IHCA

Reportable Disease?

Critical Care Canada Forum 2014

Laurie Morrison, Li Ka Shing Knowledge Institute, St

Michael’s Hospital, University of Toronto
 COI Declaration
NIH and CIHR support

Industry
Device contributors to ROC

ALS TF, ILCOR

AHA ECC Guidelines
Saving lives through Science, Innovation and Collaboration
OHCA Network and SPARC Network

Chain of Survival

From 911 back to the

Community
IHCA Partners at St Mikes
SMH IHCA – Scope of Work

Chain of Survival
CODE Blue First Responders CODE Team ICU Team

From CODE Blue to Discharge

 IHCA – Scope of Work

SYSTEM Chain of Survival

CODE Blue First Responders CODE Team ICU Team

DNR
Status

ED Arrest…………………………………………………………….ICU Team

From Arrival to Discharge

PMID: 23479672
Counting IHCA

Incidence

• 41 hospitals >1 million admissions

• 3.7 per 1000 adult non ICU

– 65% of arrests outside ICU
• 6.7 per 1000 adult hospital wide

• 3.3 million admissions a year in Canada US data

Chan 2010
Get with the Guidelines
• Burden is 22,000 IHCA a year in Canada
PMID: 20065195
Surviving IHCA

Probability of Survival after IHCA

PMID: 18936907
Do we trust these rates?
 How to Count IHCAs

All Admitted Patients*

A

Treated for Patients with DNAR status

Cardiac Arrest prior to Cardiac Arrest ^
C
B Rate Calculations
Incidence B
A
No ROSC
Resuscitation ROSC Survival D
Terminated B

Survived to Discharge DNAR Rates C

Died in Hospital A
D
 How to Count ED IHCAs

All ED Patients*
A

Treated for Patients with DNAR status

Cardiac Arrest prior to Cardiac Arrest ^
C
B
Rate Calculations
Incidence B
No ROSC A
Resuscitation ROSC
Survival D
Terminated
B

Survived to Discharge Died in ED or in DNAR Rates C

D Hospital A
How comfortable are we with the data?
New Defibb Toys
CPR Process

Real Time Feedback

CPR Process – Intubation Pauses

30 sec CPR
Interruption

ETCO2
Signal

ET Tube
Placement
CPR
CPR Process
Process –
– Hospital Feedback
EMS Service Feedback
Survival Rates – Out-of-Hospital Cardiac Arrest* in Epistry at Rescu
(City of Toronto)
%
40
35.8
35
29.4
30 26.9
24.4 24.4
25
20.3
18.6
20 16.8

15

10

0
2006 2007 2008 2009 2010 2011 2012 2013 Year

Alive to discharge
* : EMS treated, Adult, No obvious cause, Bystander witnessed, VF/VT/Shockable rhythm
 SMH IHCA Team

Paul Dorian
Dana Edelson
Univ of Chicago

Natalie Wong - Lead

Katie Allen Phd (c)

Matt Common MSc (c)
 IHCA

SYSTEM Chain of Survival

CODE Blue First Responders CODE Team ICU Team

DNR
Status

ED Arrest…………………………………………………………….ICU Team

From Arrival to Discharge

 IHCA

SYSTEM Chain of Survival

CODE Blue First Responders CODE Team ICU Team

DNR
status

ED Arrest…………………………………………………………….ICU Team

From Arrival to Discharge

 IHCA

SYSTEM Chain of Survival

CODE Blue First Responders CODE Team ICU Team

DNR
status

ED Arrest…………………………………………………………….ICU Team

From Arrival to Discharge

Defibrillator Display Real-Time

 See-Thru CPR

 CPR Feedback

 ETCO2 Monitoring

 Data Collection & Storage & Upload

Data Types
The defibrillator records important device and event data

 Full Disclosure Recording:

Full ECG
CPR quality data
Shocks
ET CO2 Capnography waveform data

 Incident Log:
Log of every button push (max 1000) for every drug or procedure
Data Transfer to Computer or Hand Held
Defib Upload Service

 Windows Server 2003, 32bit

platform

 Service: “pick-up and point”

 Specified network folder

Full Disclosure File
Full Disclosure File con’t
SMH Code Blue/Cardiac Arrest Registry
4. Daily Hospital Wide Crash Cart Checklist
First Responder Training
Random Mock Codes on
the Wards
Holy Crap Rounds
Added
ETco 2
Monitoring
a work in progress.
Reporting IHCA
…the reality