6. Rea et all, Resuscitation, 2004
2.2 3.3
16.0 30.0
7. Why Such Variability in Survival
?
• In large part, due to
differences in the system of
care
– Public relations and
incidence of bystander CPR
– Dispatch provision of CPR
instructions
– Placement of AED’s in the
community
– Timely EMS response
– Different community
practices for activation of 911
• The SYSTEM of care
surrounding OHCA may
have some responsibility
for the survivability
Baker et all Resuscitation, 2008
8. Let’s Think About the Pieces of
the System
Saving Lives
• Early Access to 911
• Layperson training in
CPR
• Public Access
Defibrillator (PAD)
programs
• EMD assisted chest
compressions
• First responder
defibrillation – BLS
• ACLS
Saving Life Style
• Early, goal directed
therapy
– Shivering control
– Glucose control
– Hemodynamic support
• Therapeutic hypothermia
• Early PCI
• Prognostication
• Implantable Cardiac
Defibrillators
9. The EMS Side:
Save A Life – Restore Spontaneous Circulation #1
EVERYTHING we do should promote
forward flow of blood
ANYTHING that interrupts forward blood
flow should be critically evaluated
10. The EMS Side:
Save A Life – Restore Spontaneous Circulation #2
0
2
4
6
8
10
12
Normal
Flow
No Flow
Arest
Low
Flow -
CC
ROSC
11. Model EMS System of Care #1
1. Establish a Registry
– Measure your starting point
2. Improve Layperson Involvement
– Layperson Chest Compression Training
– Implement Dispatcher Assisted CPR
3. Improve EMS Performance
– Implement High Performance CPR
4. Decrease Time to Patient Access
– Implement Rapid Dispatch
12. Model EMS System of Care #2
5. Voice Record All Resuscitations
6. Begin Police Defibrillation
7. Establish Public Access Defibrillation
Program
8. Supplemental Funding and Support for
Training and QI
9. Work Toward A Culture of Excellence
13. The Hospital Side:
Save Lifestyle – Mitigating Organ Damage #1
Nichol et Al: Regional Systems of Care for Out-of-Hospital Cardiac Arrest: A Policy Statement From the
American Heart Association, Circulation 2010
14. Putting It All Together…
Nichol et Al: Regional Systems of Care for Out-of-Hospital Cardiac Arrest: A Policy Statement From the
American Heart Association, Circulation 2010
