The mission of the UC San Diego Center for Resuscitation Science (CRS) is to integrate cutting-edge research, education, and clinical leadership in order to improve resuscitation practices and patient outcomes, in and out of the hospital.
team of experienced educators trains more than 3,000 health care providers annually.
Training Program and Registration
Advanced Resuscitation Training (ART) is a comprehensive program that integrates resuscitation training, performance improvement, critical procedures, and in-hospital patient safety initiatives. ART employs a broad definition of "resuscitation" to include patient surveillance/monitoring, critical care, intra-arrest, and post-resuscitative care. In addition, ART empowers health care providers of all disciplines by creating a "culture of resuscitation" that enhances patient safety.
The UC San Diego Center for Resuscitation Science has developed numerous innovative training programs for hospital providers, EMS personnel, and laypeople. The training adapts to the unique needs of individual institutions and various providers.
In the hospital, we have decreased cardiac arrest incidence by more than 50 percent and more than doubled survival for remaining victims. This has resulted in a decrease in arrest-related deaths by more than 75 percent and it reduced overall hospital mortality by 20 percent.
In the out-of-hospital environment, our training improved performance of critical resuscitation skills, including CPR and endotracheal intubation, doubled survival-to-hospital admission from cardiopulmonary arrest in air- and ground-paramedic units.
The ART program is designated as the Best Practices Model by the Joint Commission and has been recognized by the Society of Hospital Medicine and National Association of Public Hospitals.
UC San Diego Health employees with questions regarding registration can contact:
Simulation technologies are increasingly important in medical education and training. To support and expand this trend, the UC San Diego Division of Medical Education has opened a new
Simulation Training Center equipped with a Laerdal SimMan 3G and variety of "partial task trainers" and diagnostic/monitoring equipment.
CRS Research Efforts
From cell cultures and animal models of brain injury and cardiopulmonary arrest, to clinical trials involving people both in and out of the hospital, UC San Diego Health’s Center for Resuscitation Science is internationally recognized as a leading contributor in the field of resuscitation science.
CRS Program Accomplishments
Since the program began in 2008, we improved the following:
- Hospital mortality has decreased 20 percent.
- Cardiopulmonary arrest survival has doubled and is currently more than twice the national average.
- Neurologically intact arrest survival rates have tripled in non‐ICU patients.
- The incidence of non‐ICU arrests have decreased by more than 60 percent.
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On the surface, Advanced Resuscitation Training (ART) and Basic Resuscitation Training (BART) may appear to be alternatives to the Advanced Cardiac Life Support (ACLS) and Basic Life Support (BLS) courses from the American Heart Association. However, ART is actually a resuscitation management program for hospitals, clinics, and EMS agencies rather than a specific course. A broad definition of resuscitation is used for both the inpatient and out-of-hospital environments. Inpatient ART considers a spectrum of resuscitation issues – from surveillance and monitoring of all patients through critical care, cardiopulmonary arrest and post-resuscitative care. Out-of-hospital ART includes cardiopulmonary arrest, prevention of arrest in critically ill patients, advanced procedures such as airway management and intubation, and sophisticated monitoring strategies. Finally, the training is adaptive to address the unique requirements of various providers and flexible to integrate CQI data and specific institutional needs, staffing, and workflow.
Resuscitation events are relatively infrequent, with each provider participating in only a few events each year. Resuscitation performance is strongly linked to patient outcomes, underscoring the importance of optimal training and effective treatment algorithms. Integrating the broad scope of resuscitation under a single, unified curriculum enhances provider understanding of key concepts and ultimately clinical performance.
The ART program empowers health care providers by creating a “culture of resuscitation” that serves to enhance patient safety in unprecedented fashion. Unlike the existing model of life support training, the ART program recognizes the complexity of deterioration and incorporates cardiopulmonary arrest prevention. The program employs an original “Integrated Critical Care Model” to integrate multiple components of resuscitation science and defines a new paradigm for inpatient and prehospital medicine.
The ART program consists of the following core philosophies:
- A simplified and institution-specific approach to resuscitation, with consideration given to the specific equipment and capabilities of the response team.
- Integration of a broad spectrum of resuscitation concepts, from monitoring/surveillance and arrest prevention through critical care, arrest, post-resuscitative care, and end-of-life issues.
- The use of CQI data to modify treatment algorithms and training and guide new initiatives.
- A comprehensive approach to critical care education that relates three basic physiological processes (perfusion, oxygenation and ventilation).
- A flexible, adaptive curriculum that responds to the unique needs of trainees based on provider-type and specific patient characteristics.
- Adult learning principles including the use of expert physician and code RN instructors.
The ART program links CQI with training, treatment algorithms, and special projects and initiatives. At the center of the CQI process is the ART Matrix, which represents a sophisticated taxonomy to describe the various etiologies of cardiopulmonary arrest. The Matrix is hierarchical and categorizes resuscitation events into discrete boxes.
The effectiveness of ART is best reflected by the results achieved at UC San Diego Medical Center (see graph below). ART has reduced the incidence of cardiopulmonary arrest by almost 50 percent. This reduction in arrest frequency has occurred predominantly in the non-ICU environment where the current incidence of arrests is about one-quarter of baseline. These results support the IOM goals of reducing preventable arrests and fostering an environment of enhanced patient safety. For the remaining patients who suffer cardiopulmonary arrest, neurologically intact survival has more than doubled. Survival-to-discharge rates have been sustained at a level more than twice that of the benchmark established by the American Heart Association’s Get With The Guidelines database for eight consecutive years. The ART program has resulted in a 20 percent reduction in overall hospital mortality.
As a result, ART has been designated as a Best Practices Model by the Joint Commission and recognized as a Best Patient Safety Initiative by both the National Association of Public Hospitals and the University of California Regents. Most recently, UC San Diego Health received a Quality Leadership Award from the University Health System Consortium (UHC) based on rapid improvements in overall mortality and patient safety and a top-five ranking in overall quality of care. Perhaps the most telling statistic for ART is that observed mortality at UC San Diego Health is 38 percent below expected values, leading to UC San Diego’s recognition as one of the safest hospitals in the county, state and country.
In the pre-hospital environment, ART training has resulted in similar outcomes. For patients arresting in the presence of air medical providers, survival-to-ED-admission more than doubled following training. Survival from out-of-hospital cardiac arrest increased 50 percent following ART training in a cohort of San Diego County EMS agencies, and survival among patients arriving to the UC San Diego Emergency Department with ongoing chest compressions rose from zero to more than 9 percent.
Since the initiation of the ART program:
- Cardiopulmonary arrest survival has doubled and is currently more than twice the national average (defined by the American Heart Association Get With The Guidelines).
- Neurologically intact arrest survival has tripled in non-ICU patients.
- The incidence of non-ICU arrests has decreased by more than 60%.
- The improved survival and decreased arrest incidence in non-ICU patients have dramatically enhanced patient safety.
- Expenditures for life support training have decreased by over 35%.
The three main components to facilitate broad implementation of the ART program include: 1) ART University, 2) a Mentored Implementation program, and 3) information technology resources to facilitate ART implementation and maintenance, training, and CQI.
- ART University employs a center-of-excellence model. Teams from various hospitals implementing ART can attend a workshop with the following objectives: 1) to understand the ART program and all of its components, 2) to review the science behind the various treatment algorithms, 3) to understand the principles behind the CQI Matrix, 4) to review training options, 5) to gain exposure to the various information technology support tools and training resources available through the ART program, and 6) to receive specific guidance on implementation strategies.
The ART program may actually cost less than current life-support training expenditures. At UC San Diego we spent a mean of $170 per inpatient provider under the traditional resuscitation training model. The annual cost of the ART program, including leadership, CQI support, trainers, and administration, averages approximately $120 per inpatient provider. It is anticipated that each participating institution will reallocate a portion of this savings to support the ART infrastructure through a licensing fee.
While a 40 percent savings in life support training is substantial, the real financial benefit of the ART program lies in the preventable deaths avoided. More than 70 deaths are prevented at UC San Diego each year compared to our baseline. The Agency for Healthcare Research and Quality estimates unexpected inpatient deaths cost $50,000 in the short term. This means the ART program saves our institution $3.5 million annually. In addition, savings in prevented lawsuits and decreased premiums will also be substantially greater than the decrease in training costs. It is no coincidence that our first grant was awarded by the UC Regents liability carrier. Finally, pay-for-performance and value-based purchasing will incentivize programs that improve mortality and enhance patient safety.
The great potential to save additional lives with further expansion of our programs makes the UC San Diego Center for Resuscitation Science an attractive opportunity for philanthropy, both from individuals and corporations. The impact in just a few short years has been so profound that an investment in the center is essentially guaranteed to produce positive results.
Indeed, the dramatic improvements in outcome, both in and out of the hospital, and the universal nature of death and resuscitation would suggest that everyone is affected by the center’s work at some level.
Finally, our recognition as to the importance of end-of-life issues and ongoing exploration of the interface between science and spirituality are unique and represent a broader vision than other scientific organizations. This is perhaps best reflected by our motto “People should not die before they are done living.”