cardiac arrest review 2018 - washtenaw
TRANSCRIPT
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Cardiac Arrest Review2018
Robert Domeier, MD
EMS Medical Director
Washtenaw/Livingston MCA
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Prehospital Cardiac Arrest Survival
▪ First collection 1988 – Ron Maio, MD
▪ Arrests identified by EMS
▪ Adult arrests of presumed cardiac origin
▪ Excluded
▪ Dead on scene (no resuscitation attempt)
▪ DNR, GI Bleeds, Overdoses, Prisoners
▪ Health care arrests (hospital, clinic, dialysis)
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Cardiac Arrest Outcomes
▪ Hospital outcomes obtained
▪ Cases not retrospectively excluded for non-cardiac origin, including:
▪ Respiratory
▪ Intercranial bleed
▪ Vascular catastrophe (AAA)
▪ Data compiled by Medical Control Authority through 2013
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CARES
▪ Cardiac Arrest Registry to Enhance Survival (CARES) initiated 2014
▪ Presumed Cardiac
▪ Rhythms condensed
▪ VF/VT/Unknown Shockable
▪ Asystole
▪ PEA/EMD
▪ Unknown unshockable
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Resuscitations Attempted
0
50
100
150
200
250
300
350
1990 1995 2000 2005 2010 2015
Arrests per Year
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Gender Distribution
20%
30%
40%
50%
60%
70%
80%
1990 1995 2000 2005 2010 2015
Arrest Gender
Male Female
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Age of Resuscitation Attempts
62
63
64
65
66
67
68
1990 1995 2000 2005 2010 2015
Arrest Age
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Witnessed Arrests
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
1990 1995 2000 2005 2010 2015
Witnessed Arrests
Bystander Witnessed EMS Witnessed
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Bystander CPR Rate
20.0%
25.0%
30.0%
35.0%
40.0%
45.0%
50.0%
55.0%
60.0%
1990 1995 2000 2005 2010 2015
Bystander CPR
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ALS Response Time
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Rhythm at Presentation
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
1990 1995 2000 2005 2010 2015
Arrest Rhythm
VF/VT/Unk Shockable Asystole
PEA/EMD Unknown Unskockable
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Overall Survival
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
1990 1995 2000 2005 2010 2015
Survival to Hospital Admission and Discharge
Hospital Admission Hospital Discharge
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Witnessed VF/VT Survival
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
40.0%
1990 1995 2000 2005 2010 2015
Witnessed Shockable RhythmSurvival to Discharge
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Attempts to Improve Survival
▪ 1990 - AEDs for first responders 1990
▪ 1995 - Work all arrests at the scene
▪ 2007 – 2009 ResQ Trial training to improve Standard CPR & C/D CPR with ITD with renewed emphasis on working arrests at the scene
▪ 2012 – ITD use and hospital exchange
▪ 2017 – ResQ CPR System
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Scene Termination of Resuscitation
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
1990 1995 2000 2005 2010 2015
Scene Termination of Resuscitation
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Witnessed VF/VT Survival
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
40.0%
1990 1995 2000 2005 2010 2015
Witnessed Shockable RhythmSurvival to Discharge
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WLMCA vs State vs NationalNon-Traumatic
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WLMCA vs State vs NationalNon-Traumatic