Transcript Document
Take Heart Minnesota Planning Session August 27, 2009 A 3 Phase Demonstration Project deploying recent advances in resuscitation science highly recommended by the AHA in 2005 to significantly increase resuscitation rates after cardiac arrest. Phase I: St. Cloud MN and Anoka County MN (complete as of 2009). Phase II: Columbus OH and Austin TX (in process). Phase III: 20 US Cities and 3 States (MN began 2009) (TX, MS in initial planning stages) It began with a four-city demonstration project to dramatically improve survival from sudden cardiac arrest Ben Jabs, 21 Student Anoka County, Minn. No history of heart problems One of the first survivors in THA Sudden Cardiac Arrest: Summer 2006 Treatment: Bystander CPR from mother BLS unable to defibrillate Advanced CPR by EMS, including new devices to improve effectiveness of CPR and defibrillation Level 1 Cardiac Arrest Center care In-hospital cooling Implantable defibrillator Future: Marketing career: graduate U of MN in 2009 Minnesota Barbara and family, age 42 Cardiac Arrest October 2008, Sartell MN, survivor It has become a coalition of health care providers, educators, foundations, corporations, health departments, athletic associations, hospitals and survivor volunteers, and the list is growing. Take Heart America coordinates what the AHA recommends and what SCA victims need… Bystander CPR Quality CPR and new circulation enhancement devices by rescuers AED Improved drug delivery After resuscitation: specialized care including cooling, blockage removal and implantable defibrillator Systems Based Approach • Widespread CPR Training (e.g. CPR Anytime) • AEDs • Public Education First Responder Lay Public Survival • Rapid Response • Start CPR immediately • Rapid AED placement • High Quality CPR • ITD (ResQPOD) Resuscitation Centers of Excellence • Hypothermia • 24/7 Revascularization • ICDs Hospital EMS • High Quality CPR • Advanced Airways • Intra-osseous drug delivery prn • ITD (ResQPOD) • Automated CPR (LUCAS) Intervention Outcome Relationships in Take Heart America Intervention Effect Survival rate ↑ over baseline Bystander CPR: in schools, homes & public meeting places Rapid EMS notification Start circulation 2 - 5% AED Use : Widespread strategic AED deployment Reduce time to 1st shock in VF patients 4 - 6% Improved CPR Quality Prevent hyperventilation, continuous chest compressions, CPR pre/post shock, intra-osseous drug delivery Increase circulation to heart & brain Increase O2 & drug delivery 4 - 6% Impedance Threshold Device (ITD) BLS & ALS deployment Increase circulation to heart & brain Increase O2 & drug delivery 5% Cooling, ICU, Cardiology Standard hypothermia protocols, cardiac angiography (including during CPR) & EP Revascularization Prevent sudden cardiac death 10 - 15% _______ 25 - 37% Meet Samantha Take Heart America Save March 2009 Samantha: 18 yrs old 16 wks Pregnant VF Bystander CPR First responders: New CPR, ITD, AED ALS: Stabilize, Transport Resuscitation Center: Cooling, ICD Widespread CPR • Increase the percentage of SCA victims who receive effective bystander CPR – AHA’s CPR Anytime for Family & Friends – High school & college students & their families – Communities at large – Survivor network participation – St Cloud– all 9th graders/families trained CPR – CPR Goes to College More Rapid Response of Critical Elements • Widespread automatic external defibrillator (AED) deployment First Responders • • • • Decrease EMS response times to SCAs Immediate CPR Rapid AED Improve the Quality of pre-hospital CPR High Performance CPR CPR before and after Shock Devices, including ResQPOD, to more than double circulation during CPR Control ventilation rate and volume Hand position and Chest wall recoil All 911 responders (including police) carry and AED and ITD and have continuous retraining Increase the percentage of SCA victims who receive enhanced circulation management with an impedance threshold device (ResQPODTM). American Heart Association AHA Recommended Therapies for Increasing Circulation during adult CPR and Improving Resuscitation Rates Class I CPR and Defibrillation and PAD Class IIa • Continuous chest compression for ALS; 30:2 BLS • Impedance Threshold Device (ITD) Class IIb • Epinephrine • Amiodarone • Mechanical CPR Devices • CPR before and after shock • full chest wall recoil Indeterminate • Vasopression • Lidocaine • Atropine EMS • • • • Improve the Quality of pre-hospital CPR IO Drug Delivery ITD Automated CPR device LUCAS Device Why Level 1 Cardiac Arrest Centers? Mission/Care • • • • • • • • • • Cooling – active protocol for rapid cooling Cardiac Catheterization – 7/24 availability Optimal care for re-arrests – New CPR, ResQPOD + LUCAS Critical Care – Boarded intensivists 7/24 EPS and ICDs – 7/24 rhythm management Rehabilitation – PT/OT teams CPR Training for family/friends – spread the word Organ donation – shown to save additional lives Transformative technologies CPR Anytime Kit ITD Lay Public First Responder Intra-osseous bone injection Survival ICD Hospital EMS Angiography AED Therapeutic hypothermia Automated CPR device Minnesota Success in Phase 1 From 2006-2007 in the two MN sites all interventions implemented: 1. 2. 3. >12,000 people were trained in CPR, bystander CPR rates increased from 21 to 27%, 3 Level One Cardiac Arrest Centers were established, Survival in all patients following out-of-hospital cardiac arrest improved from 9.3% in 2005 (historical control) to 17% (P=0.03) in 2007. >50% of all patients admitted to the hospital, regardless of etiology, are discharged to home neurologically intact. Transformative technologies Bystander CPR ITD Lay Public First Responder Intra-osseous bone injection Survival ICD Hospital EMS Angiography AED Therapeutic hypothermia Automated CPR device Keeping Families Whole Transformative technologies Bystander CPR ITD Lay Public Intra-osseous bone injection Survival ICD Hospital Angiography AED Therapeutic hypothermia Automated CPR device Transformative technologies Bystander CPR ITD First Intra-osseous bone injection Survival ICD EMS Angiography AED Therapeutic hypothermia Automated CPR device <5 percent survival 30 percent survival Minnesota Challenge • Rural – Volunteer based initiative for 1st responders – Transport to Level 1 Resuscitation Centers • Suburban – Professional and volunteer 1st responders – Public access CPR and defibrillation • Urban – Professional EMS response – Public access CPR and defibrillation Take Heart Minnesota - Educational initiatives: - Proposal: The survivor network members want to lead this charge - - Standardize BLS and ALS response - First task and goal of THMn - - Coordinate with local agencies and State Health Dept and CARES Funding for Take Heart Minnesota - - This will require a state-wide effort, time, and resources Data collection - - This will require time, resources, direction and a strategy that needs to be developed Make this a priority in 2009 grant applications Time line: Plan for full deployment of BLS/ALS in 24 months throughout the state, starting in January 2009 Celebrate the Saves With Gratitude to our Supporters & Friends Abbott Northwestern Hospital Central Minnesota Heart Center MN Ambulance Association Advanced Circulatory Systems Inc. EMSRB MN Hospital Association Allina Health System Gold Cross Ambulance NAEMSP American Heart Association Laerdal Foundation St. Cloud Hospital Boston Scientific Medtronic St. Jude Foundation CARES Medtronic Foundation Sudden Cardiac Arrest Association CentraCare Foundation Mercy & Unity Hospitals Foundation Sudden Cardiac Arrest Foundation Progress to Date: Medtronic Corporate Grant: 100K Hired Executive Director August 3 2009 – Debbie Gillquist and Program Manager august 15, 2009 – Sarah Wald Advisory Board • Widespread CPR Training • State Fair; EMS Councils; Cub Foods • Public Education • HS and University programs • HS Athletic Assoc • Solidify Slide Set/Training Materials • • Lay Public First Responder • • • • Rapid Response Start CPR immediately • First responder protocol Rapid AED placement High Quality CPR ITD (ResQPOD) • Working on distribution, packaging and training kits Meeting with EMS Councils Survival Resuscitation Centers of Excellence (buy-in MHA) Protocols under review • Hypothermia • 24/7 Revascularization • ICDs • Data: CARES, MDH • ResQTrial • First Cities/Counties Hospital EMS • High Quality CPR • Advanced Airways • Intra-osseous drug delivery prn • ITD (ResQPOD) • Automated CPR (LUCAS) Role of EMS RB Role of Keith Wesley MD Notification of First Responders EMS Med Director Annual Mtg MAA collaboration