Journal article
Improving Quality in Cardiac Arrest via Resuscitation Academy Training (IQ-CART): Study Protocol for a Mixed-Methods Study With a Focus on Low-Performing EMS Agencies
Circulation Cardiovascular quality and outcomes, Vol.18(12), e012571
12/2025
DOI: 10.1161/CIRCOUTCOMES.125.012571
PMCID: PMC12741751
PMID: 41255339
Abstract
Given the large variation in out-of-hospital cardiac arrest (OHCA) survival, the Resuscitation Academy has developed a comprehensive training and mentorship program for emergency medical service (EMS) agencies to improve OHCA care. This study will evaluate whether Resuscitation Academy training is associated with higher OHCA survival at EMS agencies, particularly those with lower OHCA survival.
Within the Cardiac Arrest Registry to Enhance Survival, we will conduct a prospective mixed-methods study of EMS agencies participating in Resuscitation Academy training between October 2024 and December 2026 with ≥2 years of OHCA data collection and ≥20 OHCAs annually. Enrollment of EMS agencies with low baseline OHCA survival and diverse sociodemographic and socioeconomic characteristics will be prioritized, with a goal of 100 enrolled agencies. Changes in OHCA survival (primary outcome: survival to hospital admission) between EMS agencies enrolled in the Resuscitation Academy, compared with control agencies, will be compared using a difference-in-difference analysis. We will also quantify changes in processes of care within individual Resuscitation Academy domains to identify those most strongly associated with survival improvement. Finally, we will identify facilitators and barriers to implementation of Resuscitation Academy recommendations through in-depth semistructured interviews with key stakeholders (EMS director, medical director, dispatchers, quality improvement director, and paramedics).
As of December 31, 2024, 15 EMS agencies have been prospectively enrolled. Twelve (80.0%) had below median OHCA survival rates to hospital admission (<24.9%), 5 (33.3%) had catchment areas that were majority (>50% of residents in the EMS catchment area) Black or Hispanic, and 7 (46.7%) served communities with below median annual household income (<$71 623) levels.
This study will provide key insights for a potential intervention to improve OHCA survival, especially at EMS agencies with lower survival. Moreover, it may serve as a roadmap for the evaluation of future health policy investments to improve OHCA care and reduce disparities.
Details
- Title: Subtitle
- Improving Quality in Cardiac Arrest via Resuscitation Academy Training (IQ-CART): Study Protocol for a Mixed-Methods Study With a Focus on Low-Performing EMS Agencies
- Creators
- Paul S Chan - University of Missouri–Kansas CityKimberly C Dukes - University of IowaJessica Sperling - Social Science Research CouncilMichael Sayre - University of WashingtonThomas Rea - University of WashingtonBryan McNally - Emory UniversitySaket Girotra - The University of Texas Southwestern Medical Center
- Resource Type
- Journal article
- Publication Details
- Circulation Cardiovascular quality and outcomes, Vol.18(12), e012571
- DOI
- 10.1161/CIRCOUTCOMES.125.012571
- PMID
- 41255339
- PMCID
- PMC12741751
- NLM abbreviation
- Circ Cardiovasc Qual Outcomes
- ISSN
- 1941-7705
- eISSN
- 1941-7705
- Publisher
- American Heart Association
- Grant note
- National Heart, Lung, and Blood Institute: R56HL158803, R01HL166305 American Heart Association
Drs Chan, Dukes, Sperling, Sayre, Rea, and Girotra receive research funding from the National Heart, Lung, and Blood Institute (grant R01HL178638). Drs Girotra, Dukes, Sperling, and Chan receive research funding from the National Heart, Lung, and Blood Institute (grant R01HL160734). Dr Girotra is also supported by funding from the National Heart, Lung, and Blood Institute (grant R56HL158803 and R01HL166305). Drs Chan and Girotra receive funding from the American Heart Association. Dr McNally is the Executive Director of the Cardiac Arrest Registry to Enhance Survival, which receives funding from the American Red Cross and the American Heart Association. None of the above funders had any role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
- Language
- English
- Electronic publication date
- 11/19/2025
- Date published
- 12/2025
- Academic Unit
- Cardiovascular Medicine; General Internal Medicine; Community and Behavioral Health; Internal Medicine
- Record Identifier
- 9985033848502771
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