Doubling Cardiac Arrest Survival by 2020: Achieving the American Heart Association Impact Goal.

Abstract

In 2010, the American Heart Association (AHA) Emergency Cardiovascular Care Committee (ECC) set a 10-year impact goal of doubling cardiac arrest survival by 2020. This goal was more ambitious than the overarching AHA impact goal to reduce death from heart disease and stroke by greater than or equal to 20% by 2020. It was hypothesized at the time that reaching this cardiac arrest impact goal was not dependent on new scientific discovery but could be achieved with full implementation of up-to-date clinical guidelines and adopting best practices for systems of care. This hypothesis was supported by the observation that there was significant variability in both in-hospital cardiac arrest (IHCA) and out-of-hospital cardiac arrest (OHCA) survival rates. In fact, the 2020 targets were already being achieved in the highest performing emergency medical services (EMS) systems and hospitals. To drive progress toward achieving these goals, the AHA ECC was restructured to increase its focus on implementation. This restructuring included creation of a Systems of Care Subcommittee charged with measurably improving the systems of care for OHCA and IHCA across the entire chain of survival. Restructuring has enabled ECC to focus on strategies that have the highest likelihood of improving outcomes, such as increasing bystander cardiopulmonary resuscitation (CPR) rates and automatic external defibrillator use, 911 dispatcher CPR instructions, CPR quality for trained providers, postcardiac arrest care, and reliable postcardiac arrest prognostication. Establishing a baseline and ongoing strategy to monitor progress toward the 2020 impact goal was the first challenge. For OHCA, the AHA initially relied on the ROC Epistry (Resuscitation Outcomes Consortium) for baseline and annual data on incidence and outcomes. Because of the cessation of National Institutes of Health funding, the ROC Epistry stopped collecting data in June 2015. In 2014, the AHA also began utilizing data from the CARES registry (Cardiac …