Critical Care Medicine

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Critical Care Medicine:
doi: 10.1097/CCM.0b013e3181fa7ce4
Clinical Investigations

Take Heart America: A comprehensive, community-wide, systems-based approach to the treatment of cardiac arrest*

Lick, Charles J. MD; Aufderheide, Tom P. MD; Niskanen, Robert A. MSEE; Steinkamp, Janet E. MA; Davis, Scott P. MD, FCCM; Nygaard, Susan D. RN; Bemenderfer, Kim K. NREMT-I; Gonzales, Louis EMT-P; Kalla, Jeffrey A. NREMT-P; Wald, Sarah K. BA; Gillquist, Debbie L. EMT-P; Sayre, Michael R. MD; Oski Holm, Susie Y. MPH; Oakes, Dana A. BS; Provo, Terry A. EMT-P; Racht, Ed M. MD; Olsen, John D. MD; Yannopoulos, Demetris MD; Lurie, Keith G. MD



In the article on page 26 of the January 2011 issue, one of the author's names was not correct.

The author should be listed as follows: Susie Y. Osaki Holm

Critical Care Medicine. 39(4):930, April 2011.

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Objectives: 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).

Patients: Out-of-hospital cardiac arrest patients in Anoka County, MN, and greater St. Cloud, MN, from November 2005 to June 2009.

Interventions: 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.

Measurements and Main Results: 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.

Conclusions: 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.

© 2011 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins

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