Take Heart America: A comprehensive, community-wide, systems-based approach to the treatment of cardiac arrest*
- 1 January 2011
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Critical Care Medicine
- Vol. 39 (1), 26-33
- https://doi.org/10.1097/ccm.0b013e3181fa7ce4
Abstract
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). Out-of-hospital cardiac arrest patients in Anoka County, MN, and greater St. Cloud, MN, from November 2005 to June 2009. 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. 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. 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.This publication has 31 references indexed in Scilit:
- Chest Compression Fraction Determines Survival in Patients With Out-of-Hospital Ventricular FibrillationCirculation, 2009
- Regional Variation in Out-of-Hospital Cardiac Arrest Incidence and OutcomeJAMA, 2008
- Heart Disease and Stroke Statistics—2006 UpdateCirculation, 2006
- Effectiveness of a 30-min CPR self-instruction program for lay responders: a controlled randomized studyResuscitation, 2005
- Effect of an inspiratory impedance threshold device on hemodynamics during conventional manual cardiopulmonary resuscitationResuscitation, 2005
- Issue HighlightsCirculation, 2005
- Cardiopulmonary resuscitation of adults in the hospital: A report of 14 720 cardiac arrests from the National Registry of Cardiopulmonary ResuscitationResuscitation, 2003
- Influence of cardiopulmonary resuscitation prior to defibrillation in patients with out-of-hospital ventricular fibrillation.JAMA, 1999
- Treatment with Indinavir, Zidovudine, and Lamivudine in Adults with Human Immunodeficiency Virus Infection and Prior Antiretroviral TherapyThe New England Journal of Medicine, 1997
- Cardiac arrest and resuscitation: A tale of 29 citiesAnnals of Emergency Medicine, 1990