title: [An urban EMS at the start of a cross-sectoral quality management system: prioritized implementation of the 2010 ERC recommendations and long-term survival after cardiac arrest].
abstract: BACKGROUND
  Due to limited resources, the 2010 European Resuscitation Council (ERC) guidelines could not be fully implemented in the Emergency Medical Services (EMS) of Brunswick, Germany. This is why implementation was prioritized according to local conditions. Thus, prehospital therapeutic hypothermia, mechanical chest compression and feedback systems were not established. Clinical data and long-term results were assessed by a QM system and room for improvement was identified.
  
  
  METHODS
  All attempted resuscitations from 2011 until 2014 were recorded and compared against the German Resuscitation Registry. Outcomes of adult patients following non-traumatic cardiac arrest were analyzed by year.
  
  
  RESULTS
  812 resuscitations were attempted (incidence 81.2/100,000 inhabitants/year). In the two years following full implementation since 2013 the discharge rate from hospital was 16.4 %, the discharge rate with a favorable neurologic outcome was 14.1 %, the 1-year survival rate was 14.4 % in 2013. A significant improvement of risk-adjusted ROSC rate during the investigation period was demonstrated. The discharge rates remained unchanged; the increase in the discharge rates paralleled the increase in CPR incidence. EMS response times were remarkably shorter.
  
  
  CONCLUSIONS
  The implementation of the ERC guidelines chosen appears to be generally safe. Fast EMS response contributed to superior results. All links of the chain of survival showed room for improvement, especially the proportion of lay rescuer CPR and telephone-assisted CPR. The high CPR incidence might indicate room for improvement in prevention. Access to resuscitation care can hardly be evaluated. Age-related access to pre-hospital resuscitation seems to be appropriate.
authors.affiliation: Ärztlicher Leiter Rettungsdienst, Berufsfeuerwehr Braunschweig, Braunschweig, Deutschland Klinik für Anästhesiologie, Städtisches Klinikum Braunschweig, Braunschweig, Deutschland. Electronic address: andreas.guenther@braunschweig.de.
authors.forename: Andreas
authors.initials: A
authors.lastname: Günther
authors.affiliation: Zentrale Notfallaufnahme, Klinikum Wolfsburg, Wolfsburg, Deutschland Rettungsdienst, Berufsfeuerwehr Braunschweig, Braunschweig, Deutschland, Arbeitsgemeinschaft in Norddeutschland tätiger Notärzte e.V.
authors.forename: Ulf
authors.initials: U
authors.lastname: Harding
authors.affiliation: Medizinische Informatik, Universitätsklinikum Heidelberg, Heidelberg, Deutschland.
authors.forename: Matthias
authors.initials: M
authors.lastname: Gietzelt
authors.affiliation: Medizinische Intensivstation, Medizinische Klinik II, Städtisches Klinikum Braunschweig, Rettungsdienst, Berufsfeuerwehr Braunschweig, Braunschweig, Deutschland.
authors.forename: Frank
authors.initials: F
authors.lastname: Gradaus
authors.affiliation: Peter L. Reichertz Institut für Medizinische Informatik, Medizinische Hochschule Hannover und Technische Universität Braunschweig, Braunschweig, Deutschland.
authors.forename: Erik
authors.initials: E
authors.lastname: Tute
authors.affiliation: Klinik für Anästhesie, Operative Intensivmedizin, Notfallmedizin und Schmerztherapie, Klinik am Eichert Göppingen, Göppingen, Deutschland.
authors.forename: Matthias
authors.initials: M
authors.lastname: Fischer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D004632:Emergency Medical Services / Q000458:organization & administration* / Q000592:standards*; D005260:Female; D005858:Germany; D019983:Guideline Adherence; D006284:Health Plan Implementation / Q000458:organization & administration / Q000592:standards; D006323:Heart Arrest / Q000401:mortality* / Q000628:therapy*; D006786:Hospitals, Urban / Q000458:organization & administration* / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009313:National Health Programs / Q000458:organization & administration* / Q000592:standards*; D017063:Outcome Assessment, Health Care / Q000458:organization & administration / Q000592:standards; D058996:Quality Improvement / Q000458:organization & administration / Q000592:standards; D012042:Registries; D012151:Resuscitation / Q000379:methods* / Q000592:standards*; D016019:Survival Analysis; D017741:Survivors / Q000706:statistics & numerical data; D017749:Total Quality Management / Q000458:organization & administration* / Q000592:standards*; D055815:Young Adult
keywords: Cardiopulmonary resuscitation; Ergebnisqualität; Kardiopulmonale Reanimation; Rettungsdienst; Versorgungsforschung; emergency medical services; health services accessibility; out-of-hospital cardiac arrest; outcome assessment; prähospitaler Herzkreislaufstillstand