All under the division of cardiovascular medicine University of Minnesota

Transcription

1 The Team 1) Demetris Yannopoulos M.D. Medical Director, 2) Kim Harkins, Program Manager 3) Lucinda Klann, CARES Data Manager 4) Esther Almeida, Administrative Assistant All under the division of cardiovascular medicine University of Minnesota

2 HeartRescue Partners

3 Advisory Committe e Bystander Response Prehospital Response Hospital Response

4

5 If you don t measure it - you can t improve it HeartRescue Data Partner

6 and a Systems-based Approach to Care Collect data to identify the problem and measure improvement. Education and increasing awareness for CPR and Resuscitation Broad implementation of early access to defibrillation. Increasing bystander CPR rates and improving the quality of CPR performed by first responders and paramedics. ( that includes, limiting interruptions, adequate CCR of 100 Unifying across the system BLS and ACLS strategies in order to optimize identification of interventions that improve or impede outcomes. Utilization of technologies to enhance the efficiency of CPR, allow for early mobilization of patients to the hospitals and allow for targeted therapies to reversible causes of cardiac arrest. (those include the ITD, LUCAS, end tidal CO2 monitoring and pre hospital cooling technologies) Advance circulatory assist devices such as cardiohelp and Impella as well as intravascular and surface cooling technologies Advanced and early activation of the CCL for resuscitated patients from VF/VT/shockable AED rhythms in order to evaluate coronary anatomy and intervene if necessary. 6

7 What is CARES data collection? CARES is a secure, Web-based data management system that is designed to consolidate all essential data elements of a pre-hospital cardiac arrest event in an efficient manner, including collecting outcome data. With this standardized collection system, participants can track ongoing system performance in several, tailored reports. The data used for this presentation is compiled of aggregate reports throughout Minnesota for 2011 and The data used for the following slides is not for publication or distribution and is preliminary data.

8 CARES We started with 5 agencies, 5 hospitals and 1 county in May As of Dec 2012: 19 agencies 45 hospitals 32 counties 283 First Responders Nov-12 Currently covering 73% of the MN population 5 0 Hospitals Agencies Counties

9 The circle of life and chain of survival Widespread CPR Training Community, Schools, Business AED Placement Public Education Media Announcements Presentations Lay Public First Responder 911 CPR Instruction Rapid Response Start CPR immediately First responder protocol Rapid AED placement High Quality CPR Resuscitation Centers of Excellence Hypothermia 24/7 Revascularization ICDs Data: CARES Hospital Survival EMS High Quality CPR Advanced Airways Intra-osseous drug delivery Automated CPR / devices Statewide Cardiac Arrest Protocol

10 bystander CPR 27% 31.50% 34% AED applied by bystander 5% 8% 9% VF rate 30% 31% 31% Hypothermia field 7% 9% 11% 911 to BLS CPR NA NA 3.5 min 911 to ALS CPR NA NA 8.2 min avg scene time NA NA 33.4 min

11 Defibrillation. The need to know where the AEDs are for early access and deployment.

12

13 2012 MN CARES data: all cases of presumed cardiac etiology & worked by EMS or Defibrillated AND were bystander witnessed AND had NO bystander CPR Presenting shockable rhythm (n=118) Presenting nonshockable rhythm (n=203) Bystander witnessed/no bystander CPR (n=321) Total 118/321= 37% 203/321=63% 321 (26% of all CARES cases) ROSC 57/118=48% 65/203=32% 122/321=38% DC ALIVE 28/118=24% 7/203=3% 35/321=11%

14 2012 MN CARES data: all cases of presumed cardiac etiology & worked by EMS or Defibrillated AND were bystander witnessed AND had bystander CPR Presenting shockable rhythm (n=105) Presenting non-shockable rhythm (n=106) Bystander witnessed/with bystander CPR (n=211) Total 105/211=50% 106/211=50% 211(17% of all CARES cases) ROSC 66/105= 63% 38/106=36% 104/211=49% DC ALIVE 41/105=39% 7/106=7% 48/211=23%

15 So for all rhythms and patients with witnessed cardiac arrest that needed resuscitation at the arrival of first responders or paramedics the presence of bystander CPR drastically increased the overall survival. 48/211 versus 35/321 p=

16 AUTOMATED CPR DEVICES LUCAS 2: STERNAL COMPRESSION CPR Autopulse device: Semi-Circumferential Compression Device

17 Other Lucas + ITD No Devices Total shockable cases = 516

18 2011/2012 Shockable 516/1716 (30%) EMS CPR EMS CPR Overall Lucas + ITD 209/ /516 No Devices ROSC 50% (93/209) 43% (17/100) 17% Admit 48% (91/209) 43% (16/100) 16% DC 32% (51/209) 25% (14/100)14%

19 Acute Coronary Occlusion is Associated with Cardiac Arrest! By the OLD BOOKS, 50% of the STEMIs do not make it the hospital due to sudden cardiac death. (Braunwald's heart disease textbook) Absence of ST elevation on surface 12-lead after restoration of circulation not predictive of absence of coronary occlusion on acute angiography Spaulding N Engl J Med 1997 Case series of patients with unsuccessful field resuscitation suggest that VF more likely to be associated with coronary disease than is asystole or PEA. Silfvast J Intern Med 1991 Autopsy study compared cases who died within six hours of symptom onset due to ischemic heart disease with controls who died within six hours of symptom onset due to natural or unnatural noncardiac causes. Controls matched to cases by age, gender, and socioeconomic status. Intraluminal thrombosis observed in 93% of cases vs. 4% of controls. Davies N Engl J Med 1984

20 AHA 2010 Guidelines for CPR and ECC In patients with out-of-hospital cardiac arrest due to VF, emergent angiography with prompt revascularization of the infarct-related artery is recommended. Part 10: acute coronary syndromes: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.O'Connor RE, Brady W, Brooks SC, Diercks D, Egan J, Ghaemmaghami C, Menon V, O'Neil BJ, Travers AH, Yannopoulos D. Circulation Nov 2;122(18 Suppl 3):S

21 N Engl J Med Jun 5;336(23):