b'In contrast to the challenges at the national level, local trend analysis is often more dependable due to the stability of data collection at the state or regional level. States with consistent, comprehensive participation can offer a steady stream of data, enabling more precise local-level trend analysis. This approach allows for targeted improvements in specific regions based on the unique needs and characteristics of those communities. However, for national-level trend analysis to be meaningful, a cohort-based approach is necessary. This would focus on analyzing data exclusively from agencies that contribute year after year, ensuring a more accurate representation of trends nationwide. By limiting the analysis to regions with reliable, continuous data, CARES can generate more accurate, actionable insights to guide policy and intervention strategies at the national level. Expanding participation across all states and ensuring consistent annual contributions will be essential for generating reliable, data-driven insights that improve survival outcomes nationwide.Over the past 20 years, CARES has established itself as a cornerstone of OHCA data-driven quality improvement, surveillance, research, and public health intervention. With advancements in data collection, visualization, and security through the NextGen CARES platform, the program continues to evolve, fostering national and international collaboration. Through targeted community engagement, technology-driven solutions, and impactful research, CARES is positioned to drive the next wave of advancements in OHCA care. As we look ahead, the continued expansion of CARES promises to enhance emergency response, improve bystander compliance, and ultimately save more lives across the United States. 1. Chan P, Girotra S, Tang Y, Al-Araji R, Nallamothu B, McNally B. Outcomes for Out-of-Hospital Cardiac Arrest in theUnited States During the Coronavirus Disease 2019 Pandemic. JAMA Cardiol. doi:10.1001/jamacardio.2020.6210.2. Coute RA, Nathanson BH, Kurz MC, DeMasi S, McNally B, Mader TJ. Annual and lifetime economic productivity loss due to adult out-of-hospital cardiac arrest in the United States: A study for the CARES Surveillance Group. Resuscitation. Oct;167:111-117 (2021). 3. Garcia RA, Spertus JA, Girotra S, Nallamothu BK, Kennedy KF, McNally BF, Breathett K, Del Rios M, Sasson C, Chan PS. Racial and Ethnic Differences in Bystander CPR for Witnessed Cardiac Arrest. N Engl J Med. 387(17):1569-1578 (2022).4. Chan PS, Merritt R, McNally B, Chang A, Al-Araji R, Mawani M, Ahn KO, Girotra S. Bystander CPR and Long- Survival in Older Adults With Out-of-Hospital Cardiac Arrest. JACC Adv. 2(8):100607 (2023).5. Del Rios M. Strategies to increasing bystander CPR in high-risk neighborhoods [abstract]. Presented at: 2017 Resuscitation Science Symposium (ReSS). 6. Odom E, Nakajima Y, Vellano K, Al-Araji R, Coleman King S, Zhang Z, Merritt R, McNally B. Trends in EMS-attended Out-of-Hospital Cardiac Arrest Survival, United States 2015-2019. Resuscitation. 179:88-93 (2022).7. Chan PS, McNally B, Tang F, Kellermann A. Recent Trends in Survival from Out-of-Hospital Cardiac Arrest in the United States. Circulation. 130:1876-1882 (2014).61'