Author Block:
Keith Lurie, Advanced Circulatory Systems, Inc., Eden Prairie, MN; Janet Steinkamp, Central Minnesota Heart Center, St. Cloud, MN; Charles Lick, Allina Medical Transportation, St. Paul, MN; Tom Aufderheide, Medical College of Wisconsin, Milwaukee, WI; Michael Sayre, Ohio State University, Columbus, OH; Lynn White, Ohio State University Medical Center, Columbus, OH; Edward Racht, Louis Gonzales, City of Austin / Travis County EMS System, Austin, TX; Susan Nygaard, Allina Health System, Minneapolis, MN; Robert Niskanen, Resurgent Biomedical Consulting LLC, Shoreline, WA

Abstract:
Introduction: Take Heart America (THA) is a community-based initiative intended to improve survival from sudden, out-of-hospital cardiac arrest (OHCA) in four US communities: St. Cloud (MN), Anoka County (MN), Columbus (OH) and Austin (TX).

Hypothesis: Implementing a continuum of resuscitation care that includes the most highly recommended 2005 AHA resuscitation guidelines will improve survival from OHCA.

Methods: In Phase I, the two MN sites (population: greater St. Cloud: ~160K; Anoka Co: ~320K) implemented: a) widespread CPR training in schools and businesses; b) retraining of all EMS personnel in methods to enhance circulation including minimizing CPR interruptions, performing CPR prior to and after single shock defibrillation, and use of an impedance threshold device; c) more widespread deployment of AEDs in schools and public places; and d) transport to and treatment by Level One Cardiac Arrest Centers that provide: therapeutic hypothermia (applied to all comatose patients regardless of initial arrest rhythm), coronary artery evaluation and treatment, and widespread electrophysiological evaluation. During Phase II, Austin and Columbus will implement these same steps. A Standard Chi-Square analysis was performed.

Results: From 2006-2007 in the two MN sites, >12,000 people were trained in CPR, bystander CPR rates increased by ~5%, three Level One Cardiac Arrest Centers were established, and interventions a-d above were fully implemented. Survival in all patients following OCHA improved from 9.3% (14/151) in 2005 (historical control) to 17% (31/181) (P=0.0373) in 2007 in these two sites.

Conclusions: In conclusion, when OHCA patients were treated with a continuum of pre-hospital and in-hospital interventions intended to optimize defibrillation and circulation during CPR, and preserve heart and brain function following cardiac arrest, survival rates nearly doubled when compared to historical controls. The THA initiative is effective in mid-size communities, but regular retraining of EMS personnel is needed to assure full implementation of the key aspects of the program. Phase II is underway to determine if the program can be successfully implemented with similar positive results in communities with populations of 500-1000K

Author Disclosure Information: K. Lurie, National Institute of Health and Department of Defense research grants, Significant, 2. Research Grant (includes principal investigator, collaborator or consultant and pending grants as well as grants already received); Chief Medical Officer for Advanced Circulatory Systems, Inc. - manufacturer of the impedance threshold device, Significant, 6. Ownership Interest (includes stock, stock option, partnership, membership or other equity position in an entity regardless of form of the entity, or any option or right to acquire such position, and any rights in any patent or other intellectual property); J. Steinkamp, None; C. Lick, None; T. Aufderheide, NHLBI, NINDS, SBIR, Significant, 2. Research Grant (includes principal investigator, collaborator or consultant and pending grants as well as grants already received); Consultant for JoLife, consultant for Medtronic, Board of Directors for Take Heart America, Significant, 7. Consultant/Advisory Board; M. Sayre, Program funding from Medtronic; research support from Medivance, Modest, 2. Research Grant (includes principal investigator, collaborator or consultant and pending grants as well as grants already received); L. White, None; E. Racht, Scientific Advisory Board for Vidacare, Modest, 7. Consultant/Advisory Board; L. Gonzales, Paid consultant to the AHA ECC Product Development Group (2005-2006), Modest, 7. Consultant/Advisory Board; S. Nygaard, None; R. Niskanen, Managing Director of Resurgent Biomedical Consulting LLC that has provided consultant services to Jolife AB, Advanced Circulatory Systems, PhysioControl, VidaCare, Atrus and Take Heart America, Significant, 7. Consultant/Advisory Board.

Author Block: Keith Lurie, Pam Schnettler, Janet Steinkamp, Joe Hellie, Roberta Basol, Scott Davis, St. Cloud Hospital, St. Cloud, MN

Abstract:
Introduction/Hypothesis: Specialized care after cardiac arrest in Level One Cardiac Arrest Centers (L1CAC) may provide improved care in a cost-effective manner for this gravely ill patient population in an analogous manner to Level One Trauma Centers.

Methods: In December 2005 a regional referring hospital in central Minnesota (St. Cloud Hospital) established and implemented protocols for all patients admitted following out-of-hospital cardiac arrest that included standardized treatment with hypothermia (if comatose upon admission and regardless of initial arrest rhythm), 24/7 percutaneous cardiac interventions (PCI), critical care management and specialized electrophysiological evaluation and treatment. Hospital discharge rates were compared to historical controls one year prior to the new interventions. Cost effectiveness data were obtained from reviewing the individual billing, collection and revenue generation from all patients after the new program was implemented over the subsequent 19-month period of time. A Standard Chi-Square Test was performed.

Results: Between 11/04 - 11/05, 33 patients were admitted alive to the hospital and 11 (33.3%) survived to hospital discharge versus 54/104 (51.9%) admitted between 12/05 - 12/07 (p=0.062 for historical control vs. intervention group). Mean age (72 vs 76) and male gender (58% vs 72%) were similar between the historical control and intervention group, respectively. During the intervention year, 70% of admitted patients were treated with therapeutic hypothermia. The revenues associated with billing for 69 patients treated with hypothermia averaged $57,783/patient who survived to hospital discharge with a direct margin after direct costs of $20,684/patient. The direct revenue and margins for those who expired in the hospital were $12,014 and $3,329, respectively.

Conclusions: In conclusion, L1CAC that specialize in care for patients after cardiac arrest that include hypothermia, 24/7 PCI, critical care management and specialized electrophysiological treatment have a >50% higher hospital discharge rate compared with historical controls. This specialized care is cost effective and results in a net direct margin of >$20,000 for every patient who is discharged alive from the hospital.

Author Disclosure Information: K. Lurie, NHLBI and Department of Defense research grants, Significant, 2. Research Grant (includes principal investigator, collaborator or consultant and pending grants as well as grants already received); Chief Medical Officer and ownership of Advanced Circulatory Systems, Inc., manufacturer of an impedance threshold device, Significant, 6. Ownership Interest (includes stock, stock option, partnership, membership or other equity position in an entity regardless of form of the entity, or any option or right to acquire such position, and any rights in any patent or other intellectual property); Board of Directors for Take Heart America, Modest, 7.
Consultant/Advisory Board; P. Schnettler, None; J. Steinkamp, None; J. Hellie, None; R. Basol, None; S. Davis, None.

Scott Davis MD, Ken Thigpen RT, Roberta Basol RN, Tom Aufderheide MD

Background: Survival after in-hospital cardiac arrest (I-HCA) remains low, despite rapid care by trained medical personnel. An estimated 1,000 patients die each day in the United States alone from I-HCA.

Objective: Determine the impact of the 2005 American Heart Association (AHA) resuscitation guidelines and use of an impedance threshold device (ITD) on survival after I-HCA.

Hypothesis: Greater circulation delivered by combining more efficient and effective CPR together with an ITD, recommended in the 2005 AHA Guidelines to increase circulation and return of spontaneous circulation rates during CPR, will increase survival after I-HCA.

Methods: Two community hospitals that are early adopters and track outcomes after I-HCA compared hospital discharge rates from before and after implementation of the new AHA CPR and ITD (ResQPODTM, Advanced Circulatory Systems, Eden Prairie, MN) protocols. The intervention included an emphasis on the proper ventilation rate, full chest wall recoil, continuous CPR once the patient was intubated, and use of the ITD that included a timing light to guide the rate of positive pressure ventilations and compressions. St. Cloud Hospital tracks outcomes following the National CPR Registry template. IRBs at the respective hospitals approved the study.

Results: St. Cloud Hospital, St. Cloud, Minnesota is a 500 bed hospital with ~ 13 HCA/month. Historical control data were obtained from the prior 18 months (8/2005-8/2006) and the intervention group was for the subsequent 18 mo. In St. Dominic Hospital, Jackson Mississippi, a 570 bed hospital with ~12 I-HCA/month, historical control data were used from the prior 12 months (6/2005-6/2006) and the intervention group was from the subsequent 12 mo. The combined hospital discharge rate for patients (n=390)with an I-HCA was 20.7% in the control phase versus 35.8% in the intervention phase (n=341 patients) (p<0.001 by Chi square test). In both hospitals implementation of the new Guidelines including the ITD was easily performed with in-servicing and there was no increase in complication rates with the new method and device.

Conclusion: Implementation of improved ways to increase circulation during CPR resulted in a marked increased in-hospital discharge rates >70% compared with historical controls in two large community hospitals. These data demonstrate that immediate care with improved means to circulate blood during CPR can significantly reduce hospital mortality rates after in-hospital sudden cardiac arrest.

On Tuesday April 15th, 2008 the Take Heart St. Cloud Sudden Cardiac Arrest Survival Initiative (THSC) taught CPR (cardio pulmonary resuscitation) and AED (automated external defibrillator) skills to a group of approximately 30 St. Francis Xavier members and community residents. The session was hosted by St. Francis Xavier of Sartell and the session was held in the St. Francis Gathering Place. Each participant paid a nominal fee of $10.00 and received an American Heart Association Family and Friends CPR Training Kit. The kit contains an inflatable manikin, a training DVD and a training booklet. Each participant was asked, upon completion of their training, to train three members of their families and friends.

This is the third Take Heart St. Cloud CPR session hosted by the St. Francis Xavier Parish. The sessions were taught by Take Heart St. Cloud instructors Jo Deter, Kelijo Fernholz and Renee Illies. Instructor, Jo Deter, stated that “Learning CPR is the most unselfish thing one can do; it isn’t something you will ever do on yourself.” Also in attendance were Bob Kempenich and Michael Hengel; both are Sudden Cardiac Arrest (SCA) survivors and members of the THSC SCA Survivor’s Network. Bob experienced Sudden Cardiac Arrest in December of 2005 and was given CPR by two strangers who happened to be near him when he collapsed. He commented “I’m here today because people like you took the time to learn CPR.”

Sudden Cardiac Arrest is the #1 killer of men and women in this country. Approximately 1000 people die everyday; over 350,000 people die each year. Approximately 80% of these deaths happen in people’s homes; only 15% of these people receive immediate CPR from family or friends. The intention of the Take Heart St. Cloud project is to train the general public to recognize when to use CPR and how to use an AED. By increasing the number of people who know how to perform CPR and use an AED it is believed that CPR can be initiated immediately by friends and family members, while waiting for the emergency people to arrive. The sooner CPR begins the better a person’s chance is of surviving.

Take Heart St. Cloud, is part of the nation-wide Take Heart America program. The project aims to increase the survival rate of sudden cardiac arrest through community-wide CPR/AED training, distribution of new technology and implementation of new in-hospital treatments. St. Cloud is among only four communities in the country that have been selected to implement the program. This initiative is being funded through the CentraCare Health Foundation,Central MNHeart Center, the Medtronic Heart Rescue program, the St. Jude Medical Foundation and the Boston Scientific Foundation.

“It’s time for a new approach to saving the lives of people who experience Sudden Cardiac Arrest,” says Janet Steinkamp, St. Cloud Site Director. “We need to be ready to perform CPR on our fellow community members; their lives may depend on us.”

Take Heart St. Cloud brings doctors, nurses, paramedics, community leaders and community members together in a new project designed to dramatically increase the number of people who survive. The training goal of Take Heart St. Cloud is to train 25% of the 160,000 people in the Gold Cross Ambulance service area – that’s 40,000 people. With the help of the American Heart Association’s Family and Friends CPR Training kit, and individuals teaching their family and friends, this goal will easily be accomplished. Widespread CPR training plays a critical role in reducing deaths from cardiac arrest.

This class was sponsored by the St. Francis Xavier Health and Wellness Committee of Sister Cordelia Korkowski, OSF Pastoral Minister, Karen Reinholz, Jackie McCann, Deb Carey, Chuck and Sharon Kalkman, Bob Barret, Deacon Steve Yanish, Val Jefferson, Mary Mader, Wendi Johnson and Marilyn Ross.