Take Heart Minnesota Planning Session

August 27, 2009

A 3 Phase Demonstration Project deploying recent advances in resuscitation science highly recommended by the AHA in 2005 to significantly increase resuscitation rates after cardiac arrest.

Phase I: St. Cloud MN and Anoka County MN (complete as of 2009).

Phase II: Columbus OH and Austin TX (in process). Phase III: 20 US Cities and 3 States (MN began 2009)

(TX, MS in initial planning stages)

It began with a four-city demonstration project to

dramatically improve survival from sudden cardiac arrest

Ben Jabs, 21StudentAnoka County, Minn.No history of heart problems

One of the first survivors in THA

Sudden Cardiac Arrest: Summer 2006

Treatment:

Bystander CPR from motherBLS unable to defibrillateAdvanced CPR by EMS,

including new devices to improve effectiveness ofCPR and defibrillation

Level 1 Cardiac Arrest Center careIn-hospital coolingImplantable defibrillator

Future: Marketing career: graduateU of MN in 2009

It has become a coalition of health care providers, educators, foundations,

corporations, health departments, athletic associations, hospitals and survivor volunteers, and the list is growing.

Minnesota

Barbara and family, age 42 Cardiac Arrest October 2008, Sartell MN,survivor

Bystander CPRQuality CPR and new circulation

enhancement devices by rescuersAED Improved drug deliveryAfter resuscitation: specialized care including

cooling, blockage removal and implantable defibrillator

Take Heart America coordinates what the AHA recommends and what

SCA victims need…

Systems Based Approach

Lay Public

Hospital EMS

First Responder

• Widespread CPR Training (e.g. CPR Anytime)

• AEDs• Public Education

• Rapid Response• Start CPR

immediately• Rapid AED

placement• High Quality CPR• ITD (ResQPOD)

• High Quality CPR• Advanced Airways• Intra-osseous drug

delivery prn• ITD (ResQPOD)• Automated CPR

(LUCAS)

Resuscitation Centers of Excellence

• Hypothermia• 24/7

Revascularization• ICDs

Survival

Intervention Outcome Relationships inTake Heart America

Intervention Effect Survival rate ↑ over

baseline

Bystander CPR: in schools, homes & public meeting places

Rapid EMS notificationStart circulation

2 - 5%

AED Use : Widespread strategic AED deployment

Reduce time to 1st shock in VF patients

4 - 6%

Improved CPR Quality

Prevent hyperventilation, continuous chest compressions, CPR pre/post shock, intra-osseous drug delivery

Increase circulation to heart & brainIncrease O2 & drug delivery

4 - 6%

Impedance Threshold Device (ITD) BLS & ALS deployment

Increase circulation to heart & brainIncrease O2 & drug delivery

5%

Cooling, ICU, Cardiology

Standard hypothermia protocols, cardiac angiography (including during CPR) & EP

Revascularization Prevent sudden cardiac death

10 - 15%

_______

25 - 37%

Meet Samantha

Take Heart America SaveMarch 2009

Samantha:18 yrs old16 wks PregnantVF

Bystander CPRFirst responders:

New CPR, ITD, AEDALS:

Stabilize, TransportResuscitation Center:

Cooling, ICD

Widespread CPR

• Increase the percentage of SCA victims who receive effective bystander CPR– AHA’s CPR Anytime for Family &

Friends– High school & college students &

their families– Communities at large– Survivor network participation– St Cloud– all 9th graders/families

trained CPR– CPR Goes to College

More Rapid Response of Critical Elements

• Widespread automatic external defibrillator (AED) deployment

• Decrease EMS response times to SCAs

• Immediate CPR

• Rapid AED

• Improve the Quality of pre-hospital CPR

First Responders

High Performance CPR CPR before and after Shock Devices, including ResQPOD, to more than

double circulation during CPR Control ventilation rate and volume Hand position and Chest wall recoil

All 911 responders (including police) carry and AED and ITD and have continuous retraining

Increase the percentage of SCA victims who receive enhanced circulation management with an impedance threshold device (ResQPODTM).

American Heart Association

AHA Recommended Therapies for Increasing Circulation during adult CPR and Improving Resuscitation Rates

• Continuous chest compression for ALS; 30:2 BLS• Impedance Threshold Device (ITD)

Class IIa

• Epinephrine • Amiodarone • Mechanical CPR Devices • CPR before and after shock • full chest wall recoil

Class IIb

• Vasopression • Lidocaine • Atropine

Indeterminate

CPR and Defibrillation and PADClass I

• Improve the Quality of pre-hospital CPR

• IO Drug Delivery

• ITD

• Automated CPR device

EMS

LUCAS Device

Why Level 1 Cardiac Arrest Centers?

Mission/Care

• Cooling – active protocol for rapid cooling• Cardiac Catheterization – 7/24 availability• Optimal care for re-arrests – New CPR, • ResQPOD + LUCAS• Critical Care – Boarded intensivists 7/24• EPS and ICDs – 7/24 rhythm • management• Rehabilitation – PT/OT teams• CPR Training for family/friends – spread the word• Organ donation – shown to save additional lives

Transformative technologies

CPR Anytime Kit ITD

Therapeutic hypothermia

AED

Intra-osseous bone injection

ICD

Angiography

Automated CPR device

Lay

Public

Hospital

EMS

First

Responder

Survival

Minnesota Success in Phase 1

From 2006-2007 in the two MN sites all interventions implemented:

1. >12,000 people were trained in CPR, 2. bystander CPR rates increased from 21 to 27%, 3. 3 Level One Cardiac Arrest Centers were established,

Survival in all patients following out-of-hospital cardiac arrest improved from 9.3% in 2005 (historical control) to 17% (P=0.03) in 2007.

>50% of all patients admitted to the hospital, regardless of etiology, are discharged to home neurologically intact.

Transformative technologies

Bystander CPR ITD

Therapeutic hypothermia

AED

Intra-osseous bone injection

ICD

Angiography

Automated CPR device

Lay

Public

Hospital

EMS

First

Responder

Survival

Keeping Families Whole

Transformative technologies

Bystander CPR ITD

Therapeutic hypothermia

AED

Intra-osseous bone injection

ICD

Angiography

Automated CPR device

Lay

Public

Hospital

Survival

Transformative technologies

Bystander CPR ITD

Therapeutic hypothermia

AED

Intra-osseous bone injection

ICD

Angiography

Automated CPR device

EMS

First

Survival

<5 percent survival

30 percent survival

Minnesota Challenge

• Rural– Volunteer based initiative for 1st responders– Transport to Level 1 Resuscitation Centers

• Suburban– Professional and volunteer 1st responders– Public access CPR and defibrillation

• Urban– Professional EMS response– Public access CPR and defibrillation

Take Heart Minnesota- Educational initiatives:

- Proposal: The survivor network members want to lead this charge- This will require time, resources, direction and a strategy that needs to be

developed

- Standardize BLS and ALS response- First task and goal of THMn

- This will require a state-wide effort, time, and resources

- Data collection- Coordinate with local agencies and State Health Dept and CARES

- Funding for Take Heart Minnesota- Make this a priority in 2009 grant applications

- Time line: Plan for full deployment of BLS/ALS in 24 months throughout the state, starting in January 2009

Celebrate the Saves

With Gratitude to our Supporters & Friends

Abbott Northwestern Hospital Central Minnesota Heart Center

MN Ambulance Association

Advanced Circulatory Systems Inc.

EMSRB MN Hospital Association

Allina Health System Gold Cross Ambulance NAEMSP

American Heart Association Laerdal Foundation St. Cloud Hospital

Boston Scientific Medtronic St. Jude Foundation

CARES Medtronic Foundation Sudden Cardiac Arrest Association

CentraCare Foundation Mercy & Unity Hospitals Foundation

Sudden Cardiac Arrest Foundation

Progress to Date:Medtronic Corporate Grant: 100K

Hired Executive Director August 3 2009 – Debbie Gillquist and Program Manager august 15, 2009 – Sarah Wald

Advisory Board

• Widespread CPR Training

• State Fair; EMS Councils; Cub Foods

• Public Education• HS and University

programs• HS Athletic Assoc• Solidify Slide

Set/Training Materials

• Rapid Response• Start CPR immediately

• First responder protocol• Rapid AED placement• High Quality CPR• ITD (ResQPOD)

• Working on distribution, packaging and training kits

• Meeting with EMS Councils

• High Quality CPR• Advanced Airways• Intra-osseous drug delivery prn• ITD (ResQPOD)• Automated CPR (LUCAS)Role of EMS RBRole of Keith Wesley MDNotification of First RespondersEMS Med Director Annual MtgMAA collaboration

Resuscitation Centers of Excellence (buy-in MHA)Protocols under review

• Hypothermia• 24/7 Revascularization• ICDs• Data: CARES, MDH

• ResQTrial• First Cities/Counties

Survival