CPR and AEDs in Schools Why not everyone? Why not everywhere? How to Implement a CPR and AED Training Program in My School/College/University: and Innovations Like How To Stop the Zombie Apocalypse

Speakers Stu Berger, MD Jeff Ranous, PhD, ATC, NREMT Professor and Vice Chair of Pediatrics; Chief of Pediatric Cardiology; Director Project ADAM - UC Davis Jeff Ranous, PhD, ATC, NREMT Director State and Community Advocacy AHA Ed Stapleton, EMT-P Program Committee Chair ECCU; Stony Brook University Irfin Asif, MD Vice Chair Academics and Research, Director Sports Medicine Fellowship, University of South Carolina Jennifer Edwards, BA Director of Operations, ACT Foundation of Canada

Speakers Stu Berger (8 minutes) Jeff Ranous (8 minutes) Introduction, review of 4 recent important studies and a call to arms Jeff Ranous (8 minutes) Maps, states, legislation, barriers; are we at the “tipping point” for all 50 states Ed Stapleton (8 minutes) The New York school experience Irf Asif (8 minutes) The college/university level; barriers and keys to success Jennifer Edwards (8 minutes) The Zombie Apocalypse, mass training and assorted strategies Stu Berger (2 minutes) Summary

RECENT AHA DATA 1.6 million high school students will have been trained in CPR-AED use this year 27 states with legislation thus far with for mandatory CPR education Goal for training high school students in CPR-AED use for next year is 2.5 million

Some very recent and important studies JAMA – 2 studies on CPR education Japanese study North Carolina JAHA CARES registry review of OHCA survival in children NEJM Early CPR in OHCA

Japanese Study Nakahara JAMA 2015 167,912 bystander-witnessed OHCAs of presumed cardiac origin 2005-2007 Japanese National OHCA registry Evaluated: Incidence of bystander pre-hospital intervention Neurologically intact survival at 1 month or at discharge

Japanese Study Nakahara JAMA 2015 The age-adjusted proportion of neurologically intact survival increased over time from 3.3% to 8.2% Still not great, but better WHY THE IMPROVEMENT?

Japanese Study Nakahara JAMA 2015 DURING THIS STUDY PERIOD The rates of bystander CPR increased from 38.6% to 50.9% The rate of bystander-only CPR increased from 0.1% to 2.3% The rate of combined bystander plus EMS defibrillation increased from 0.1% to 1.4% EMS ONLY defibrillation decreased from 26.6% to 23.5%

North Carolina Study Hansen JAMA 2015 Examined the temporal changes in resuscitation performed by bystanders and first responders FOLLOWING STATE-WIDE INITIATIVES to improve resuscitation efforts in North Carolina between 2010-2013 4,961 patients with OHCA in the CARES registry from 2010 to 2013

North Carolina Study Hansen JAMA 2015 Initiatives Train members of the general population in CPR and in the use of AEDs Train first responders in team-based CPR including AED use and high performance CPR Train dispatch centers to recognize cardiac arrest

North Carolina Study Hansen JAMA 2015 The administration of bystander CPR and first responder defibrillation in combination increased from 14.1% in 2010 to 23.1% in 2013 (p <.01) Survival with favorable neurologic outcome increased from 7.1% in 2010 to 9.7% in 2013 and was favorably associated with bystander initiated CPR (p = .02)

North Carolina Study Hansen JAMA 2015 Compared with survival following EMS-initiated CPR and defibrillation (15.2%), survival following bystander-initiated CPR and defibrillation (33.6%), survival following bystander CPR and first responder defibrillation (24.2%) and survival following first responder CPR and defibrillation (25.2%) WERE HIGHER

JAHA 2015 Jayaram, McNally, et al. Survival After Out-of-Hospital Cardiac Arrest in Children Prospective CARES registry Children < 18 years old from October 2005 to December 2013 Assessed survival to hospital discharge by age, sex and race Infants 0 to 1 year Younger children 2-7 years of age Older children 8-12 years of age Teenagers 13-17 years of age

JAHA 2015 Jayaram, McNally, et al. Additionally assessed whether survival improved over 3 time periods 2005-2007 2008-2010 2011 1980 children with OHCA 429 (21.7%) infants 952 (48.1%) younger children 276 (13.9%) older children 323 (16.3%) teenagers

JAHA 2015 Jayaram, McNally, et al. OVERALL 162 (8.2%) children survived to hospital discharge Infants and younger children were less likely to survive compared with teenagers There were no differences in survival by sex or race There were NO temporal trends in survival across the study periods – SURVIVAL RATES HAVE NOT INCREASED IN RECENT YEARS

NEJM Early CPR in OHCA – June 2015; Swedish Study Three million people in Sweden are trained in CPR Does this increase the frequency of bystander CPR? Does it increase survival? Analysis of 30,381 OHCAs from January 1990 to December 2011 to answer these questions

NEJM Early CPR in OHCA – June 2015; Swedish Study Performed before the arrival of EMS = 15,512 (51.1%) NOT performed before the arrival of EMS = 14,869 (48.9%) 30-day survival rate When CPR performed before EMS arrival 10.5% When NOT performed before EMS arrival 4.0% p<0.0001

NEJM Early CPR in OHCA – June 2015; Swedish Study Conclusions from the Swedish study CPR performed before EMS arrival resulted in a 30-day survival rate after OHCA that was more than twice as high as survival associated with no CPR before EMS arrival

HOW MIGHT THESE STUDIES INFLUENCE AND DRIVE US TO DO BETTER?

IS IT POSSIBLE FOR EVERY PERSON IN THE UNITED STATES TO LEARN CPR AND TO USE AN AED? AND TO SUBSEQUENTLY BE WILLING AND ABLE TO INTERVENE IN THE EVENT OF A CARDIAC ARREST?

AND BY SO DOING CAN WE DO BETTER WITH THE OUTCOMES FOR OHCA SURVIVAL? 8.2% for children in the JAHA study

Yes, yes and yes And by so doing WE CAN MAKE A DIFFERENCE Let’s begin to hear how others have done it!!!!!

AND THEN OF COURSE… LET’S JUST DO IT!!!!!

GOAL: 100% of all high school students in the United States SHOULD LEARN CPR-AED USE PRIOR TO GRADUATION

Jeff Ranous

Ed Stapleton

The New York Experience 1980s Key Question How do we train a sufficient number of rescuers for a population of 8 million people?

1986 “CPR: It’s About Time”