Faculty Collaboration Database

Take Heart America: A comprehensive, community-wide, systems-based approach to the treatment of cardiac arrest. Crit Care Med 2011 Jan;39(1):26-33

Date

10/05/2010

Pubmed ID

20890185

DOI

10.1097/CCM.0b013e3181fa7ce4

Scopus ID

2-s2.0-78651227923 (requires institutional sign-in at Scopus site)

Abstract

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.

Author List

Lick CJ, Aufderheide TP, Niskanen RA, Steinkamp JE, Davis SP, Nygaard SD, Bemenderfer KK, Gonzales L, Kalla JA, Wald SK, Gillquist DL, Sayre MR, Osaki Holm SY, Oakes DA, Provo TA, Racht EM, Olsen JD, Yannopoulos D, Lurie KG

Author

Tom P. Aufderheide MD Professor in the Emergency Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

American Heart Association
Cardiopulmonary Resuscitation
Community Health Services
Defibrillators
Electric Countershock
Emergency Medical Services
Female
Guideline Adherence
Health Promotion
Heart Massage
Humans
Male
Minnesota
Out-of-Hospital Cardiac Arrest
Practice Guidelines as Topic
Program Evaluation
Risk Assessment
Survival Analysis
United States