Out-of-Hospital Cardiac Arrest

(Circulation. 2010;121:709-729.)
© 2010 American Heart Association, Inc. 

AHA Policy Statement

Regional Systems of Care for Out-of-Hospital Cardiac Arrest

A Policy Statement From the American Heart Association

Graham Nichol, MD, MPH, FAHA, Chair; Tom P. Aufderheide, MD, FAHA; Brian Eigel, PhD;Robert W. Neumar, MD, PhD; Keith G. Lurie, MD; Vincent J. Bufalino, MD, FAHA; Clifton W. Callaway, MD, PhD;Venugopal Menon, MD, FAHA; Robert R. Bass, MD; Benjamin S. Abella, MD, MPhil; Michael Sayre, MD;Cynthia M. Dougherty, PhD, FAHA; Edward M. Racht, MD; Monica E. Kleinman, MD; Robert E. O'Connor, MD;John P. Reilly, MD; Eric W. Ossmann, MD; Eric Peterson, MD, MPH, FAHA, on behalf of the American Heart Association Emergency Cardiovascular Care Committee; Council on Arteriosclerosis, Thrombosis, and Vascular Biology;Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation; Council on Cardiovascular Nursing;Council on Clinical Cardiology; Advocacy Committee; Council on Quality of Care and Outcomes ResearchOut-of-hospital cardiac arrest continues to be an important public health problem, with large and important regional variations in outcomes. Survival rates vary widely among patients treated with out-of-hospital cardiac arrest by emergency medical services and among patients transported to the hospital after return of spontaneous circulation. Most regions lack a well-coordinated approach to post–cardiac arrest care. Effective hospital-based interventions for out-of-hospital cardiac arrest exist but are used infrequently. Barriers to implementation of these interventions include lack of knowledge, experience, personnel, resources, and infrastructure. A well-defined relationship between an increased volume of patients or procedures and better outcomes among individual providers and hospitals has been observed for several other clinical disorders. Regional systems of care have improved provider experience and patient outcomes for those with ST-elevationmyocardial infarction and life-threatening traumatic injury. This statement describes the rationale for regional systems of care for patients resuscitated from cardiac arrest and the preliminary recommended elements of such systems. Many more people could potentially survive out-of-hospital cardiac arrest if regional systems of cardiac resuscitation were established. A national process is necessary to develop and implement evidence-based guidelines for such systems that must include standards for the categorization, verification, and designation of components of such systems. The time to do so is now./.../