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ALAMEDA COUNTY CA
Take Heart America Bundles and System of Care for OHCA Michael Jacobs, Paramedic
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Michael Jacobs, Paramedic
“ Take Heart America Bundles and System of Care for OHCA”
FINANCIAL DISCLOSURE:
• “NO relevant financial relationship (s) exist.”
• UNLABELED/UNAPPROVED USES DISCLOSURE: “None”
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ALAMEDA COUNTY CA, USA
1.6 Million Population
Extreme Demographic Diversity
1100 OHCA Resuscitations Annually
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IT TAKES A VILLAGE
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myCares™
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myCares™
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Widespread CPR Training
Increase the percentage of SCA victims who receive effective bystander CPR
AHA’s CPR Anytime for Family & Friends
CPR7-all 7th graders/families in Alameda County trained in CPR
~10,000 7th graders trained each school year (2010-18):30,000 Trained Annually
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2000+ Known AED’S in the County
Widespread public access
automatic external defibrillator
(AED) deployment
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MPDS
Pre-arrival instructions
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Crowdsourcing
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Connecting the Community DOTS
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myCares™
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Rapid ALS Response Time 5.2 Min.
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PIT CREW
Team Approach
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Mechanical CPR
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Adjuncts
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EMS ROSCABC
GCS
BG
ECG
SRC/CARC
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myCares™
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7 STEMI/Cardiac Arrest Receiving Centers
ABSMC / KFO
Highland
St. Rose
WHHS / KFF
Stanford Valley Care
700+ EMS Resuscitation Transports Annually
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NO EMS ROSC / Re-Arrest / Arrest in Cath-Lab
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Targeted Temperature Management
FKA: Therapeutic Hypothermia
TTM
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(n=1047)
Transports
(n=1028)
Transports
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Alameda County’s 2012Prescribed Therapies for OHCA
ITD
Mechanical CPR
Therapeutic Hypothermia
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446/1599
51/1483
301/898
49/771
0
5
10
15
20
25
30
35
40
ROSC CPC≤2
Pa
tie
nts
(%
)
All patients regardless of treatment
2009-2011
2012
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Patient outcomes by study period (n=2921)
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Utilization of Therapies
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Prehosp Emerg Care. 2016 Sep 14:1-6. [Epub ahead of print]
Continuous Quality Improvement Efforts Increase Survival with Favorable Neurologic Outcome after Out-of-hospital Cardiac Arrest.
Sporer K, Jacobs M, Derevin L, Duval S, Pointer J.
Abstract
OBJECTIVE: To assess system-wide implementation of specific therapies focused on perfusion during cardiopulmonary resuscitation (CPR) and cerebral recovery after Return of Spontaneous Circulation (ROSC).
METHODS: Before and after retrospective analysis of an out-of-hospital cardiac arrest database. Implementation trial in the urban/suburban community of Alameda County, California, USA, population 1.6 million, from November 2009-December 2012. Adult patients with non-traumatic out-of-hospital cardiac arrest (OHCA) who received CPR and/or defibrillation. The impedance threshold device was used throughout this study and there was an increased use of mechanical CPR (mCPR) and in-hospital therapeutic hypothermia (HTH).
RESULTS: Rates of ROSC, survival to hospital discharge and Cerebral Performance Category (CPC) scores were compared using univariate and multivariable analyses. A total of 2,926 adult non-traumatic patients with OHCA received CPR during the study period. From 2009-2011 to 2012, there was an increase in ROSC from 29.0% to 34.4% (p = 0.003) and a non-significant increase in hospital discharge from 10.2% to 12.0% (p = 0.16). There was a 76% relative increase in survival with favorable neurologic function between the two periods, as determined by CPC ≤ 2, from 4.5% to 7.9% (unadjusted OR = 1.80; CI = 1.31, 2.48; p < 0.001). After adjusting for witnessed arrest, bystander CPR, initial rhythm (VT/VF vs. others), placement of an advanced airway, EMS response time, drugs administered, and age, the OR was 1.61 (1.10, 2.36; p = 0.015). Using a stepwise multivariable logistic regression model, the independent predictors of CPC ≤ 2 were 2012 (vs. 2009-2011; p = 0.022), witnessed arrest (p < 0.001), initial rhythm VT/VF (p < 0.001), and advanced airway (inverse association p < 0.001). Additional analyses of the three prescribed therapies, separately and in combination, demonstrated that for those patients admitted to the hospital, mCPR with HTH had the biggest impact on survival to hospital discharge with CPC ≤ 2.
CONCLUSIONS: Specific therapies within a system of care (mCPR, HTH), developed to enhance circulation during CPR and cerebral recovery after ROSC, significantly improved survival by 76% with favorable neurologic function following OHCA.
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Count - 2012 % of Total - 2012
184 19.7%
749 80.3%Non-VF/VT VF/VT
2012 ALCO EMS Initial ECG Rhythm
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NON-SHOCKABLE RHYTHMS
~50% of OHCA SURVIVORS
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ALCO EMS System Enhancements and VF/VT
Survival to Hospital Discharge
36%
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ALAMEDA COUNTYCALIFORNIANATIONAL
2016 CARES
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EMS Non-Trauma OHCA ResuscitationsALCO n= 1047
CA n= 6902
NATIONAL n= 61607
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Utstein (1)ALCO n= 121
CA n= 840
NATIONAL n= 7256
¹Witnessed by bystander and found in a shockable rhythm
Utstein (2)ALCO n= 35
CA n= 479
NATIONAL n= 4301
²Witnessed by bystander, found in shockable rhythm, and received some bystander
intervention (CPR by bystander and/or AED applied by bystander)
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N=70
N=1047
N=586
N=586
N=222
N=95
N=47
N=48
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ALAMEDA COUNTYCALIFORNIANATIONAL
2017 CARES
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EMS Non-Trauma OHCA Resuscitations
ALCO n= 1028
CA n= 8746
NATIONAL n= 76215
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Utstein (1)ALCO n= 121
CA n= 840
NATIONAL n= 7256
¹Witnessed by bystander and found in a shockable rhythm
Utstein (2)ALCO n= 35
CA n= 479
NATIONAL n= 4301
²Witnessed by bystander, found in shockable rhythm, and received some bystander
intervention (CPR by bystander and/or AED applied by bystander)
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N=1028
N=84 N=54 N=30
N=239
N=555
N=555
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155 OF THOSE SURVIVED
WITH GOOD NEUROLOGIC
FUNCTION: 73%!
2016-2017
213 PEOPLE SURVIVED OHCA! FULL 737-800
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SCIENCE TO SURVIVALCONTINUITY OF CARE
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2019
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Take Action
America
Take Care
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Thank You
LOVE LIFE!