Can one woman single-handedly save Anoka County?

Rather than try, Peggy McNabb has recruited 1,200 helpers.

McNabb, an Anoka County Human Services administrator, is responsible for the distribution of 1,200 CPR kits to Anoka County employees and their families and associates, said Jerry Soma, manager of the county’s Human Services Division.

Last summer, Dr. Charles Lick, co-founder of Take Heart Minnesota and medical director of Allina Medical Transportation, spoke to county officials about the importance of CPR training programs for employees.

Learning about cardiopulmonary resuscitation wasn’t a hard sell.

“We were very impressed and decided immediately that we would spearhead a campaign to get people into CPR training,” Soma said.

“When I say ‘we,’ I’m really talking about Peggy McNabb.”

That was in July. By August, McNabb was handing out training kits to 36 people.

“It wasn’t just me,” McNabb said. “It was the employees who left that first meeting who wanted to train the staff.”

McNabb says she merely played bookkeeper while others learned about CPR and then passed on their knowledge and kits. But Soma says McNabb’s being modest. She sent out e-mail after e-mail, sometimes under Soma’s name, explaining that if someone trains three people, the $10 Allina CPR kit would be free.

So employees trained family members and others, and the kits kept coming.

The campaign is winding down now, McNabb says. Interest in CPR hasn’t waned. It’s just that there aren’t many county employees she hasn’t already contacted, Soma said.

“The kits have gone to churches, to book clubs, to neighborhoods,” McNabb said. “My part in this was small. It’s everyone else who did the work.”

Take Heart America brings doctors, nurses, paramedics, community leaders and people like you together in a new program designed to dramatically increase the number of people who survive.

Take Heart Anoka County is hosting a free event Thursday, May 14 from 3:30 to 5:00 p.m. at Fridley High School, funded in part by a $30,000 HeartRescue Grant from the Medtronic Foundation. Take Heart Anoka County is working to increase the number of people trained in CPR, place more automated external defibrillators (AEDs) in the community, and train people to use them. All participants in the May 14 event will receive:

• CPR training from 4:15 - 5 p.m.
• A DVD about CPR: “Take Action, Save Lives”
• Set of seven Heart Healthy/CPR posters
• Handouts about implementing CPR and AED education in classrooms

In addition, Friends and Family CPR Anytime Kits will be available for $10 each. This fee is refundable after the kit is used to teach CPR to three other people.

Space is limited, so RSVP to Marilyn Lingard at 612-262-6061 or via email at TakeHeartAnoka@allina.com

Grant applications are due August 21st.

Through a grant funded by Mercy & Unity Hospitals Foundation, Take Heart Anoka offers two programs available to anyone living in the Mercy or Unity service areas: the CPR Anytime package and the AED package.

Employees are encouraged to apply on behalf of community organizations, churches or service clubs, or share the information with family and friends. The deadline for the next round of grants is August 21. The simple, seven-step application is available here.

In addition CPR Anytime training sessions are held throughout the year at Mercy and Unity.

Take Heart Anoka County is funded by grants from the Mercy & Unity Hospitals Foundation and administered by Allina Community Benefit and Allina Medical Transportation. For more information, visit takeheartanoka.org or call 651-228-8470.

Tim Hinz of South Haven probably couldn’t have picked a better place for his heart to stop pumping.

The 37-year-old family man went into sudden cardiac arrest in the Buffalo Clinic parking lot, which is attached to Buffalo Hospital, on Tuesday, Jan. 13, while helping a friend start a stalled car.

Within minutes numerous emergency workers were at his side giving lifesaving shocks with an automated external defibrillator and administering cardiopulmonary resuscitation.

Hinz lived to tell about it Wednesday, Feb. 18, at a ceremony in the hospital to recognize 10 people who helped save his life.

A concrete worker, Hinz lives near South Haven with his wife, Tammy, and sons A.J., 9, and Colby, 4.

“It’s real lucky” the emergency happened where it did, he said, crediting his being alive to that and all the people who came to his aid.

“If it would have happened at home, I’d be dead and I wouldn’t be here,” he said.

“There must be somebody up there looking down on me for whatever reason. It was damn lucky.”

Here’s what happened, according to accounts of some of those involved:

Hinz’s friend Ted Hilsgen of South Haven picked him up that cold winter morning to help him start a van owned by Hilsgen’s girlfriend, who had left it in the Buffalo Clinic lot.

Hinz had been sitting in the front passenger seat of the car thumbing through a magazine when Hilsgen got in the driver’s seat about 11 a.m. to warm up.

He thought his friend was sleeping and elbowed him, but Hinz fell against the door. “That’s when I knew something was wrong.”

He called 911 on his cell phone, adjusted Hinz’ seat to a reclining position and began performing chest compressions on him. Police arrived in about two minutes. “They were very fast.”

Wright County sheriff’s deputy Aaron Myren got there seconds before Buffalo police officer Jennifer Almeida.

Myren pulled Hinz out of the car, laid him on the ground and did chest compressions. Using the AED Almeida carries in her squad car, Myren prepared Hinz and she applied the shock to restart his heart.

Multiple shocks

The two shocked Hinz “multiple times,” according to Myren. Then deputies James Parker and Jason Oltmanns arrived to administer chest compressions and oxygen.

Buffalo officers Rick Chirero and Josh Erickson arrived to help the others, as did Buffalo Clinic doctors Cynthia Larson and Brett Oden. They got Hinz on a gurney and wheeled him through the clinic hallways to the hospital emergency room.

There ER nurses and Dr. Gary Starr took over and prepared Hinz for Allina Ambulance to take him to Mercy Hospital in Coon Rapids, a facility with a higher care level.

Allina Ambulance manager Brian Nord arrived on the scene to provide support, and Allina emergency medical technician Patty Rose of Annandale was in the ER after another call.

She helped place Hinz on a bed and took over from a doctor who had been performing chest compressions.

Rose, paramedic Bill Sandberg and another medic set out with Hinz for Mercy, but they weren’t even out of Buffalo when Sandberg told her to pull over because the patient had gone into cardiac arrest and needed another shock.

It was the fifth time that day that he was shocked to restart his heart.

Hinz said there were no warning signs and he doesn’t remember anything until he woke up in Mercy Hospital the following Monday morning.

Heart problems run in the family, he said. His father, Richard “Fuzzy” Hinz of Kimball, has had five of them and has a pacemaker in his chest.

Blockage

In his own case, doctors found a blockage in the main artery from the heart and have put a stent in to open it up, Tim Hinz said.

He’s taking part in cardiac rehabilitation at Buffalo Hospital, and Hinz said if he takes care of himself he can lead a normal life.

“I’m grateful to them for everything,” he said of the people who helped him survive.

Kelly Lewis of Buffalo Hospital, who is coordinator of Heart Safe Communities, presented them Hero awards.

Lewis, who looks after the placement and maintenance of AEDs in the county, said they’ve saved the lives of 14 people including Hinz in the past two years in Wright County alone.

There are 208 of them in public places throughout the county including 17 in Annandale, and more are being added.

People can buy one or get free AED training by calling Lewis at 763-684-6603.

Sudden cardiac arrest is caused by an electrical malfunction that leaves the heart muscle unable to pump blood through the body. An electric shock to the heart from an AED can allow its normal rhythm to regain control.

Deputy Myren said the Hinz episode was the third time he’s used an AED to help save someone in cardiac arrest in 11/2 years.

“It is a lifesaving machine,” he said.

The experience, meanwhile, has changed Hinz’s life in other ways.

He’s eating better foods and trying to quit smoking.

“You don’t know what you’ve got until it’s almost taken away from you,” he said.

The North Star State is on the cutting edge of the quest to boost survival rates with cardiac arrest centers, cooling devices, and community CPR initiatives.

Specialized facilities such as trauma, burn, and stroke centers improve outcomes by delivering standardized care to patients. Now hospitals are applying those lessons to SCA patients. According to Take Heart America, an estimated 300,000 Americans die each year from SCA — more than from car accidents, firearms, house fires, AIDS, and breast, prostate, and colorectal cancer combined.

Unity Hospital in Fridley, Minn.; Mercy Hospital in Coon Rapids, Minn.; members of the Allina Hospitals & Clinics network; and St. Cloud (Minn.) Hospital are cardiac arrest centers, also known as resuscitation centers.

Keith Lurie, MD, who has been working for more than 20 years to improve survival from SCA, says a cardiac arrest center “needs to offer therapeutic hypothermia and immediate cardiac catheterization for revascularization to be in the game.” Other services should include placement of implantable cardiac defibrillators, CPR training for family and friends, critical care management, and the ability to track outcomes. Lurie is professor of internal medicine and emergency medicine at the University of Minnesota and director of the resuscitation center at St. Cloud.

Gentle Cooling

Therapeutic hypothermia is the cornerstone of the cardiac arrest center. The American Heart Association endorsed it in 2003 on the basis of positive results from two large clinical trials, yet adoption of this treatment is lacking.

Before therapeutic hypothermia, the survival rate to hospital discharge for patients with SCA was 25% at St. Cloud Hospital, according to Lori Potter, RN-BC, CCU core charge nurse. “After we started the therapeutic hypothermia protocol, the survival rate more than doubled to 58%,” she says. “That’s a 132% increase in survival.”

The hospital cools patients with the Arctic Sun unit, which uses thermal-heat exchange cooling pads to control temperature. “We use two nurses for the initial setup,” says Potter. During initial cooling, the nurse-to-patient ratio is 1:1.

“Once we start, we cool for 24 hours and re-warm over 20 hours,” she says. A bladder temperature catheter is used to monitor temperature, and the patient is cooled only to 92.3 degrees F or 33.5 degrees C.

Often patients receive an insulin drip to manage blood glucose. “Glycemic control can be a challenge, but we have detailed protocols, so we manage it autonomously,” says Potter. Patients receive fentanyl, and cisatracurium besylate is used to prevent shivering. Nurses monitor serum electrolytes, as well. “We chase a lot of low potassiums,” she says.

Nurses at St. Cloud haven’t seen complications with therapeutic hypothermia, according to Potter. “We thought one of the biggest complications was going to be bleeding, but we haven’t had problems with that.” Still, nurses monitor patients closely.

Family members receive a timeline explaining the process and the care their loved one will receive. Lurie says a financial analysis reveals therapeutic hypothermia will pay for itself. On average, each SCA patient in the ED generated $27,900 in revenue and $9,400 of direct margin, regardless of the patient’s outcome in the hospital.

“To say it’s too expensive is hogwash,” he says. But the best payoff is the increase in the number of patients saved.

Taking CPR to the Streets

“We have to link interventions together the same way cancer therapeutic drugs are linked together to get a better result for SCA patients,” says Lurie.

Take Heart Anoka County does just that as one of four sites nationwide taking part in TakeHeartAmerica.org. “It’s a grassroots effort between the community and healthcare providers to boost the number of people who survive SCA,” says Susan Nygaard, RN, BSN, PHN, Anoka County’s site manager.

One of the group’s primary initiatives is getting 25% of the population trained in CPR, says Nygaard.

To meet that goal, the group offers CPR Anytime Kits, supported by a grant from the Mercy & Unity Hospitals Foundation. The $10 deposit fee for the kit is refunded after a person trains three people. The kits can be used anywhere and are offered to the general public, too. To boost their numbers, the group is partnering with larger organizations such as the Anoka County human services division, which is using the kits to train 1,800 employees in CPR.

Early defibrillation is another key to survival after SCA, and Nygaard says facilities such as churches, fitness clubs, correctional facilities, and police departments can pay a deposit of $400 for an automated external defibrillator. The Anoka County staff advises the organization on the best AED for its situation, and either trains 25 people or trains a trainer who then teaches others. Once 25 people are trained, the $400 is refunded.

The group also collaborates with the Minnesota SCA Survivor Network, www.MNscaSurvivor.org, in its mission to support SCA survivors and their families, and educate people about SCA and early defibrillation.

“Improving survival from cardiac arrest is a public health priority,” says Nygaard. “We need to take away the fear for lay people by teaching them hands-only CPR.” Studies show this type of CPR increases survival.

“I tell nurses that cardiac arrest can happen anywhere, anytime, to anyone,” Nygaard says. “It could be your family member the next go around.”

Cynthia Saver, RN, MS, is a freelance writer. To comment, e-mail editorHTL@nurseweek.com.

“Take Heart Anoka County” aims to save lives
A new community approach to saving lives is under way in Anoka County. Take Heart Anoka County, a coalition of doctors, nurses, paramedics, health educators, and community leaders aims to dramatically increase the likelihood of survival after sudden cardiac arrest by training more people in cardio pulmonary resuscitation (CPR) and placing automated external defibrillators (AEDs) in public places throughout the community. An estimated 350,000 people in the U.S. die from sudden cardiac arrest annually. The survival rate for sudden cardiac arrest is low — just five percent. If untreated, death results in as little as six minutes from the time of collapse, rarely enough time for emergency responders to arrive. By training more people in CPR and having more AEDs available in public places, the Take Heart Anoka County initiative hopes to increase survival rates.

Take Heart Anoka County has two grants available funded by the Mercy & Unity Hospitals Foundation to help train the public in CPR and AED use. The first allows people to buy a CPR Anytime kit for $10 (normally $30) that teaches CPR and AED use in less than an hour using a DVD and inflatable mannequin. If someone uses that kit to train at least three people in CPR and AED use, they get their $10 back. The other grant allows the purchase of a $2,000 AED and mounting cabinet for $400. If grant recipients show that the AED has been placed in a public location and at least 25 people have been trained in CPR and AED use, they get their $400 back.

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 OHCA 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.

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.

Rex Veeder- St. Cloud, Minnesota- 60 years old at time of cardiac arrest. (2007)

Rex has been an educator for the majority of his professional life. He enjoys writing poetry and painting, and enjoys combining the two. When he finishes a painting he will often write a poem over the painting to create a unique work of art.

On June 28, 2007, Rex came home from visiting friends with his wife, Marcia. He told her that he was feeling unusually tired, and that he had never felt this tired in the past. Rex went straight to bed.

While he was in bed, Marcia saw that Rex was turning blue. Rex had suffered a cardiac arrest and, with his heart no longer beating, his body was taking its final, gasping breaths. Marcia immediately began CPR and continued until paramedics arrived.

Rex was rushed to St. Cloud Hospital, where his body was cooled to about 91° F, which doctors have found can prevent swelling of the brain. Cooling is one of the therapies that has been incorporated into the “Take Heart America” program (www.takeheartamerica.org) that Rex was fortunate to be part of. Fortunate because, in less than 2 weeks, Rex made a full neurological recovery and was ready to go back to work.

Today Rex is the Vice President of Academic & Student Affairs at Central Lake College in Brainerd, Minnesota. He maintains a healthy lifestyle for the body and mind by doing daily exercises, reading, painting and writing poetry. He looks forward to family reunions and some upcoming 80th birthdays within the family.

Rex, who has five children and four grandchildren says, “I was profoundly moved by the care I was given by my doctors. I have a great reverence for their profession.”