The Cardiac Arrest Registry to Enhance Survival (CARES)

Each year, approximately 350,000 persons in the United States experience an out-of-hospital cardiac arrest (OHCA) or sudden death; approximately 90% of persons who experience an OHCA die. Despite decades of research, median reported rates of survival to hospital discharge are poor (10.4%) and have remained virtually unchanged for the past 30 years. Without a uniform and reliable method of data collection, communities cannot measure the effectiveness of their response systems, nor can they assess the impact of interventions designed to improve OHCA survival. Participation in an OHCA registry enables communities to compare patient populations, interventions, and outcomes with the goal of identifying opportunities to improve quality of care and ascertain whether resuscitation is provided according to evidence based guidelines. 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 MHCA’s Executive director serves as the Mississippi State Coordinator for the CARES registry, working with participating EMS agencies and hospitals to see how we can improve emergency cardiac treatments across the state.

MHCA pays for the CARES registry in Mississippi, contributing to ongoing resuscitation research. Reporting at the state and local levels allows state and local public health and EMS agencies to coordinate their efforts to target improving emergency response for OHCA events which can lead to improvement in OHCA survival rates.

Overall, the CARES program seeks to:

• Save more lives from OHCA
• Strengthen collaboration between 911 centers, first responders, emergency medical services (EMS) agencies and hospitals.
• Provide a simple, confidential process for assessing patient outcomes in compliance with HIPAA.
• Offer technical assistance (TA) to help community leaders identify and prioritize opportunities to improve EMS performance.
• Generate annual national and statewide reports for benchmarking capability.

CARES is a secure, Web-based data management system in which participating
communities enter local data and generate their own reports. Communities can
compare their EMS system performance to de-identified aggregate statistics at the
local, state, or national level and discover promising practices that could improve
emergency cardiac care.

Working Together to Improve Emergency Cardiac Care

The CARES system:

• Uses a secure Web database with restricted access for authorized users.
• Has software that collects and links data sources to create a single de-identified record for each OHCA event.
• Uses a simple, HIPAA-compliant methodology to protect confidentiality.
• Accepts a variety of input methods, such as uploaded data files or online data entry.
• Collects 9-1-1 computer-aided dispatch data for EMS response times.
• Allows longitudinal, internal benchmarking of key performance indicators.

Helping Communities Identify Opportunities for
Improvement

CARES helps local EMS administrators and community leaders answer such questions
as:

• Who is affected in my community?
• When and where are cardiac events happening?
• What parts of the system are working well?
• What parts of the system could work better?
• How can we improve emergency cardiac treatment?

Saving Lives Through Improved Care and Prevention

CARES data are used to help communities benchmark and improve their performance for OHCA care. CARES allows participating communities to view their own statistics online confidentially and compare their performance to anonymous aggregated data at the local, regional, or national level. CARES automatically calculates local 911 response intervals, delivery rates for critical interventions (e.g., bystander CPR and public access defibrillation [PAD]), and community rates of survival and functional status at discharge, on the basis of each patient's CPC Scale.

An annual report is provided to all participating communities that summarizes local results in comparison to regional and national benchmarks. Tracking performance longitudinally allows communities to better understand which elements of their care are working well and which elements need improvement. Reporting at the state and local levels can enable state and local public health and EMS agencies to coordinate their efforts to target improving emergency response for OHCA events which can lead to improvement in OHCA survival rates.