Any attempt to predict the future of out-of-hospital cardiac arrest resuscitation is fraught with misadventure, in part because resuscitation is so challenging and the solutions often unexpected. In no other health condition do life and death hang in such a time-pressured balance, where success relies on a diverse set of rescuers who must immediately work together—often without knowing each other’s names or even having met prior to the event.
Moreover, just when we think we have the solution, we discover another puzzle. The advent of the automated external defibrillator (AED) was thought to be the holy grail that would jumpstart survival rates. Yet in Seattle and King County, Wash., we observed only a modest bump. Decades later, we now appreciate that the AED distracted the first responder—defibrillation may have occurred sooner but CPR suffered. Best practices now emphasize the synergy of defibrillation and CPR to achieve the greatest chance of survival.
Despite the challenges, there’s real reason for optimism looking forward. We don’t need to wait for a magic drug discovery, a new CPR device or new guidelines— we know fundamentally what works now. The potential to transform resuscitation can be achieved by implementing current best practices across emergency systems. And the key to success lies squarely with prehospital professionals.
Several communities have now provided a roadmap for success. For the past several years, communities involved in the HeartRescue Project have made progress, often through straightforward strategies that consider measurement, implementation and expectations.
The need to measure is fundamental. Importantly, communities making up about a quarter of the U.S. population now participate in the Cardiac Arrest Registry to Enhance Survival (CARES).
Improvement also requires effective program implementation and training. The HeartRescue Project supports the Resuscitation Academy as a way to inform and motivate EMS leaders.
Empowered with objective information and a thoughtful plan for improvement, communities are making real progress—and the result is a change in expectations. Of course not every patient will survive, but there’s a shift in attitude that treats each cardiac arrest as an opportunity for success as opposed to one destined for failure.
The HeartRescue Project’s partners will continue to advocate measurement and improvement on a statewide basis. Resources will be used strategically to assist with building statewide models to improve care for resuscitation. Several states, including Utah, Michigan, Hawaii and Maryland, have already taken steps toward a statewide registry, creating an infrastructure to move forward with the measure-and-improve strategy. The leadership and determination in those states serves as a model for others.
There’s increasing appreciation from local, regional and national leaders that efforts to measure and improve resuscitation serve as an important benchmark for a community’s emergency system. A recent comprehensive report from the Institute of Medicine (now the National Academy of Medicine), Strategies to Improve Cardiac Arrest Survival: A Time to Act, highlighted the need to improve public health by improving resuscitation care. The report is groundbreaking, but true lifesaving improvements only happen when local EMS leadership commits to measure and improve.
Perhaps instead of trying to predict the future of resuscitation, we consider that the future is now. The HeartRescue Project has adopted this model of quality improvement, and many communities have reaped real benefit. The experience provides a practical roadmap for communities to achieve success.
More than ever, there are opportunities for communities to make strides in improving their emergency response systems. We should all challenge ourselves and our EMS organizations to do better. If successful on a broad scale, we can save thousands more lives each year.