Evaluating Cardiac Care Systems

As reported by the American Heart Association www.heart.org in the U.S., 359,400 cardiac arrests occur outside of a hospital annually with a survival rate of 9.5 percent. Life sustaining circulation can be created by using effective and uninterrupted chest compressions.

However, performing manual chest compressions of high quality is both difficult, tiring, and impossible in certain situations. The quality varies and depends on the person that is providing CPR so in certain situations, the medical situation can deteriorate quickly after only one or two minutes.

Last fall, the Center for Rural Health http://ruralhealth.und.edu at the University of North Dakota School of Medicine and Health Sciences www.med.und.edu received funding from The Leona M. and Harry B. Helmsley Charitable Trust http://helmsleytrust.org for $2,198,154 to evaluate cardiac care systems in Wyoming, Minnesota, Nebraska, Iowa, and Montana, plus North and South Dakota.

The fact is that a statewide system of care is needed for cardiac-arrest patients everywhere but the system is particularly needed in rural areas since urban residents may be only a few minutes from the nearest ambulance and emergency room.

Also, urban hospitals are usually fully equipped to treat cardiac patients. However, in some cases, in rural North Dakota and other rural areas, a cardiac-arrest patient many need to be transferred from one ambulance to another and from one hospital to another.

As it also happens many times in rural areas, the cardiac-arrest event may be treated by nearby volunteers that aren’t medical professionals plus bystanders can supply inadequate information on location to 9-1-1 dispatchers. An effective cardiac care system needs to include 9-1-1 dispatch, emergency medical services, critical access hospitals, tertiary care facilities, as well as telemedicine specialists.

The project’s director Dr. Ralph Renger, is working with the North Dakota Department of Health www.ndhealth.gov, along with the South Dakota Office of Rural Health http://doh.sd.gov/providers/ruralhealth, plus dispatch, ambulances, and hospital services to develop a strategy to use to evaluate cardiac care systems.

The evaluation includes studying the relatively new medical device known as the “Lund University Cardiopulmonary Assist System” also known as (LUCAS 2) www.lucas-cpr.com/en/lucas_cpr/lucas_cpr to change how CPR is administered. The device is a mechanical CPR device that delivers automated and consistent chest compressions for a patient suffering from cardiac arrest. The device is lightweight and portable and can be applied in less than a minute.

In 2013, the state health departments of North Dakota and South Dakota received grants for just over $7 million to provide the device to more than 400 ambulances and hospitals across the two states. Once the devices were in place in North Dakota, the State Health Department’s Division of Emergency Medical Services and Trauma www.ndhealth.gov/ems set up a project to evaluate the effectiveness of the devices on patient outcomes.

The ongoing evaluation project runs through August 31, 2017. Other the next three years, the project will establish a sustainable process for the states to use to continually evaluate and improve how heart attack patients receive care.

“This level of cooperation from all stakeholders involved in the use of cardiac care systems to successfully implement an evaluation project of this scale has been unprecedented.” reports Dr. Renger.

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