Ezem Natalie, Lewinski Allison A, Miller Julie, King Heather A, Oakes Megan, Monk Lisa, Starks Monique A, Granger Christopher B, Bosworth Hayden B, Blewer Audrey L
Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States.
Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, United States.
Resusc Plus. 2024 Jan 20;17:100550. doi: 10.1016/j.resplu.2024.100550. eCollection 2024 Mar.
Survival to hospital discharge from out-of-hospital cardiac arrest (OHCA) after receiving treatment from emergency medical services (EMS) is less than 10% in the United States. Community-focused interventions improve survival rates, but there is limited information on how to gain support for new interventions or program activities within these populations. Using data from the RAndomized Cluster Evaluation of Cardiac ARrest Systems (RACE-CARS) trial, we aimed to identify the factors influencing emergency response agencies' support in implementing an OHCA intervention.
North Carolina counties were stratified into high-performing or low-performing counties based on the county's cardiac arrest volume, percent of bystander-cardiopulmonary resuscitation (CPR) performed, patient survival to hospital discharge, cerebral performance in patients after cardiac arrest, and perceived engagement in the RACE-CARS project. We randomly selected 4 high-performing and 3 low-performing counties and conducted semi-structured qualitative interviews with emergency response stakeholders in each county.
From 10/2021 to 02/2022, we completed 29 interviews across the 7 counties (EMS ( = 9), telecommunications ( = 7), fire/first responders ( = 7), and hospital representatives ( = 6)). We identified three themes salient to community support for OHCA intervention: (1) initiating support at emergency response agencies; (2) obtaining support from emergency response agency staff (senior leadership and emergency response teams); and (3) and maintaining support. For each theme, we described similarities and differences by high- and low-performing county.
We identified techniques for supporting effective engagement of emergency response agencies in community-based interventions for OHCA improving survival rates. This work may inform future programs and initiatives around implementation of community-based interventions for OHCA.
在美国，院外心脏骤停（OHCA）患者接受紧急医疗服务（EMS）治疗后存活至出院的比例不到10%。以社区为重点的干预措施可提高存活率，但关于如何在这些人群中获得对新干预措施或项目活动的支持的信息有限。利用心脏骤停系统随机整群评估（RACE-CARS）试验的数据，我们旨在确定影响应急响应机构支持实施OHCA干预措施的因素。
根据各县的心脏骤停病例数、旁观者进行心肺复苏（CPR）的比例、患者存活至出院的情况、心脏骤停后患者的脑功能以及对RACE-CARS项目的参与度，将北卡罗来纳州各县分为表现优秀或表现不佳的县。我们随机选择了4个表现优秀的县和3个表现不佳的县，并对每个县的应急响应利益相关者进行了半结构化定性访谈。
从2021年10月至2022年2月，我们在这7个县完成了29次访谈（EMS人员9名、电信人员7名、消防/急救人员7名、医院代表6名）。我们确定了社区支持OHCA干预措施的三个突出主题：（1）在应急响应机构启动支持；（2）从应急响应机构工作人员（高级领导和应急响应团队）获得支持；（3）维持支持。对于每个主题，我们描述了表现优秀和表现不佳的县之间的异同。
我们确定了支持应急响应机构有效参与基于社区的OHCA干预措施以提高存活率的技术。这项工作可能为未来围绕实施基于社区的OHCA干预措施的项目和倡议提供参考。
