University of Texas Southwestern Resuscitation Research Projects University of Texas Southwestern Resuscitation Research Projects

Presentation to the University Park City Council 07/06/06Presentation to the University Park City Council 07/06/06

The Preparation for Research The National Institutes of Health The National Heart, Lung, Blood Institute The National Institutes of Health The National Heart, Lung, Blood Institute

What are We Studying: All CPR’s All Traumatic Hemorrhagic Shocks, 17 or older, with a pressure of 90 or less Traumatic Brain Injury Acute Coronary Syndrome All CPR’s All Traumatic Hemorrhagic Shocks, 17 or older, with a pressure of 90 or less Traumatic Brain Injury Acute Coronary Syndrome

National Institutes of Health National Institutes of Health ResuscitationOutcomesConsortiumResuscitationOutcomesConsortium

A ten city/state assembly of EMS research centers A ten city/state assembly of EMS research centers

Dallas San Diego Seattle/King County Iowa Toronto Ottawa Pittsburgh Alabama Milwaukee Portland Dallas San Diego Seattle/King County Iowa Toronto Ottawa Pittsburgh Alabama Milwaukee Portland

About a million EMS transports Over 10,000 Cardiac Arrests Over 50,000 Trauma Patients About a million EMS transports Over 10,000 Cardiac Arrests Over 50,000 Trauma Patients

Studying: Improving survival in cardiac arrest Improving survival in major trauma Studying: Improving survival in cardiac arrest Improving survival in major trauma

Cardiac Arrest  Circulation of blood stops  CPR moves very little blood  Improving blood return to the heart improves circulation Cardiac Arrest  Circulation of blood stops  CPR moves very little blood  Improving blood return to the heart improves circulation

Cardiac Arrest  Turn CPR into a “two stroke” process  Put a small device on the breathing tube that improves “negative pressure” inside of the chest  Increases blood flow  Should improve survival Cardiac Arrest  Turn CPR into a “two stroke” process  Put a small device on the breathing tube that improves “negative pressure” inside of the chest  Increases blood flow  Should improve survival

Impedance Threshold Valve - 12 cm H 2 O For Cardiac Arrest

Cardiopulmonary Resuscitation Cardiopulmonary Resuscitation The Impedance Threshold Device Intubated with ET or Combitube Possibly even Bag to Mask Looking for any differences in survival The Impedance Threshold Device Intubated with ET or Combitube Possibly even Bag to Mask Looking for any differences in survival

Cardiac Arrest  Survival to Admission  Survival to Discharge  Quality of Life with Survival Cardiac Arrest  Survival to Admission  Survival to Discharge  Quality of Life with Survival

Cardiac Arrest Survival to Hospital Admission Cardiac Arrest Survival to Hospital Admission

Hemorrhagic Shock due to Trauma Hemorrhagic Shock due to Trauma

The risk is that bleeding can be so severe, the patient will die before transport to the operating room The risk is that bleeding can be so severe, the patient will die before transport to the operating room

Pepe et al showed that using excessive amounts of IV fluids worsens bleeding and lowers survival Pepe et al showed that using excessive amounts of IV fluids worsens bleeding and lowers survival

We have 5 quarts of blood in our bodies We have 5 quarts of blood in our bodies

But! We have over ten quarts of fluid in the body that can be pulled into the blood system But! We have over ten quarts of fluid in the body that can be pulled into the blood system

Giving a concentrated solution of salt water (hypertonic saline) can pull this fluid back into the blood vessels Giving a concentrated solution of salt water (hypertonic saline) can pull this fluid back into the blood vessels Body Fluid Compartments Total Body Water Body Weight (%) Total Body Water (%) Total60100 Intracellular4067 Extracellular2033 Intravascular58 Interstitial1525

Hypertonic saline has been shown to be safe and effective in large trials Hypertonic saline has been shown to be safe and effective in large trials

Hypertonic Saline

We will give either 250 cc (about a cup) of Hypertonic SalineOR Standard IV Fluids We will give either 250 cc (about a cup) of Hypertonic SalineOR Standard IV Fluids

Hypertonic Saline Hypertonic Saline H.S. vs. Regular Fluids Transfer to Trauma Unit Survival to Short and Long Term Survival H.S. vs. Regular Fluids Transfer to Trauma Unit Survival to Short and Long Term Survival

Heart Attacks The Most Common Cause of Death in Americans The Most Common Cause of Death in Americans

Heart Attacks Lead to Congestive Heart Failure, one of the largest medical burdens for cities Lead to Congestive Heart Failure, one of the largest medical burdens for cities

National Heart, Lung, Blood Institute National Heart, Lung, Blood Institute The IMMEDIATE Trial Trial

A six city assembly of EMS research centers A six city assembly of EMS research centers

Dallas Milwaukee Worcester Concord Brockton Springfield Dallas Milwaukee Worcester Concord Brockton Springfield

Heart Attacks

The Acute Coronary Syndrome The Acute Coronary Syndrome

The Acute Coronary Syndrome The Acute Coronary Syndrome

The Acute Coronary Syndrome The Acute Coronary Syndrome Examine the patient Perform and interpret a 12 lead Speak to BioTel Initiate the infusion Examine the patient Perform and interpret a 12 lead Speak to BioTel Initiate the infusion

The Acute Coronary Syndrome The Acute Coronary Syndrome Glucose, Insulin, and Potassium Infusion vs. Placebo 30 day and 1 year Survival Glucose, Insulin, and Potassium Infusion vs. Placebo 30 day and 1 year Survival

Why Do It? Intense practice and preparation Enhanced education Data tracking on some 15% of patients to 6 to 12 mos outcomes Demonstrate the value-added of our EMS work to our cities Create a “test-bed” for leading the field of EMS to better care Intense practice and preparation Enhanced education Data tracking on some 15% of patients to 6 to 12 mos outcomes Demonstrate the value-added of our EMS work to our cities Create a “test-bed” for leading the field of EMS to better care

Getting Ready for Research! Getting Ready for Research! Less Run Sheet Dependence BioTel Real-time Data “Must Call List” for medics Agency Contacts Hospital Contacts Paperwork? Less Run Sheet Dependence BioTel Real-time Data “Must Call List” for medics Agency Contacts Hospital Contacts Paperwork?

Data that we will be tracking Data that we will be tracking

Date MICU Incident # Patient Name Patient Age Patient Gender Ethnicity Dispatch Time On Scene Time Witnessed Cardiac Arrest? Bystander CPR? Initial Heart Rhythm Carbon Dioxide Level on Intubation Return of Spontaneous Circulation Hospital Destination Hospital Arrival Time Carbon Dioxide Level on Intubation Survived to Hospital Admission Survived to Hospital Discharge Date MICU Incident # Patient Name Patient Age Patient Gender Ethnicity Dispatch Time On Scene Time Witnessed Cardiac Arrest? Bystander CPR? Initial Heart Rhythm Carbon Dioxide Level on Intubation Return of Spontaneous Circulation Hospital Destination Hospital Arrival Time Carbon Dioxide Level on Intubation Survived to Hospital Admission Survived to Hospital Discharge

Challenges: Avoiding paperwork for EMS Getting BioTel databases ready Comparing Run Sheets Factor in to these efforts the agencies going paperless Orienting and monitoring staff Remediation Getting the training modules finished Avoiding paperwork for EMS Getting BioTel databases ready Comparing Run Sheets Factor in to these efforts the agencies going paperless Orienting and monitoring staff Remediation Getting the training modules finished

Next Steps NIH Human Subject Testing 1.5 to 2 hours to complete Web-based Will reimburse medics $25 to complete the course EKG Assessment Test Hypertonic Saline Protocol NIH Human Subject Testing 1.5 to 2 hours to complete Web-based Will reimburse medics $25 to complete the course EKG Assessment Test Hypertonic Saline Protocol

Website for Test for “EKG Assessment”

Questions?