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Cardiac Arrest Registry to Enhance Survival
CARES
CARESDataSharingUserGuide
Cardiac Arrest Registry to Enhance Survival
CARES
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INDEX
WhatisCARES?……………………………………………………..…………………………………………………..............1
WhoownsCARESdata?………………………………………………………………….………………………...............1
WhatisaCAREScase?………………………………………………………………….………………………..................1
HowisCARESdatacollected?…………………………………………………………………..……………................1
WhatkindofdatadoesCAREScollect?………………………………………………………….………................2
HowcanIaccessCARESdata?…………………………………………………………………………………...............2
Myprojecthasbeenapproved.Whatarethenextsteps?…………………………………………...........3
I’mreadytostartmydataanalysis.WhatshouldIconsider?………………..……………………..........3
Authorship…………………………………………………………….…………………………………..............................4
Abstracts……………………………………………………………….…………………………………………………..............4
Manuscripts………………………………………..………………….………………………………….............................4
AppendixA:CARESForms………………………………………..………………………………….………………………..5
AppendixB:CARESDataSharingApplication…………………………………….….……………….……………..7
AppendixC:DataSharingChecklist………………………………...….……………………….…………………...…11
AppendixD:DataElementDefinitions………………………………...….……………………………..…………..12
AppendixE:CARESDatabaseStructure…………………………….……………………….………………………..14
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WhatisCARES?
In2004,theCentersforDiseaseControlandPrevention(CDC)establishedtheCardiacArrestRegistrytoEnhanceSurvival(CARES)incollaborationwiththeDepartmentofEmergencyMedicineattheEmoryUniversitySchoolofMedicine.CARESwasdevelopedtohelpcommunitiesdeterminestandardoutcomemeasuresforout-of-hospitalcardiacarrest(OHCA),bylinkingthethreesourcesofinformationthatdefinethecontinuumofemergencycardiaccare:911dispatchcenters,emergencymedicalservices(EMS)providers,andreceivinghospitals.ParticipatingEMSsystemscancomparetheirperformancetode-identifiedaggregatestatistics,allowingforlongitudinalbenchmarkingcapabilityatthelocal,regional,andnationallevel.
CARESbegandatacollectioninAtlantain2005.Theprogramhassinceexpandedtoinclude20state-basedregistries(Alaska,California,Delaware,Hawaii,Illinois,Maine,Maryland,Michigan,Minnesota,Montana,Nebraska,NewHampshire,NorthCarolina,NorthDakota,Oregon,Pennsylvania,SouthCarolina,Utah,Vermont,andWashington)withmorethan60communitysitesin22additionalstates,representingacatchmentareaofapproximately107millionpeopleor33%oftheUSpopulation.Morethan1,400EMSagenciesandover1,800hospitalsparticipatenationwide.
WhoownsCARESdata?
CARESisasecureandconfidentialdatamanagementsystemthatallowsEMSagenciesandhospitalstomonitortheirperformanceandcomparethemselvesagainststateandnationalbenchmarks.LocalEMSagenciesandhospitalshaveownershipoftheirowndata.CARESiscommittedtomaintainingtheconfidentialityofEMSagencyandhospitaldata;therefore,alldataissharedinade-identified,aggregateformat.Fieldsthatcouldidentifyapatient,EMSagency,orhospitalareremovedfromresearchdatasets,andpublicationsshallnotseparatelyidentifyparticipatingEMSagencies,hospitals,ortheircontributeddata.Datasharingapplicationsandagreementsareproposal-specificandlimitedtoeachindividualproject.
WhatisaCAREScase?
EMSagenciesareinstructedtoincludeallout-of-hospitalcardiacarrests(OHCAs)ofnon-traumaticetiologywherethepatient:1)receivesresuscitativeeffortsfromFirstRespondersorEMS,or2)isdefibrillatedpriortoEMSarrival.CARESincludesOHCApatientsofallages.
ThefollowingarenotconsideredCAREScases:1)Arrestoccurringduringaninter-facilitytransfer,2)Resuscitativeeffortsnotinitiatedorterminatedduetorigor,lividity,decomposition,injuriesincompatiblewithlife,DoNotResuscitatedirective,and/orobvioussignsofdeath.
HowisCARESdatacollected?
TheCARESsoftware(https://mycares.net),developedandmaintainedbyPhysio-Control,Inc.,linksthreesourcestodescribeeachOHCAevent:1)911callcenterdata,2)EMSdata,and3)hospitaldata.TheregistryevaluatesOHCAeventsofnon-traumaticetiologythatinvolvepersonswhoreceivedresuscitativeefforts,includingCPRand/ordefibrillation.EMSinitiatesaCARESrecordandcansubmitdataintwoways:usingadata-entryformontheCARESwebsite,orviauploadfromanagency’selectronicpatient-carerecord(ePCR)system.Whenthepatientsurvivestothehospitalwithongoingresuscitation,CARESrequestsoutcomedatafromtherecievingfacility.
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WhatkindofdatadoesCAREScollect?
DatacollectionwithinCARESisbasedontheUtstein-styledefinitions–astandardizedtemplateofuniformreportingguidelinesforclinicalvariablesandpatientoutcomesthatwasdevelopedbyinternationalresuscitationexperts1.
From2005-2012,onlypatientswithapresumedcardiacetiologywereincludedinCARES.However,inalignmentwiththeUtsteinguidelinesandILCORrecommendation,theregistry’sinclusioncriteriaweremodifiedinJanuary2013toincludeallpatientswithnon-traumaticOHCA.Assuch,dataanalysisisrestrictedtothe2013-2016dataset,whichincludesmorethan193,000records.
MandatorydataelementscollectedfromEMSprovidersincludedemographics(i.e.name,age,dateofbirth,incidentaddress,sex,andrace/ethnicity),arrest-specificdata(i.e.locationtypeofarrest,witnessstatus,andpresumedetiology),andresuscitation-specificdata(i.e.informationregardingCPRinitiationand/orAEDapplication,defibrillation,initialarrestrhythm,returnofspontaneouscirculation[ROSC],fieldhypothermia,andpre-hospitalsurvivalstatus).
EMSprovidersarealsoabletoenteranumberofoptionalelements,whichfurtherdetailarrestinterventions(i.e.usageofmechanicalCPRdevice,ITD,12Lead,automatedCPRfeedbackdevice,andadvancedairway;administrationofdrugs;anddiagnosisofSTEMI).
TheCARESformalsoincludesanumberofoptionaltimeelements,includingestimatedtimeofarrest,defibrillatoryshock,andinitialCPR.Supplementaldataelementscollectedfromthe911callcentersincludethetimethateach911callwasreceived,thetimeofdispatchforbothfirstresponderandEMSproviders,andarrivaltimeatthescene.
Dataelementscollectedfromreceivinghospitalsincludeemergencydepartmentoutcome,provisionoftherapeutichypothermia,hospitaloutcome,dischargelocation,andneurologicaloutcomeatdischarge(usingtheCerebralPerformanceCategories[CPC]Scale).Receivingfacilitiesmayalsocompleteoptionalelementsoutlininghospitalprocedures,includingcoronaryangiography,CABG,andstentorICDplacement.
TheCARESdatasetisgeocodedonanannualbasis,usingCentrusDesktopGeocoder,andlinkedtoanumberofcensus-tractlevelvariablesincluding:medianhouseholdincome,medianage,race,unemploymentrate,andeducationalattainment.
TheCARESforms(requiredelementsonly,andrequiredandsupplementalelements)arelocatedinAppendixA.
HowcanIaccessCARESdata?
InquiriesaboutthenationaldatasetshouldbedirectedtoKimberlyVellano([email protected]),DirectorofDataManagementforCARES.Inquiresaboutstate-specificprojectsshouldbedirectedtotherespectiveCARESStateCoordinator(contactinformation:https://mycares.net/sitepages/contactus.jsp).
ResearcherswhowanttoanalyzestateornationalaggregatedatamustsubmitaresearchproposaltotheCARESDataSharingCommittee.Eachuniqueprojectrequiresaseparateproposalsubmission.TheCARESDataSharingApplicationislocatedinAppendixB.Oncecompleted,theapplicationwillbedistributedtocommitteemembersforreview.Feedbackwillbeprovidedwithinfourweeksofsubmission.
ThegoalsofthenationalandstateDataSharingCommitteesareasfollows:
o TopromoteaccurateandscientificallysoundpresentationsandpapersfromtheCARESprogram.
1Resuscitation. 2015 Nov;96:328-40.
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o TooverseetheuseofthedatabelongingtoEMSagenciesandhospitalsandprotectagencyandhospitalconfidentiality.
o Toensurethatallinvolvedpartieshaveconsentedtotheuseoftheirdata,or,iftheresearchoranalysisisde-identified,cumulativedata,thatitisapprovedbyacommittee.
o Toensureparticipationandsupportfromallstakeholders.
o Toavoidduplicationofeffortanddatamining.
Thecommitteeevaluatestheproposalforscientificmeritandmakesrecommendations.Iftherearenoconcernsorissuesraised,theresearcherwillbeinformedthattheirproposalhasbeenapproved.Anycommentsorsuggestionsfromthecommitteewillbesharedwiththeleadinvestigator.
Myprojecthasbeenapproved.Whatarethenextsteps?
AnoverviewoftherequiredstepscanbefoundintheDataSharingChecklist(AppendixC).
Step1:Non-DisclosureAgreement&IRBapproval
PriortoreceiptoftheCARESdataset,theleadresearchermustsignaNon-DisclosureAgreementforInformationRecipientsstatingtheywillnotsharethedatasetorexpandtheanalysisbeyondthescopeoftheproposal.ThesignedNDAshouldbesenttotheCARESDataSharingCoordinatorforfinalexecutionbyEmoryUniversity.Afullyexecutedcopywillbereturnedonceavailable.
LeadauthorsmustobtainIRBapprovalfromtheirinstitutionswithin3monthsofreceivingthedatasetforanalysis.AcopyoftheIRBapprovalmustbesharedwiththeCARESDataSharingCoordinator.
Step2:Datasetreviewwebinar
AfterapprovaloftheproposalbytheDataSharingCommittee,theCARESDataSharingCoordinatorwillprovidetherequestedde-identifieddatasetspecifictothestudyproposal.TheDataSharingCoordinatorwillscheduleawebinarwiththestudyinvestigatorsandaffiliatedstatisticalstafftoreviewthedatasetandanswerquestionsaboutinterpretationoftheCARESelements.
I’mreadytostartmydataanalysis.WhatshouldIconsider?
Dataelementdefinitionsandcodingconsiderations(includinginformationaboutlocationtype,bystanderCPR,PAD,andpatientoutcome)arefoundinAppendixD.AdditionalinformationcanbefoundintheCARESDataDictionary(https://mycares.net/sitepages/dataelements.jsp).
DetailsregardingthedatasetstructureandrelationshipsbetweenCARESquestionsarefoundinAppendixE.
Step3:Senddescriptivedatatablesforreviewpriortofurtheranalysis
DescriptivedatatablesshouldbesharedwiththeCARESDataSharingCoordinatorforreviewpriortofurtheranalysis.Thiswillallowforfeedbackregardinginclusion/exclusioncriteria,dataelementinterpretation,andcodinginadvanceofmoresophisticatedanalyses.
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Authorship
AuthorswhoparticipateinthewritingofamanuscriptshoulddosoinaccordancewiththeInternationalCommitteeofMedicalJournalEditorsguidelines(JAMA1997;277(11):927-934).
Allabstracts/manuscriptswrittenusingCARESdatawillusethefollowingformattolistauthorship:
o Individualauthorswillbelistedfirst.
o Allabstracts/manuscriptsshouldincludethewords“andtheCARESSurveillanceGroup”intheauthorshiplinefollowingtheindividualauthors(e.g.SchwammL,GeorgeM,MattersM,andtheCARESSurveillanceGroup).
The"Acknowledgement"sectionofallmanuscriptsshouldreferencetheCARESparticipatingsitesbyprovidingtheweblinkhttps://mycares.net/sitepages/map.jsp.
Abstracts
Abstractorpresentationproposalsmustbefollowedupwithasubmissionwithinthreemonthsofthedatethatthedatasetisprovided.
AbstractsforpresentationsatscientificmeetingsshouldbesenttotheDataSharingCommitteeforapprovalpriortosubmission.Committeememberswillreviewtheabstracttodeterminewhetheritisaccurateandscientificallysound.Thecommitteewillrespondtotheinvestigatorswithintwoweeksofsubmissionforabstracts.Underverylimitedcircumstances,aresearchermaycallforanexpeditedreviewofanabstract.Requestsforanexpeditedreviewshouldbesubmittedtothecommitteewithjustificationfortheneedtoexpeditethereview.Failureoftheresearchertocompletetheworkinatimelymannerand/orfailuretodeterminedeadlinespriortobeginningtheprojectDOESNOTjustifyexpeditedreview.
AcopyofacceptedabstractsshouldbesenttotheCARESDataSharingCoordinatorfortherecord.
Manuscripts
Manuscriptsmustbesubmittedforreviewwithinninemonthsofthedatethatthedatasetisprovided.
DraftmanuscriptsshouldbesenttotheDataSharingCommitteeforapprovalpriortojournalsubmission.Committeememberswillreviewthemanuscripttodeterminewhetheritisaccurateandscientificallysound.Thecommitteewillrespondtotheinvestigatorswithinfourweeksofsubmissionformanuscripts.Underverylimitedcircumstances,aresearchermaycallforanexpeditedreview.Requestsforanexpeditedreviewshouldbesubmittedtothecommitteewithjustificationfortheneedtoexpeditethereview.Failureoftheresearchertocompletetheworkinatimelymannerand/orfailuretodeterminedeadlinespriortobeginningtheprojectDOESNOTjustifyexpeditedreview.
TheCARESDataSharingCoordinatorshouldbenotifiedwitheachjournalsubmissionandpeerreview,inordertotrackprojects.
AcopyofacceptedpublicationsshouldbesenttotheCARESDataSharingCoordinatorfortherecord.
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AppendixA:CARESForms
CARESRequiredElements:
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CARESRequired&SupplementalElements:
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AppendixB:CARESDataSharingProposalForm
ThankyouforyourinterestintheCardiacArrestRegistrytoEnhanceSurvival(CARES).ToinitiatearesearchprojectutilizingCARESdata,pleasecompletetheapplicationbelowandsubmitelectronicallytoKimberlyVellanoatkhauste@emory.edu.TheproposalwillbereviewedbytheCARESDataSharingCommitteewithin4weekstodeterminethatitisscientificallysoundandthatthescopeoftheanalysisisreasonable.Ifthecommitteeapprovestheproposal:
• CARESstaffwillconductawebinartoreviewthedataelementsandanswerquestionspriortoprovidingtheresearcherwiththede-identifieddataset.
• TheresearchermustsignaNon-DisclosureAgreementstatingtheywillnotsharethedatasetorexpandtheanalysisbeyondthescopeoftheproposal.
• Abstractsforpresentationsatscientificmeetingsshouldbesubmittedwithin3monthsofreceiptofthedataset.AbstractsmustbesenttotheCARESDataSharingCommitteeforreview2weeksinadvanceofsubmission.
• Publicationmanuscriptsshouldbesubmittedwithin9monthsofreceiptofthedataset.ManuscriptdraftsmustbesenttotheCARESDataSharingCommitteeforreview4weeksinadvanceofsubmission.
MoredetailedinformationabouttheCARESDataSharingPolicyandGuidelinescanbefoundat:https://mycares.net/sitepages/datashare.jsp.
PrimaryContactInformationName:
Title:
Hospital/University/Company:
StreetAddress:
City,State,Zip:
Phone:
Email:
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Projectname/Workingtitle:Leadinvestigator:TargetConference:TargetJournal:
A) StudyInvestigators
Name Institution Email(required)
1.
2.
3.
4.
5.
6.
7.
8.
B) Mainobjective,aim,orhypothesis
C) Background/Rationale
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D) MethodsSpecificoutcome(s)ofinterest:Explanatoryvariablesofinterest:
Studypopulation(inclusion/exclusioncriteria):Analysisplan(withpowercalculationsandplansforobtainingstatistical/epidemiologicalexpertise,ifrelevant):
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E) Relevantreferences
FORUSEBYCARES:Datesubmitted:CARESDSCdeadline:Dateapproved:
DSCFeedback/Comments:
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AppendixC:DataSharingChecklist
¨ SignCARESNon-DisclosureAgreementforInformationRecipients
¨ CompletedatasetreviewwebinarwithCARESDataSharingCoordinator
¨ SubmitIRBapprovallettertoCARESDataSharingCoordinatorwithin3monthsofreceiptofdataset
¨ SenddescriptivedatatablestoCARESDataSharingCoordinatorforreviewpriortofurtheranalysis
o Submitabstractsforpresentationsatscientificmeetingswithin3monthsofreceiptofdataset
o SendabstracttoCARESforcommitteereview2weeksinadvanceofsubmission
o Include"andtheCARESSurveillanceGroup"intheauthorshiplinefollowingtheindividualauthors
o IncludeCARESlogoonposter
o Submitpublicationmanuscriptswithin9monthsofreceiptofdataset
o SendmanuscripttoCARESforcommitteereview4weeksinadvanceofsubmission
o Include"andtheCARESSurveillanceGroup"intheauthorshiplinefollowingtheindividualauthors
o InAcknowledgementssection,referencetheCARESparticipatingsitesbyprovidingtheweblink:https://mycares.net/sitepages/map.jsp.
o SendtoCARESforre-reviewifthemanuscriptisrevisedbasedonpeerreviewprocess
¨ SendacopyofacceptedabstractormanuscripttoCARESDataSharingCoordinator
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AppendixD:DataElementDefinitionsCARESCaseDefinition:ACAREScaseisanon-traumaticout-of-hospitalcardiacarresteventwhereresuscitationisattemptedbya911responder(CPRand/ordefibrillation).ThisincludespatientsthatreceivedanAEDshockbyabystanderpriortothearrivalof911responders.CAREScollectedonlyarrestsofpresumedcardiacetiologyfrom2005-2012.In2013,CARESexpandedtoincludeallnon-traumaticarrests.LocationType:Typeoflocationwherethepatientarrested.CARESlocationtypesaregenerallygroupedintothefollowing:
• Home/Residence:Home/Residence• NursingHomeorHealthcareFacility:NursingHome;HealthcareFacility• Public:Public/CommercialBuilding;Street/Highway;PlaceofRecreation;IndustrialPlace;
TransportCenter;OtherBystander-Alayperson,laypersonfamilymember,orlaypersonmedicalprovider.FirstResponder–Personnelwhorespondtothemedicalemergencyinanofficialcapacityaspartofanorganizedmedicalresponseteambutarenotthedesignatedtransporterofthepatienttothehospital.EmergencyMedicalServices(EMS)-Personnelwhorespondtothemedicalemergencyinanofficialcapacity(i.e.respondtothe911call)aspartofanorganizedmedicalresponseteamandarethedesignatedtransporterofthepatienttothehospital.BystanderCPR–Cardiopulmonaryresuscitationinitiatedbyalayperson,laypersonfamilymember,or
laypersonmedicalprovider.
BystanderCPRRate:Werecommendexcluding911Responderwitnessedeventsaswellasthosethatoccurredinanursinghome/healthcaresettingfrombystanderCPRratecalculations,asthesearescenarioswhereatrainedmedicalprofessionalwouldmostlikelybeperformingCPR.
Exclude“ArrestWitnessStatus=911ResponderWitnessed”AND“LocationType=NursingHome;HealthcareFacility”fromnumeratoranddenominator.
Numerator:WhoInitiatedCPR=layperson,laypersonfamilymember,orlaypersonmedicalprovider
AEDApplication:“WasanAEDappliedpriortoEMSarrival”denotesAEDapplicationbyalaypersonorFirstResponderpriortothearrivalofEMS,regardlessofwhetherdefibrillationoccurred.“Yes,withdefibrillation”,and“Yes,withoutdefibrillation”arebothaffirmativeresponsestothisquestion.
PADRate:WhentheoutcomeofinterestistheuseofanAEDbyabystander,werecommendexcluding911Responderwitnessedeventsaswellasthosethatoccurredinahealthcarefacilityornursing
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home,asthesearescenarioswhereatrainedmedicalprofessionalwouldmostlikelybeapplyinganAEDormonitor.AEDsarerarelyusedduringcardiacarrestsoccurringinresidentiallocations;therefore,werecommendexcludingarreststhatoccurredinanon-publiclocationandevaluatingthepublicaccessdefibrillation(PAD)rate.
Exclude“ArrestWitnessStatus=911ResponderWitnessed”AND“LocationType=NursingHome;HealthcareFacility;Home/Residence”fromnumeratoranddenominator.
Numerator:WhofirstappliedtheAED=layperson,laypersonfamilymember,orlaypersonmedicalprovider
Whofirstdefibrillatedthepatient?–Usedtodeterminethefrequencyofdefibrillatoryshocksamongbystandersandresponders.“NotApplicable”isselectedwhendefibrillationdidnotoccur.FirstArrestRhythm-Firstcardiacrhythmpresentwhenamonitor/defibrillatororAEDisattachedtoapatient.SustainedROSC-ReturnofSpontaneousCirculation(ROSC)isdefinedastherestorationofapalpablepulseorameasurablebloodpressure.SustainedROSCisdeemedtohaveoccurredwhenchestcompressionsarenotrequiredfor20consecutiveminutesandsignsofcirculationpersist.“Yes”,“Yes,butpulselessatendofEMScare”,and“Yes,pulseatendofEMScare”areallaffirmativeresponsestothisquestion.Fieldhypothermia-Measuresweretakeninthefieldtoreducethepatient’sbodytemperaturebymeansofexternalcoldpackapplicationtoarmpits/groinoradministrationofcoldintravenoussalinebolus,withorwithoutsedationorothermedications.Survivedtohospitaladmission-IncludespatientsforwhomEROutcome=Admittedtohospital.Survivedtohospitaldischarge-IncludespatientsforwhomHospitalOutcome=DischargedAliveorPatientMadeDNR=DischargedAlive.GoodCerebralPerformance–CPC1;Patientisconscious,alert,abletoworkandleadanormallife.ModerateCerebralPerformance–CPC2;Patientsisconsciousandabletofunctionindependently(dress,travel,preparefood),butmayhavehemiplegia,seizures,orpermanentmemoryormentalchanges.UtsteinPatients-Thosewhohadabystanderwitnessedarrestandpresentedinashockablerhythm.ToviewCARESUtsteinpatients,selectthefollowing:
• ArrestWitnessStatus=BystanderWitnessed• FirstRhythmType=Shockable
UtsteinBystanderSurvival-Survivalamongpatientswhosecardiacarrestwaswitnessedbyabystander,wereinashockablerhythm,andreceivedsomebystanderintervention(CPRand/orAEDapplication).
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AppendixE:CARESDatabaseStructure
ThetablebelowincludesdetailsabouttheCARESdatasetstructure,includingthedataelementsandresponses,andrelationshipsbetweenCARESquestions.Lightgreyshadingindicatesthe
supplemental/optionalCARESdataelements.
Header TitleonCARESForm Responses Description/CommentsRunID N/A UniquerecordidentifiergeneratedbyCARESsoftware.
EMSAgencyID N/A UniqueEMSagencyidentifiergeneratedbyCARES.IncludedinCARESdatasetwhenneededforanalysis.DateofArrest DateofArrest Age(Years) Age/AgeModifier Patientage,inyears.Daysandmonthshavebeenconvertedaccordingly.
Gender Gender Male
Female
Race/Ethnicity Race/Ethnicity
American-Indian/Alaskan
Asian
Black/AfricanAmerican
Hispanic/Latino
NativeHawaiian/PacificIslander
White
Unknown
Raceis"Unknown"forapproximately25%ofCAREScases,duetothefactthatanumberofcommunities
donotcollectthisinformation.
MedicalHistory MedicalHistory
No
Unknown
Cancer
Diabetes
HeartDisease
Hyperlipidemia
Hypertension
RenalDisease
RespiratoryDisease
Stroke
Other
DestinationHospitalID N/A UniquehospitalidentifiergeneratedbyCARES.IncludedinCARESdatasetwhenneededforanalysis.
LocationType LocationType
Home/Residence
Public/CommercialBuilding
Street/Hwy
NursingHome
HealthcareFacility
PlaceofRecreation
IndustrialPlace
TransportCenter
Other
ArrestWitnessStatusArrestWitnessed/ArrestAfter
Arrivalof911Responder
Unwitnessed
BystanderWitnessed
911ResponderWitnessed
Thisvariablemapsresponsesfrom"ArrestWitnessed"and"ArrestAfterArrivalof911Responder".
PresumedCardiacArrest
EtiologyPresumedCardiacArrestEtiology
PresumedCardiacEtiology
Trauma
Respiratory
Drowning
Electrocution
DrugOverdose
Exsanguination/Hemorrhage
Other
From2005-2012,CARESonlyrequiredarrestsofpresumedcardiacetiologytobeentered.InJanuary
2013,ourcasedefinitionexpandedtoincludeallnon-traumaticworkedarrests.AnalysesusingCARES
dataMUSTincludeallnon-traumaticetiologies.
DrugOverdoseandExsanguination/HemorrhagearenewanswerchoicesasofJanuary2017.Priorto
this,theseetiologieswerecodedasOther.
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Header TitleonCARESForm Responses Description/Comments
ResuscitationAttempted
ResuscitationAttemptedby911
Responder(orAEDshockgivenprior
toEMSarrival)
Yes
No
CARESrequiresthatcardiacarresteventswhereresuscitationwasattemptedbeenteredintothe
registry.DOAs/unworkedarrestsarenotCAREScasesandarethereforeremovedfromdatasets.
InitiatedCPR WhoInitiatedCPR
NotApplicable
LayPerson
LayPersonFamilyMember
LayPersonMedicalProvider
FirstResponder(non-EMS)
RespondingEMSPersonnel
TypeofBystanderCPR
ProvidedTypeofBystanderCPRProvided
Compressionsandventilations
Compressionsonly
Ventilationsonly
ThisfieldisapplicableonlyifInitiatedCPR=LayPerson,LayPersonFamilyMember,orLayPerson
MedicalProvider.
DispatcherCPRinstructions
provided
WereDispatcherCPRinstructions
provided?
Yes
No
Unknown
WasanAEDappliedpriorto
EMSarrival
WasanAEDappliedpriortoEMS
arrival
Yes,withdefibrillation
Yes,withoutdefibrillation
No
WhoFirstAppliedtheAED WhoFirstAppliedtheAED
LayPerson
LayPersonFamilyMember
LayPersonMedicalProvider
FirstResponder
Thisfieldisapplicableonlyif"WasanAEDappliedpriortoEMSarrival"="Yeswithdefibrillation"or"Yes
withoutdefibrillation".
DidpolicefirstapplytheAED Ifyes,wasitappliedbypolice?Yes
NoThisfieldisapplicableonlyif"WhoFirstAppliedtheAED"=FirstResponder.
WhoFirstDefibrillatedthe
PatientWhoFirstDefibrillatedthePatient
NotApplicable
LayPerson
LayPersonFamilyMember
LayPersonMedicalProvider
FirstResponder(nonEMS)
RespondingEMSPersonnel
ThisquestionincludesNotApplicableasaresponse,forcaseswherenoshockwasgiven.Thisquestionis
notspecifictoAEDs,butappliestodefibrillationwithanydevice.
Didpolicefirstdefibrillatethe
patient
Ifyes,didpolicedefibrillatethe
patient?
Yes
NoThisfieldisapplicableonlyif"WhoFirstDefibrillatedthePatient"=FirstResponder.
Did911Responderperform
CPRDid911ResponderperformCPR
Yes
No
FirstMonitoredRhythm FirstArrestRhythmofPatient
VentricularFibrillation
VentricularTachycardia
Asystole
Idioventricular/PEA
UnknownShockableRhythm
UnknownUnshockableRhythm
Firstcardiacrhythmpresentwhenamonitor/defibrillatororAEDisattachedtoapatient.
UnknownShockableorUnknownUnshockableareincludedforsituationswherethedevicelacked
recordingability.
FirstRhythmType N/AShockable
Non-Shockable
CategorizesFirstMonitoredRhythmasShockable(VF,VT,UnknownShockable)orNonshockable
(Asystole,Idioventricular/PEA,UnknownUnshockable).
SustainedROSC
SustainedROSC(20consecutive
minutes)orpresentatendofEMS
care
Yes
Yes,butpulselessatendofEMScare
Yes,pulseatendofEMScare
No
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Header TitleonCARESForm Responses Description/Comments
WhendidsustainedROSC
firstoccurWhendidsustainedROSCfirstoccur
Never
AfterBystanderCPROnly
AfterBystanderdefibshock
After911ResponderCPRonly
After911Responderdefibshock
AfterALS
Unknown
Washypothermiacare
providedinthefield
Washypothermiacareprovidedin
thefield
Yes
No
MechanicalCPRdeviceUsed MechanicalCPRdeviceUsedYes
No
MechanicalCPRdeviceUsed
detailIf"Yes",pleasespecify:
Load-DistributingBand(AutoPulse)
ActiveCompressionDecompression
(LUCASDevice)
MechanicalPiston
Other
ApplicablewhenMechanicalCPRdeviceUsed=Yes.
AutomatedCPRfeedback
deviceused
AutomatedCPRfeedbackdevice
used
Yes
No
AdvancedAirwaysuccessfully
placedinthefield
AdvancedAirwaysuccessfully
placedinthefield
Yes
No
AdvancedAirwaydetail If"Yes",pleasespecify:
Combitube
KingAirway
LMA
Oral/NasalET
Other
ApplicablewhenAdvancedAirwaysuccessfullyplacedinthefield=Yes.
ITDUsed ITDUsedYes
No
ITDUseddetail If"Yes",pleasespecify:
Bagvalvemask
Endotrachealtube
Combitube
KingAirway
LMA
Oral/NasalET
Other
ApplicablewhenITDUsed=Yes.
Weredrugsadministered WeredrugsadministeredYes
No
Drugsadministereddetail If"Yes",pleasespecify:
Epinephrine
Atropine
Amiodarone
Bicarbonate
Dextrose
Lidocaine
Vasopressin
Other
ApplicablewhenWeredrugsadministered=Yes.
Vascularaccess Vascularaccess
NoIV
IV
IO
12Lead 12LeadYes
No
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Header TitleonCARESForm Responses Description/Comments
STEMI STEMI
Yes
No
Unknown
STEMILocation If"Yes",selectlocation:Anterior
InferiorApplicablewhenSTEMI=Yes.
EndOfTheEvent EndOfTheEvent
DeadinField
PronouncedDeadinED
EffortCeasedduetoDNR
OngoingResuscitationinED
CARESdoesnotrequirethatfieldDNRsbeenteredintotheregistry.DNRsarenotCAREScasesandare
thereforeremovedfromdatasets.
EmergencyRoomOutcome EmergencyRoomOutcome
ResuscitationterminatedinED
Admittedtohospital
Transferredtoanotheracutecarefacility
fromtheED
ThisistheseconddataelementwhichcanindicatethatthepatientdiedintheED(see"Endofthe
Event").Ifpatientwasadmittedtothehospital,thefollowinghospitalquestions(HypothermiaCare&
HospitalOutcome)areapplicable.
SurvivedtoHospital
AdmissionN/A
Yes
No
Missing
Thisdataelementindicateswhetherthepatientsurvivedtohospitaladmission,andmapsresponses
from"EndoftheEvent"and"EROutcome".
HospitalOutcome HospitalOutcome
Diedinthehospital
DischargedAlive
PatientmadeDNR
Transferredtoanotheracutecare
hospital
Notyetdetermined
Ifthepatientdiedinthehospital,therecordiscomplete.Iftheyare"DischargedAlive"thenthe
followinghospitalquestions(DischargefromtheHospitalandNeuroOutcome)areapplicable.
PatientmadeDNRoutcome PatientmadeDNRoutcome
Diedinthehospital
DischargedAlive
Transferredtoanotheracutecare
hospital
Notyetdetermined
If"HospitalOutcome=PatientmadeDNR",thenthehospitaluserispromptedtoenterthefinalpatient
outcomefromadrop-downmenu.
SurvivedtoHospital
DischargeN/A
Yes
No
Missing
Thisdataelementindicateswhetherthepatientsurvivedtohospitaldischarge,andmapsresponsesfrom
"SurvivedtoHospitalAdmission","HospitalOutcome",and"PatientmadeDNROutcome".
DischargeFromTheHospital DischargeFromTheHospital
Home/Residence
RehabilitationFacility
SkilledNursingFacility/Hospice
NeurologicalOutcomeNeurologicalOutcomeatDischarge
fromHospital
GoodCerebralPerformance(CPC1)
ModerateCerebralDisability(CPC2)
SevereCerebralDisability(CPC3)
Coma,vegetativestate(CPC4)
CPCScore N/A
CPC1/2
CPC3/4
Missing
ThisdataelementmapsneurologicaloutcometoCPCScore,groupingCPC1and2,andCPC3and4.We
recommendthatCPC1and2begroupedtogetherasapositiveneurologicaloutcome.
Hospital-Washypothermia
careinitiated/continued
Washypothermiacareinitiatedor
continuedinthehospital
Yes
NoThisfieldisapplicableonlyifEROutcome=Admittedtohospital.
OriginalEmergencyRoom
OutcomeN/A
TransferHospitalID N/A UniquetransferhospitalidentifiergeneratedbyCARES.IncludedinCARESdatasetwhenneededfor
analysis.
Hospital(Trans)-Was
hypothermiacare
initiated/continued
N/A Thisfieldisapplicableonlyifthepatientwastransferredandadmittedtoasecondaryreceivingfacility.
Cardiac Arrest Registry to Enhance Survival
CARES
18
Header TitleonCARESForm Responses Description/Comments
Whywashypothermiacare
notinitiatedorcontinuedin
thehospital?
Whywashypothermiacarenot
initiatedorcontinuedinthe
hospital?
Awake/Followingcommands
DNR/Familyrequest
Unwitnessedcardiacarrest
Unshockablerhythm
NoTHprograminplace
Other
Thissupplementalhospitalelementwasaddedin2016.
FinalDiagnosisMyocardial
Infarction
Wasthefinaldiagnosisacute
myocardialinfarction
Yes
No
CoronaryAngiography
PerformedCoronaryAngiographyPerformed
Yes
No
Unknown
CoronaryAngiographyDateIf"Yes",pleaseprovidedateand
time:MM/DD/YY ThisfieldisapplicableonlyifCoronaryAngiographyPerformed=Yes.
CoronaryAngiographyTimeIf"Yes",pleaseprovidedateand
time:HH:MM ThisfieldisapplicableonlyifCoronaryAngiographyPerformed=Yes.
Wasacardiacstentplaced Wasacardiacstentplaced
Yes
No
Unknown
CABGPerformed CABGPerformed
Yes
No
Unknown
ICDplacedand/orscheduled WasanICDplacedand/orscheduled
Yes
No
Unknown
EstimatedTimeOfArrest EstimatedTimeOfArrest HH:MM:SS
Timeof1stCPR Timeof1stCPR HH:MM:SS
Timeof1stDefibrillation Timeof1stDefibrillatoryShock HH:MM:SS
CallReceivedAtDispatch
CenterTimecallreceivedatdispatchcenter HH:MM:SS
FRDispatched TimeFirstResponderdispatched HH:MM:SS
FREnRoute TimeofFirstResponderenroute HH:MM:SS
AmbulanceDispatched TimeAmbulancedispatched HH:MM:SS
AmbulanceEnRoute TimeforAmbulanceenroute HH:MM:SS
FROnSceneTimeFirstResponderarrivedat
sceneHH:MM:SS
AmbulanceOnScene TimeAmbulancearrivedatscene HH:MM:SS
EMSAtPatientSide TimeEMSarrivedapatient'sside HH:MM:SS
AmbulanceLeftScene TimeAmbulanceleftscene HH:MM:SS
AmbulanceArrivedAtED TimeAmbulancearrivedatED HH:MM:SS