title: Impact of a "Team-focused CPR" Protocol on Out-of-hospital Cardiac Arrest Survival in a Rural EMS System.
abstract: More than 300,000 persons in the United States experience an out-of-hospital cardiac arrest every year. The American Heart Association emphasizes on the rapid, effective delivery of cardiac arrest interventions by bystanders and emergency medical services (EMS) on scene. In July 2013, the EMS of Randolph County, a rural county in central North Carolina, implemented a team-focused cardiopulmonary resuscitation(CPR) protocol. The protocol emphasized early chest compressions and resuscitation on scene until the return of spontaneous circulation (ROSC) or until efforts were deemed futile.
  
  
  
  Data were collected on all cardiac out-of-hospital cardiac arrest cases from June 30, 2012 to June 30, 2014. Outcomes for the year before the institution of the team-focused CPR protocol were compared with rates for the year following implementation.
  
  
  
  A significantly higher proportion of patients achieved ROSC after protocol implementation: 25/38 [66%, 95% confidence interval (CI), 49%-80%] versus 19/67 (28%; 95% CI, 18-41%, P < 0.001). More patients survived to hospital admission in the team-focused CPR group (16/38, 42.1%, 95% CI, 26%-59%) versus the preprotocol period (10/67, 14.9%, 95% CI, 7.4%-26%, P = 0.004). Although survival to discharge was higher in the team-focused protocol period (6/38, 15.8%, 95% CI, 6.0%-31%) than the preprotocol period (4/67, 6.0%, 95% CI, 1.7%-14.6%), this did not meet statistical significance (P = 0.16).
  
  
  
  The introduction of a team-focused CPR protocol in a single rural county-based EMS system dramatically improved ROSC and hospital admission rates, but not survival to discharge. Continued surveillance, as well as evaluation and optimization of inpatient care, is warranted.
authors.affiliation: From the *Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, NC; and †Department of Emergency Medicine, Wayne State University, Detroit, MI.
authors.forename: Jason P
authors.initials: JP
authors.lastname: Stopyra
authors.forename: Cheryl
authors.initials: C
authors.lastname: Courage
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Davis
authors.forename: Brian C
authors.initials: BC
authors.lastname: Hiestand
authors.forename: Robert D
authors.initials: RD
authors.lastname: Nelson
authors.forename: James E
authors.initials: JE
authors.lastname: Winslow
mesh_terms: D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005500:Follow-Up Studies; D006780:Hospitals, Rural / Q000706:statistics & numerical data*; D006801:Humans; D009657:North Carolina / Q000453:epidemiology; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality / Q000628:therapy*; D012042:Registries; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D061665:Time-to-Treatment