CARES (Cardiac Arrest Registry to Enhance Survival)

Sudden cardiac death (SCD) is the leading cause of death among adults in the United States and Western countries. It is estimated that approximately 400,000 deaths occur every year. Most of these deaths are due to a fatal heart rhythm disturbance called ventricular fibrillation.

Nationally, only about 35 communities actively monitor and report their survival rates from out-of-hospital cardiac arrest. The range of survival in these communities for ventricular fibrillation is anywhere - from 2% to 35%, a striking difference, since the approach to the care of these patients is uniform and there is no evidence that patients in one part of the country are different biologically from another.

CARES will create a model SCD registry capable of identifying and tracking all cases of cardiac arrest in a defined geographic area. During the first year of development, the system will be confined to Fulton County, the most populous county in the state of Georgia. In year two, it will be expanded to a multi-county area of metropolitan Atlanta, GA. At that point we will offer to expand the system statewide. We will also work collaboratively with the CDC and the American Heart Association to share the templates and data elements with other metropolitan areas and regional or state EMS systems that wish to improve their performance in the treatment of out-of-hospital cardiac arrest. Because the data system we are devising is intended to be universally applicable to EMS operations nationwide, it will be designed to be compatible with the National Electronic Disease Surveillance System (NEDSS) and use generally agreed upon standardized data elements and definitions.

The ultimate goals of this cardiac arrest registry will be to help local EMS administrators and medical directors identify who is affected, when and where cardiac arrest events occur, which elements of the system are functioning properly and which elements are not, and how changes can be made to improve cardiac arrest outcomes.

A uniform, simple and sustainable cardiac arrest registry is essential to help communities assess their provision of care to victims of SCD and measure the outcomes that are achieved. It is arguably the most important step in improving out of hospital care, and ultimately the community's rate of survival from this common and devastating event. Decades of research have established that the likelihood that a victim who sustains a witnessed cardiac arrest from ventricular fibrillation will survive with good neurological function largely depends on receiving bystander CPR and rapid defibrillation within 4-8 minutes of collapse. The longer these vital interventions are delayed, the more likely the cardiac arrest event will be irreversible and the victim will die. Presently, the odds of surviving an episode of out of hospital cardiac arrest in the United States vary by a factor of 10 to 20, depending on the community in which it occurs. Disparities in outcome this extreme are unacceptable and are what the CARES project will be able to identify and allow communities to improve upon.