Take Heart America: A comprehensive, community-wide, systems-based approach to the treatment of cardiac arrest.
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.
Lick
Charles J
CJ
Allina Medical Transportation, St. Paul, MN, USA.
Aufderheide
Tom P
TP
Niskanen
Robert A
RA
Steinkamp
Janet E
JE
Davis
Scott P
SP
Nygaard
Susan D
SD
Bemenderfer
Kim K
KK
Gonzales
Louis
L
Kalla
Jeffrey A
JA
Wald
Sarah K
SK
Gillquist
Debbie L
DL
Sayre
Michael R
MR
Osaki Holm
Susie Y
SY
Oski Holm
Susie Y
SY
Oakes
Dana A
DA
Provo
Terry A
TA
Racht
Ed M
EM
Olsen
John D
JD
Yannopoulos
Demetris
D
Lurie
Keith G
KG
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