Modified Resuscitation Protocol for Out-of-Hospital Cardiac Arrest

State: MO Type: Model Practice Year: 2009

The protocol addresses the poor survival rate for out-of-hospital witnessed cardiac arrest. The goal of the modified protocol was to use increased quality chest compressions to create an optimal environment for defibrillation, improving the patient’s chance at survival. Comparing three years prior to implementation to one year subsequent, survival in witnessed cardiac arrest patients with ventricular fibrillation to hospital discharge increased from 22.4 percent (32/143) to 43.9 percent (25/47). Of the 25 survivors, 88 percent (22/25) had favorable Cerebral Performance Category results upon discharge.
Nationally, an estimated 250,000 to 450,000 people die in the United States from sudden cardiac arrest, with most dying before they reach the hospital. Every year Kansas City’s EMS responds to approximately 400 medical cardiac arrests calls. All cases of cardiac arrest are deemed a public health issue in Kansas City, and have been continuously entered into the cardiac arrest database for more than 15 years. This protocol addresses the treatment received by those cardiac arrest patients and greatly improves the survival rate within a specific subset of those patients. At the time of the development and initiation of this protocol, the national standards for treatment were the American Heart Association ECC 2000 guidelines and the Advanced Cardiac Life Support standard, from which this protocol differs.The Advanced Cardiac Life Support standard chest compression to ventilation ratio for to rescuers was at the time 5:2; the protocol increased that to 50:2. The protocol also set a minimum number of compressions prior to rhythm analysis and shock unless the cardiac arrest was witnessed by EMS or had a reliable history of quality chest compressions. Ten other changes were made in the protocol, including number and time of intubation attempts and so on.
Agency Community RolesAt the time the new protocol was developed and implemented, EMS was a section of the health department. EMS worked with other divisions within the health department to promote the practice within the department, to the fire department, to medical professionals in the area by way of a health summit in October 2005, and to the general public. Community partners involved in the public promotion of the practice included Anne Peterson Productions, the Heartsafe Campaign, and Kansas City International Airport. Partners in implementing the protocol included the Metropolitan Ambulance Services Trust (MAST) and the Kansas City fire department. The health department supports the implementation of the protocol and its continued use by EMS, MAST, and the fire department, and promotes the protocol to other public health and health care agencies and publications. Costs and ExpendituresAs the protocol used staff and equipment already in place, the sole cost was training time. ImplementationBased on strategies implemented by the Tucson fire department and then in several counties in Wisconsin, the EMS section of the City of Kansas City, Missouri, health department developed the revised cardiac arrest protocol to be implemented by all EMS personnel in Kansas City. All ambulance and fire department personnel were trained in the new protocol in classroom settings and simulated practice sessions over a three-month period from January to March 2006, and the protocol took effect April 1, 2006.
At this time the protocol is in place for both the fire department and MAST and has been for nearly three years; a study of the success of the protocol has been presented at the 2007 American Heart Association Conference and has been submitted for publication. As this protocol requires no additional resources above what was previously required and shows a significant increased in survival of patients, it is likely to perpetuate itself. In addition, the health department continues to promote this protocol through national organizations and medical publications. Continued success under the protocol and publication in major medical journals will help sustain this protocol and encourage its use in other areas around the nation.