title: Implementation of Pit Crew Approach and Cardiopulmonary Resuscitation Metrics for Out-of-Hospital Cardiac Arrest Improves Patient Survival and Neurological Outcome.
abstract: BACKGROUND
  Survival from out-of-hospital cardiac arrest (OHCA) varies by community and emergency medical services (EMS) system. We hypothesized that the adoption of multiple best practices to focus EMS crews on high-quality, minimally interrupted cardiopulmonary resuscitation (CPR) would improve survival of OHCA patients in Salt Lake City.
  
  
  RESULTS
  In September 2011, Salt Lake City Fire Department EMS providers underwent a systemwide restructuring of care for OHCA patients that focused on the adoption of high-quality CPR with minimal interruptions and offline medical review of defibrillator data and feedback on CPR metrics. Victims were directed to ST-elevation myocardial infarction receiving centers. Prospectively collected data on patient survival and neurological outcome for all OHCAs were compared. In the postintervention period, there were 407 cardiac arrests with 65 neurologically intact survivors (16%), compared with 330 cardiac arrests with 25 neurologically intact survivors (8%) in the preintervention period. Among patients who survived to hospital admission, a higher proportion in the postintervention period survived to hospital discharge (71/141 [50%] versus 36/98 [37%], P=0.037) and had a favorable neurological outcome (65 [46%] versus 25 [26%], P=0.0005) compared with patients treated before the protocol changes. The univariate odds ratio or the association between neurologically intact survival (cerebral performance category 1 and 2) and protocol implementation was 2.3 (95% CI 1.4 to 3.7, P=0.001). Among discharged patients, the distribution of cerebral performance category scores was more favorable in the postintervention period (P<0.0001).
  
  
  CONCLUSIONS
  A multifaceted protocol, including several American Heart Assocation best practices for the resuscitation of patients with OHCA, was associated with improved survival and neurological outcome.
authors.affiliation: Division of Emergency Medicine, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT (C.L.H., S.T.Y.).
authors.forename: Christy L
authors.initials: CL
authors.lastname: Hopkins
authors.affiliation: Salt Lake City Fire Department, Salt Lake City, UT (C.B., S.M., C.B., S.T.Y.).
authors.forename: Chris
authors.initials: C
authors.lastname: Burk
authors.affiliation: Salt Lake City Fire Department, Salt Lake City, UT (C.B., S.M., C.B., S.T.Y.).
authors.forename: Shane
authors.initials: S
authors.lastname: Moser
authors.affiliation: Gold Cross Ambulance, Salt Lake City, UT (J.M.).
authors.forename: Jack
authors.initials: J
authors.lastname: Meersman
authors.affiliation: Salt Lake City Fire Department, Salt Lake City, UT (C.B., S.M., C.B., S.T.Y.).
authors.forename: Clair
authors.initials: C
authors.lastname: Baldwin
authors.affiliation: Division of Emergency Medicine, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT (C.L.H., S.T.Y.) Salt Lake City Fire Department, Salt Lake City, UT (C.B., S.M., C.B., S.T.Y.).
authors.forename: Scott T
authors.initials: ST
authors.lastname: Youngquist
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D019985:Benchmarking; D016887:Cardiopulmonary Resuscitation / Q000592:standards; D019091:Critical Pathways; D016208:Databases, Factual; D004632:Emergency Medical Services / Q000458:organization & administration* / Q000592:standards; D004634:Emergency Medical Technicians / Q000458:organization & administration* / Q000592:standards; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D058687:Out-of-Hospital Cardiac Arrest / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D010343:Patient Admission; D010351:Patient Discharge; D017410:Practice Guidelines as Topic; D015397:Program Evaluation; D058996:Quality Improvement; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D014589:Utah; D057188:Workflow
keywords: cardiac arrest; emergency medical services