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The Prehospital & Transport Medicine Research Program

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.

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The Prehospital & Transport Medicine Research Program

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  1. The Prehospital & Transport Medicine Research Program Sunnybrook & Women’s College Health Sciences Centre

  2. Funding Agencies

  3. Resuscitation Outcomes Consortium

  4. ROC Sites

  5. Toronto Regional RESCUeNET TORONTO Regional RESuscitation RESearch oUt of hospital NETwork

  6. Toronto Regional RESCUeNET Sites • Durham • Hamilton • Muskoka • Ontario Air Ambulance Program • Peel • Simcoe • Toronto • York

  7. The ROC Structure:The 30,000 Foot Overview

  8. Registry Protocol

  9. 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)

  10. Proposed Protocols Cardiac

  11. CPR: Back to the Basics

  12. Compelling Evidence NeutraIImpact Positive Impact Negative Impact

  13. 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)

  14. Three-Phases of VF Shock CPR ?

  15. Analyze Later versus Analyze Early

  16. Impedance Threshold Valve

  17. ResQPOD

  18. WHO? Inclusion Criteria: • Age >18yrs • Non-traumatic cardiac arrest • Receive defibrillation &/or CPR by EMS

  19. Monitoring the Quality of CPR

  20. Trauma

  21. Hypertonic Saline and Dextran

  22. Advantages • 250 ml ~ 3 litres of Ringer’s lactate • ↓ early systemic inflammatory response • ↓ incidence of sepsis

  23. Goal • ↑Survival • ↑ Cognitive Performance • ↓ Multi Organ Dysfunction (MOD)

  24. Who? Hypovolemic Cohort Inclusion Criteria: • Blunt or Penetrating Trauma • Prehospital SBP • < 70 or • SBP 70 - 90 & HR > 108/min • Age >15yrs or >50kg

  25. Who? TBI Cohort Inclusion Criteria: • Blunt trauma • Prehospital GCS < 8 and prehospital SBP >90 mmHg • Age >15yrs or >50kg

  26. 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

  27. Keeping You in the Loop

  28. The Research Wire

  29. www.prehospitalresearch.com

  30. Username & Password

  31. Paramedic Resources

  32. Thank You!

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