Abstract 15255: How Would Use of Flow-Focused Adjuncts, Passive Ventilation and Head-Up CPR Affect All-Rhythm Cardiac Arrest Resuscitation Rates in a Large, Complex EMS System?

Introduction: Sprawling and multi-ethnic with extremes of age / socioeconomics, Palm Beach County (PBC), FL (pop. 1.4 mill) has still realized short term survival rates (hospital admission) akin to nationwide data for out of hospital cardiac arrest (OOHCA). Then, in early 2015, a new medical direction/training team at PBC Fire Rescue (PBCFR) re-focused on nontraditional protocols including flow oriented CPR methods and head/torso up positioning. The purpose of this analysis was to evaluate how these nontraditional tactics would affect outcomes. Methods: All OOHCA cases (all rhythms) in PBC were followed over 2 years (2014-15). In 2015, PBCFR crews were trained to: 1) ensure proper use of mechanical CPR (Lucas © ); 2) apply O 2 but defer ventilation 6 mins; 3) apply impedance threshold devices; 4) raise the backboard 30 o (head/torso up position). With neuro-intact hospital discharge data not available before 2015, short term survival was used for consistent comparisons. Quarterly reports were run to identify any periodic variations or incremental effects during protocol transition (late Quarter 1 / early Quarter 2, 2015). Results: Among 1,304 consecutive OOHCA cases in 2014-15, survival rates (Fig 1) were fairly constant in 2014 (17.4% mean, range 15-20%) but rose steadily during the transition with an ensuing sustained doubling of survival (36.0%; range 35-37%). Outcome improved across subgroups while response intervals, indications for initiating CPR and bystander CPR rates were unchanged. Regionally in 2015, hospital admission rates were found to remain proportional to neuro-intact discharge. Conclusions: Though using historically-controlled data that did not examine the relative influence of each non-traditional CPR method, the immediate, steady rise in resuscitation rates seen in the transition phase (which endured) still makes a strong case that re-searching novel approaches can help EMS further improve OOHCA outcomes, even in large, complex settings.