Sometimes breaking off the rear view mirror and starting down a new path is the way to go. That’s what Daniel Davis, MD, advocates when it comes to improving survival of cardiac arrest patients, preventing events and enabling better neurological outcomes. A unique resuscitative training program at the University of California San Diego (UCSD) has helped increase the survival rate of cardiac arrest to 47 percent—more than triple the national average—as well as decreasing the overall incidence of arrests through surveillance and a rapid response team.
“Everyone recognizes that [resuscitative care] has been a frustrating piece of medicine for a long time,” says Davis, who is the resuscitation director at UCSD and director of the UCSD Center for Resuscitation Science. “Outcomes have not improved consistently, or really at all.”
Resuscitative care is as much an art as a science. Training is key for both. That’s where Davis comes in—an emergency medicine physician, researcher and evangelist who preaches that training methods need to be changed to improve patient outcomes. “There are patients dying who shouldn’t be,” says Davis, who also is medical director for a half-dozen air medical bases in Southern California. “There is a solution that can save a lot of lives, people just need to use it.”
Davis led the change at UCSD in 2007 when they instituted a set of training programs called Advanced Resuscitation Training (ART) and Basic Resuscitation Training (BART). This new resuscitation strategy comes in the form of a template that depends on uninterrupted compressions, frequent training, excellent teamwork and highly intuitive user interfaces with technologies that enable split-second decision-making. Fast work and fast thinking are bringing excellent results. In addition to UCSD increasing the survival rate of cardiac arrest to 47 percent, they simultaneously reduced the rate of cardiac arrests by 50 percent. Training has worked across town, too, at the VA Medical Center where cardiac arrest survival has increased to 44 percent, which is almost three times the national average. Similarly, since implementing the training program in November 2012, the Oxnard, Calif., fire department saw cardiac arrest survival rates increase 50 percent, posting some of the highest survival rates in the world. Several one-day primer training courses for air medical crews across the West and Midwest have shown immediate results with survival for arrest victims more than doubling. As further testament to success, UCSD began expanding the training program to other University of California campuses on July 1st.
ART’s mission is to “prevent the preventable, resuscitate the resuscitatable and recognize the futile.” It includes high-quality CPR: Stay on the chest. Do continuous chest compressions. Do not break compressions to ventilate. Push hard. Push deep. Make sure there is good chest recoil. Many studies demonstrate a correlation between deep compressions with good recoil and survival, likely by increasing perfusion pressure.
The resuscitation program facilitates the integration of intuitive technology into clinical practice, specifically ZOLL equipment with software that displays the depth and rate of the compressions and provides filtered EKGs. The filtered EKG allows the care team to see the patient’s underlying rhythm as they do compressions because the artifacts are filtered out. The necessary pauses to confirm a rhythm or check a pulse are thus shorter.
Access to that critical data is essential to effective treatment, Davis says. “I say you have 1.7 seconds to look at a display that includes over 20 data points and gather all the information that you need. The user interface is so key to resuscitation success. We need the essential information in a highly viewable form.”
Clinician training focuses on a core principle: the prevention of interruptions in compressions at all costs. Compressions should be performed from the moment the arrest begins until return of spontaneous circulation (ROSC) is confirmed. Technology is essential to monitoring compressions and patient response and providing resuscitation metrics to identify needed performance improvement during the code. Reviewing the metrics is an effective way to assist better training for future codes.
The clinical staff of UCSD all receive training from a set of in-house instructors who are consistent in message and method. Staffers take a four-hour class once a year and participate