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Cardiac Arrest

Starting in January 2011, the Fire and Emergency Medical Services Department (FEMS) began submitting cardiac arrest data to the Cardiac Arrest Registry to Enhance Survival (or CARES, please click here view registry website). 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. The CARES registry includes 105 data field elements completely describing each cardiac arrest case. FEMS is responsible for creating each record and entering 77 data elements, while hospitals that receive cardiac arrest patients transported by FEMS are responsible for entering 28 data elements. During the period of a year, FEMS typically treats and/or transports between 500 and 600 cardiac arrest patients. 
 
CARES produces cardiac arrest patient outcome data using “Utstein Style” reports (to view the original AHA statement concerning “Utstein Style” reporting published in a medical journal, please click here and for the AHA consensus statement updating “Utstein Style” measures, please click here). “Utstein Style” reports categorize cardiac arrest patient outcomes using a number of sorting methods, standardized for nationally comparable data. CARES/FEMS “Utstein Style” reports for cardiac arrest patient outcomes by fiscal year (FY 2012 to FY 2017) are available below:
 
Document Link: FY 2012 Utstein Report
Document Link: FY 2013 Utstein Report
Document Link: FY 2014 Utstein Report
Document Link: FY 2015 Utstein Report
Document Link: FY 2016 Utstein Report
Document Link: FY 2017 Utstein Report
 
To better evaluate and present CARES data, FEMS created patient data “panels” to assess cardiac arrest patient outcome. Each data panel contains a group of cardiac arrest patients characterized by certain conditions. Each data panel begins with “total cardiac arrests” shown at the top and then reduces patient counts by limiting conditions. Patient outcomes shown at the bottom of each data panel include Cerebral Performance Category (CPC) Scores. This includes “Good Cerebral Performance” (Normal Life, or CPC-1), “Moderate Cerebral Disability” (Disabled but Independent, or CPC-2), “Severe Cerebral Disability” (Conscious but Disabled and Dependent, or CPC-3) and “Coma/Vegetative State” (Unconscious, or CPC-4; for a medical journal discussion describing CPC Scores, please click here and for the American Heart Association (AHA) consensus statement on the validity of CPC Scores, please click here). FEMS patient data panels used to evaluate cardiac arrest patient outcome include the following  
 
  • Panel 1: All Cardiac Arrests.  This panel shows outcomes for all patients treated and/or transported by FEMS as the result of a cardiac arrest. The panel includes the count of patients transported to hospitals, admitted to hospitals and discharged alive. Patient survival rates include an overall survival rate (all patients discharged alive) and survival rates for patients discharged alive with CPC-1 or CPC-2 ratings.
  • Panel 1-A: All Cardiac Arrests (ROSC).  This sub-panel shows outcomes for patients described by Panel 1 who experienced return of spontaneous circulation (ROSC) during pre-hospital treatment and arrived at the hospital emergency department with a pulse. A pre-hospital ROSC rate is included, along with the overall survival rate (all patients discharged alive) and a survival rate for patients discharged alive with CPC-1 or CPC-2 ratings but limited to this sub-panel.
  • Panel 2: Cardiac Arrests Witnessed by Bystanders.  This panel shows outcomes for all patients treated and/or transported by FEMS as the result of a cardiac arrest witnessed by a bystander other than first responding or EMS personnel. The panel includes the count of patients transported to hospitals, admitted to hospitals and discharged alive. Patient survival rates include an overall survival rate (all patients discharged alive) and survival rates for patients discharged alive with CPC-1 or CPC-2 ratings.
  • Panel 2-A: Cardiac Arrests Witnessed by Bystanders (ROSC).  This sub-panel shows outcomes for patients described by Panel 2 who experienced ROSC during pre-hospital treatment and arrived at the hospital emergency department with a pulse. A pre-hospital ROSC rate is included, along with the overall survival rate (all patients discharged alive) and a survival rate for patients discharged alive with CPC-1 or CPC-2 ratings but limited to this sub-panel.
  • Panel 3: Cardiac Arrests (of Cardiac Etiology) Witnessed by Bystanders.  This panel shows outcomes for all patients treated and/or transported by FEMS as the result of a cardiac arrest with suspected cardiac etiology that was witnessed by a bystander other than first responding or EMS personnel. The panel includes the count of patients transported to hospitals, admitted to hospitals and discharged alive. Patient survival rates include an overall survival rate (all patients discharged alive) and survival rates for patients discharged alive with CPC-1 or CPC-2 ratings.
  • Panel 3-A: Cardiac Arrests (of Cardiac Etiology) Witnessed by Bystanders (ROSC).  This sub-panel shows outcomes for patients described by Panel 3 who experienced ROSC during pre-hospital treatment and arrived at the hospital emergency department with a pulse. A pre-hospital ROSC rate is included, along with the overall survival rate (all patients discharged alive) and a survival rate for patients discharged alive with CPC-1 or CPC-2 ratings but limited to this sub-panel.
  • Panel 4: Cardiac Arrests (Cardiac Etiology/“Shockable” Rhythm) Witnessed by Bystanders.  This panel shows outcomes for all patients treated and/or transported by FEMS as the result of a cardiac arrest with suspected cardiac etiology that was witnessed by a bystander other than first responding or EMS personnel with an initial rhythm of ventricular fibrillation, ventricular tachycardia or other “shockable rhythm”. The panel includes the count of patients transported to hospitals, admitted to hospitals and discharged alive. Patient survival rates include an overall survival rate (all patients discharged alive) and survival rates for patients discharged alive with CPC-1 or CPC-2 ratings.
  • Panel 4-A: Cardiac Arrests (Cardiac Etiology/“Shockable” Rhythm) Witnessed by Bystanders (ROSC).  This sub-panel shows outcomes for patients described by Panel 4 who experienced ROSC during pre-hospital treatment and arrived at the hospital emergency department with a pulse. A pre-hospital ROSC rate is included, along with the overall survival rate (all patients discharged alive) and a survival rate for patients discharged alive with CPC-1 or CPC-2 ratings but limited to this sub-panel.
FEMS patient data panels (with charts) for cardiac arrest patient outcomes by fiscal year and month (FY 2012 to FY 2017) are available below. Long term cardiac arrest patient outcome charts by quarter are also included:  
 
 
Two FEMS patient data panels were incorporated for use as Key Performance Indicators (KPIs) described by the Department’s FY 2017 Performance Plan. These data panels include FEMS Panel 2 (Cardiac Arrests Witnessed by Bystanders) and FEMS Panel 4 (Cardiac Arrests (Cardiac Etiology/“Shockable” Rhythm) Witnessed by Bystanders).  
 
  • Panel 2 was used to evaluate patient outcomes for cardiac arrests witnessed by bystanders. FEMS has established a FY 2017 goal of not less than 15% of cardiac arrests witnessed by bystanders resulting in patient survival. The FEMS KPI measure for this goal is the “percentage of patients who survived to hospital discharge after experiencing a sudden cardiac arrest witnessed by a bystander.” The table below shows the counts and percentages of Panel 2 surviving patients (by quarter) using this measure during FY 2017 (October 1, 2016 to September 30, 2017).

FY 17 (12-A) FEMS-CA-P2-SR.png

The chart below shows the counts and percentages of Panel 2 surviving patients (by month) using this same measure during FY 2017.

FY 17 FEMS CA Panel 2.png

  • Panel 2 was used to evaluate bystander CPR participation. For these patients, element (2) of the AHA chain of survival or “early cardiopulmonary resuscitation (CPR) with an emphasis on chest compressions” (please click this link to review) when available, is most likely to improve patient survival rates. FEMS has established a FY 2017 goal of not less than 60% of cardiac arrests witnessed by bystanders resulting in bystander CPR participation. The FEMS KPI measure for this goal is the “percentage of patients who experienced a sudden cardiac arrest, witnessed by a bystander, with CPR performed by a bystander.” The table below shows the counts and percentages of Panel 2 patients (by quarter) receiving bystander CPR assistance using this measure during FY 2017 (October 1, 2016 to September 30, 2017).

FY 17 (12-B) FEMS-CA-P2-CPR.png

The chart below shows the counts and percentages of Panel 2 patients receiving bystander CPR assistance (by month) using this same measure during FY 2017.

FY 17 FEMS CA CPR.png

  • Panel 2 was used to evaluate bystander AED use. For these patients, element (3) of the AHA chain of survival or “rapid defibrillation” when available, is most likely to improve patient survival rates. The table below shows the counts and percentages of Panel 2 patients (by quarter) receiving bystander AED assistance using this measure during FY 2017 (October 1, 2016 to September 30, 2017).

FY 17 (12-C) FEMS-CA-P2-AED.png

The chart below shows the counts and percentages of Panel 2 patients receiving bystander CPR assistance (by month) using this same measure during FY 2017.

FY 17 FEMS CA AED.png

  • Panel 4 was used to evaluate patient outcomes for cardiac arrests witnessed by bystanders with an initial rhythm of ventricular fibrillation, ventricular tachycardia or other “shockable” rhythm. FEMS has established a FY 2017 goal of not less than 30% of cardiac arrests witnessed by bystanders with initial “shockable” rhythms (including ventricular fibrillation and ventricular tachycardia) resulting in patient survival. The FEMS KPI measure for this goal is the “percentage of patients with suspected cardiac etiology who survived to hospital discharge after experiencing a sudden cardiac arrest witnessed by a bystander with an initial rhythm of ventricular fibrillation.” 
 
Panel 4 uses nationally comparable “Utstein Style” reporting to evaluate patient outcome for bystander witnessed cardiac arrests. According to the CY 2015 Utstein Survival Report published by CARES (using the national data record set, please click this link to view), there were 6,189 cardiac arrests witnessed by bystanders with an initial rhythm of ventricular fibrillation, ventricular tachycardia or other “shockable” rhythm evaluated for patient outcome. Of these 6,189 patient cases, 2,088 (or 33.7% of patients) survived and 1,872 (or 30.2% of patients) were discharged alive with CPC-1 or CPC-2 ratings. The table below shows the counts and percentages of FEMS Panel 4 surviving patients (by quarter) using this same measure during FY 2017 (October 1, 2016 to September 30, 2017).
 
FY 17 (12-D) FEMS-CA-P4-SR.png

The chart below shows the counts and percentages of FEMS Panel 4 surviving patients (by month) using this same measure during FY 2017.

FY 17 FEMS CA Panel 4.png

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