4 INTRODUCTION EMS-treated out-of-hospital cardiac arrest (OHCA) affects more than 250,000 Americans each year and is the third leading cause of disability adjusted life years (DALYs) in the United States, following cardiovascular disease and back pain. Typically, one in ten patients survive to hospital discharge, with 80% having no or moderate neurological disability. Cardiac arrest resuscitation serves as a critical benchmark for evaluating a community’s preparedness to respond to medical emergencies. Successful resuscitation requires a coordinated, community-based system of care that engages a wide range of individuals—including bystanders, emergency medical dispatchers, first responders, paramedics, and hospital providers—to improve survival. Performing bystander CPR can nearly double survival, and public access to defibrillation results in an almost 50% survival rate for patients presenting in a shockable rhythm. It is important to remember that these impactful community-based interventions happen in advance of 911 responders arriving on the scene. Without data on key indicators, such as patient outcomes and bystander interventions, communities and EMS leadership lack the information needed to assess their performance relative to others and to evaluate the success of their quality improvement efforts. Data collection is crucial in identifying gaps and planning next steps to strengthen the chain of survival. OHCA registries fill this role by compiling standardized measures at the community, state, and national level. Benefits of participating in such registries include determining patient outcomes, uniform benchmarking, identifying opportunities for improvement, and assessing the effectiveness of specific interventions. The Cardiac Arrest Registry to Enhance Survival (CARES) allows communities to benchmark their performance with local, state, and national metrics to better identify opportunities to improve their OHCA care. CARES offers a comprehensive understanding of where arrests are occurring, whether bystanders are providing intervention prior to EMS arrival, EMS and hospital performance, and patient outcomes. This in turn provides the data necessary to make informed decisions and allocate limited resources for maximal community benefit. By creating an easy-to-use and flexible system to collect OHCA data and forming a community to share best practices, CARES has transformed the way EMS agencies are treating cardiac arrest. Participating agencies can make decisions in their community based on real-time feedback and analysis to increase survival. CARES reaches a key milestone during the national reporting process, which begins after the calendar year dataset is finalized. Participating states, EMS agencies, and hospitals receive their official CARES reports for the year. For 2025, more than 11,500 reports were generated during the three-day reporting process, making it possible for every CARES participant to compare local, regional, and national data for benchmarking and surveillance purposes with the goal of increasing survival from OHCA. We extend our sincere gratitude to the members of the EMS and hospital CARES communities, as well as our valued partner organizations—the American Heart Association, American Red Cross, Centers for Disease Control and Prevention, and Emory University Woodruff Health Sciences Center—for their continued support of our mission to save lives and improve patient care. We also acknowledge the Cardiovascular Advances in Research and Opportunities Legacy (CAROL) Act, which made the CDC CARES Expansion and Modernization Grant (2023–2028) possible. With this support, we are proud to present the CARES 2025 Annual Report. Photo courtesy of Guilford County Emergency Services, NC
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