Regional cardiac resuscitation systems of care.
OBJECTIVE
Out-of-hospital cardiac arrest (OOHCA) is a common public health problem. Regional systems of care have improved provider experience and patient outcomes for those with ST-elevation myocardial infarction and life-threatening traumatic injury. We review evidence of the effectiveness of regional cardiac resuscitation systems and describe preliminary recommended elements of such systems.


RESULTS
There is large and important regional variation in survival among patients treated with OOHCA by emergency medical services, or among patients transported to the hospital after return of spontaneous circulation (ROSC). Most regions lack a well coordinated approach to postcardiac arrest care. There is little evidence to show small increases in transport time or distance have an adverse impact on survival, so bypassing closer hospitals may be feasible. Hospitals that have facilities to provide a comprehensive package of postresuscitation care including percutaneous coronary intervention and therapeutic hypothermia appear to have better survival but further studies are needed. A well defined relationship between increased volume of patients or procedures of individual providers and hospitals and better outcomes has been observed for several clinical disorders and there are suggestions that this may also be true for patients with ROSC after cardiac arrest.


CONCLUSIONS
Many more people could survive OOHCA if regional systems of cardiac resuscitation were established. The time has come to implement such systems whenever feasible.
Nichol
Graham
G
University of Washington-Harborview Center for Prehospital Emergency Care, Seattle, Washington, USA. nichol@u.washington.edu <nichol@u.washington.edu>
Soar
Jasmeet
J
D000800:Angioplasty, Balloon; D016887:Cardiopulmonary Resuscitation / Q000379:methods* / Q000401:mortality; D004632:Emergency Medical Services / Q000458:organization & administration*; D006297:Health Services Accessibility / Q000458:organization & administration; D006323:Heart Arrest / Q000401:mortality / Q000628:therapy*; D006739:Hospital Administration; D006801:Humans; D011787:Quality of Health Care / Q000458:organization & administration; D012041:Regional Medical Programs / Q000458:organization & administration*; D013997:Time Factors; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000401:mortality / Q000628:therapy