Portland, Ore.
OHSU awarded $3 million to focus on improving care at the scene of traumas and cardiac arrests
From the moment a person experiences trauma or cardiac arrest, his or her life begins to tick away. The key to survival is getting immediate emergency medical care. Heart disease and trauma remain two of the most common causes of death in the United States. The question is what kind of medical care at the scene of these tragedies can improve survival?
For the first time, Oregon Health & Science University's Center for Policy and Research in Emergency Medicine and nine academic health centers are collaborating in the hope of answering that question through studies conducted in the community where traumas and cardiac arrests occur.
The national consortium, called the Resuscitation Outcomes Consortium (ROC), is funded by a $30 million National Heart, Lung, and Blood Institute grant.
"We are dedicated to finding the best ways to handle medical emergencies, and the only way to do this is to actually try experimental procedures in the field. Only then will we know what the best procedures are," said Jerris Hedges, M.D., OHSU's principal investigator and professor of emergency medicine in the OHSU School of Medicine. "Nationally, we hope to make major strides in averting sudden unexpected death."
Individual institutions have conducted research on pre-hospital care, but because emergency medical service (EMS) systems are different around the country, outcomes from one city's study may not work in another. This new consortium will ensure that the research findings apply to a broad range of cardiac arrest and trauma victims from across the United States and Canada. The inclusion of multiple centers will also allow eligible patients to be enrolled more quickly and definitive studies completed more quickly, thus allowing effective practice interventions to be identified and widely disseminated more quickly.
OHSU investigators are able to conduct this important EMS research thanks to strong, coordinated community support by trauma colleagues from Legacy Health System and EMS providers throughout Multnomah, Clackamas, Washington and Clark counties.
OHSU is one of three universities in the consortium that will also become a training center for future emergency medicine clinical researchers to maintain momentum in this area of study.
The consortium will conduct unique research because patients will be enrolled at the scene of an accident or cardiac arrest and will not be able to give their consent due to the life-threatening nature of their condition. For this reason, the universities are required by federal law to obtain the community's consent before the study can begin. Each study conducted by this consortium in the Portland-metro area will be highly publicized so the community is made aware of the risks and benefits of the clinical trial before the study begins.
"Patient safety is our highest concern. All study protocols will be reviewed before implementation by an independent panel of scientists chosen by the National Institutes of Health, but not participating in the study design. Each community also will perform its usual and customary review of the study protocols before implementation," said Hedges. "Finally, a second independent panel of scientists (Data and Safety Monitoring Board) will monitor each trial for safety purposes."
OHSU hopes to begin its first study with the consortium next year. Proposed projects include a study to determine whether hypertonic saline can improve the survival and neurological outcome of a person who has suffered a traumatic brain injury. This study is important because hypertonic saline (due to its higher salt concentration) may be given as a smaller volume of intravenous resuscitation fluid, making it more portable and reducing the potential for raising blood pressure too high, and which aggravates ongoing bleeding. Another proposed project will assess the use of a device that attaches to the airway bag used by paramedics to ventilate patients in cardiac arrest. In preliminary trials, this device enhanced blood flow during cardiopulmonary resuscitation (CPR) and therefore may enhance survival from cardiac arrest.
Some of the other universities participating in the consortium include: University of Washington; University of Iowa; University of Texas Southwestern Medical Center at Dallas; University of California, San Diego; University of Toronto; Medical College Wisconsin; University of Alabama at Birmingham; University of Pittsburgh Medical Center; and The University of British Columbia.
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