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