Critical Care Explorations (Oct 2020)
Rationale and Strategies for Development of an Optimal Bundle of Management for Cardiac Arrest
- Paul E. Pepe, MD, MPH, MCCM,
- Tom P. Aufderheide, MD, MS,
- Lionel Lamhaut, MD, PhD,
- Daniel P. Davis, MD,
- Charles J. Lick, MD,
- Kees H. Polderman, MD,
- Kenneth A. Scheppke, MD,
- Charles D. Deakin, MD,
- Brian J. O’Neil, MD,
- Hans van Schuppen, MD,
- Michael K. Levy, MD,
- Marvin A. Wayne, MD,
- Scott T. Youngquist, MD, MS,
- Johanna C. Moore, MD, MS,
- Keith G. Lurie, MD,
- Jason A. Bartos, MD, PhD,
- Kerry M. Bachista, MD, EMT-P,
- Michael J. Jacobs, EMT-P,
- Carolina Rojas-Salvador, MD,
- Sean T. Grayson, MS, EMT-P,
- James E. Manning, MD,
- Michael C. Kurz, MD,
- Guillaume Debaty, MD, PhD,
- Nicolas Segal, MD, PhD,
- Peter M. Antevy, MD,
- David A. Miramontes, MD,
- Sheldon Cheskes, MD,
- Joseph E. Holley, MD,
- Ralph J. Frascone, MD,
- Raymond L. Fowler, MD,
- Demetris Yannopoulos, MD,
- on behalf of fellow International Resuscitation Collaborative Members,
- Paul E. Pepe,
- Tom P. Aufderheide,
- Lionel Lamhaut,
- Daniel P. Davis,
- Charles J. Lick,
- Kees H. Polderman,
- Kenneth A. Scheppke,
- Charles D. Deakin,
- Brian J. O’Neil,
- Hans van Schuppen,
- Michael K. Levy,
- Marvin A. Wayne,
- Scott T. Youngquist,
- Johanna C. Moore,
- Keith G. Lurie,
- Jason A. Bartos,
- Kerry M. Bachista,
- Michael J. Jacobs,
- Carolina Rojas-Salvador,
- Sean T. Grayson,
- James E. Manning,
- Michael C. Kurz,
- Guillaume Debaty,
- Nicolas Segal,
- Peter M. Antevy,
- David A. Miramontes,
- Sheldon Cheskes,
- Joseph E. Holley,
- Ralph J. Frascone,
- Brent Parquette,
- Raymond L. Fowler,
- Demetris Yannopoulos,
- Brent A. Parquette,
- Ganesh Raveendran,
- Alice Hutin,
- Renaud Tissier,
- Robert Niskanen,
- James H. Logan,
- Debbie Gillquist
Affiliations
- Paul E. Pepe, MD, MPH, MCCM
- 1 Dallas County Fire Rescue, Dallas, TX.
- Tom P. Aufderheide, MD, MS
- 6 Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI.
- Lionel Lamhaut, MD, PhD
- 7 Department of Cardiology, Université Paris Descartes-Sorbonne Paris Cité, Paris, France.
- Daniel P. Davis, MD
- 9 Riverside County Fire Department, Riverside, CA.
- Charles J. Lick, MD
- 10 Allina Transportation, St. Paul, MN.
- Kees H. Polderman, MD
- 11 Department of Intensive Care, The Essex Cardiothoracic Centre, Basildon University Hospital, Basildon, Essex, England, United Kingdom.
- Kenneth A. Scheppke, MD
- 2 Palm Beach County Fire Rescue, West Palm Beach, FL.
- Charles D. Deakin, MD
- 13 National Institute for Health Research (NIHR) Southampton Respiratory Biomedical Research Unit, Southampton, United Kingdom.
- Brian J. O’Neil, MD
- 14 Department of Emergency Medicine, Wayne State University, Detroit, MI.
- Hans van Schuppen, MD
- 15 Department of Anesthesiology, Amsterdam University Medical Center and the University of Amsterdam, Amsterdam, The Netherlands.
- Michael K. Levy, MD
- 16 Anchorage Fire Department, Anchorage, AK.
- Marvin A. Wayne, MD
- 17 Department of Emergency Medicine, PeaceHealth St. Joseph Medical Center and Whatcom County Emergency Medical Services, Bellingham, WA.
- Scott T. Youngquist, MD, MS
- 18 Salt Lake City Fire Department, Salt Lake City, UT.
- Johanna C. Moore, MD, MS
- 20 Department of Emergency Medicine, Hennepin Healthcare Research Institute, Minneapolis, MN.
- Keith G. Lurie, MD
- 20 Department of Emergency Medicine, Hennepin Healthcare Research Institute, Minneapolis, MN.
- Jason A. Bartos, MD, PhD
- 22 Department of Medicine, Cardiovascular Division, University of Minnesota, MN.
- Kerry M. Bachista, MD, EMT-P
- 23 Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville, FL.
- Michael J. Jacobs, EMT-P
- 24 Alameda County EMS, San Leandro, CA.
- Carolina Rojas-Salvador, MD
- 20 Department of Emergency Medicine, Hennepin Healthcare Research Institute, Minneapolis, MN.
- Sean T. Grayson, MS, EMT-P
- 25 City of Rialto Fire Department, Rialto, CA.
- James E. Manning, MD
- 26 Department of Emergency Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC.
- Michael C. Kurz, MD
- 27 Department of Emergency Medicine, University of Alabama School of Medicine, Birmingham, AL.
- Guillaume Debaty, MD, PhD
- 28 Department of Emergency Medicine, Grenoble Alpes University Hospital, Grenoble, France.
- Nicolas Segal, MD, PhD
- 29 Department of Emergency Medicine, University of New Mexico Hospital, Albuquerque, NM.
- Peter M. Antevy, MD
- 2 Palm Beach County Fire Rescue, West Palm Beach, FL.
- David A. Miramontes, MD
- 30 Department of Surgery, The University of Texas Health Science Center, San Antonio, TX.
- Sheldon Cheskes, MD
- 32 Department of Family and Community Medicine, Division of Emergency Medicine, University of Toronto, ONT, Canada.
- Joseph E. Holley, MD
- 33 Department of Emergency Medicine, University of Tennessee, Memphis, TN.
- Ralph J. Frascone, MD
- 36 Department of Emergency Medicine, Regions Hospital, St. Paul, MN.
- Raymond L. Fowler, MD
- 37 University of Texas Southwestern Medical Center, Dallas, TX.
- Demetris Yannopoulos, MD
- 22 Department of Medicine, Cardiovascular Division, University of Minnesota, MN.
- on behalf of fellow International Resuscitation Collaborative Members
- Paul E. Pepe
- Tom P. Aufderheide
- Lionel Lamhaut
- Daniel P. Davis
- Charles J. Lick
- Kees H. Polderman
- Kenneth A. Scheppke
- Charles D. Deakin
- Brian J. O’Neil
- Hans van Schuppen
- Michael K. Levy
- Marvin A. Wayne
- Scott T. Youngquist
- Johanna C. Moore
- Keith G. Lurie
- Jason A. Bartos
- Kerry M. Bachista
- Michael J. Jacobs
- Carolina Rojas-Salvador
- Sean T. Grayson
- James E. Manning
- Michael C. Kurz
- Guillaume Debaty
- Nicolas Segal
- Peter M. Antevy
- David A. Miramontes
- Sheldon Cheskes
- Joseph E. Holley
- Ralph J. Frascone
- Brent Parquette
- Raymond L. Fowler
- Demetris Yannopoulos
- Brent A. Parquette
- Ganesh Raveendran
- Alice Hutin
- Renaud Tissier
- Robert Niskanen
- James H. Logan
- Debbie Gillquist
- DOI
- https://doi.org/10.1097/CCE.0000000000000214
- Journal volume & issue
-
Vol. 2,
no. 10
p. e0214
Abstract
Objectives:. To construct a highly detailed yet practical, attainable roadmap for enhancing the likelihood of neurologically intact survival following sudden cardiac arrest. Design, Setting, and Patients:. Population-based outcomes following out-of-hospital cardiac arrest were collated for 10 U.S. counties in Alaska, California, Florida, Ohio, Minnesota, Utah, and Washington. The 10 identified emergency medical services systems were those that had recently reported significant improvements in neurologically intact survival after introducing a more comprehensive approach involving citizens, hospitals, and evolving strategies for incorporating technology-based, highly choreographed care and training. Detailed inventories of in-common elements were collated from the ten 9-1-1 agencies and assimilated. For reference, combined averaged outcomes for out-of-hospital cardiac arrest occurring January 1, 2017, to February 28, 2018, were compared with concurrent U.S. outcomes reported by the well-established Cardiac Arrest Registry to Enhance Survival. Interventions:. Most commonly, interventions and components from the ten 9-1-1 systems consistently included extensive public cardiopulmonary resuscitation training, 9-1-1 system-connected smart phone applications, expedited dispatcher procedures, cardiopulmonary resuscitation quality monitoring, mechanical cardiopulmonary resuscitation, devices for enhancing negative intrathoracic pressure regulation, extracorporeal membrane oxygenation protocols, body temperature management procedures, rapid cardiac angiography, and intensive involvement of medical directors, operational and quality assurance officers, and training staff. Measurements and Main Results:. Compared with Cardiac Arrest Registry to Enhance Survival (n = 78,704), the cohorts from the 10 emergency medical services agencies examined (n = 2,911) demonstrated significantly increased likelihoods of return of spontaneous circulation (mean 37.4% vs 31.5%; p < 0.001) and neurologically favorable hospital discharge, particularly after witnessed collapses involving bystander cardiopulmonary resuscitation and shockable cardiac rhythms (mean 10.7% vs 8.4%; p < 0.001; and 41.6% vs 29.2%; p < 0.001, respectively). Conclusions:. The likelihood of neurologically favorable survival following out-of-hospital cardiac arrest can improve substantially in communities that conscientiously and meticulously introduce a well-sequenced, highly choreographed, system-wide portfolio of both traditional and nonconventional approaches to training, technologies, and physiologic management. The commonalities found in the analyzed systems create a compelling case that other communities can also improve out-of-hospital cardiac arrest outcomes significantly by conscientiously exploring and adopting similar bundles of system organization and care.