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Minnesota Boosts Sudden Cardiac Arrest Survival

Monday January 12, 2009
<b>The North Star State is on the cutting edge of the quest to boost survival rates with cardiac arrest centers, cooling devices, and community CPR initiatives.</b>
The North Star State is on the cutting edge of the quest to boost survival rates with cardiac arrest centers, cooling devices, and community CPR initiatives.
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Americans who suffer sudden cardiac arrest outside the hospital have a dismal survival rate of 1% to 3%. But Minnesota residents might have a better chance of surviving SCA.

The North Star State is on the cutting edge of the quest to boost survival rates with cardiac arrest centers, cooling devices, and community CPR initiatives.

Specialized facilities such as trauma, burn, and stroke centers improve outcomes by delivering standardized care to patients. Now hospitals are applying those lessons to SCA patients. According to Take Heart America, an estimated 300,000 Americans die each year from SCA — more than from car accidents, firearms, house fires, AIDS, and breast, prostate, and colorectal cancer combined.

Unity Hospital in Fridley, Minn.; Mercy Hospital in Coon Rapids, Minn.; members of the Allina Hospitals & Clinics network; and St. Cloud (Minn.) Hospital are cardiac arrest centers, also known as resuscitation centers.

Keith Lurie, MD, who has been working for more than 20 years to improve survival from SCA, says a cardiac arrest center "needs to offer therapeutic hypothermia and immediate cardiac catheterization for revascularization to be in the game." Other services should include placement of implantable cardiac defibrillators, CPR training for family and friends, critical care management, and the ability to track outcomes. Lurie is professor of internal medicine and emergency medicine at the University of Minnesota and director of the resuscitation center at St. Cloud.

Gentle Cooling

Therapeutic hypothermia is the cornerstone of the cardiac arrest center. The American Heart Association endorsed it in 2003 on the basis of positive results from two large clinical trials, yet adoption of this treatment is lacking.

Before therapeutic hypothermia, the survival rate to hospital discharge for patients with SCA was 25% at St. Cloud Hospital, according to Lori Potter, RN-BC, CCU core charge nurse. "After we started the therapeutic hypothermia protocol, the survival rate more than doubled to 58%," she says. "That's a 132% increase in survival."

The hospital cools patients with the Arctic Sun unit, which uses thermal-heat exchange cooling pads to control temperature. "We use two nurses for the initial setup," says Potter. During initial cooling, the nurse-to-patient ratio is 1:1.

"Once we start, we cool for 24 hours and rewarm over 20 hours," she says. A bladder temperature catheter is used to monitor temperature, and the patient is cooled only to 92.3 degrees F or 33.5 degrees C.

Often patients receive an insulin drip to manage blood glucose. "Glycemic control can be a challenge, but we have detailed protocols, so we manage it autonomously," says Potter. Patients receive fentanyl, and cisatracurium besylate is used to prevent shivering. Nurses monitor serum electrolytes, as well. "We chase a lot of low potassiums," she says.

Nurses at St. Cloud haven't seen complications with therapeutic hypothermia, according to Potter. "We thought one of the biggest complications was going to be bleeding, but we haven't had problems with that." Still, nurses monitor patients closely.

Family members receive a timeline explaining the process and the care their loved one will receive. Lurie says a financial analysis reveals therapeutic hypothermia will pay for itself. On average, each SCA patient in the ED generated $27,900 in revenue and $9,400 of direct margin, regardless of the patient's outcome in the hospital.

"To say it's too expensive is hogwash," he says. But the best payoff is the increase in the number of patients saved.

Taking CPR to the Streets

"We have to link interventions together the same way cancer therapeutic drugs are linked together to get a better result for SCA patients," says Lurie.

Take Heart Anoka County does just that as one of four sites nationwide taking part in TakeHeartAmerica.org. "It's a grassroots effort between the community and healthcare providers to boost the number of people who survive SCA," says Susan Nygaard, RN, BSN, PHN, Anoka County's site manager.

One of the group's primary initiatives is getting 25% of the population trained in CPR, says Nygaard.

To meet that goal, the group offers CPR Anytime Kits, supported by a grant from the Mercy & Unity Hospitals Foundation. The $10 deposit fee for the kit is refunded after a person trains three people. The kits can be used anywhere and are offered to the general public, too. To boost their numbers, the group is partnering with larger organizations such as the Anoka County human services division, which is using the kits to train 1,800 employees in CPR.

Early defibrillation is another key to survival after SCA, and Nygaard says facilities such as churches, fitness clubs, correctional facilities, and police departments can pay a deposit of $400 for an automated external defibrillator. The Anoka County staff advises the organization on the best AED for its situation, and either trains 25 people or trains a trainer who then teaches others. Once 25 people are trained, the $400 is refunded.

The group also collaborates with the Minnesota SCA Survivor Network, www.MNscaSurvivor.org, in its mission to support SCA survivors and their families, and educate people about SCA and early defibrillation.

"Improving survival from cardiac arrest is a public health priority," says Nygaard. "We need to take away the fear for lay people by teaching them hands-only CPR." Studies show this type of CPR increases survival.

"I tell nurses that cardiac arrest can happen anywhere, anytime, to anyone," Nygaard says. "It could be your family member the next go around."


Cynthia Saver, RN, MS, is a freelance writer. To comment, e-mail editorHTL@nurseweek.com.
CPR Mechanical Assistance

Mechanical devices are easing fatigue associated with CPR and improving its effectiveness.

Impedance threshold devices. The ITD increases circulation during CPR by regulating the flow of air into the lungs when the chest recoils after a compression. The vacuum created by an ITD decreases intrathoracic pressure, which improves blood return to the heart, and increases blood flow to the body’s vital organs. Another benefit is lower intracranial pressure.

“You get double the blood flow back to the heart with each compression,” says Keith Lurie, MD, who founded the company that makes ResQPOD-Advanced Circulatory Systems Inc. and is its chief medical officer. ResQPOD is the only ITD on the market in the U.S.

The ResQPOD is placed between the ventilation source, such as a bag-valve, and an airway adjunct. The American Heart Association says when trained personnel use an ITD along with CPR in intubated adult cardiac arrest patients, it can improve hemodynamic parameters and return of spontaneous circulation. The ITD also can be used with an oxygen facemask, and is being applied in the field and in hospitals.

For information, visit www.AdvancedCirculatory.com.

Lund University Cardiopulmonary Assist System (Lucas). The Lucas device is being used in three of the four Take Heart America sites. This gas-powered device provides automatic chest compressions and active chest decompression by pulling the chest up slightly so it fully recoils. Studies indicate no increase in CPR-related injuries with Lucas.

The combined effect of ITD and Lucas can be impressive. Lurie placed an implantable cardiac defibrillator in a man who had 45 minutes of Lucas and ICD. “He is totally intact neurologically,” Lurie says.