Take It To Heart

     There are no magic bullets when someone goes into cardiac arrest. Rather, there are a range of interventions and treatments that each help boost their chances of survival. The best we can do for such patients is have all those elements in place and working in concert as part of an integrated program designed to maximize such patients' chances.

     That's the idea behind the Take Heart America initiative, a pilot project that's bringing the full suite of approaches together in attempt to improve cardiac arrest outcomes in four U.S. communities: Austin, TX; Columbus, OH; St. Cloud, MN; and Anoka County, MN.

     It entails widespread CPR and AED training, beneficial technology in the field and state-of-the-art post-resuscitation care, all tightly coordinated in an effort so cohesive and encompassing, it was initially described as "tenting the town."

     "Essentially it's an effort by the entire community to implement all the current findings and guidelines as effectively as we can, and do everything we can, based on the evidence, to decrease morbidity and mortality from out-of-hospital cardiac arrest," says Ed Racht, MD, medical director for Austin-Travis County EMS, a major player in the Take Heart Austin part of the initiative.

     Here's a brief look at the elements:

FOR THE PUBLIC
     The public education aspect of the Take Heart program is based around training the public in CPR and increasing their knowledge and comfort in acting when a victim goes down. In Austin, the American Heart Association's recent approval of compression-only CPR for bystanders to witnessed arrests is being incorporated into this outreach. The hope is that the simpler approach will result in greater involvement.

     "Our goal is to create a message that in less than 10 minutes, we're going to show you the basic principles of resuscitation," says Racht, "so that you remember it, so you won't be afraid to do it, and so you'll be interested in pursuing more training. And that's a key issue: We don't want the hands-only CPR to discourage people from getting more training. What we do want to do is target those folks who wouldn't have taken a class at all."

     Among the venues for this instruction are local schools; one district even won a Medtronic grant for CPR training. County schools are also getting defibrillators through an aggressive local public placement program and efforts at the state level.

     In the business world, the department has reached out to major local entities, offering basic lifesaving instruction and incorporation into community response frameworks.

     "We have a corporate response network that I think is up to about 32 community organizations that have first-responder teams," says Racht. "They're credentialed, with badges that say Austin-Travis County EMS Office of the Medical Director, even though they're working at Dell or wherever. And we work with their leadership to help make defibrillators available."

     That's been especially beneficial for businesses with big campuses, where EMS can face delays in accessing patients. As well, the extra trained hands provided unanticipated backup support when the city hosted refugees from hurricanes Katrina and Rita.

FOR EMS AND HOSPITALS
     EMS' job hasn't changed much; providers still deliver good CPR fast, with minimal interruptions. In Take Heart communities, their efforts are bolstered with use of an impedance threshold device (the ResQPOD, from Advanced Circulatory Systems), which enhances circulation in CPR recipients. Austin-Travis County providers are also using team leaders to oversee care on cardiac arrest calls. "That's an individual who has primary responsibility in a resuscitation scenario for oversight of continuity and appropriateness of compressions, and limitation of prolonged airway attempts, so that we focus on the perfusion side of the house," says Racht. The department also offers prearrival instructions to 9-1-1 callers and participates in the CARES registry (https://mycares.net), which allows benchmarking against other communities.

     Full-spectrum post-resuscitation care, including hospital cooling, completes the Take Heart litany. (Austin-Travis County, like many jurisdictions, is also implementing field cooling.) The department is developing criteria for hospitals wishing to be designated as cardiac receiving centers, and local hospitals and cardiologists are promoting fast post-arrest catheterization.

A PERSONAL FACE
     A final step is to put a personal face on the process. In Austin that's accomplished through survivor reunions each Valentine's Day. Those who have survived the experience gather to meet their rescuers and share stories among themselves and with the community at large.

     "It sends the message that this isn't a universally fatal event, that there are people who survive and go on to live great lives," says Racht. "It's a good motivator in terms of getting everybody on board."

     For more on Take Heart America, see www.takeheartamerica.org. For more on the Austin system and its efforts, see www.atcems.org.