Seven EMS Practices Boost Cardiac Arrest Survival Rates


A study reveals that seven practices by emergency medical service (EMS) agencies are associated with higher rates of favorable neurological survival following out-of-hospital cardiac arrest (OHCA).


  • The researchers surveyed 470 EMS agencies within the Cardiac Arrest Registry to Enhance Survival (CARES) that treated 181,707 patients (mean age, 62 years; 36.2% women) who experienced OHCA between 2015 and 2019.
  • The primary outcome was an EMS agency’s rate of favorable neurological survival, defined as survival to hospital discharge without severe neurological disability.
  • The secondary outcome was an EMS agency’s rate of survival to hospital admission.


  • The mean rate of risk-standardized favorable neurological survival was 8.1%.
  • The mean rate of risk-standardized survival to hospital admission was 27.8%.
  • Seven EMS practices across training, cardiopulmonary resuscitation (CPR), and transport domains were significantly associated with higher survival rates. Adoption of over half of the seven practices was more common in EMS agencies in the highest survival quartile (59.3%) than in those in the lowest quartile (35.6%) (P <.001).
  • EMS agencies with higher risk-standardized favorable neurological survival were more likely to do the following:
    • Use simulation to assess competency in CPR (risk-standardized survival [β] 0.54; P =.05)
    • Assess competency of new staff in CPR at least twice a year(β 0.51; P =.04)
    • Use full-scenario multiperson simulation for ongoing skills training (β 0.48; P =.01)
    • Perform simulation training involving all agency members at least once every 6 months (β 0.63; P <.001)
    • Conduct training in the use of mechanical CPR devices at least once annually (β 0.43; P =.04)
    • Use CPR feedback devices (β 0.58; P =.007)
    • Transport patients to a designated cardiac arrest or ST-segment elevation myocardial infarction receiving center (β 0.57; P =.003)


“Given wide variability in OHCA survival among EMS agencies, our findings provide initial insights into EMS practices that distinguish top-performing EMS agencies,” the authors concluded.


The study was conducted by Saket Girotra, MD, SM, University of Texas Southwestern Medical Centre, Dallas, Texas, and published online in JAMA Cardiology


The survey was restricted to EMS agencies in CARES, a catchment area for about 53% US residents, and may not accurately represent nonparticipating agencies, particularly those with low OHCA volumes. The study did not assess response time as a metric for EMS quality due to high rates of missing data and non-EMS first responders arriving before EMS in over 40% cases. The observational study design limited the determination of a causal relationship between identified practices and EMS survival.


The study did not receive any specific funding. One author reported receiving grants from the National Institutes of Health (NIH) and personal fees from the American Heart Association (AHA); one author reported receiving grants from the NIH and the National Heart, Lung, and Blood Institute (NHLBI); one author reported receiving grants from the NIH and NHLBI and serving as the AHA Chair of the Emergency Cardiovascular Care Committee, Science subcommittee; one author reported receiving grants from the Centers for Disease Control and Prevention Cardiac Arrest Registry to Enhance Survival; and one author reported receiving grants from the NHLBI and the AHA and consulting fees from Optum Consulting. Other authors declared no conflicts of interest.


Leave a Reply

Your email address will not be published. Required fields are marked *