Setting

Los Angeles County includes 88 cities spanning 4058 square miles with a population of 10 million.12 The Los Angeles County Emergency Medical Services Agency (LAC-EMS) operates a regional cardiac arrest system that has been previously described and is closely coordinated with systemwide care standards and quality improvement.13., 14. EMS throughout LAC use uniform field treatment protocols, which at the time of the study included obtaining a POC glucose for non-shockable cardiac arrest, though it was common practice to obtain field POC in most patients with OHCA. Point-of-care glucose measurements are obtained using a portable glucometer and testing blood from an IV insertion or finger stick. EMS transports patients resuscitated from OHCA to one of 36 designated cardiac arrest receiving centers with 24/7 cardiac catheterization capabilities and targeted temperature management (TTM) policies.

Cardiac arrest receiving centers submit outcome data on all adult patients with ROSC after OHCA to a single registry maintained and verified by LAC-EMS.15., 16. Abstracted data elements include field ROSC, survival to hospital discharge (SHD), and neurologic outcome assessed with Cerebral Performance Category (CPC) extracted from the medical record. EMS provider agencies submit data on the field management of all patients to LAC-EMS, including point of care (POC) glucose testing, medications, and field outcome and disposition. These field data are merged with hospital outcome data based on a unique identifier for the EMS encounter.