cardiac arrest review 2018 - washtenaw
TRANSCRIPT
Cardiac Arrest Review2018
Robert Domeier, MD
EMS Medical Director
Washtenaw/Livingston MCA
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)
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
CARES
▪ Cardiac Arrest Registry to Enhance Survival (CARES) initiated 2014
▪ Presumed Cardiac
▪ Rhythms condensed
▪ VF/VT/Unknown Shockable
▪ Asystole
▪ PEA/EMD
▪ Unknown unshockable
Resuscitations Attempted
0
50
100
150
200
250
300
350
1990 1995 2000 2005 2010 2015
Arrests per Year
Gender Distribution
20%
30%
40%
50%
60%
70%
80%
1990 1995 2000 2005 2010 2015
Arrest Gender
Male Female
Age of Resuscitation Attempts
62
63
64
65
66
67
68
1990 1995 2000 2005 2010 2015
Arrest Age
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
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
ALS Response Time
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
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
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
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
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
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
WLMCA vs State vs NationalNon-Traumatic
WLMCA vs State vs NationalNon-Traumatic