The Prehospital

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The Prehospital Transport Medicine Research
Program
Sunnybrook Womens College Health Sciences
Centre
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Funding Agencies
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Resuscitation Outcomes Consortium
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ROC Sites
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Toronto Regional RESCUeNET

• TORONTO Regional RESuscitation RESearch
  oUt of hospital NETwork

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Toronto Regional RESCUeNET Sites

• Durham
• Hamilton
• Muskoka
• Ontario Air Ambulance Program
• Peel
• Simcoe
• Toronto
• York

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The ROC StructureThe 30,000 Foot Overview
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Registry Protocol
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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)

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Proposed Protocols

• Cardiac

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CPR Back to the Basics
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Compelling Evidence
NeutraIImpact
Positive Impact
Negative Impact
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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)
• Ventilations rates of 20/min (61) (AHA
  guidelines are 10 to 12/min)
• Wik prospective observational study 2005 (176
  pts)
• 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)

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Three-Phases of VF
Shock
CPR
?
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Analyze Later versus Analyze Early
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Impedance Threshold Valve
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ResQPOD
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WHO?

• Inclusion Criteria
• Age gt18yrs
• Non-traumatic cardiac arrest
• Receive defibrillation /or CPR by EMS

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Monitoring the Quality of CPR
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• Trauma

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Hypertonic Saline and Dextran
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Advantages

• 250 ml 3 litres of Ringers lactate
• ? early systemic inflammatory response
• ? incidence of sepsis

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Goal

• ?Survival
• ? Cognitive Performance
• ? Multi Organ Dysfunction (MOD)

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Who?

• Hypovolemic Cohort Inclusion Criteria
• Blunt or Penetrating Trauma
• Prehospital SBP
• lt 70 or
• SBP 70 - 90 HR gt 108/min
• Age gt15yrs or gt50kg

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Who?

• TBI Cohort Inclusion Criteria
• Blunt trauma
• Prehospital GCS lt 8 and prehospital SBP gt90 mmHg
• Age gt15yrs or gt50kg

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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

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Keeping You in the Loop
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The Research Wire
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www.prehospitalresearch.com
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Username Password
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Paramedic Resources
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Thank You!