title: Take Heart America: A comprehensive, community-wide, systems-based approach to the treatment of cardiac arrest.
abstract: OBJECTIVE
  To determine out-of-hospital cardiac arrest survival rates before and after implementation of the Take Heart America program (a community-based initiative that sequentially deployed all of the most highly recommended 2005 American Heart Association resuscitation guidelines in an effort to increase out-of-hospital cardiac arrest survival).
  
  
  METHODS
  Out-of-hospital cardiac arrest patients in Anoka County, MN, and greater St. Cloud, MN, from November 2005 to June 2009.
  
  
  METHODS
  Two sites in Minnesota with a combined population of 439,692 people (greater St. Cloud and Anoka County) implemented: 1) widespread cardiopulmonary resuscitation and automated external defibrillator skills training in schools and businesses; 2) retraining of all emergency medical services personnel in methods to enhance circulation, including minimizing cardiopulmonary resuscitation interruptions, performing cardiopulmonary resuscitation before and after single-shock defibrillation, and use of an impedance threshold device; 3) additional deployment of automated external defibrillators in schools and public places; and 4) protocols for transport to and treatment by cardiac arrest centers for therapeutic hypothermia, coronary artery evaluation and treatment, and electrophysiological evaluation.
  
  
  RESULTS
  More than 28,000 people were trained in cardiopulmonary resuscitation and automated external defibrillator use in the two sites. Bystander cardiopulmonary resuscitation rates increased from 20% to 29% (p = .086, odds ratio 1.7, 95% confidence interval 0.96-2.89). Three cardiac arrest centers were established, and hypothermia therapy for admitted out-of-hospital cardiac arrest victims increased from 0% to 45%. Survival to hospital discharge for all patients after out-of-hospital cardiac arrest in these two sites improved from 8.5% (nine of 106, historical control) to 19% (48 of 247, intervention phase) (p = .011, odds ratio 2.60, confidence interval 1.19-6.26). A financial analysis revealed that the cardiac arrest centers concept was financially feasible, despite the costs associated with high-quality postresuscitation care.
  
  
  CONCLUSIONS
  The Take Heart America program doubled cardiac arrest survival when compared with historical controls. Study of the feasibility of generalizing this approach to larger cities, states, and regions is underway.
authors.affiliation: Allina Medical Transportation, St. Paul, MN, USA.
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Lick
authors.forename: Tom P
authors.initials: TP
authors.lastname: Aufderheide
authors.forename: Robert A
authors.initials: RA
authors.lastname: Niskanen
authors.forename: Janet E
authors.initials: JE
authors.lastname: Steinkamp
authors.forename: Scott P
authors.initials: SP
authors.lastname: Davis
authors.forename: Susan D
authors.initials: SD
authors.lastname: Nygaard
authors.forename: Kim K
authors.initials: KK
authors.lastname: Bemenderfer
authors.forename: Louis
authors.initials: L
authors.lastname: Gonzales
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Kalla
authors.forename: Sarah K
authors.initials: SK
authors.lastname: Wald
authors.forename: Debbie L
authors.initials: DL
authors.lastname: Gillquist
authors.forename: Michael R
authors.initials: MR
authors.lastname: Sayre
authors.forename: Susie Y
authors.initials: SY
authors.lastname: Osaki Holm
authors.forename: Susie Y
authors.initials: SY
authors.lastname: Oski Holm
authors.forename: Dana A
authors.initials: DA
authors.lastname: Oakes
authors.forename: Terry A
authors.initials: TA
authors.lastname: Provo
authors.forename: Ed M
authors.initials: EM
authors.lastname: Racht
authors.forename: John D
authors.initials: JD
authors.lastname: Olsen
authors.forename: Demetris
authors.initials: D
authors.lastname: Yannopoulos
authors.forename: Keith G
authors.initials: KG
authors.lastname: Lurie
mesh_terms: D000572:American Heart Association / Q000458:organization & administration; D016887:Cardiopulmonary Resuscitation / Q000401:mortality* / Q000592:standards*; D003153:Community Health Services / Q000458:organization & administration; D047548:Defibrillators / Q000592:standards; D004554:Electric Countershock / Q000592:standards; D004632:Emergency Medical Services / Q000458:organization & administration; D005260:Female; D019983:Guideline Adherence; D006293:Health Promotion / Q000458:organization & administration; D006336:Heart Massage / Q000592:standards; D006801:Humans; D008297:Male; D008910:Minnesota; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality* / Q000628:therapy*; D017410:Practice Guidelines as Topic; D015397:Program Evaluation; D018570:Risk Assessment; D016019:Survival Analysis; D014481:United States