title: Regional systems of care for out-of-hospital cardiac arrest: A policy statement from the American Heart Association.
abstract: Out-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-elevation myocardial 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.
authors.forename: Graham
authors.initials: G
authors.lastname: Nichol
authors.forename: Tom P
authors.initials: TP
authors.lastname: Aufderheide
authors.forename: Brian
authors.initials: B
authors.lastname: Eigel
authors.forename: Robert W
authors.initials: RW
authors.lastname: Neumar
authors.forename: Keith G
authors.initials: KG
authors.lastname: Lurie
authors.forename: Vincent J
authors.initials: VJ
authors.lastname: Bufalino
authors.forename: Clifton W
authors.initials: CW
authors.lastname: Callaway
authors.forename: Venugopal
authors.initials: V
authors.lastname: Menon
authors.forename: Robert R
authors.initials: RR
authors.lastname: Bass
authors.forename: Benjamin S
authors.initials: BS
authors.lastname: Abella
authors.forename: Michael
authors.initials: M
authors.lastname: Sayre
authors.forename: Cynthia M
authors.initials: CM
authors.lastname: Dougherty
authors.forename: Edward M
authors.initials: EM
authors.lastname: Racht
authors.forename: Monica E
authors.initials: ME
authors.lastname: Kleinman
authors.forename: Robert E
authors.initials: RE
authors.lastname: O'Connor
authors.forename: John P
authors.initials: JP
authors.lastname: Reilly
authors.forename: Eric W
authors.initials: EW
authors.lastname: Ossmann
authors.forename: Eric
authors.initials: E
authors.lastname: Peterson
mesh_terms: D004632:Emergency Medical Services / Q000379:methods* / Q000458:organization & administration; D006323:Heart Arrest / Q000401:mortality / Q000628:therapy*; D006801:Humans; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy; D011634:Public Health / Q000379:methods; D012151:Resuscitation / Q000379:methods; D014481:United States; D014947:Wounds and Injuries / Q000401:mortality / Q000628:therapy