The Prehospital & Transport Medicine Research Program
Sunnybrook & Women’s College Health Sciences Centre
Funding Agencies
Resuscitation Outcomes Consortium
ROC Sites
Toronto Regional RESCUeNET
TORONTO Regional RESuscitation RESearch oUt of hospital NETwork
Toronto Regional RESCUeNET Sites
Durham Hamilton Muskoka Ontario Air Ambulance Program Peel Simcoe Toronto York
The ROC Structure:
The 30,000 Foot Overview
Canadian Institute of Health Research (CIHR) National Institute of Health (NIH) Departments of Defense (Canada & US)
Resusitation Outcomes Consortium (ROC)
University of Washington (Data Coordinating Centre)
10 Sites (2 Canada & 8 US)
Toronto Regional RESCUeNET
· · · · ·
8 EMS Services 32 Fire Services 28 Dispatch Centres 5 Base Hospitals 53 Receiving Hospitals
Registry Protocol
Registry
Epidemiological Databank ( registry) of: – Out-of-Hospital Cardiac Arrests – Major trauma Population based (includes all cases) In-hospital outcomes
Regional specific information to the Service / Base Hospital – Web-based and password protected Form the basis of a Canadian Registry of Out-of-Hospital Resuscitation
CIHI – linkage with other data sets (trauma, cardiac care, stroke, oncology)
Proposed Protocols
Cardiac
CPR: Back to the Basics
Compelling Evidence
Negative Impact
NeutraII mpact
Positive Impact
More Compelling Evidence
Cobb – observational - 1999 (3 years-639 pts vs 2 years-478 pts)
– 90 seconds CPR prior to shock – survival to hosp discharge (30% vs 24%)
Wik – randomized - 2003 (200 pts)
– 3 minutes of CPR – survival to hosp discharge (22% vs 15%)
Abella – prospective observational study – 2005 (67 pts)
Wik – prospective observational study – 2005 (176 pts)
– Ventilations rates of 20/min (61%) (AHA guidelines are 10 to 12/min)
– Rate of compression 64/min (AHA guidelines are 100/min) – Depth of compression 34 mm (AHA guidelines are 38 to 52 mm) – Hands off time 48% (38% when exclude ECG & shock analysis)
Three-Phases of VF
Electrical Phase Circulatory Phase Metabolic Phase
Shock
CPR
?
0
2
4
6
8
10
12
14
16
18
20
Arrest Time (min)
Analyze Later versus Analyze Early
Compressor Other Provider(s)
Apply AED & Turn On 30-60 sec 300 compressions Apply ITD
30-60 sec
Compressor
50 + compressions
Other Provider(s)
Apply AED & Turn On Apply ITD
Analyze/shock
ACLS
3 min
Analyze/shock
ACLS
Impedance Threshold Valve
ResQPOD
WHO?
Inclusion Criteria: Age >18yrs
Non-traumatic cardiac arrest Receive defibrillation &/or CPR by EMS
Monitoring the Quality of CPR
Trauma
Hypertonic Saline and Dextran
Advantages
250 ml ~ 3 litres of Ringer’s lactate ↓ early systemic inflammatory response ↓ incidence of sepsis
Goal
↑Survival ↑ ↓
Cognitive Performance
Multi Organ Dysfunction (MOD)
Who?
Hypovolemic Cohort Inclusion Criteria: Blunt or Penetrating Trauma
Prehospital SBP – < 70 or – SBP 70 - 90 & HR > 108/min Age >15yrs or >50kg
Who?
TBI Cohort Inclusion Criteria: Blunt trauma
Prehospital GCS < 8 and prehospital SBP >90 mmHg Age >15yrs or >50kg
What is Being Asked of the You?
Registry: Identify Registry patients CPR: Pads on patient; 50 or 300 compressions / analyze ITV: Attach valve to mask or ET tube Hypertonic Saline: Piggy back 250 ml bag / bolus Common to all Studies: Data Collection Sheet
Keeping You in the Loop
The Research Wire
www.prehospitalresearch.com
Username & Password
Paramedic Resources
Thank You!