Journal
CRITICAL CARE MEDICINE
Volume 39, Issue 1, Pages 26-33Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/CCM.0b013e3181fa7ce4
Keywords
heart arrest; cardiopulmonary resuscitation; compressions; defibrillation; hypothermia; survival; neurological function
Categories
Funding
- CentraCare Health Foundation
- Allina Hospitals and Clinics
- Mercy Foundation
- Unity Hospital Foundation
- Medtronic Corporation
- Medtronic Foundation
- St. Jude Medical Foundation
- Boston Scientific Foundation
- Advanced Circulatory Systems
- Resuscitation Outcomes Consortium [NIH U01 HL077866]
- Neurological Emergencies Treatment Trials (NETT) Network [NIH U10 NS058927]
- IMMEDIATE Trial [NIH R01 HL077821]
- ResQTrial [NIH 2-R44-HL65851]
- Medtronic
- Laerdal Foundation
- NATIONAL HEART, LUNG, AND BLOOD INSTITUTE [R44HL065851, U01HL077866] Funding Source: NIH RePORTER
- NATIONAL INSTITUTE OF NEUROLOGICAL DISORDERS AND STROKE [U10NS058927] Funding Source: NIH RePORTER
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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. (Crit Care Med 2011; 39:26-33)
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