Figure 2.

Seven pillars of care. All 10 emergency medical services systems first focused on the rapid delivery of chest compressions and performance of high-quality manual cardiopulmonary resuscitation (CPR) by first responders. Several included the use of one or more CPR feedback tools or guides. All of these systems implemented one or more of the recent technology and procedural advances such as expedited dispatch-assisted CPR instructions or smart phone apps, mechanical CPR, active compression decompression CPR, impedance threshold device airway attachments, elevation of the head and thorax during CPR, targeted temperature management strategies, extracorporeal membrane oxygenation CPR, and rapid percutaneous coronary intervention as part of the bundle. ETCo₂ = end-tidal Co₂, IHCA = in-hospital cardiac arrest, OHCA = out-of-hospital cardiac arrest, ROSC = return of spontaneous circulation, SCA = sudden cardiac arrest.