Literature DB >> 20890185

Take Heart America: A comprehensive, community-wide, systems-based approach to the treatment of cardiac arrest.

Charles J Lick1, Tom P Aufderheide, Robert A Niskanen, Janet E Steinkamp, Scott P Davis, Susan D Nygaard, Kim K Bemenderfer, Louis Gonzales, Jeffrey A Kalla, Sarah K Wald, Debbie L Gillquist, Michael R Sayre, Susie Y Osaki Holm, Susie Y Oski Holm, Dana A Oakes, Terry A Provo, Ed M Racht, John D Olsen, Demetris Yannopoulos, Keith G Lurie.   

Abstract

OBJECTIVES: To determine out-of-hospital cardiac arrest survival rates before and after implementation of the Take Heart America program (a community-based initiative that sequentially deployed all of the most highly recommended 2005 American Heart Association resuscitation guidelines in an effort to increase out-of-hospital cardiac arrest survival). PATIENTS: Out-of-hospital cardiac arrest patients in Anoka County, MN, and greater St. Cloud, MN, from November 2005 to June 2009.
INTERVENTIONS: Two sites in Minnesota with a combined population of 439,692 people (greater St. Cloud and Anoka County) implemented: 1) widespread cardiopulmonary resuscitation and automated external defibrillator skills training in schools and businesses; 2) retraining of all emergency medical services personnel in methods to enhance circulation, including minimizing cardiopulmonary resuscitation interruptions, performing cardiopulmonary resuscitation before and after single-shock defibrillation, and use of an impedance threshold device; 3) additional deployment of automated external defibrillators in schools and public places; and 4) protocols for transport to and treatment by cardiac arrest centers for therapeutic hypothermia, coronary artery evaluation and treatment, and electrophysiological evaluation.
MEASUREMENTS AND MAIN RESULTS: More than 28,000 people were trained in cardiopulmonary resuscitation and automated external defibrillator use in the two sites. Bystander cardiopulmonary resuscitation rates increased from 20% to 29% (p = .086, odds ratio 1.7, 95% confidence interval 0.96-2.89). Three cardiac arrest centers were established, and hypothermia therapy for admitted out-of-hospital cardiac arrest victims increased from 0% to 45%. Survival to hospital discharge for all patients after out-of-hospital cardiac arrest in these two sites improved from 8.5% (nine of 106, historical control) to 19% (48 of 247, intervention phase) (p = .011, odds ratio 2.60, confidence interval 1.19-6.26). A financial analysis revealed that the cardiac arrest centers concept was financially feasible, despite the costs associated with high-quality postresuscitation care.
CONCLUSIONS: The Take Heart America program doubled cardiac arrest survival when compared with historical controls. Study of the feasibility of generalizing this approach to larger cities, states, and regions is underway.

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Year:  2011        PMID: 20890185     DOI: 10.1097/CCM.0b013e3181fa7ce4

Source DB:  PubMed          Journal:  Crit Care Med        ISSN: 0090-3493            Impact factor:   7.598


  24 in total

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