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.

Professor of Emergency Medicine and Associate Chair of Research Affairs
Department of Emergency Medicine, Medical College of Wisconsin

Dr. Tom Aufderheide is a Professor of Emergency Medicine and Director of Research Services in the Department of Emergency Medicine at the Medical College of Wisconsin. He is a nationally and internationally recognized researcher in the field of emergency cardiac care with over 100 original research papers published in the peer-reviewed literature (including the New England Journal of Medicine), 37 textbooks related to emergency cardiac care, and 22 book chapters. The focus of much of Dr. Aufderheide’s research has been rapid identification and intervention in the out-of-hospital setting for patients with myocardial ischemia and cardiac arrest, which has been funded by the National Institutes of Health. He has served as Basic Life Support Science Editor as an author and editor of most CPR, AED, and First Aid courses for the National American Heart Association the past 15 years.

Along with these significant accomplishments in research and education, Dr. Aufderheide has achieved many additional scholarly accomplishments that include: member of the National Heart Lung and Blood Institute’s National Heart Attack Alert Program Working Group on Methods/Technologies for Early Identification of Acute Cardiac Ischemia/Acute Myocardial Infarction in the Emergency Department; member of the NIH Small Business Innovation Research Grant Review Committee; International Liaison Committee on Resuscitation, developing international CPR guidelines; and member of the National Highway Traffic Safety Administration’s Steering Implementation Committee for the “EMS Agenda for the Future”. Tommy Thompson recognized Dr. Aufderheide for his work in writing and supporting Automated External Defibrillation (AED) legislation in the state of Wisconsin. He has also served as a consultant to the Assistant Surgeon General of the United States for implementation of public access defibrillation in federal buildings.

Dr. Aufderheide is currently Principal Investigator of a number of NIH-funded clinical trials and directs the resuscitation Research Center in the department of Emergency Medicine at the Medical College of Wisconsin.

Conflict of Interest

Grants: Resuscitation Outcomes Consortium (NHLBI), Immediate Trial (NHLBI), ResQTrial (NHLBI), Neurological Emergency Treatment Trials (NETT) Network
(NINDS)
Paid Consultant: Medtronic, JoLife, Take Heart America
Paid Speaker: EMS Today
Volunteer: National American Heart Association
Volunteer President: Citizen CPR Foundation

President, Take Heart America
Managing Director, Resurgent Biomedical Consulting

Robert A. Niskanen is the Managing Director of Resurgent Biomedical Consulting, LLC, in Seattle. He works with several companies on induced hypothermia, mechanical CPR devices, and airway control as methods to improve resuscitation. In addition, he is the President of Take Heart America, a demonstration project aimed to improve survival from sudden cardiac arrest (SCA) in three U.S. cities.

Previously, he served as a Senior Principal Scientist at Medtronic Emergency Response Systems (ERS) in Redmond, Washington. He was part of the research efforts at Physio-Control Corporation/ Medtronic ERS, for more than 25 years, serving previously as the Director of Research and then VP of Clinical Research. He graduated from the University of Washington with a MSEE in 1976.

Bob has been active in biomedical engineering for more than 30 years. His primary professional interests center on resuscitation, emergency medicine and cardiovascular disease. He has been involved in both technical and clinical research in CPR, defibrillation, ventilation, acute myocardial infarction triage and medical data management. He delights in working with engineers, scientists, physicians, researchers, business professionals and others to solve problems in emergency medicine.

He is active with a number of professional organizations, including the National Association of EMS Physicians, the Society for Academic Emergency Medicine, the American College of Emergency Physicians, the American Heart Association, European Resuscitation Council, and Citizen CPR Foundation. He was active with the National Center for Early Defibrillation during its existence at the University of Pittsburgh.

Bob is convinced that dramatic improvements can and will be made in the survival rate of sudden cardiac arrest through collaboration. He believes an increased emphasis should be place on the role and influence of SCA survivors in fighting this national medical tragedy.

Conflict of Interest

Compensated

Medivance Inc
Jolife AB
Advanced Circulatory
Atrus Inc
CPR Medical Devices
AMR
Take Heart America
Sudden Cardiac Arrest Survival Initiative

Non-compensated

Sudden Cardiac Arrest Foundation
Society of Academic Emergency Medicine
American Heart Association
National Association of EMS Physicians
European Resuscitation Council

Medical Director, Allina Medical Transportation
Anoka County, MN

Charles Lick, MD, has been an emergency physician or 20 years in the Minneapolis/St. Paul area.

He has held many leadership and medical director roles in his career and is currently medical director of Buffalo Hospital Emergency department and of Allina Medical Transportation.

He started Allina’s Heart Safe Communities program in 2001. This program has placed > 1200 automated external defibrillators throughout central Minnesota that have saved countless lives. Dr. Lick has been focusing on improvements in cardiac arrest resuscitation for many years and has implemented numerous different treatment strategies to improve survival of cardiac arrest.

Volunteer for the American Heart Association

Medical Director, City of Austin/Travis County EMS

Edward M. Racht, M.D. is the Medical Director for the City of Austin / Travis County Emergency Medical Services System, a diverse group of Providers and Organizations including Austin - Travis County Emergency Medical Services, the Austin Fire Department, Austin - Travis County 911 Emergency Communications, multiple Public Safety Agencies, fifteen first responder fire departments and EMS agencies and a Corporate Response Group made up of twenty-two regional corporate response teams.

Dr. Racht has been involved in Emergency Medical Services for over twenty years. He received his Medical degree from Emory University in Atlanta and completed his residency at the Medical College of Virginia. Before relocating to Texas, he was an Assistant Professor and Associate Chief of the Medicine Section of Emergency Medical Services at the Medical College of Virginia in Richmond. He was Medical Director for multiple career and volunteer EMS agencies, Fire Departments and the Richmond Police Department SWAT team. He was appointed by two Governors of Virginia to three successive terms on the State EMS Advisory Board.

Dr. Racht is a Clinical Associate Professor of Emergency Medicine at the University of Texas Southwestern Medical School. Appointed by then-Governor George Bush, Racht has served as the Chairperson of the Governor’s EMS & Trauma Advisory Council for the State of Texas since it’s inception in 1999. He has also been extensively involved with the American Heart Association at the local, affiliate and national level. He has been active in International EMS, serving as a consultant to the World Bank and as the American founder of the Vladivostok and Moscow, Russia EMS Training Centers.

Dr. Racht serves as the Medical Advisor for the NHTSA Educational Standards Project, the coordinator of the Take Heart Austin Cardiac Arrest Initiative and serves on multiple national and local committees and advisory boards. The City of Austin / Travis County EMS System was recently cited in the Institute of Medicine’s report on Emergency Medical Services as an example of effective regional collaboration, a philosophy near and dear to Racht’s practice of medicine.

In 1999, Dr. Racht was named EMS Medical Director of the year for the State of Texas. In 2000, he was named Volunteer of the Year for the Capital Area Division of the American Heart Association, and in 2004 he received the American Heart Association’s Paul Ledbetter MD Physician Volunteer of the Year Award. He was also featured in a cover article in JEMS magazine on a “New Breed of Medical Directors” in July 1997.

Dr. Racht is married to Cheryl, a wonderful mom and an accomplished nurse and they have three very high-maintenance, absolutely amazing children - Twins Brandon & Taylor and their big brother Harrison.

Associate Professor, Department of Emergency Medicine
The Ohio State University
Columbus, Ohio, USA

Michael R. Sayre, MD is a native of Cincinnati, Ohio. He attended Xavier University and received his Doctor of Medicine from University of Cincinnati in 1984. Dr. Sayre completed a residency in Emergency Medicine at Allegheny General Hospital in Pittsburgh, PA and remained on the attending staff there until 1990 when he returned to Cincinnati.

While on the faculty of the Department of Emergency Medicine at the University of Cincinnati, Dr. Sayre focused on Emergency Medical Services and sudden cardiac arrest resuscitation. In 2003, Dr. Sayre moved to The Ohio State University. He has remained active with cardiac arrest research and served as the Principal Investigator for the Ohio site in the ASPIRE clinical trial of the AutoPulse CPR assist device. He was the Chair of the AHA Basic Life Support Subcommittee during the 2005 ECC Guidelines process. He is currently the Vice-chairman of the AHA Emergency Cardiovascular Care Committee and the Columbus site leader for Take Heart America, the Cardiac Arrest Survival Initiative.

Staff Cardiologist, St. Cloud Hospital
Professor of Internal & Emergency Medicine, University of Minnesota
Chief Medical Officer, Advanced Circulatory Systems, Inc.

Keith Geoffrey Lurie received his undergraduate education in architecture and molecular biophysics and biochemistry from Yale University and a medical degree from Stanford University in 1982. Following a clinical pharmacology fellowship at Stanford (1982-1983), a residency in internal medicine at the University of Pennsylvania (1983-1985), a fellowship in biochemistry and biophysics at the University of Pennsylvania (1985-1987), Dr. Lurie completed his cardiology and electrophysiology training at the University of California in San Francisco. He served on the faculty there as an assistant professor until moving to Minnesota in 1991. Since that time he has served as a faculty member at the University of Minnesota.

Dr. Lurie is currently a Professor of Internal Medicine and Emergency Medicine at the University of Minnesota and he practices cardiac electrophysiology in St. Cloud two days/week. Dr. Lurie has received multiple National Institute of Health and Defense Department grant awards and is an inventor of multiple different technologies. He founded Advanced Circulatory Systems in 1997 and remains Chairman of the Board and Chief Operating Officer. Dr. Lurie served on the American Heart Association Basic Life Support subcommittee from 1998-2007. He co-founded Take Heart America in 2005.

Conflict of Interest
Founder of Advanced Circulatory Systems; a Resuscitation Technology company. Advanced Circulatory Systems manufactures and sells the impedance threshold device (ITD: ResQPOD) and other technologies.

Interested in implementing a workplace CPR training program?   Workplace CPR Training Guide

Take Heart Anoka County awarded churches, businesses, a local fire department, City offices, a horseback riding camp and others with multiple Friends and Family CPR Anytime kits and AEDs. Due to the success of the first round of grants a second deadline has been established as August 29th 2008.

Click here for your grant application

Questions regarding Take Heart Anoka County can be directed to

takeheartanoka@allina.com or 651-228-8470.

GOAL 1: Increase public awareness of SCA and the Take Heart initiatives

Strategies
Offer the services of an SCA Speakers Bureau to other organizations.

Tactics

1. Create customized presentations for specific needs, such as police departments, school boards, and community groups.
2. Develop and distribute an SCA Speakers Bureau Brochure.
3. Participate in public education events and health fairs.
4. Review local and regional opportunities and prioritize events for participation.
5. Create Public Service Announcements and/or programs and distribute to media outlets including free access and local cable channels.
6. Institute a program for recognizing SCA rescuers and publicizing saves.

GOAL 2: Increase placement of AEDs in our communities.

Strategies
Assist in CPR bystander training, AED distribution, ResQPod training and advocacy of cooling protocol.

Tactics

1. Conduct a survey to assess their current experience with, and feelings about CPR bystander training and AED programs.
2. Work with policymakers to support the four Take Heart initiatives.
3. Actively work with legislators and decision makers on the following key legislation goals:
4. CPR/AED training required in all high schools.
5. AEDs to be carried by all first responder vehicles
6. AEDs to be placed in all high schools.
7. AEDs placed in all public gathering sites.