Sudden Cardiac Arrest Disparities In Survival Richard Lamphier, RN Program Manager Project S.A.V.E. Children’s Healthcare of Atlanta

S A V E Project S.A.V.E. Sudden Cardiac Arrest Awareness Vision for Prevention Education A V E

Resuscitation. 2013;84:1093-1098

When Seconds Count Public’s role is crucial in saving a life Prepared and willing to deliver basic life support (high quality CPR) Publicly accessible AED’s Time between onset of arrest and provision of care is fundamental 4 reasons why people won’t do CPR. Albany example of mouth to mouth Grady story Florida case in Schools Hurt someone Shortening Time Best Way Reduce Death and Disability From Cardiac Arrest.

87/146 (60%) families completed survey   Retrospective study of PHW families with child or young adult who suffered SCD 87/146 (60%) families completed survey 72% SCA victims with > 1 CV S/S prior to SCD Fatigue 44%, near syncope 30% 24% victims with prior syncope / seizure CV S/S first appeared 30 months prior to SCD 26% families reported unexplained SCA < 50 years of age Drezner, J. JABFM. January 2012

Key SCA Warning Signs / Symptoms Exercise, emotion, startle seizure or syncope Exercise chest pain or SOB Sudden, unexpected, unexplained death before age 50 years Family history known genetic CM, channelopathy We talk about what warning signs look like Seizure activity schools are familiar with seizures We emphasize SCA until proven otherwise

Circulation. 2008;117:704-709 “In places where widespread first responder CPR training has been provided (e.g. as part of community lay rescuer AED programs), survival rates from witnessed SCA associated with ventricular fibrillation have been reported to be as high as 49% to 74%%.” N Engl J Med. 2002;347:1242-1247 N Engl J Med. 2000;343:1206-1209

Circulation. 2008;117:704-709 3 important concepts High-quality CPR is an important determinant of survival from SCA More victims of out-of-hospital SCA should receive bystander CPR CPR must be performed effectively by bystanders and healthcare providers

Basic Life Support Identify the emergency Calling 911 or Internal First Responders Early High Quality CPR Publicly available AED Advance care and transport Post arrest care Consider reworking slide but keeping concept Heart Attack S/S Adult female/male SCA Child seizure like activity Who knows where the nearest AED is?

Primary Focus Schools have 20% of the Countries population during school days, AL- coaches are usually parents who get off work @ 3 or 4, may have little or no training CC Boys and Girls clubs Metro Atlanta have 150-450 kids/day

CPR

CPR is inherently inefficient; it provides only10% to 30% of normal blood flow to the heart and 30% to 40% of normal blood flow to the brain even when delivered according to guidelines. This inefficiency highlights the need for trained rescuers to deliver the highest quality CPR possible. Circulation. 2013;128:417-435

High Quality CPR

AED

You show the public and AED – first picture But all they see is electricity – second picture

Then you open it And all they see is the inside of a cockpit – VERY complicated

Early defibrillation matters

EAP

Venue Still working on design Equipment Do you have an AED How many Accessibility Budget for replacement pads & batteries Buildings Building Names Doors – keys or access codes Elevators or stairs EMS Access Points Construction Locked gates Still working on design County lines, cell towers full? Mention concerts/sporting events, Atlanta’s big Chicken, is their construction between venue and EMS-secondary route Can you get a shock off in less than 3 minutes??? Closer to 1

382,800 people ~ 38,000 survivors Overall Survival Less than 6% outside the hospital Almost ZERO if not treated in 10 minutes A half a million people. Equilivent to all of the attendees of the 2014 & 15 Daytona 500 An estimated 382,800 people experience sudden cardiac arrest in the United States each year. Approximately 92% of those who experience sudden cardiac arrest do not survive.

~245,005 survivors

How successful is Project S.A.V.E.? Over 1200 Schools and Community Centers 72 Lives Saved 36 Children 36 Adults 2 School Nurses

CPR & AEDs Work QUESTIONS?