Objectives: To determine out-of-hospital cardiac arrest survival rates before and after implementation of the Take Heart America program (a community-based initiative that sequentially deployed all of the most highly recommended 2005 American Heart Association resuscitation guidelines in an effort to increase out-of-hospital cardiac arrest survival). Patients: Out-of-hospital cardiac arrest patients in Anoka County, MN, and greater St. Cloud, MN, from November 2005 to June 2009. Interventions: Two sites in Minnesota with a combined population of 439,692 people (greater St. Cloud and Anoka County) implemented: 1) widespread cardiopulmonary resuscitation and automated external defibrillator skills training in schools and businesses; 2) retraining of all emergency medical services personnel in methods to enhance circulation, including minimizing cardiopulmonary resuscitation interruptions, performing cardiopulmonary resuscitation before and after single-shock defibrillation, and use of an impedance threshold device; 3) additional deployment of automated external defibrillators in schools and public places; and 4) protocols for transport to and treatment by cardiac arrest centers for therapeutic hypothermia, coronary artery evaluation and treatment, and electrophysiological evaluation. Measurements and main results: More than 28,000 people were trained in cardiopulmonary resuscitation and automated external defibrillator use in the two sites. Bystander cardiopulmonary resuscitation rates increased from 20% to 29% (p = .086, odds ratio 1.7, 95% confidence interval 0.96-2.89). Three cardiac arrest centers were established, and hypothermia therapy for admitted out-of-hospital cardiac arrest victims increased from 0% to 45%. Survival to hospital discharge for all patients after out-of-hospital cardiac arrest in these two sites improved from 8.5% (nine of 106, historical control) to 19% (48 of 247, intervention phase) (p = .011, odds ratio 2.60, confidence interval 1.19-6.26). A financial analysis revealed that the cardiac arrest centers concept was financially feasible, despite the costs associated with high-quality postresuscitation care. Conclusions: The Take Heart America program doubled cardiac arrest survival when compared with historical controls. Study of the feasibility of generalizing this approach to larger cities, states, and regions is underway.
Bibliographical noteFunding Information:
Funding and in-kind support were provided in part by the CentraCare Health Foundation, Allina Hospitals and Clinics, Mercy & Unity Hospital Foundations, Medtronic Corporation, Medtronic Foundation, St. Jude Medical Foundation, Boston Scientific Foundation, and Advanced Circulatory Systems.
Charles J. Lick, MD, is the Emergency Medical Services Medical Director for Allina Medical Transportation. Tom P. Aufderheide, MD, is employed by Medical College of Wisconsin, received grants from Resuscitation Outcomes Consortium (NIH U01 HL077866) , Neurological Emergencies Treatment Trials (NETT) Network (NIH U10 NS058927) , IMMEDIATE Trial (NIH RO1 HL077821) , and ResQTrial (NIH 2-R44-HL65851) . He is a Board Member of Take Heart America, a Consultant for JoLife, Medtronic, and a Volunteer for the National American Heart Association. Robert A. Niskanen, MSEE, is affiliated with Resurgent Biomedical Consulting, is a Consultant for Medivance, Jolife AB, Advanced Circulatory Systems, Atrus, CPR Medical Devices, AMR, Take Heart America, and Sudden Cardiac Arrest Survival Initiative. Susan D. Nygaard, RN, is employed by Allina Health System and Take Heart America. Sarah K. Wald, BA, and Debbie L. Gillquist, EMT-P, are employed by Take Heart America, which received grants from Medtronic, the Medtronic Foundation, the Laerdal Foundation, St. Jude's Medical Foundation, Boston Scientific Foundation, CentraCare Health Foundation, and the Mercy and Unity Hospitals Foundation. Terry A. Provo, EMT-P, is affiliated with Advanced Circulatory Systems. Keith G. Lurie, MD, is Founder of Advanced Circulatory Systems, a resuscitation device manufacturer that manufactures the impedance threshold device (ResQPOD). The remaining authors have not disclosed any potential conflicts of interest.
- cardiopulmonary resuscitation
- heart arrest
- neurological function