The Prehospital & Transport Medicine Research Program
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Transcript of The Prehospital & Transport Medicine Research Program
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The Prehospital & The Prehospital & Transport Medicine Transport Medicine Research ProgramResearch Program
Sunnybrook & Women’s College Health Sciences Centre
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Funding AgenciesFunding Agencies
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Resuscitation Outcomes Resuscitation Outcomes ConsortiumConsortium
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ROC SitesROC Sites
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Toronto Regional Toronto Regional RESCUeNETRESCUeNET
TORONTO Regional RESuscitation TORONTO Regional RESuscitation RESearch RESearch oUt of hospital oUt of hospital NETworkNETwork
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Toronto Regional Toronto Regional RESCUeNET SitesRESCUeNET Sites
DurhamDurham HamiltonHamilton MuskokaMuskoka Ontario Air Ontario Air
Ambulance Ambulance ProgramProgram
PeelPeel SimcoeSimcoe TorontoToronto YorkYork
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The ROC Structure:The ROC Structure:The 30,000 Foot OverviewThe 30,000 Foot Overview
National Institute of Health(NIH)
Resusitation Outcomes Consortium
(ROC)
University of Washington(Data Coordinating Centre)
Canadian Institute of Health Research
(CIHR)
Departments of Defense(Canada & US)
10 Sites(2 Canada & 8 US)
Toronto RegionalRESCUeNET
· 8 EMS Services· 32 Fire Services· 28 Dispatch Centres· 5 Base Hospitals· 53 Receiving Hospitals
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Registry ProtocolRegistry Protocol
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RegistryRegistry Epidemiological Databank (Epidemiological Databank ( registry) of:registry) of:
– Out-of-Hospital Cardiac ArrestsOut-of-Hospital Cardiac Arrests– Major traumaMajor trauma
Population based (includes all cases)Population based (includes all cases)
In-hospital outcomesIn-hospital outcomes
Regional specific information to the Service / Base HospitalRegional specific information to the Service / Base Hospital– Web-based and password protectedWeb-based and password protected
Form the basis of a Canadian Registry of Out-of-Hospital Form the basis of a Canadian Registry of Out-of-Hospital ResuscitationResuscitation
CIHI – linkage with other data sets (trauma, cardiac care, stroke, CIHI – linkage with other data sets (trauma, cardiac care, stroke, oncology)oncology)
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Proposed ProtocolsProposed Protocols
CardiacCardiac
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CPR: Back to the BasicsCPR: Back to the Basics
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Compelling EvidenceCompelling Evidence
NegativNegative e
ImpactImpact
NeutraNeutraIImpacIImpac
tt
PositivPositive e
ImpactImpact
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More Compelling More Compelling EvidenceEvidence
CobbCobb – observational - 1999 (3 years-639 pts vs 2 years- – observational - 1999 (3 years-639 pts vs 2 years-478 pts)478 pts)– 90 seconds CPR prior to shock 90 seconds CPR prior to shock – survival to hosp discharge (30% vs 24%)survival to hosp discharge (30% vs 24%)
WikWik – randomized - 2003 (200 pts) – randomized - 2003 (200 pts)– 3 minutes of CPR3 minutes of CPR– survival to hosp discharge (22% vs 15%)survival to hosp discharge (22% vs 15%)
AbellaAbella – prospective observational study – 2005 (67 pts) – prospective observational study – 2005 (67 pts)– Ventilations rates of 20/min (61%) (AHA guidelines are 10 to Ventilations rates of 20/min (61%) (AHA guidelines are 10 to
12/min)12/min)
WikWik – prospective observational study – 2005 (176 pts) – prospective observational study – 2005 (176 pts)– Rate of compression 64/min (AHA guidelines are 100/min) Rate of compression 64/min (AHA guidelines are 100/min) – Depth of compression 34 mm (AHA guidelines are 38 to 52 mm) Depth of compression 34 mm (AHA guidelines are 38 to 52 mm) – Hands off time 48% (38% when exclude ECG & shock analysis)Hands off time 48% (38% when exclude ECG & shock analysis)
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Three-Phases of VFThree-Phases of VF
0 2 4 6 8 10 12 14 16 18 20
Arrest Time (min)
Circulatory
Phase
Elec trical
Phase
Metabolic
Phase
Shock CPR ?
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Analyze Later versus Analyze Later versus Analyze EarlyAnalyze Early
300 compressions
Apply AED& Turn On
Apply ITD30-60 sec
Compressor Other Provider(s)
Analyze/shock
ACLS
3 min
50 +compressions
Apply AED& Turn On
Apply ITD30-60 sec
Compressor Other Provider(s)
Analyze/shock
ACLS
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Impedance Threshold Impedance Threshold ValveValve
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ResQPODResQPOD
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WHO? WHO?
Inclusion Criteria:Inclusion Criteria: Age Age >>18yrs18yrs
Non-traumatic cardiac arrestNon-traumatic cardiac arrest
Receive defibrillation &/or CPR by EMSReceive defibrillation &/or CPR by EMS
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Monitoring the Quality of Monitoring the Quality of CPRCPR
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TraumaTrauma
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Hypertonic Saline and Hypertonic Saline and DextranDextran
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AdvantagesAdvantages
250 ml ~ 3 litres of Ringer’s 250 ml ~ 3 litres of Ringer’s lactatelactate
↓↓ early systemic inflammatory early systemic inflammatory responseresponse
↓↓ incidence of sepsisincidence of sepsis
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GoalGoal
↑↑SurvivalSurvival
↑ ↑ Cognitive PerformanceCognitive Performance
↓↓ Multi Organ Dysfunction Multi Organ Dysfunction (MOD)(MOD)
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Who?Who?
Hypovolemic Cohort Inclusion Criteria:Hypovolemic Cohort Inclusion Criteria: Blunt or Penetrating TraumaBlunt or Penetrating Trauma
Prehospital SBP Prehospital SBP – < 70 or < 70 or – SBP 70 - 90 & HR > 108/minSBP 70 - 90 & HR > 108/min
Age Age >>15yrs or >50kg15yrs or >50kg
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Who?Who?
TBI Cohort Inclusion Criteria:TBI Cohort Inclusion Criteria: Blunt traumaBlunt trauma
Prehospital GCS Prehospital GCS < < 8 and 8 and prehospital SBP >90 mmHgprehospital SBP >90 mmHg
Age Age >>15yrs or >50kg15yrs or >50kg
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What is Being Asked of What is Being Asked of the You?the You?
Registry: Identify Registry patients Registry: Identify Registry patients
CPR: Pads on patient; 50 or 300 compressions / CPR: Pads on patient; 50 or 300 compressions / analyzeanalyze
ITV: Attach valve to mask or ET tubeITV: Attach valve to mask or ET tube
Hypertonic Saline: Piggy back 250 ml bag / bolusHypertonic Saline: Piggy back 250 ml bag / bolus
Common to all Studies: Data Collection Sheet Common to all Studies: Data Collection Sheet
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Keeping You in the Keeping You in the LoopLoop
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The Research WireThe Research Wire
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www.prehospitalresearch.www.prehospitalresearch.comcom
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Username & PasswordUsername & Password
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Paramedic ResourcesParamedic Resources
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Thank You!Thank You!