fems

Fire and EMS Department
 

DC Agency Top Menu

-A +A
Bookmark and Share

CARDIAC ARREST

CARDIAC ARREST SURVIVAL 

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 700 and 900 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 (October to September) 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
Document Link: FY 2018 Utstein Report
Document Link: FY 2019 Utstein Report
Document Link: FY 2020 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 (October to September) are available below:
 
 
Two FEMS patient data panels were incorporated for use as Key Performance Indicators (KPIs) described by the Department’s 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 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 fiscal year quarter (October to September).

FY 20-01A CARDIAC ARREST T-1 Image Q-4 (Website).png

The chart below shows the counts and percentages of Panel 2 surviving patients (by month) using this same measure.FY 20-01B CARDIAC ARREST P-2 Image Q-4 (Website).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” when available, is most likely to improve patient survival rates. FEMS has established a goal of not less than 50% 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 receiving bystander CPR assistance by fiscal year quarter (October to September).

FY 20-01C CARDIAC ARREST T-2 Image Q-4 (Website).png

The chart below shows the counts and percentages of Panel 2 patients receiving bystander CPR assistance (by month) using this same measure.FY 20-01D CARDIAC ARREST CPR Image Q-4 (Website).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 receiving bystander AED assistance by fiscal year quarter (October to September).

FY 20-01E CARDIAC ARREST T-3 Image Q-4 (Website).png

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

FY 20-01F CARDIAC ARREST AED Image Q-4 (Website).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 goal of not less than 32% 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 FY 2020 Utstein Survival Report published by CARES (using the national data record set, please click this link to view), there were 11,411 cardiac arrests witnessed by bystanders with an initial rhythm of ventricular fibrillation, ventricular tachycardia or other “shockable” rhythm evaluated for patient outcome. Of these 11,411 patient cases, 3,452 (or 30.3% of patients) survived and 3,069 (or 26.9% 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 2020 (October 1, 2019 to September 30, 2020).
   
   FY 20-01G CARDIAC ARREST T-4 Image Q-4 (Website).png

 

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

FY 20-01H CARDIAC ARREST P-4 Image Q-4 (Website).png

 
SEE ALSO:
 

CARDIAC ARREST PATIENT CARE 

To better evaluate the effectiveness of pre-hospital patient care provided to cardiac arrest patients by FEMS first responders and Paramedics, the EMS Continuous Quality Improvement (CQI) office reviews patient cases treated and transported by FEMS personnel on a monthly basis. FEMS has established a goal of not less than 95% of patient cases reviewed indicating timely, appropriate and successful patient treatment. The FEMS KPI measure for this goal is the “percentage of patient cases reviewed indicating timely, appropriate and successful patient treatment.”

EMS CQI review focuses on five patient treatment elements for cardiac arrest cases. These include: (1) if FEMS first responders and/or Paramedics took appropriate time resuscitating the patient while still at an incident scene, (2) if an endotracheal tube (ETT) or King laryngeal device was used to establish a patient airway, with successful placement confirmed, (3) if an intraosseous (IO) or intravenous line (IV) was successfully established for the administration of resuscitation drugs to the patient, (4) if high quality cardio-pulmonary resuscitation (CPR) and/or a Lucas Device (mechanical chest compression) was continuously provided for the patient, and (5) if advanced cardiac life support (ACLS) resuscitation drugs were appropriately administered to the patient following the requirements of FEMS medical treatment protocol. Each of these elements contributes to effective patient treatment and must be completed by FEMS first responders and Paramedics when treating and/or transporting a cardiac arrest patient.   

The table below shows the number of cardiac arrest cases reviewed by the EMS CQI office, the count of required patient treatment elements completed by FEMS personnel, the percentage of required patient treatment elements completed by FEMS personnel and the overall completion rate for all required elements (combined): 

FY 20-01I CARDIAC ARREST T-5 Image Q-4 (Website).png

The chart below shows the total count of cardiac arrest cases with individual counts of required patient treatment elements completed by FEMS personnel (by month):

FY 20-01J CARDIAC ARREST-01 Image Q-4 (Website).png

The chart below shows the combined count of required patient treatment elements, with the combined counts and percentages of required patient treatment elements completed by FEMS personnel for cardiac arrest cases (by month):

FY 20-01K CARDIAC ARREST-02 Image Q-4 (Website).png

 

SEE ALSO: