Factors influencing support for the implementation of community-based out-of-hospital cardiac arrest interventions in high- and low-performing counties

Natalie Ezem; Allison A Lewinski; Julie Miller; Heather A King; Megan Oakes; Lisa Monk; Monique A Starks; Christopher B Granger; Hayden B Bosworth; Audrey L Blewer

doi:10.1016/j.resplu.2024.100550

Factors influencing support for the implementation of community-based out-of-hospital cardiac arrest interventions in high- and low-performing counties

Resusc Plus. 2024 Jan 20:17:100550. doi: 10.1016/j.resplu.2024.100550. eCollection 2024 Mar.

Authors

Natalie Ezem¹, Allison A Lewinski^{2

3}, Julie Miller¹, Heather A King^{1

2

4}, Megan Oakes^{1

2}, Lisa Monk⁵, Monique A Starks^{5

6}, Christopher B Granger^{3

5

6}, Hayden B Bosworth^{1

2

3

5

7

8

4}, Audrey L Blewer^{1

3

7}

Affiliations

¹ Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States.
² Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, United States.
³ School of Nursing, Duke University, Durham, NC, United States.
⁴ Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, United States.
⁵ Duke Clinical Research Institute, Durham, NC, United States.
⁶ Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, NC, United States.
⁷ Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC, United States.
⁸ Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States.

Abstract

Aim of the study: 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.

Methods: 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.

Results: From 10/2021 to 02/2022, we completed 29 interviews across the 7 counties (EMS (n = 9), telecommunications (n = 7), fire/first responders (n = 7), and hospital representatives (n = 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.

Conclusions: 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.

Keywords: Community-based interventions; Emergency medical services; First responders and medical professionals; Implementation science; Out-of-hospital cardiac arrest (OHCA).