ALAMEDA COUNTY CA

Take Heart America Bundles and System of Care for OHCA Michael Jacobs, Paramedic

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”

ALAMEDA COUNTY CA, USA

1.6 Million Population

Extreme Demographic Diversity

1100 OHCA Resuscitations Annually

IT TAKES A VILLAGE

myCares™

myCares™

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

2000+ Known AED’S in the County

Widespread public access

automatic external defibrillator

(AED) deployment

MPDS

Pre-arrival instructions

Crowdsourcing

Connecting the Community DOTS

myCares™

Rapid ALS Response Time 5.2 Min.

PIT CREW

Team Approach

Mechanical CPR

Adjuncts

EMS ROSCABC

GCS

BG

ECG

SRC/CARC

myCares™

7 STEMI/Cardiac Arrest Receiving Centers

ABSMC / KFO

Highland

St. Rose

WHHS / KFF

Stanford Valley Care

700+ EMS Resuscitation Transports Annually

NO EMS ROSC / Re-Arrest / Arrest in Cath-Lab

Targeted Temperature Management

FKA: Therapeutic Hypothermia

TTM

(n=1047)

Transports

(n=1028)

Transports

Alameda County’s 2012Prescribed Therapies for OHCA

ITD

Mechanical CPR

Therapeutic Hypothermia

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

Patient outcomes by study period (n=2921)

Utilization of Therapies

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.

Count - 2012 % of Total - 2012

184 19.7%

749 80.3%Non-VF/VT VF/VT

2012 ALCO EMS Initial ECG Rhythm

NON-SHOCKABLE RHYTHMS

~50% of OHCA SURVIVORS

ALCO EMS System Enhancements and VF/VT

Survival to Hospital Discharge

36%

ALAMEDA COUNTYCALIFORNIANATIONAL

2016 CARES

EMS Non-Trauma OHCA ResuscitationsALCO n= 1047

CA n= 6902

NATIONAL n= 61607

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)

N=70

N=1047

N=586

N=586

N=222

N=95

N=47

N=48

ALAMEDA COUNTYCALIFORNIANATIONAL

2017 CARES

EMS Non-Trauma OHCA Resuscitations

ALCO n= 1028

CA n= 8746

NATIONAL n= 76215

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)

N=1028

N=84 N=54 N=30

N=239

N=555

N=555

155 OF THOSE SURVIVED

WITH GOOD NEUROLOGIC

FUNCTION: 73%!

2016-2017

213 PEOPLE SURVIVED OHCA! FULL 737-800

SCIENCE TO SURVIVALCONTINUITY OF CARE

2019

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