New AHA Guidelines Improve Kan. EMS Cardiac Arrest Save Rates
The Garden City Telegram, Kan.
Feb. 02—Recommendations set forth for EMS cardiac arrest treatment in a 2015 American Heart Association study have resulted in a change to Finney County EMS protocol that has pushed the county's cardiac arrest survival rate to nearly three times the national average.
According to the AHA's 2015 report, the average out-of-hospital cardiac arrest survival rate is 10.6 percent, a number sourced from data collected in 2011. Meanwhile, data collected by the Centers for Disease Control and Prevention from October 2005 to December 2010 suggested an overall survival rate of 9.6 percent, and the Cardiac Arrest Registry to Enhance Survival (CARES) places the median survival rate over the past 30 years at 7.8 percent.
In 2017, the survival rate among cases addressed by Finney County EMS was about 31 percent, according to Brent Rouse, assistant director and training officer at FCEMS.
According to AHA, about 356,000 Americans experience cardiac arrest outside of a hospital setting each year, and roughly one in 10 survive.
Rouse said 32 people in 2017 were treated for cardiac arrest by FCEMS, and 10 survived. In 2016, 22 percent of cardiac arrest patients treated by FCEMS survived, a disparity Rouse attributed to the transitional period in the agency's protocol.
Cardiac arrest survival is measured by the rate of final hospital discharge, including discharges from hospitals where a patient was transferred for intensive care.
Rouse said the AMA's 2015 study suggested that chest compression time intervals are more important than previously thought. The finding resulted in a local policy change that emphasizes the continuation of chest compressions even as airways are opened up and medications are administered.
Rouse said EMS also remains on the scene when possible for about 20 minutes, instead of interrupting chest compressions to immediately load a patient into the back of an ambulance for transportation to a hospital. He added that EMTs and paramedics only pause to quickly check a patient's pulse and to administer initial rescue breaths. For backup, he said, fire department personnel and law enforcement officers from the sheriff's office and police department are trained to perform CPR until EMS arrives.
The 2015 AHA study updated resuscitation guidelines and recommended interrupted chest compressions, a sequence of 30 compressions followed by two rescue breaths. The recommendations did, however, also allow for uninterrupted chest compressions, which do not include rescue breaths. Meanwhile, research sourced from Arizona suggested cardiac arrest survival rates are higher when first responders and bystanders skip rescue breaths.
The AHA study examined survival rates among nearly 24,000 patients. About half received interrupted chest compressions and half received continuous chest compressions. Among those who received continuous compressions without rescue breaths, 9 percent were discharged from the hospital and able to function, while 9.7 percent who received interrupted chest compressions with rescue breaths were discharged and able to function.
Simultaneously, patients who received continuous chest compressions were less likely to be taken to the hospital, meaning they were more likely to die on the scene. Clifton Callaway, M.D., Ph.D., one of the investigators and the chair of the committee that compiled the AHA guidelines, said results favored the approach involving interrupted chest compression with rescue breaths, even if the success rates were marginally different.
Rouse said FCEMS uses the interrupted approach with rescue breaths at first, but quickly shifts into continual chest compressions while remaining on the scene for a longer duration.
"The other piece of our success here has really been bystanders realizing that somebody's heart has stopped and performing that bystander CPR," Rouse said. "Even when we don't have a bystander that's going to perform the chest compressions, our law enforcement officers, both the police department and the sheriff's office, they usually arrive quite a bit before the ambulance, and the patient doesn't have to lay there and wait for us to get there for treatment."
He explained that the sheriff's office and police department are able to start compressions "right away," resulting in a "huge" increase to the FCEMS success rate.
Early response has been proven to make a significant difference. According to the AHA study, about 326,000 people experienced out-of-hospital cardiac arrest in 2011, compared to 424,000 in 2014. While 10.6 percent of those affected by cardiac arrest survived in 2011, 19,300 of those incidents involved a bystander witness who was able to assist in maintaining a heartbeat rhythm treatable by a defibrillator—31.4 percent of those patients survived, a rate on par with the reported 2017 FCEMS survival rate.
Cardiac arrest incidents have been all over the board in Finney County since at least 2012. FCEMS does not attempt to resuscitate everyone affected by cardiac arrest, such as those who have been down too long or those with a do-not-resuscitate order. Rouse said EMS worked 17 cases out of 36 incidents in 2012, 23 cases out of 35 incidents in 2013, 30 cases out of 56 incidents in 2014, 24 cases out of 61 incidents in 2015, and 17 cases out of 39 incidents in 2016.
According to Rouse, the majority of incidents are cardiac-related, especially in adults, meaning the patient's heart stopped as a result of an issue directly affecting the heart, such as a heart attack.
The Garden City Fire Department has been offering free CPR classes to the public for nearly 25 years, according to Chief Allen Shelton. The GCFD partners with the Garden City branch of the Fraternal Order of the Eagles on a grant that covers the costs of the classes. Shelton said the GCFD certifies about 600 people per year in the use of CPR techniques.
"It's a very important project that we have, as far as teaching people how to properly do CPR," he said. "We have really enjoyed doing it over the past 25 years. We feel like a real asset to the community to be able to provide it."
Shelton said the GCFD offers three classes a month, one during the week and two over the weekend. Interested residents can contact the GFCD for scheduling.