Take Heart Minnesota Planning Session August 27, 2009

It began with a four-city demonstration project to dramatically improve survival from sudden cardiac arrest

Ben Jabs, 21 Student Anoka County, Minn. No history of heart problems One of the first survivors in THA

Sudden Cardiac Arrest: Summer 2006 Treatment: Bystander CPR from mother BLS unable to defibrillate Advanced CPR by EMS, including new devices to improve effectiveness of CPR and defibrillation Level 1 Cardiac Arrest Center care In-hospital cooling Implantable defibrillator Future: Marketing career: graduate U 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 CPR Quality CPR and new circulation enhancement devices by rescuers AED Improved drug delivery After 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 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 in Take Heart America InterventionEffect Survival rate ↑ over baseline Bystander CPR: in schools, homes & public meeting places  Rapid EMS notification  Start circulation 2 - 5% AED Use : Widespread strategic AED deployment  Reduce time to 1 st 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 & brain  Increase O 2 & drug delivery 4 - 6% Impedance Threshold Device (ITD) BLS & ALS deployment  Increase circulation to heart & brain  Increase O 2 & drug delivery 5% Cooling, ICU, Cardiology Standard hypothermia protocols, cardiac angiography (including during CPR) & EP  Revascularization  Prevent sudden cardiac death % _______ %

Meet Samantha Take Heart America Save March 2009 Samantha: 18 yrs old 16 wks Pregnant VF Bystander CPR First responders: New CPR, ITD, AED ALS: Stabilize, Transport Resuscitation 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 9 th 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 (ResQPOD TM ).

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

Transformative technologies Bystander CPR ITD Therapeutic h ypothermia 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 h ypothermia AED Intra-osseous bone injection ICD Angiography Automated CPR device Lay Public Hospital Survival 

Transformative technologies Bystander CPR ITD T herapeutic h ypothermia 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 1 st 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 HospitalCentral Minnesota Heart Center MN Ambulance Association Advanced Circulatory Systems Inc. EMSRBMN Hospital Association Allina Health SystemGold Cross AmbulanceNAEMSP American Heart AssociationLaerdal FoundationSt. Cloud Hospital Boston ScientificMedtronicSt. Jude Foundation CARESMedtronic FoundationSudden Cardiac Arrest Association CentraCare FoundationMercy & Unity Hospitals Foundation Sudden Cardiac Arrest Foundation

Progress to Date: Medtronic Corporate Grant: 100K Hired Executive Director August – 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 RB Role of Keith Wesley MD Notification of First Responders EMS Med Director Annual Mtg MAA collaboration Resuscitation Centers of Excellence (buy-in MHA) Protocols under review Hypothermia 24/7 Revascularization ICDs Data: CARES, MDH ResQTrial First Cities/Counties Survival 