Illinois Heart Rescue

Eddie J Markul, MD

EMS Medical Director, Chicago EMS

Advocate Illinois Masonic Medical Center

Physician Co-Leader, Prehospital Sphere, ILHR

Disclosure

Receive salary support from Illinois Heart Rescue

Overview

• Statewide quality improvement project

targeting out of hospital cardiac arrest

(OHCA)

• Purpose: to double neurologically intact

OHCA survival

Out Of Hospital

Cardiac Arrest

System Of Care

Scope of the Problem

• Leading Causes Of Death

Cancer 591,700

OHCA 395,000

Accidents 136,100

Stroke 133,100

Influenza/Pneumonia 55,200

Large Regional Variation in SurvivalAfter Out-of-Hospital Cardiac Arrest

0

20

40

60

Su

rviv

al

to D

isch

arg

e (

%)

Region

EMS-Assessed

EMS-Treated

VF

500% difference in survival

Nichol JAMA 2008

time to cpr and shock

su

rviv

al

Time is Critical

Survival decreases by 10% for every

minute treatment is delayed

Time Is NOT Our Friend

0:00:26 0:02:29 0:03:59

PSAP Handling Turnout

0:00:26 0:02:03 0:01:30

Travel

0:09:28

0:05:29

To patient First shock

0:01:00-

0:02:00

0:01:00-

0:02:00

10:28-

11:28

11:28-

13:28

• Survival from out of hospital cardiac arrest is

directly linked to the system of care that

exists in the community

Lynn White

Every Second Counts, Every Action Matters

USA TODAY, 2003, Robert Davis

“Most cities don’t measure their performance

effectively, if at all. They don’t know how many

lives they are losing, so they can’t determine

ways to increase survival rates.”

• 2011: Medtronic Philanthropy

– Assembled organizations renowned for

resuscitation excellence

• Charged with implementing programs in their

specific geographies to improve survival from

cardiac arrest

HeartRescue Partners

Center for

Resuscitation

Science

Heart Rescue Objectives

• Involve a state’s entire population

• Effective community-based programs

• Translating science to practice through

“Resuscitation Academies” (RA)

• Measure and improve strategies for community,

prehospital and hospital responses

“ So if you are going to have a cardiac arrest, where should you try not to be? An obvious choice would be…Chicago and Detroit, cities with the nations lowest published survival rates for cardiac arrest.”

Mickey S. Eisenberg, MDResuscitate, page 1202009

Seattle RA, Fall 2011

Illinois Heart Rescue Goal

Double survival for OHCA over 5 years

*Best pre-ILHR estimate was approximately 4% survival

Structure

Community Sphere

• The Challenge:

– National OHCA victims

• 33% bystander CPR

• 3% public access defibrillation

– Illinois circa 2011

• <4% bystander CPR

• <1% public access defibrillation

Bystander CPR Improves Chance of Survival

100%

80%

60%

40%

20%

0%

Time between collapse and defibrillation (min)0 1 2 3 4 5 6 7 8 9

3% to 4% each minute in patients receiving Conventional CPR

Nagao, K Current Opinions in Critical Care 2009

2% each minute in patients receivingchest compression-only CCR

7% to 10% each minute in patients receiving

no CPR

Surv

ival

(%

)

The Message

• Call 911

• AED

• Hands only CPR

Community Sphere

• Partnership with schools, community and faith

based organizations

• Targets “high risk” communities

• Model / layered learning

• PSAs

• Live training

• Resources for additional training

O'Hare

Austin

South Deering

Ashburn

Englewood

New City

Roseland

Hegewisch

Dunning

Beverly

Little Village

Riverdale

Chatham

Norwood Park

Uptown

Clearing

Humboldt Park

Portage ParkIrving Park

Garfield Ridge

Lake View

West Pullman

Morgan Park

Belmont Cragin

Garfield Park

Avondale

Gage Park

North Lawndale

Little Italy, UIC

East Side

West Ridge

West Lawn

Pullman

Chicago Lawn

South Shore

North Park

South Chicago

Loop

Grand Crossing

Auburn Gresham

Bridgeport Douglas

Brighton Park

Lincoln Park

West Town

Logan Square

West Loop

Lower West Side

Lincoln SquareJefferson Park

North Center

Albany Park

Rogers Park

Mount Greenwood

Washington Heights

Woodlawn

Archer Heights

Sauganash,Forest Glen

Hyde Park

Edgewater

Hermosa

River North

Kenwood

Bucktown

Calumet Heights

Galewood

Avalon Park

Grand Boulevard

Mckinley Park

Montclare

Edison Park

West ElsdonWashington Park

United Center

Wicker ParkOld Town

Near South Side

Oakland

Burnside

Fuller Park

Jackson Park

Streeterville

Armour Square

Chinatown

Museum Campus

Grant Park

Andersonville

Wrigleyville

Gold Coast

Ukrainian Village

East Village

Sheffield & DePaul

Boystown

Millenium Park

Printers Row

High-Risk Chicago Census Tracts:High Out-of-Hospital Cardiac Arrest and No Bystander CPR,

Sept 2013- Sept 2014

Accomplishments

• Over 12,000 people trained

• Illinois bystander CPR: 27%

• National 40%

• Illinois AED use: 3%

• National: 3%

Prehospital Sphere

• EMS and hospital

enrollment in a data registry

• Dispatch Directed CPR

• Protocol Change:

• High Performance CPR

• Cardiac Arrest Centers

• Resuscitation Academies

• Quality Assurance

Dispatch Directed CPR

• Just in time CPR training

• Just in time CPR refresher

• Chicago Dispatch: 80 dispatchers can

provide CPR instructions to 3 million

people

Two Questions Can Save a Life!

High Quality Resuscitation

High Quality Resuscitation

• High performance CPR

• Early defibrillation

• Controlled ventilation

• Capnography

• Medications

Keys to High Performance CPR

1. Optimize rate: 100-120 cpm

2. Optimize depth: > 2 inches (50 mm)

3. Full chest recoil

4. Minimize interruptions

• Chest compression fraction >80%

CPR Analytics

Rescue NetCode Stat

Prehospital Accomplishments

• 8 resuscitation

academies statewide

• Agencies recruited

represent 7.4 million

people

• 12.8 million total

Hospital Sphere

• Survivors of OHCA should have access to

a hospitals with the following interventions:

• Therapeutic hypothermia

• Hemodynamic stabilization

• Coronary reperfusion when indicated

• Glycemic control

• Neurologic management and prognostication

Hospital Report Card

0

10

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30

40

50

60

70

80

Admit to hosp Cooled D/C alive CPC 1-2

UNIVERSITY OF ILLINOIS HOSPITAL

2014

2015

Nat'l

Survivors Network

• Network of SCA survivors

• Promote CPR training

• Support after hospital discharge

CARES

• Links 911, EMS, and hospital data

• Collaboration between CDC, AHA, and

Emory University

• Secure and HIPPA compliant

• Only YOU can see your data

Data and Transparency

Data Definitions

• Overall survival

– OCHA of cardiac etiology

• Excludes trauma, drowning, respiratory causes,

electrocution, overdose/poisoning

– All rhythms

• Utstein survival

– OHCA of cardiac etiology

– Witnessed and shockable

Illinois Survival Since ILHR

0

1

2

3

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5

6

7

8

9

2013 2014 2015

Overall Survival

Surivival CPC 1-2

Per

cen

t S

urv

ival

Illinois Survival Since ILHR

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40

2013 2014 2015

Utstein and Utstein with Bystander CPR

Utstein Utstein Bystander

Illinois Versus National

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2013 2014 2015

Overall Survival

Illinois National

Per

cen

t S

urv

ival

Illinois Versus National

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5

10

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2013 2014 2015

Utstein

Illinois National

Per

cen

t S

urv

ival

Challenges• Lack of a mandate to participate

• Unengaged EMS/hospitals

• Limited funding

• Data entry:

• Manual

• ePCR download into CARES

Future Goals

• 100% recruitment

• Implementation of a Statewide OHCA

system of care incorporating Heart Rescue

principles

Summary

Questions?

Teri Campbell RN, BSN, CEN, CFRN

Director

tlc.ilhr@outlook.com