OOHCA System of Care

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OOHCA System of Care

  1. 1. What Is An Ideal Cardiac Arrest System of Care? Matthew Sholl, MD, MPH, FACEP
  2. 2. What Is A “System of Care”
  3. 3. First, Where are We At Currently?
  4. 4. Total Cardiac Arrests Curr Op Crit Care 2004;10:208-212
  5. 5. Rea et all, Resuscitation, 2004 2.2 3.3 16.0 30.0
  6. 6. 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
  7. 7. 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
  8. 8. 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
  9. 9. 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
  10. 10. 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
  11. 11. 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
  12. 12. 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
  13. 13. 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
  14. 14. Questions
  15. 15. Questions

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