Our Mission
50.1% neurologically intact survival by 2030
Our mission as a SMART objective:
- Specific: Survival from all initial rhythms in out-of-hospital cardiac arrest, measured in at least 1 ACR agency
- Measurable: 50.1% or greater neurologically intact (CPC 1 or 2) survival from out-of-hospital cardiac arrest
- Achievable: using the latest tools, technology, training, and teamwork
- Realistic: 7% to 50% ? Well, that's why it's called the moonshot...
- Time Frame: by 12/31/2030
SCIENCE behind STRATEGIES
Cardiac Arrest Care... Then and Now
Attempts to revive the dead date back centuries. Unfortunately, most antiquated techniques weren't only barbaric and harmful, they also weren't successful in producing a meaningful recovery from cardiac arrest. Fast-forward nearly hundreds of years and survival of out-of-hospital cardiac arrest remains incredibly poor. Under the current treatment guidelines, people have less than 10% change of surviving cardiac arrest without devastating physical or cognitive deficits. This has not changed much in 50 years. Using the latest technology and developing integrated strategies from peer reviewed publications, the ACR seeks to improve neurologically intact survival of out-of-hospital cardiac arrest.
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Automated CPR
Automated or mechanical cardiopulmonary resuscitation (mCPR) provides continuous and uniform compressions. Manual CPR is more susceptible to human error, variability, and fatigue. mCPR can deliver more consistent high-quality CPR with less variability. mCPR has been found to have similar outcomes to manual high-quality CPR while reducing stress on care teams.
However, all cardiac arrest management should begin with immediate high-quality manual CPR until a mechanical CPR device can be safely and appropriately deployed.
For additional information on mCPR, click here.
Intrathoracic Pressure Regulation
Intrathoracic Pressure Regulation (IPR) using an Impedance Threshold Device (ITD) provides multiple benefits in cardiac arrest management. IPR lowers intrathoracic pressure and intracranial pressure. IPR increases cardiac preload while improving cerebral and systemic circulation. We utilize IPR to improve cerebral perfusion in patients receiving chest compressions and artificial ventilation.
Expanded use of waveform Capnography (ETCO2)
ETCO2 allows us to measure perfusion during cardiac arrest in real-time. We use ETCO2 to determine appropriate timing of other interventions during cardiac arrest. Low ETCO2 levels are strongly associated with low probability of ROSC and favorable neurological outcome.
Clinically Appropriate Defibrillation
Defibrillation is not a benign process, so we prefer to shock a patient once, when it will be most effective. Published data supports defibrillating when ETCO2 values indicate better perfusion, suggesting the heart is more receptive to the electricity after a period of resuscitation. We still advocate for immediate defibrillation for witnessed arrests with HQ-CPR initiated immediately after arrest.
Clinically Appropriate Epinephrine
Tradition is the enemy of progress. For decades, epinephrine has been the most commonly used medication in cardiac arrest. However, the use of epinephrine in cardiac arrest has never been supported by rigorous scientific data. Epinephrine may be associated with higher rates of short-term survival (ROSC at ED or hospital admission), but, more importantly, decreased neurologically intact survival. EMS protocols dictating epinephrine administration in cardiac arrest vary widely. Recent studies have cast doubt on the universal use of epinephrine in cardiac arrest. Delaying, minimizing, or even avoiding epinephrine may be beneficial in out-of-hospital sudden cardiac arrest patients.
Community Partnerships
We can't fight this war alone. While the care provided by EMS clinicians is critically important, and the most apparent to the public, patient outcomes are heavily dependent many other aspects of the community. From early recognition of cardiac arrest to rehabilitation care, survival of out-of-hospital cardiac arrest is vulnerable to a weak link anywhere along the "chain of survival." Within ACR, we strive to improve these aspects of our community response with as much vigor as teaching excellent on-scene care. Early bystander recognition of cardiac arrest, immediate hands-only CPR, dispatch-guided CPR (tCPR), access to and training on AEDs, early bystander defibrillation, rapid EMS response, well-equipped Emergency Departments, and excellent ICU care must all come together to achieve neurologically-intact survival. Through partnerships with other organizations, we can help provide tools, strategies, and examples to improve these components in communities around the world.
Overall Bundle of Care
By combining all of the concepts above, we can improve how we respond to and treat OHCA. It is time we move the needle forward and improve our management of OCHA. Many agencies are still treating OCHA today the same way they did in 1990, with (not surprisingly), the same survival rates. We should embrace the new evidence and technology that allows us to respond to OCHA in a more systematic and scientifically-advanced manner.
Data Collection and Early Results
ACR works closely with all participating agencies to collect OHCA outcome data. We plan to develop research studies and publish results to add to the body of evidence that already supports the above concepts.
