18 CARES OVERVIEW CARES began data collection in Atlanta, with nearly 600 cases captured in 2005. The program has since expanded to include 36 state-based registries (Alabama, Alaska, California, Colorado, Connecticut, Delaware, Florida, Hawaii, Illinois, Indiana, Iowa, Kansas, Kentucky, Maine, Maryland, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Jersey, New York, North Carolina, Ohio, Oregon, Pennsylvania, Rhode Island, South Dakota, Texas, Utah, Vermont, Washington, Wisconsin, and Wyoming) plus 56 community sites in 10 additional states, representing a catchment area of approximately 189 million people or 56% of the US population. To date, the registry has captured over 1.3 million records, with more than 3,200 EMS agencies and over 2,300 hospitals participating nationwide. CARES captures data on all non-traumatic out-of-hospital cardiac arrests where resuscitation is attempted by a 911 Responder (CPR and/or defibrillation). This also includes patients who receive an AED shock by a bystander prior to the arrival of 911 Responders. Inclusion and exclusion criteria are described below (Tables 1 and 2). Case Definition Table 1. CARES inclusion criteria (all of the following) • Patients of all ages who experience a non-traumatic, out-of-hospital cardiac arrest. • Patients who are pulseless on arrival of 911 Responder; OR • Patients who become pulseless in the presence of 911 Responder; OR • Patients who have a pulse on arrival of EMS, where a successful attempt at defibrillation was undertaken by a bystander prior to arrival of 911 Responder. Table 2. CARES exclusion criteria (any of the following) • Unworked/untreated cardiac arrests, to include codes that are terminated immediately upon arrival of EMS because the patient is not a viable candidate for resuscitation due to: • Injuries incompatible with life. • Signs of decomposition. • The presence of rigor mortis or lividity. • Presence of a valid DNR. • Stillborn neonates/perinatal newborns, born without signs of life. • Private EMS transport that did not involve 911 dispatch. • Cardiac arrest of clear and obvious traumatic etiology. • Bystander suspected cardiac arrest, where ROSC was achieved without the need for defibrillation or 911 Responder CPR. Data collection within CARES is based on the Utstein-style definitions – a standardized template of uniform reporting guidelines for clinical variables and patient outcomes that was developed by international resuscitation experts.1,2 The CARES web-based software (https://mycares.net), links three sources to describe each OHCA event: 1) 911 call center data, 2) EMS data, and 3) hospital data. Data can be submitted in two ways: using a data-entry form on the CARES website, or via daily upload from an agency’s electronic patient-care record (ePCR) system. Access to the CARES website is restricted to authorized users, who are prohibited from viewing data from another agency or hospital. Data Collection & Elements
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