Community and EMS Interventions to Improve Survival in Cardiac Arrest

BACKGROUND: Early cardiopulmonary resuscitation (CPR) and defibrillation improve survival after out-of-hospital cardiac arrest, but evidence from randomized trials about whether community-based implementation strategies improve outcomes is lacking. METHODS: We conducted a registry-based, cluster-randomized trial involving adults with out-of-hospital cardiac arrest treated by emergency medical services (EMS) in North Carolina counties. The counties were grouped into clusters, which were then randomly assigned in a 1:1 ratio to implement a multifaceted intervention or administer usual care. The intervention included four components: training of 911 telecommunicators to improve rapid recognition of cardiac arrest, training of 911 telecommunicators to improve delivery of CPR instructions from telecommunicators to bystanders, community CPR training, and enhanced use of automated external defibrillators by first responders or bystanders before EMS arrival. Data were collected through the Cardiac Arrest Registry to Enhance Survival. The primary outcome was survival to hospital discharge with a good neurologic outcome (Cerebral Performance Category score of 1 or 2; range, 1 to 5, with higher scores indicating worse neurologic outcome). RESULTS: From July 1, 2022, to June 30, 2026, a total of 28 clusters comprising 11,615 patients were assigned to the intervention group, and 27 clusters comprising 10,844 patients were assigned to the usual-care group. The median age of the patients was 64.0 years, and 36.7% were women. The percentage of patients who survived to hospital discharge with a good neurologic outcome was 9.0% (1048 of 11,608 patients) in the intervention group and 9.4% (1017 of 10,839 patients) in the usual-care group (adjusted odds ratio, 0.97; 95% confidence interval, 0.75 to 1.26; P = 0.80). CONCLUSIONS: Among adults with out-of-hospital cardiac arrest, implementation of a multifaceted strategy involving the community and EMS did not result in a greater percentage of patients who survived to hospital discharge with a favorable neurologic outcome than usual care. (Funded by the National Heart, Lung, and Blood Institute of the National Institutes of Health; RACE-CARS ClinicalTrials.gov number, NCT04660526.).