Improve cardiac arrest survival by strengthening each link in the chain of survival

Alameda County, California, says they’ve found the "prescription for success" in improving cardiac arrest outcomes

SAN DIEGO — Paramedic Michael Jacobs described the results of several years of trying to improve cardiac arrest survival in Alameda County, California, during a session at the Emergency Cardiovascular Care Update 2015.

Jacobs started out by discussing the Take Heart America approach, which involves the community, emergency responders and hospital and other health care workers in a collaborative effort to strengthen the chain of survival. He reported that cardiac arrest survival rates in Alameda County were significantly higher in 2012 than they had been in 2009 through 2011, which he credited to both improving rates of bystander CPR and changes in the resuscitation tools used by EMS.

In Alameda County, a program called CPR-7 distributes 10,000 CPR training kits to seventh graders each year — through this program, Jacobs said, the county estimates that more than 10 percent of the population has been trained in hands-only CPR. The county has also emphasized dispatcher-assisted CPR and has begun using PulsePoint, an app that notifies bystanders when a cardiac arrest occurs nearby so they can initiate CPR.

Once responders arrive, Jacobs said, they are using mechanical CPR devices and impedance threshold devices (ITDs). Although the latest guidelines don’t recommend the use of ITDs, Jacobs said the research indicates they can make a difference when combined with other therapies.

"ITD makes outcomes better if there’s good CPR, and worse with bad CPR," he said. "We’ve got to get it just right. If one thing’s off, it may not be effective. It may even be detrimental."

Jacobs also said that half of the county’s cardiac arrest survivors presented with non-shockable rhythms, and EMS providers needed to treat these patients with the same expectations for success as those who have ventricular fibrillation.

Memorable quotes on treating cardiac arrest:
Here are other memorable quotes from the presentation.

"Historically, (people in nonshockable rhythms) don’t do so good. But do you really think the brain cares what rhythm stopped flow? … I truly believe that preconception will equal performance. If you don’t think you can win the game, why would you try? Or why would you try as hard as when you can win, like with shockable VFib?"

"Hyperventilation is deadly. It kills."

"You can have all the technology in the world, but if you don’t know how to use it or you’re not willing to use it or you’re not willing to use it correctly… I don’t think we’re ever going to move the needle."

"You are cardiopulmonary bypass for these patients until you can restore circulation."

"If you’re doing something that you really think makes a difference, then study it hard, and share it with the rest of the community."

Michael Jacobs

Key takeaways:
Here are three top takeaways to improve cardiac arrest survival for the patients in your community.

1. Give every patient a shot at survival
Although survival rates are higher in patients with shockable rhythms, patients in asystole and PEA sometimes survive. Treating these patients like they will live gives them the best chance.

2. There is no silver bullet
No single intervention improved cardiac arrest survival rates as much as the combination of the interventions. There is a synergistic effect of the treatments and technologies, and each has to properly fit with the others in order to have the most impact.

3. Perfusion is key
Without CPR, blood flow stops quickly. Getting hands on chest is absolutely critical to restoring circulation to the brain in order to delay cell death and ensure that patients don’t just survive, but survive and thrive.  

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