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Sunday, November 14, 2010

Systems Approach Improves Survival

Abstract 51: Implementation of the American Heart Association Guidelines With a Systems-Based Approach Improves Survival to Hospital Discharge Following Prehospital Cardiac Arrest

Michael Dailey; Jonathan Politis; Terry A Provo

Albany Med Cntr, Albany, NY; Town of Colonie EMS Dept, Latham, NY; Advanced Circulatory Systems, Roseville, MN

Intro: A systems-based approach to out-of-hospital cardiac arrest (OHCA) involves optimizing the care continuum beginning with public recognition and bystander CPR, and continuing through specialized post-resuscitation care at Level One Cardiac Arrest Centers (L1CACs).

Hypothesis: Implementing a systems-based approach to resuscitation care that includes the most highly recommended AHA resuscitation guidelines will improve survival.

Methods: Beginning in 2006, the Town of Colonie (NY) (population 80,000) EMS system began phasing in multiple recommended therapies from the 2005 AHA CPR guidelines including: 2006) new CPR guidelines and expanded bystander CPR Anytime training; 2007) use of an impedance threshold device and emphasis on, and more rapid deployment of, mechanical CPR; 2008) improvements in dispatch to reduce response times, two minutes of CPR prior to defibrillation, and delaying advanced airway placement and IV access in favor of a period of high quality CPR;and 2009) hospital therapeutic hypothermia for comatose resuscitated arrests. EMS shift commanders respond to all cardiac arrests to assure strict protocol compliance. Resuscitated arrests are transported to L1CACs capable of continuing therapeutic hypothermia. A Standard Chi-Square analysis was performed.

Results: Since 2005 {approx}200 people/year were trained in CPR, dispatch improvements reduced response times by one minute, and three L1CACs were established. Survival following OHCAimproved from 4% (3/75; 2005 historical control) to 22% (14/64) (p=0.0013) in 2009. Survivors from 2009 were neurologically intact.

Conclusion: When OHCA patients were treated with a systems-based approach intended to improve bystander CPR rates, rapidly defibrillate, optimize circulation during CPR, and preserve vital organ function following cardiac arrest, survival rates quadrupled compared to historical controls. This approach had dramatic effects on survival in this mid-size community.


Author Disclosures: M. Dailey: None. J. Politis: None. T.A. Provo: Employment; Significant; ACSI.

From Circulation, a peer-reviewed journal of the AHA