Washington, DC (5/30/2008)

Dr. Brent Myers, Medical Director of the Wake EMS System presented to the Society of Academic Emergency Medicine the results of implementation of new methods of CPR, adjunct airways and induced hypothermia.

The report represents a clinically significant increase of survival from out of hospital cardiac arrest where these new methods were used.

The complete presentation is available at:

www.wakeems.com/saem

A new study finds that recent guidelines outlined by the American Heart Association (AHA) for treatments used by emergency medical practitioners on cardiac arrest patients has lead to substantial improvements in survival rates. The findings show that, when fully implemented, the treatment protocol increased the odds of survival nearly four-fold for victims of cardiac arrest.

The study, led by Drs. Paul Hinchey, Brent Myers of the Wake County EMS System in Raleigh, N.C., is the first comprehensive evaluation of 2005 American Heart Association guidelines on the use of compression, ventilation and induced hypothermia after community-wide implementation. The results are based on the outcomes of adults treated for cardiac arrest by emergency responders in an urban/suburban emergency medical services system with existing advanced life support.

The authors highlight the benefits a healthcare community being able to implement a comprehensive care plan for victims of cardiac arrest “from the living room of the victim’s home to the intensive care unit (ICU).”

The essential elements of this plan were a focus on simple, continuous cardiac compressions, controlled ventilations, early utilization of induced hypothermia and transport of resuscitated patients to specialized post-resuscitation hospitals.

There is ample evidence to support the use of continuous compressions and induced hypothermia. However, unlike previous studies that demonstrate the effectiveness of individual interventions on a study population, this study demonstrates the substantial impact that comprehensive implementation of a multi-disciplinary treatment protocol can have on a community.

“Our findings not only demonstrate beneficial outcomes for victims of cardiac arrest, but also suggest the possibility that such treatment plans can be implemented for other medical conditions,” say the authors.
The presentation is entitled “Out-of-Hospital Cardiac Arrest Survival after the Sequential Implementation of 2005 AHA Guidelines for Compressions, Ventilations, and Induced Hypothermia”

This paper was presented at the 2008 SAEM Annual Meeting, May 29-June 1, 2008, Washington, D.C. Additional information is available at: www.wakeems.com/saem

Medical News: Emergency Medicine

SAEM: AHA Guidelines for Cardiac Arrest Treatment Increase Survival
By Todd Neale, Staff Writer, MedPage Today
Published: May 30, 2008
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco

WASHINGTON, May 30 — The rate of resuscitation after out-of-hospital cardiac arrests jumped nearly four-fold when new guidelines on CPR were fully implemented in a
North Carolina county, according to researchers here.

The 2005 American Heart Association guidelines outlined a protocol calling for simple, continuous chest compressions, controlled ventilation, and early use of induced hypothermia.

When the guidelines were fully implemented in Wake County, which has urban and suburban areas and a population of about 815,000, cardiac arrest survival increased 3.99-fold (95% CI 2.19 to 7.27), Brent Myers, M.D., M.P.H., medical director of the Emergency Medical Services System in Raleigh, N.C., reported at the Society for Academic Emergency Medicine meeting here.

Overall survival increased from 2.4% using older guidelines to 6.7% after introduction of the full 2005 AHA protocol. He said that “the neurologic improvement was at least as robust as the survival improvement.” The entire protocol was introduced for less than $200 per patient, he said. “All of these changes are simple, they are inexpensive, and they are incredibly effective,” he said.

CLINK HERE FOR COMPLETE STORY

Source reference:
Hinchey P, et al “Out-of-hospital cardiac arrest survival after the sequential implementation of 2005 AHA guidelines for compressions, ventilations, and induced hypothermia” SAEM Meeting 2008; Abstract 167.

Wake County EMS has established a resources page for EMS System medical directors and educators.

Click on the picture below to be taken to the most recent concepts and case reports.

WASHINGTON, DC - Wake EMS System’s medical directors, Drs. Brent Myers and Paul Hinchey, will present findings from latest changes in resuscitation in the prehospital area. Using new techniques for CPR (continious compression CPR), use of the ITD “ResQPod” and induced hypothermia by Ems.

This past Wednesday, during National EMS Week, Wake County EMS System recognized 49 survivors from sudden cardiac arrest. Raleigh’s Fletcher auditorium was filled with over 300 people from 911 Telecommunicators, first responders, EMT’s and Paramedics. Several survivors and family members were invited to this year’s program.

Dr. Brent Myers, Medical Director for the Wake EMS System, read the date of each cardiac arrest and recognized the responders with a certificate and award pin.

The keynote speaker for the evening was Mr. Walter Davis, a former paramedic, who told his story of sudden death. “You make a difference” Davis told the crowd as he described his sudden death event, including the 911 call his wife made and the life saving instructions from Emergency Medical Dispatchers. Having been defibrillated by first responders and care provided by paramedics including being cooled using early hypothermia, Davis described what he went through and how thankful he and his family were to his responders.

Earlier in the week, the Wake County Commissioners were presented with next years budget. EMS will begin a specialized program of advanced practice paramedics to add to the experience in cardiac arrest management and other community medical issues.

5/20/2008

During National EMS Week, May 18-24, 2008, the Wake County Emergency Medical System (EMS) will celebrate achievements that show dramatic strides in cardiac arrest care. Recently completed data from 2007 shows that Wake’s EMS System successfully resuscitated 49 people who experienced cardiac arrest – a life-threatening condition in which the heart stops beating effectively.

These accomplishments will be celebrated at the Cardiac Arrest Save Ceremony, on Wednesday, May 21, 2008, at 7 p.m., at the Fletcher Opera Theater, 2 E. South St., Raleigh. Members of the media are invited to attend as Wake County emergency responders and 2007 cardiac arrest survivors meet to celebrate the achievements of the Cardiac Saves program and the efforts of the emergency medical care system.

Changes in the way local emergency responders manage cardiac arrest patients have yielded significant gains in the number of survivors. In April 2005, the Wake County EMS System began practicing Constant Compression Cardiopulmonary Resuscitation (CPR), or CPR with a focus on preventing interruptions in chest compressions. Automatic External Defibrillators (AEDs) remain a vital component of cardiac arrest survival. Finally, the EMS System, in partnership with Rex Healthcare and WakeMed Health and Hospitals, has been using induced hypothermia to improve neurological outcomes for cardiac arrest patients for more than a year.

Key elements of cardiac arrest resuscitation are early provision of cardiac compressions and the timely response of a defibrillator that can shock the heart back into a normal rhythm. The EMS System relies on firefighter first-response agencies across Wake County to provide these life-saving interventions; more than half of the cardiac arrests occur in the City of Raleigh, with the remaining half divided among more than 20 fire departments in Wake County. Incredibly, in the City of Raleigh, 49 percent of victims of ventricular fibrillation survive to hospital discharge, better than 2.5 times the national average.

“Many ingredients go into this success here in Wake County,” said Wake County EMS Chief Skip Kirkwood. “The first link in the chain is community awareness, which is bystander and family CPR and the use of automatic defibrillators, or AEDs. We benefit from the professionalism of our 911 Emergency Medical Dispatchers, who provide care instructions and coordinating emergency response.

“Our local firefighters have also done an outstanding job of responding quickly and providing CPR and defibrillation, the cornerstones of successful cardiac arrest resuscitation. Our Paramedics provide advanced medical care as they manage the patient on scene and to the hospital. And our partners in the hospital systems continue outstanding care and see the patients through to their discharge.”

A large national study published in the March 12, 2008, Journal of the American Medical Association indicates a rate of five percent survival in ventricular fibrillation patients before the 2005 changes to a rate of 18 percent after the changes.

Wake County’s overall rate before the changes was eight percent, compared to the national study at two percent. Post-change rates for Wake County in 2007 were 19 percent for all cardiac arrest types versus five percent in the national study.

Photographs by Wake EMS Photo Unit:

Mike Legeros andLee Wilson