1. 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

3. 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

4. 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

5. 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

6. 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

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

8. 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?

9. 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%

10. 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
4,961 patients with OHCA in the CARES registry from 2010 to 2013

11. 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

12. 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)

13. 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

14. 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 to 1 year
Younger children 2-7 years of age
Older children years of age
Teenagers years of age

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

16. 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

17. 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

18. 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

19. 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

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

21. 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?

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

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

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

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

26. Jeff Ranous

28. Ed Stapleton

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

30. 1986
“CPR: It’s About Time”