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Cardiac arrest project initiated by the Joint commision.

The Joint Commission has announced a project to identify, develop and test standardized performance measures to assess care of patients experiencing sudden cardiac arrest in both in-patients and the emergency department. The project is being funded by an unrestricted educational grant from Medtronic, St. Jude Medical, and Boston Scientific.

These companies are all manufacturers of medical equipment used in cardiac care. These corporations, however, are not participating in the design and conduct of the project, or in the collection, analysis and interpretation of the information collected or the results. The project is completely under the control of the Joint Commission.


Respiratory therapists are well aware of the prevalence of sudden cardiac arrest and the ensuing quality issues with the management of cardiac arrest. There are more than 350,000 deaths annually from sudden cardiac arrest in the U.S. Although there have been quality efforts in this area, there are no formal, evidence-based guidelines or standards that are in place for the management of sudden cardiac arrest. The Joint Commission has identified the potential for significant improvement in the prevention and treatment of sudden cardiac arrest.

The Sudden Cardiac Arrest Technical Advisory Panel was convened in 2009 by the Joint Commission. The panel is comprised of leaders of various organizations who were considered stakeholders in this project. The panel recommended the development of a set of performance measures for in-patients and a monograph for community-based effective practices, focusing on both prevention and treatment of cardiac arrest. The organizations include:

* National Medical Association

* Heart Rhythm Society

* American Heart Association

* American College of Emergency Physicians

* Society for Cardiovascular Angiography and Interventions

* American Society of Health System Pharmacists

* National Association of Emergency Medical Technicians

* Sudden Cardiac Arrest Foundation

* American Nurses Association

* Emergency Nurses Association

* American College of Cardiology

* Sudden Cardiac Arrest Association

* American Medical Society for Sports Medicine

* National Association of EMS Physicians

The Advisory Panel suggested priority areas related to sudden cardiac arrest at their initial meeting, and further refined these areas in February 2010. The preliminary priority areas that were identified are targeted for the list of standardized performance measures. The measures include cardiac arrest treatment, post arrest prevention, outcome and at-risk populations.

The Joint Commission issued a call for measures within these areas of interest for submission by April 30, 2010. The following are the topics identified at this point, but are not considered all inclusive at this point:

* Cardiac Arrest Treatment:

* Use of Therapeutic Hypothermia

* Time from recognition of cardiac arrest to initiation of CPR

* Tie from recognition of cardiac arrest to defibrillation

* CPR continuity

* Compliance with ACLS protocol

* Urgent catheterization for witnessed ventricular fibrillation arrest

* Proper neurologic prognostication

* Search for reversible causes of arrest

* Over, under, or appropriate use of Intracardiac Defibrillator

The Advisory Panel also identified areas of community-based practice that should be included in the monograph of effective practices. This includes effective practices, implementation strategies, programs in pre-hospital or post-discharge care, community preparedness programs or EMS related topics. The objectives are to develop a set of performance measures that are evidence-based for hospitals and to publish a monograph detailing effective practices that are community based.

The call for abstracts in these particular areas requires submission to the Joint Commission by May 21, 2010. The programs or practices should reference one of the following areas of interest:

* Out of hospital arrest

- Transfer to EKG information from EMS systems

- Transfer of outcome information to EMS systems

* Organized systems of community care

* Programs for survivors of sudden cardiac arrest

* Programs for those with risk factors for sudden cardiac arrest

* EMS/hospital/community coordination

* Public access to Automated External Defibrillators (AEDs)

* Innovative and state of the art care by EMS

* Community preparedness

- Pre-arrival advice to family members

- 911 operator training

- Priority dispatch

- CPR/AED training programs (public)

- SCA awareness campaigns--success stories

- Risk factor reduction in geographic areas

- Disparities in cardiac arrest care

- Access to care

- Bystander CPR

Both of these projects by the Joint Commission will be of great interest to respiratory therapists. Because respiratory therapists participate in more resuscitation than almost any other allied health specialty, we will want to play an active role in any of these projects at our institutions. We are a critical part of any sudden cardiac arrest response and need to ensure that our vantage point is taken into consideration during these important activities.

The Sudden Cardiac Arrest project is expected to conclude in February 2012. The results of this project will be invaluable to quality improvement efforts for victims of sudden cardiac arrest. This will provide essential data to provide evidence-based care by all healthcare professionals working on this critically important patient population.

For further information on these projects, please visit:

David Gourley, MHA, RRT, FAARC, is the assistant vice president of regulatory affairs at Chilton Memorial Hospital in Pompton Plains, N.J.

by David Gourley MHA, RRT, FAARC
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Author:Gourley, David
Publication:FOCUS: Journal for Respiratory Care & Sleep Medicine
Geographic Code:1USA
Date:May 1, 2010
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