Feature: Midwest cardiac arrest care model may save lives, money

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Hypothermia therapy is a class II indication for post-cardiac arrest patients and is recommended by the American Heart Association. Yet, U.S. hospitals are slow to adopt its routine use, says Scott Pham, MD, an electrophysiologist and chief of cardiology for Sanford USD Medical Center in Sioux Falls, S.D.

"Unfortunately, the cost of hypothermia therapy is high and most hospitals can't afford it because there is no reimbursement for it," Pham told Cardiovascular Business News.

Pham and colleagues have been utilizing therapeutic hypothermia (Arctic Sun, Medivance) for about four years. The first system cost about $250,000. They have since purchased two more systems, as neurosurgeons also make use of the technology.

The theory is that once the heart starts to pump again following a cardiac arrest, the metabolic cascade, which feeds the brain valuable oxygen and nutrients, also delivers a toxic amount of free radicals. Cooling the body to about 32 degrees Celsius helps to slow the delivery of toxins and results in better neurological outcomes for patients.

Such systems, which continuously pump water through blankets that are wrapped around the legs and trunk, can lower or raise the body's core temperature.

The cooling therapy, however, is merely one aspect of sudden cardiac arrest care that Sanford USD employs as a level I cardiac arrest center. The concept is similar to a level I trauma center where hospitals specialize in offering the best care and try to achieve the best outcomes. The concept of the level I cardiac arrest center is part of the Take Heart America initiative started by a few hospitals in the Midwest.

The initiative involves reaching out into the community, supplying community organizations such as churches and schools with automated external defibrillators (AEDs), training people how to use AEDs, ensuring they know how to maintain their AEDs and training people how to effectively perform CPR.

"We have paramedics, nurses and professionals who volunteer teach CPR and work closely with the hospital to get AEDs installed in the community. Effective CPR and early defibrillation are key to survival," Pham said. "Studies have shown that public awareness of resuscitation can increase survival our out-of-hospital sudden cardiac arrest from 5 percent, the current national average, to 15 and 20 percent."

It's a team effort, Pham said. The community has to embrace the idea and it needs financial support to equip local organizations with AEDs.

Cost-effective care
Keith G. Lurie, MD, a staff cardiologist at St. Cloud Hospital in Minneapolis and co-founder of the Take Heart America initiative, and colleagues reported about their experience with the first level I cardiac arrest center at St. Cloud at AHA.09. The specialized care – which includes hypothermia, 24/7 PCI, critical care management and specialized electrophysiological treatment – resulted in a greater than average number of survivors and was found to be cost effective.

In the study, only one-third of the historical controls survived to discharge (11/33), whereas 54 out of 104 patients survived under the Take Heart America initiative. During the intervention year, 70 percent of admitted patients were treated with therapeutic hypothermia.

The revenues associated with billing for 69 patients treated with hypothermia averaged $57,783 per patient who survived to hospital discharge with a direct margin after direct costs of $20,684 per patient. The direct revenue and margins for those who expired in the hospital were $12,014 and $3,329, respectively, according to the study.

Lurie et al said it's important to treat patients aggressively after cardiac arrest because studies have demonstrated that despite a 60 percent 24-hour survival rate for patients treated with active compression-decompression CPR and an impedance threshold device, most patients died before hospital discharge.