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 THE SEATTLE SECRET

Two years ago the National Institutes of Health joined other agencies to fund a $50 million Resuscitation Outcomes Consortium (ROC) that established ten research centers. The goal of the two-to-three year study is to oversee innovational clinical trials to determine the effectiveness of selected life-saving interventions. http://www.utsouthwestern.edu/utsw/cda/dept37389/files/303192.html

ROC planned to enroll 15,000 cardiac arrest and 5,000 major trauma patients. At last week’s Society for Academic Emergency Medicine [ http://www.saem.org ] annual meeting some of the findings were shared in the presentation Bringing Back the Dead: From Down-Time to Doctor, What We Think We Know About Resuscitation, and What We Don’t Know That’s Killing Our Patients.

HEY, THEY ARE DOING BETTER THAN US

Some of the clinical interventions used equipment that measured the real-time activities during a cardiac arrest scenario, showing when ventilations, chest compressions and defibrillation occurred. One of the principal investigators (PI) noted that Seattle had some of the best spontaneous return of circulation rates within the study.

Looking at the data recorded during the resuscitation indicated that certain tasks were done in a different order in Seattle than in the PI’s hometown urban ems service. To get a better perspective, the PI rode with the paramedics in Seattle.

TEN MINUTES OF UNINTERRUPTED CHEST COMPRESSIONS

When the two Seattle Medic 1 paramedics arrive, the first medic immediately starts chest compressions at the rate of 120 compressions per minute. The second medic sets up the bag-valve-mask, defibrillator and starts the IV line. Intubation is not even considered until after ten minutes of compression are delivered.

The PI compared that procedure to his hometown urban paramedics, who traditionally place intubation as an initial clinical task. The recordings showed that while the paramedics were ventilating the patient with a bag-valve-mask while setting up the tube, no chest compressions were going on.

The cardiac arrest patient would have no chest compressions performed until six to ten minutes after the arrival of the paramedics. This was demonstrated in thousands of patients enrolled in the ROC study. The patients that received immediate chest compressions had a higher survival rate than those who were intubated first.

The PI, who has a day job as a medical director for an urban EMS agency, implemented the Seattle procedure based on his research. He has already documented an improvement in cardiac arrest patients in his hometown.

HUMAN SUBJECT RESEARCH WILL CHANGE CPR, ACLS

Prior to 2005, all of the peer-reviewed research on resuscitation were based on animal research or retrospective (looking back) data. The ROC study is the start of the next generation of resuscitation research that looks at the human response to techniques, treatments and protocols. The 2005 American Heart Association CPR and ACLS protocols were the first to benefit from human clinical outcomes … such as the push fast and deep for chest compressions.

By the time researchers have processed all of the information generated by the ROC consortium, we may be using significantly different protocols that emphasize uninterrupted chest compressions – even WHILE defibrillating the patient. Basic life support will see a higher emphasis in the 2010 AHA standards.

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