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Focus on Rural Health

Collaborating to Improve Cardiac Care

Evaluating a lifesaving device leads to a cooperative effort to review statewide cardiac care.

By Nikki Massmann on

LUCAS Staff Photo
Members of the Center for Rural Health's cardiac-care systems evaluation team are, left to right, Karin Becker, Carmen Cryer, Dustin Dalbey, Eric Souvannasacd, Makenzie McPherson, and Ralph Renger.

CPR is an initialism most people recognize. It stands for cardiopulmonary resuscitation, which when performed efficiently, saves lives of those suffering a cardiac arrest. Many people are trained in CPR, but few know how to effectively use it. Performing CPR is physically intense and can be emotionally draining, even for professional emergency medical personnel, who are well trained in doing so. The effectiveness of CPR drops quickly, even after only a minute.

A relatively new medical device, known as a LUCAS® 2 Chest Compression System (LUCAS® 2), is changing how CPR is administered. The LUCAS® 2 is a mechanical CPR device that delivers automated and consistent chest compressions for a patient suffering cardiac arrest. The device is lightweight and portable and can be applied in less than a minute. LUCAS stands for Lund University Cardiopulmonary Assist System.

In October of 2013, the state health departments of North Dakota and South Dakota received grants of just over $7 million to provide LUCAS® 2 devices to more than 400 ambulances and hospitals across the two states. The grant, provided by the Leona M. and Harry B. Helmsley Charitable Trust, represents the most expansive use of the new technology in the nation.

Once the LUCAS® 2 devices were in place in North Dakota, the state health department's Division of Emergency Medical Services and Trauma (DEMST) was in need of an evaluation of the effectiveness of the devices on patient outcomes. They wanted to know how often the devices were used, when they were used, and the outcomes for those patients receiving CPR from the LUCAS® 2. Having a history of working with the Center for Rural Health (CRH) at the University of North Dakota School of Medicine & Health Sciences, the DEMST approached the CRH with the need for evaluation and the idea to work together.

Ralph Renger, PhD, a professor at the CRH, has over 17 years of experience in the evaluation field. He approached the evaluation of the use of the LUCAS® 2 device in the state as not just an evaluation of the device but as an assessment of the entire cardiac care system within North Dakota.

"The LUCAS® 2 device is an important piece of the way we care for patients with cardiac arrest," said Renger. "With cardiac arrest, time is of the essence. The LUCAS® 2 device works quickly and allows emergency personnel to provide other types of needed care for a cardiac-arrest patient, such as administering IV medications. It's one factor in the big picture."

That "big picture" is a statewide system of care for cardiac-arrest patients. The system has many elements, particularly in rural areas. In a large city, residents may be only a few minutes from the nearest ambulance and emergency room, and their hospital is likely equipped to treat a cardiac patient. But in rural North Dakota, a cardiac-arrest patient may be transferred from one ambulance to another and from one hospital to another.

In order to fully understand the system and engage healthcare professionals in the evaluation process, Renger and the CRH evaluation team began meeting with emergency medical professionals and hospital staff in rural communities throughout the state to create process flow maps (PFMs). The PFMs provide a visual representation of how all parts of the system affect each other. Creating the PFMs is a collaborative effort and requires commitment and input from all organizations involved in treating a cardiac-arrest patient, from dispatchers to rescue personnel to hospital staff. The goal is to create a synthesized PFM for longterm use so that the North Dakota Department of Health can continually evaluate and improve the statewide system. The project has quickly expanded to include South Dakota as well.

"The health departments in North and South Dakota are working together on their statewide cardiac systems of care."

"The health departments in North and South Dakota are working together on their statewide cardiac systems of care," said Renger. "All of the leadership meetings for this project are held together with both states. The decision-making is done collaboratively. The states have slightly different systems in place to deal with cardiac arrest, and they are learning from each other. It's an efficient way to make decisions, and is truly cooperation at its best."

Collaboration has been a key factor in evaluating and improving the cardiac systems of care in both states. In North Dakota, evaluating the system led several communities, hospitals, and health organizations to coordinate a simulated cardiac-arrest training drill.

"The training drill was very successful and served several purposes," said Renger. "Emergency personnel, dispatchers, and hospital staff received real-time training on treating a patient with cardiac arrest. The drill also informed the evaluation process on the steps involved and helped create the PFM. When we evaluate the system, we're not there to drive the question. It's important that the input comes from those actually doing the work—performing the CPR, administering medications, saving lives. It couldn't have happened if the health systems involved hadn't collaborated so willingly."

While the evaluation project is funded by a three-year grant, the outcomes will be self-sustaining. All of the pieces will be in place for the North Dakota Department of Health to monitor its statewide cardiac system of care and understand where it can make improvements.

"The bottom line is that everyone involved has the same goal: to save more lives," said Renger. "Every element that is improved upon within the cardiac system of care can lead to one more cardiac patient having a positive outcome."

While the CRH has conducted a number of program evaluations over its 34-year history, the recruitment of Renger and the efforts underway for the LUCAS® 2 mechanical CPR device represent a significant step forward for the CRH.

"It has been a goal of the Center for Rural Health to develop a full-scale program evaluation division to work alongside our other divisions that focus on community development and engagement, Native American health, health workforce, policy, research, and information dissemination," said Brad Gibbens, deputy director, of the CRH. "The Helmsley Charitable Trust and our partners at DEMST have provided the CRH with the necessary resources to fast-track this development. Ultimately this helps to support the CRH in its efforts to improve health for North Dakotans and others."

The CRH's evaluation team and the UND Television Center developed a video regarding use of the LUCAS® 2 device in North Dakota. The video is featured on the Leona M. and Harry B. Helmsley Charitable Trust website: http://helmsleytrust.org/case-studies/lifesaving-cpr-technology-cardiac-arrest-patients.

This article originally appeared in the Fall 2014 issue of North Dakota Medicine.

Nikki Massmann Nikki Massmann is the Director of Communications at the Energy and Environmental Research Center (EERC). Prior to her position at the EERC, she served as Communication Coordinator at the Center for Rural Health at the University of North Dakota's School of Medicine & Health Sciences.