Who Truly CARES About Cardiac Arrest? | Peter Antevy, MD | Handtevy Minute

Hi, and welcome to another edition of the Hantevi minute. I'm Dr. Peter Anteve, and today we're tackling a critical question. Who truly cares about cardiac arrest? Well, I hope the answer is that all of us do, because how your crews perform on every single arrest has a direct impact on your yearly survival statistics. Let me illustrate with an example. Take city number one, who has 100 cardiac arrests every year, but only 2% of those patients survive? Neurologically normal. That's just two people. Meanwhile, city number two also has 100 cardiac arrests, but they have a 10% NeuroInt survival rate, meaning 10 people survive. Well, it should be pretty clear that city number one is underperforming compared to city number two. But how do they stack up against other cities in their state or across the country? Well, that's the focus of today's discussion. The data is out there. It's accessible to all of you. And once you know your agency's cardiac arrest statistics and can compare them to others, you'll be empowered to make the changes that truly move the needle. This is where CARES comes in. So what is cares? It's an out of hospital cardiac arrest registry. And if your agency participates, and as you can see in this graphic, 34 states do, each time you handle a cardiac arrest, the data is entered into the CARES website for that specific case. Now, in 2023, over 138,000 cases were uploaded to CARES from EMS agencies across the country. Now, that's a vast amount of data, and it provides a very clear picture of how we're doing on a national scale. But before we dive deeper into the registry, let's cover some basic cardiac arrest statistics that you can use to predict how many cardiac arrests you'll likely encounter in your city or county. Here's the math. For every 100,000 people in your population, you can expect around 100 cardiac arrests per year. Of those, you'll likely only work 50. Meaning that's the number of cases where resuscitation is actually attempted. Now, how many of those do you think will actually leave the hospital neurologically intact? Well, Based on the 2023 CARES data, 8.1% of all arrests resulted in patients walking out of the hospital with a CPC score of one or two. Now, that's a total of four people. Let's compare this to a lower performing agency with only a 4% neuro intact survival rate. That's just two survivors. And what about a high performing agency with a 14% survival rate? That's seven people. So in a city of 100,000 people. The difference between a high and low performing EMS system could mean five more lives saved. And every life matters. Take for example the story of Allen. He suffered a cardiac arrest on a tennis court in Palm Beach County. He received great bystander CPR from the tennis coach, followed by 30 minutes of high performance CPR by Palm Beach County Fire rescue on the scene, including six double sequential defibrillations. Now if you missed that video on double sequential, please be sure to check it out in the link below. Now here's a recent photo of Allen. That smile says it all. Every patient really does matter. Now let's take a deeper dive into cares. There are three main modules in CARES Dispatch. There's an EMS module and a hospital module. Each of these entities contribute specific data points after every cardiac arrest call. Now, as you can see from the slide, the dispatch module has only five data points. The EMS module a little longer, 37 data points. And then there's 19 additional data points. And then there's the hospital module which has five required and then eight supplemental data points. Let's quickly talk about the dispatch module. This is where critical information about the 911 call and the telecommunicator CPR is captured. For example, they ask how how long does it take your telecommunicator to recognize that cardiac arrest? What about how quickly do they begin CPR instructions and how long until the first chest compression? Now I'll tell you, if you haven't reviewed your times to first compression, I strongly encourage you to do so. It can be very eye opening, trust me. The job of the telecommunicator, by the way, is incredibly challenging and they often face barriers to effective cpr. But with the right training, continuous quality improvement and feedback, these barriers can be overcome. Trust me, the juice is definitely worth the squeeze. I have to say. In my systems we found that it was taking our Telecommunicators on average 5 minutes to start chest compressions. That was a problem. The gold standard as we know, is two minutes. Once we identified this issue, we we immediately set out to fix it. By measuring our performance, we were able to implement changes that led to better outcomes. And by benchmarking your data using cares, you can do the same. So let's take a look at where you can find your CARES data. It's as simple as logging into the MyCares.net website, putting in your username and password and it'll print out your report. You'll be able to download the three page PDF which has flow diagrams of all of your outcomes. To be honest, this is not my favorite view of the data. So instead for now let's focus on the top right of this PDF, which you can see here is a summary of the overall survival statistics. Let's go through them one at a time. First is overall survival. That refers to the percentage of patients who survived and were discharged from the hospital. However, it's important to note that this metric does not differentiate between patients who are discharged from with good neuro attack function and those who are not. This document makes it a little challenging to pinpoint the exact number of patients who survived neurologically normal. Next is bystander witness survival that indicates the survival rate of patients whose cardiac arrest was witnessed by a bystander and who survived to hospital discharge. It's a pretty straightforward metric and it emphasizes the importance of early intervention by bystanders. The last two are the Utstein survival statistics. But what is Utstein? Utstein refers to an historic abbey in Norway where In the early 90s, a group of resuscitation scientists gathered to establish standardized reporting systems for cardiac arrest outcomes. This gathering led to the development of a common nomenclature now known as the Uttstein style, which is widely used in cardiac arrest research. Ultzstein's survival specifically measures the survival rate of patients who had a witness arrest with an initial shockable rhythm. That's it. These are the patients who generally have the highest chance of survival because shockable rhythms like VF are more responsive to early defibrillation utzein. Bystander survival goes a step further. It includes patients whose cardiac arrest was witnessed, they had an initial shockable rhythm, and and they receive bystander cpr. Now, this subset of patients are expected to have an even higher chance of survival due to the critical early intervention provided by bystanders. Just like Alan, it's important to remember that of all the cardiac arrests you encounter every year, only about 20% will present with a shockable rhythm. So maximizing outcomes for these patients should be your top priority, given their higher potential for survival with timely and effective intervention. But what's missing from all these survival statistics? It's the true percentage of patients who survive neurologically intact with a CPC of 1 or 2. As you can see on this image, a CPC of 1 represents individuals who are conscious, alert and have no neurodeficits. A CPC of 2 indicates moderate disability but still allows a person to function independently. These two categories are considered neurologically intact. On the other hand, CPC of 3, 4, 5. Those are not considered good outcomes. And that's why I emphasize the importance of comparing our CPC 1 and 2 outcomes rather than just looking at all the CPC scores combined. So if we go back to the survival rates listed at the top right of the Care Survival report, these rates include all the CPC scores. So where can you find the data specifically for neuro and tax revival? Well, it's hidden. It is available on a detailed spreadsheet that I like to call the Money Shot, but this spreadsheet is only accessible to the State CARES Coordinator in Florida. We're very fortunate to have an exceptional coordinator, Tom DiBernardo, who deserves a lot of credit for successfully implementing CARES across our entire great state. The real value is here in the spreadsheet you see on the screen. Let's scroll down to the bottom where it says Overall Survival. Three rows down from that you'll find the survival statistic labeled with good or moderate cerebral performance. That means CPC 1 or 2. This is where you can truly assess your outcomes and compare them to both state national averages. I hope this video highlights the power of the CARES Registry, ensuring where your agency stands compared to the state and national averages. It's a vital tool for improving survival rates from out of hospital cardiac arrest by addressing any of the weak links in the chain of survival in your region. Remember, accurate data entry by dispatch, EMS and hospitals is crucial. By thoroughly analyzing your local data, you'll be able to identify areas for improvement and ultimately save more lives. It's stories like Alan's and many other survivors of out of hospital cardiac arrest that clearly demonstrate why our work is so important. Thank you for your dedication, your hard work and all that you do. This has been Dr. Peter Entevi thanks for watching another edition of the Hentevi Minute. It.