Improving Quality in Cardiac Arrest via Resuscitation academy Training: The IQ-CART study

Saint Luke'S Hospital, Kansas City MO

Investigators

Abstract

PROJECT SUMMARY / ABSTRACT The public health burden of out-of-hospital cardiac arrest (OHCA) is enormous, affecting ~350,000 individuals each year in the U.S. and is the third leading cause of death. Although overall survival is low (~10%), some emergency medical service (EMS) agencies are able to achieve higher survival rates for OHCA than others. In 2008, the King County EMS system, known for their excellence in prehospital OHCA care, in collaboration with the University of Washington, formed the Resuscitation Academy to share best practices that have been codified as 6 key domains of quality improvement in resuscitation care. Since its first class, many EMS agencies from around the world have attended the free three-day Resuscitation Academy training. In recent years, other countries (e.g., Germany, Singapore) have also launched their own resuscitation academies, modeled on the one in the U.S. To date, however, a systematic evaluation of Resuscitation Academy training and its association with improved survival rates for OHCA has not been conducted. Accordingly, we propose the IQ-CART (Improving Quality in Cardiac Arrest via Resuscitation academy Training (IQ-CART) study to assess whether EMS agency participation in Resuscitation Academy training is associated with higher rates of OHCA survival. First, we will conduct a prospective evaluation of whether Resuscitation Academy training is associated with improved OHCA survival, as compared to control sites, using a ‘difference-in-difference’ analysis. We will enroll a broad range of EMS agencies, including those with below average baseline rates of OHCA survival and which work in communities with different sociodemographic and socioeconomic characteristics, to ensure generalizability. Second, we will conduct surveys of EMS agencies throughout the first 2 years after Resuscitation Academy training to quantify the extent to which they were able to implement quality improvement in the 6 domains emphasized in the training. We will then assess changes in which of these domains are most strongly associated with improvements in OHCA survival after Resuscitation Academy training. And third, we will conduct qualitative interviews with key leadership at EMS agencies two years after their Resuscitation Academy training to identify facilitators and barriers to quality improvement. Findings from this study will provide critical insights as to whether Resuscitation Academy trainings are associated with higher OHCA survival at EMS agencies and whether such improvements are consistent across different types of EMS agencies. If this was to be demonstrated, making Resuscitation Academy training broadly available to EMS agencies with low survival rates or certain sociodemographic and socioeconomic characteristics may have the potential to not only increase OHCA survival but also address disparities in OHCA outcomes in the U.S.