1. University of Texas Southwestern Resuscitation Research Projects University of Texas Southwestern Resuscitation Research Projects

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

3. 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

4. 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

5. National Institutes of Health National Institutes of Health ResuscitationOutcomesConsortiumResuscitationOutcomesConsortium

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

7. 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

8. 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

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

10. 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

11. 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

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

17. 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

18. 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

19. Cardiac Arrest Survival to Hospital Admission 1997 - 2004 Cardiac Arrest Survival to Hospital Admission 1997 - 2004

20. Hemorrhagic Shock due to Trauma Hemorrhagic Shock due to Trauma

21. 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

22. 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

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

24. 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

25. 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

26. 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

27. Hypertonic Saline

28. 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

29. 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

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

32. 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

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

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

35. Dallas Milwaukee Worcester Concord Brockton Springfield Dallas Milwaukee Worcester Concord Brockton Springfield

36. Heart Attacks

37. The Acute Coronary Syndrome The Acute Coronary Syndrome

38. The Acute Coronary Syndrome The Acute Coronary Syndrome

39. 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

40. 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

43. 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

44. 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?

45. Data that we will be tracking Data that we will be tracking

46. 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

47. 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

48. 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

49. Website for Test for “EKG Assessment” http://www.immediatetrial.net

50. Questions?