system, says Dr. Jamie Jollis. Our hope is that this is only the beginning of future studies leveraging an existing data system like CARES, to advance research and quality improvement for OHCA.'