seattle: too good to be true the pearl study...the gordon a. ewy, md distinguished endowed chair of...

The PEARL Study:

A Randomized Clinical Trial of Early Coronary Angiography Versus No Early Coronary Angiography for Post-Cardiac

Arrest Patients without ST Elevation

Karl B. Kern, MD Professor of Medicine The Gordon A. Ewy, MD Distinguished Endowed Chair of Cardiovascular Medicine University of Arizona Co-Director, Sarver Heart Center, Tucson, Arizona

Seattle: Too Good to Be True…

Or Simply the Power of Hard

Work and Persistence ? Karl B. Kern, MD Professor of Medicine The Gordon A. Ewy, MD Distinguished Endowed Chair of Cardiovascular Medicine University of Arizona Co-Director, Sarver Heart Center, Tucson, Arizona

Conflicts of Interest Statement Dr. Kern has undeniable ties to the Seattle area:

Science Advisory Board member for Physio-Control Has a sister who lives in Seattle Youngest son married girl from Seattle in 2016 Has a number of friends in Seattle, including … My best fishing buddy lives in Seattle

“Wide variability in outcome emphasizes the need for each community to ‘Know its Numbers’, then concentrate on improving by focusing on

locally indentified problem areas within the Chain of Survival”

JAMA 2008;300:1462-3

JAMA 2008;300:1206.

3%

5%

11% 10% 7% 11%

16%

JAMA 2008;300:1206

Up to 5X difference in outcome depending upon where you live in the USA

8% vs 40%; 5 fold difference

[VF Cardiac Arrest]

What is they do that is so effective in saving lives from cardiac arrest ?

I believe they simply work harder.

They put on the harness, and pull harder and longer than most

We are pleased to present the 2016 Emergency Medical Services Annual Report, as required by King County Ordinance #12849.

The Medic One/EMS System in King County is distinctive from other systems in that it: (a) is medically based, (b) is regional, (c) uses a tiered out-of-hospital response.

(a) The medical model is the core of the EMS program in King County.

The leadership of the Medical Program Director (MPD) ensures the success and the ongoing medical quality improvement of the EMS system. This year, Dr. Thomas Rea was appointed MPD, replacing Mickey Eisenberg, MD, PhD, who filled this role for more than a decade.

Dr. Rea is a Professor of Medicine at the University of Washington and Harborview Medical Center. He has spent the past decade working with the King County Medic One Paramedic group, ensuring the continued high standard of EMS care. As MPD, Dr. Rea’s substantial responsibilities include • writing and approving medical protocols, • approving all initial Emergency Medical Technician (EMT) and

continuing EMT medical education, • undertaking new and ongoing medical quality improvement

activities, • initiating disciplinary actions when necessary.

To support the best possible outcomes of care, Dr. Rea oversees continual medical quality improvement activities, such as:

• the review of every cardiac arrest event for the past 35+ years and patient protocol compliance audits.

• The result of this ongoing quality improvement is enhanced patient outcomes and an excellent cardiac arrest survival rate, which has been among the highest reported in the nation.

(b) Regional partners sustain uniformity and consistency across the entire EMS system. Dr. Rea coordinates policies and procedures among the Medical Directors of the region’s six paramedic programs:

• Dr. Michael Sayre of Seattle; • Dr. Jim Boehl of Bellevue; • Dr. Adrian Whorton of Redmond; • Dr. Gary Somers of Shoreline; • Dr. Peter Kudenchuk for south King County; • Dr. Sam Warren of Vashon.

Formative Influence

(c) A tiered response system in King County ensures the most appropriate care provider responds to each 9-1-1 call.

[VF Cardiac Arrest]

Not just the “peak” survival rate, but the continued improvement that makes Seattle so special. In 2002 had the highest rate of VF survival (26%) but rather than resting upon their laurels, they continued to innovate and improve. The result was they doubled their “best” VF survival rate over the following 10 years (52%)!

Seattle: Too Good to Be True? I don’t think so.

Thanks for the Opportunity

Proportion treated/assessed = 37% 50% 69% 61%