AHA Response to
The Institute of Medicine Cardiac Arrest Report
Clifton Callaway, MD, PhD
Chair, AHA ECC Committee
Conflicts of Interest
Employed – UPMC Health System, University of Pittsburgh
Grants – NHLBI, NINDS
What is ECC?
3CPR
3CPR and ECC
AHA Board of
Directors
Science Advisory & Coordinating
Committee (SACC)
Manuscript
Oversight
Committee
ECC Committee
Council (3CPR)
Science
Education
Science and
Programs
Task Forces
Writing Groups
Systems
of Care
Pediatric
Forum
3CPR and ECC
AHA Board of
Directors
Science Advisory & Coordinating
Committee (SACC)
ECC Committee
Council (3CPR)
Science
Education
Science and
Programs
Systems
of Care
Extended ECC Volunteer
Network
Manuscript
Oversight
Committee
What Does ECC Do?
• International resuscitation science
consensus
• Guidelines & Statements
• Education & Training Content
• Public Awareness
• Collaboration with Advocacy
• Collaboration with QI
• International Training
• Strategic Alliance with Laerdal
Institute of Medicine Report
Institute of Medicine Consensus Study
• Treatment of Cardiac Arrest: Current Status & Future Directions
–
–
–
–
–
CPR and use of AEDs
EMS and hospital resuscitation systems of care
National cardiac arrest statistics
The state of resuscitation research in the US
Next steps to significantly enhance survival rates from cardiac arrest
• Public meetings held March, June and August 2014
• Final report published June 30, 2015
• Study sponsors: AHA, Red Cross, NHLBI, CDC, ACC
Introduction
– The full lifesaving potential of an optimized system of care remains
elusive in most communities.
– There are striking disparities in cardiac arrest survival, with some
systems of care reporting a 5-fold difference survival.
Nichol 2008, ROC Data
Call to Action
• To truly save as many lives as possible it will take additional
novel and innovative approaches to improve outcomes
• Intense commitment, dedication and collaboration of countless
stakeholders and partners at a national, state and local level.
– The successful development and implementation of solutions requires
action by collaborators, partners and stakeholders.
• Implementation and measuring outcomes have historically
been difficult
– Needs and gaps, such as politics, resources, leadership engagement,
differ between communities and location.
IOMSupports
Strategies for
Improving
Cardiac Arrest
AHA
IOM
Recommendations
Survival
Recommendation 1
Recommendation 2
Recommendation 3
Recommendation 4
Recommendation 5
Recommendation 6
Recommendation 7
Recommendation 8
Establish a National Cardiac Arrest Registry
Foster a Culture of Action Through Public
Awareness and Training
Enhance the Capabilities and Performance of
Emergency Medical Services (EMS) Systems
Set National Accreditation Standards Related to
Cardiac Arrest for Hospitals & Health Care Systems
Adopt Continuous Quality Improvement Programs
Accelerate Research on Pathophysiology, New
Therapies, and Translation of Science for Cardiac
Arrest
Accelerate Research on the Evaluation and
Adoption of Cardiac Arrest Therapies
Create a National Cardiac Arrest Collaborative
AHA Supports IOM Recommendations
AHA Commitments
to Increase
AHA Response
to IOM Cardiac
CardiacArrest
Arrest ReportSurvival
Recommendations
Provide funding to catalyze data interoperability. The AHA will provide
up to $5 million over 5 years to incentivize and catalyze resuscitation
Commitment 1 data interoperability of existing and novel data sources into the AHA
EMS Registry.
Actively pursue philanthropic support for local and regional
Commitment 2 implementation opportunities to increase survival by improving OHCA
& IHCA systems of care.
Actively pursue philanthropic support to launch an AHA Resuscitation
Commitment 3 Research Network.
Cosponsor a “National Cardiac Arrest Summit” to facilitate the
Commitment 4 creation of a national cardiac arrest collaborative that will unify the
field and identify common goals to improve survival.
IOM Recommendations and AHA Response
Data
Data We Have
• AHA Databases
– GWTG-R



IHCA
some OHCA
Rapid Response Teams
– Mission LifeLine - Action
Registry (with ACC)

STEMI, some EMS
– Guideline Advantage

Outpatient cardiology and
preventitive care
• CARES

EMS data for OHCA
http://www.heart.org/HEARTORG/HealthcareResearch/
GetWithTheGuidelines-Resuscitation
http://www.heart.org/HEARTORG/HealthcareResearch/
GetWithTheGuidelines-Resuscitation
GWTG - Resuscitation
279 Hospitals
-> 5% of all 5700 hospitals in US
203 Hospitals (> 200 beds)
-> 15% of 1388 US hospitals (>200 beds)
http://www.heart.org/HEARTORG/HealthcareRe
search/MissionLifelineHomePage
http://www.heart.org/HEARTORG/HealthcareRe
search/MissionLifelineHomePage
http://www.heart.org/HEARTORG/HealthcareRe
search/MissionLifelineHomePage
Mission LifeLine / Action Registry
1010 hospitals
-> 50% STEMI, NSTEMI
https:// mycares.net
https:// mycares.net
CARES – Prehospital Database
~ 45,000 OHCA / year
~ 800 EMS agencies
~ 1700 Hospitals
-> 25% OHCA
What we can do…
• Get your local EMS agencies into CARES
(https:// mycares.net)
• Get your local hospital into GWTG-R or
Mission Life Line Action Registry
– Report the “optional” out-of-hospital arrests in
the GWTG data
• Advocate for mandatory national data
warehouse…
What we can do…
• AHA will explore “interoperability” with
major electronic health record vendors
– Quintiles is a company that specializes in this
for GWTG for AHA
– QCOR has special expertise
– Hackathon?
• Council of State and Territorial
Epidemiologists
– Talk to your local Department of Health
IOM Recommendations and AHA Response
These activities are what AHA does…
Guidelines, teach, promote awareness
Resuscitation Evidence Review
AHA ECC Products
•
•
•
•
•
•
CPR Anytime series
Family & Friends CPR
Heartsaver series
CPR in Schools
RQI
Healthcare Professional: BLS, ACLS, PALS, HeartCode
Educational Science and Programs Metrics:
• # trained in ECC content / year
• # trained with real-time CPR quality feedback
• # enrolled in continuous training
IOM Recommendations and AHA Response
Help Increase Funding
Science - Increase CA grants
February submissions 2015:
47 submissions
• Basic = 28
Clinical + Pop = 19
• Basic 18% (5) success rate
• Clinical 16% (3) success rate
June submissions 2015:
23 submissions
• Basic = 10
• Clinical/Pop = 13
• 17% success (4 funded)
January Submissions 2016:
26 submissions
• Basic = 14
• Clinical/Pop: 12+2 =14
June submissions 2016:
• Basic = 14
• Clinical + Pop:15+3 =18
32 submissions
Metrics: NIH PI’s
• # of NIH–funded cardiac arrest Pis
• Goal: doubling by 2020 Data Source: NIH
Reporter
NIH-Funded Cardiac Arrest Grants and Investigators
160
140
Actively Funded CA Grants
Number
120
Actively Funded CA Investigators
100
80
60
40
20
20 additional cardiac arrest PIs needed
each year to reach 2020 goal
0
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
Funding Year
$54
2015 NIH Investment for Leading Causes of Death
Diabetes
Kidney Disease
NIH investment in
stroke research is
~$2,200 per death
(288 M)
Cancer
Influenza & Pneumonia
Alzheimers
Accidents
NIH investment in heart
disease research is
~$2,100 per death
(1,262 M)
Chronic Lower Respiratory Diseases
(COPD + Asthma)
Stroke
NIH investment in cardiac
arrest research is ~$81
per death ~$54
(41 M)
Heart Disease
Suicide
Cardiac Arrest
0
2000
4000
6000
8000
10000
12000
NIH Dollars Invested per Annual Death
Funding Year
14000
What we can do…
• Submit Grants
• Lobby for Research Funding
– Join You’re the Cure:

Advocacy for NIH Funding!
• Help local investigators
– Stakeholder involvement is major focus of
PCORI and some other new funding initiatives
– Communities should drive research
– Educational / training research needed
IOM Recommendations and AHA Response
IOM Workshop
• July 11-12, 2016, IOM hosted a cardiac arrest workshop to
follow-on the IOM Cardiac Arrest Report.
• ~120 subject matter experts and stakeholders developed
blueprints to address each of the 8 IOM recommendation
• Stakeholders are meeting now separately to advance the
recommendations….
– Form a “Collaborative
– Create a culture of action
IOM Workshop
• Form a “Collaborative”
IOM Workshop
• Create a “Culture of Action”
– Do not say “Bystander” anymore… Say “Layperson
Rescuer”
– Share your skills
http://www.pulsepoint.org/download/
Are YOU Missing?
• Join ECC –
– Send an email to Veronica Zamora (National AHA)
– [email protected]
• Join You’re the Cure
– https:// yourethecure.org
• Join AHA
– http://my.americanheart.org
– And pick the “3CPR Council” as your home council
• Send stories
– https:// www.becprsmart.org