Level 1 cardiac arrest centers: learning from the trauma surgeons.

More than 1000 patients die each day from out-of-hospital cardiac arrest. Although the reasons are multifactorial, it is remarkable that more than 50% of patients who are brought to the hospital alive after immediate resuscitation never survive to hospital discharge. Ultimate functional survival after an out-of-hospital cardiac arrest in the United States is approximately 5%. Patients die from heart failure, brain failure, and variable care in the intensive care unit. These grim statistics remind us of the results associated with traumatic injury more than 30 years ago, before the establishment of integrated trauma systems and the centers of excellence, the trauma centers that treat severe traumatic injury. The time is right to learn from the integrated and multidisciplinary trauma community and develop specialized care centers for patients who have been resuscitated from cardiac arrest. The overarching concept is to move the level of patient to the appropriate level of care at the right time. As a result of the development of trauma systems, integrating out-of-hospital guidelines, communication , capabilities, levels of care, trauma registry , uniform clinical practice guidelines, and practice in Level 1 Trauma centers across the United States, today 50-70% of all hypotensive trauma patients survive to hospital discharge. By contrast, only about 5% of the patients with out-of-hospital cardiac arrest survive to hospital discharge, despite care by qualified emergency medical services (EMS) personnel. We believe that as a nation we can do better. Building on the lessons and success of the trauma systems concept, it is time for the out-of-hospital and emergency medicine, cardiology, and critical care communities to develop and implement a Level 1 cardiac arrest system. This would also include Level 1 cardiac centers. Recent efforts to provide rapid care of patients with heart attacks, including standard out-of-hospital and emergency department care, around-the-clock acute interventions in cardiac catheterization laboratories, and standard intensive care unit practice approaches, suggest that this concept is feasible and that its time has come. An essential element of a trauma center is the trauma team, a group of physicians and nurses whose efforts are focused on giving the very best care to severely injured people. The trauma team is available 24 hours a day, 7 days a week. Each team member has a specific predetermined role and each member contributes to the team. Beginning at the point of injury and continuing though the care process there are well established protocols used …