Today, there are over 400,000 out-of-hospital cardiac arrests a year in the U.S with a survival rate of less than 10%, making cardiac arrest a highly challenging public health problem.
Dealing with this public health issue is further complicated by care fragmentation, regional variation in resources, and care gaps that can impact rural settings and racial and ethnic minorities.
Cardiac arrest is further fragmented largely due to the lack of integration and coordination among 15,000 locally administered dispatch centers and emergency medical services agencies and over 5,200 acute care hospitals involved in treating victims of cardiac arrents.
Duke University cardiology researchers are teaming up with North Carolina Emergency Care Personnel such as EMS, fire, police, 911 dispatch and community members to conduct a randomized trial to test interventions to improve survival for out of hospital cardiac arrest.
The Randomized Cluster Evaluation of Cardiac Arrest Systems referred to as (RACE-CARS), covers a geographic area of 62 counties involving eight million residents and expects to enroll 20,000 cardiac arrest patients over a four year period.
It is one of the first U.S registry trials where all eligible patients are included and data is efficiently collected in routine care. The trial is being conducted by the Duke Clinical Research Institute (DCRI) https://dcri.org with a $15 million grant from NIH https://www.nih.gov .
To do the trial, 62 counties were randomly assigned to intervention or control groups. Intervention counties are focused on community CPR and AED treatment, 911 dispatch performance, and first responder treatment for out of hospital cardiac arrest..
The goal is to have more patients with cardiac arrest treated with bystander CPR and early defibrillation. Intervention counties are working closely with the trial team to carry out and evaluate trial interventions while the control groups will continue to provide their usual care.
The data collection phase began in July 2020 and runs through June 30, 2027. The collection phase uses the pre-exiting Cardiac Arrest Registry to Enhance Survival (ARES) for patient enrollment, a platform previously implemented in North Carolina by the RACE CARS team. CARES collects data from 911 dispatch centers, EMS agencies, hospitals, and then links that information in a single record.