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2010 ReSS Hot Topic Abstracts

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2010 ReSS Hot Topic Abstracts

Resuscitation Science Symposium 2010 Session XIII: Hot Topics

Hall D2 Abstracts H1-301, H2-302, H3-303, H4-304, and H5-305

HT1-301 The Resuscitation Outcomes Consortium ROC) PRIMED Impedance Threshold Device (ITD) Cardiac Arrest Trial: A Prospective, Randomized, Double-Blind, Controlled Clinical Trial

Tom P Aufderheide, Med College of Wisconsin, Milwaukee, WI; Graham Nichol, Thomas D Rea, Univ of Washington-Harborview Cntr for Prehospital Emergency Care, Seattle, WA; Siobhan Everson-Stewart, Brian Leroux, Univ of Washington Clinical Trial Ctr, Seattle, WA; Peter J Kudenchuk, Univ of Washington-Harborview Ctr for Prehospital Emergency Care, Seattle, WA; Jim Christenson, Univ of British Columbia, Vancouver, BC, Canada; Paul E Pepe, UT Southwestern Med Cntr, Dallas, TX; Mohamud R Daya, Oregon Health Sciences Univ, Portland, OR; Paul Dorian, Univ of Toronto, Toronto, ON, Canada; Clifton W Callaway, Univ of Pittsburgh, Pittsburgh, PA; Ahamed H Idris, UT Southwestern Med Cntr, Dallas, TX; Douglas Andrusiek, British Columbia Emergency & Health Svcs Commission, Vancouver, BC, Canada; Shannon W Stephens, Univ of Alabama at Birmingham, Birmingham, AL; David Hostler, Univ of Pittsburgh, Pittsburgh, PA; Daniel P Davis, James V Dunford, Univ of California, San Diego, CA; Ronald G Pirrallo, Medical Coll of Wisconsin, Milwaukee, WI; Ian G Stiell, Catherine M Clement, Univ of Ottawa, Ottawa, ON, Canada; Alan Craig, Toronto Emergency Medical Svcs, Toronto, ON, Canada; Lois Van Ottingham, University of Washington Clinical Trial Ctr, Seattle, WA; Terri A Schmidt, Oregon Health Sciences Univ, Portland, OR; Henry Wang, Univ of Alabama at Birmingham, Birmingham, AL; Myron L Weisfeldt, Johns Hopkins Sch of Medicine, Baltimore, MD; Joseph P Ornato, Virginia Commonwealth Univ, Richmond, VA; George Sopko; NHLBI, NIH, Rockville, MD; and the Resuscitation Outcomes Consortium (ROC) Investigators

decompression phase of CPR, improving hemodynamics. We hypothesized that ITD ACD-CPR would increase survival with good neurologic function after out-of-hospital cardiac arrest (OOHCA). Methods: This prospective, randomized, multicenter trial evaluated adults with OOHCA treated by emergency medical services (EMS) in seven study sites in the United States, encompassing a population of 2.3 million. Patients were assigned to ITDACD-CPR (interven- tion) or standard CPR (control) on a 1:1 proportional basis. CPR was initiated by the first arriving basic or advanced life support EMS provider. The primary endpoint was survival to hospital discharge with good neurologic function, defined as a modified Rankin Score (MRS) 3. Secondary endpoints included major adverse events and neurologic evaluation using the Cerebral Performance Category (CPC). Patients meeting final criteria (non-traumatic arrest, presumed cardiac etiology) were included in the primary intention-to-treat analysis. Results: Of 2470 randomized patients, 1653 met final criteria. Both groups had similar clinical profiles. Survival to hospital discharge with a MRS 3 was 75/840 (8.9%) in the intervention group versus 47/813 (5.8%) in the control [p0.019, OR 1.58 (CI1.07, 2.36)]. Treatment benefit was particularly apparent when study devices were applied early, as there were no survivors with a MRS 3 in either group when EMS CPR was initiated 10 minutes after the 911 call. At 90-day follow-up, survival with good neurologic function (CPC 2) was significantly greater in the intervention group: 72/840 (8.6%) versus 47/813 (5.8%) [p0.036, OR 1.52(CI 1.02, 2.27)]. More patients survived to one year post-arrest with ITDACD-CPR: 74/840 (8.8%) versus 48/813 (5.9%) (p0.03). No differences in major adverse events were identified. Conclusion: Compared with standard CPR, ITDACD-CPR resulted in significantly increased survival with good neurologic function up to 90 days, and a 49% improvement in survival at one year. These findings support the routine use of ITD ACD-CPR for treatment of adults with OOHCA.

Author Disclosures: T.P. Aufderheide: None. R.J. Frascone: Honoraria; Advanced Circulatory Systems, Inc. M.A. Wayne: None. B.D. Mahoney: None. R.A. Swor: None. R.M. Domeier: None. M.L. Olinger: None. R.G. Holcomb: None. D.E. Tupper: None. D. Yannopoulos: None. K.G. Lurie: None.

HT3-303 The Trauma Formula-driven versus Laboratory-Guided Study: Challenges and Lessons in Desigining a Massive Transfusion Randomized Control Trial in Trauma

Background: Previous studies suggest use of the impedance threshold device (ITD) during CPR may improve survival for victims of cardiac arrest. We compared survival to hospital discharge with a modified Rankin score (MRS) 3 in patients with out-of-hospital cardiac arrest receiving manual chest compressions and cardiopulmonary resuscitation (CPR) with a sham or active ITD. Methods: This prospective, multi-center, double-blind, randomized, controlled, clinical trial evaluated adult patients (18 years old or local age of consent) with non-traumatic out-of-hospital cardiac arrest treated by emergency medical services (EMS) in the Resuscita- tion Outcomes Consortium. A partial factorial study design was implemented concurrently entering patients with initially 30 seconds of chest compressions (Analyze Early) versus 3 minutes of chest compressions (Analyze Later). Results: There were 8,718 evaluable patients entered in the study, 4,345 (49.8%) of which were treated with a sham ITD and 4,373 (50.2%) with an active ITD. Patient demographics, cardiac arrest location, incidence of bystander CPR, and time to EMS arrival were similar between groups. The overall number and proportion of patients who survived to hospital discharge with a modified Rankin score of 3 was 260/4345 (6.0%) with a sham ITD and 254/4373 (5.8%) with an active ITD, p0.61. There were no statistically significant differences in pre-specified subgroup analyses or safety measures. Conclusion: In this large effectiveness trial, manual chest compressions and an active ITD did not significantly improve functional survival from cardiac arrest compared with a sham ITD.

Author Disclosures: T.P. Aufderheide: None. G. Nichol: Research Grant; NIH, NHLBI, Asmund S Laerdal Foundation for Acute Medicine, Medtronic Foundation. Other; Research Collaborator for Gambro Renal Inc, Sotera Wireless, Lifebridge Medizintechnik AG, Chair, AHA Executive Database Steering committee, Chair, Mission: Lifeline EMS Task Force, Cochair, AHA Resuscitation Science Symposium Planning Committee, Member, AHA Advanced Cardiac Life Support Subcommittee, Member, AHA Epidemiology and Statistics Committee, Member, AHA Pacific Mountain Affiliate Board of Directors, Received travel reimbursement, AHA. T.D. Rea: None. S. Everson-Stewart: None. B. Leroux: None. P.J. Kudenchuk: None. J. Christenson: None. P.E. Pepe: None. M.R. Daya: None. P. Dorian: None. C.W. Callaway: None. A.H. Idris: None. D. Andrusiek: None. S.W. Stephens: None. D. Hostler: None. D.P. Davis: None. J.V. Dunford: None. R.G. Pirrallo: None. I.G. Stiell: None. C.M. Clement: None. A. Craig: None. L. Van Ottingham: None. T.A. Schmidt: None. H. Wang: None. M.L. Weisfeldt: None. J.P. Ornato: None. G. Sopko: None.

Sandro Rizoli, Bartolomeu Nascimento, Homer Tien, Yulia Lin, Jennie Callum; Univ of Toronto, Toronto, ON, Canada

Background: About 25 % of all severely traumatized patients are coagulopathic on arrival to hospital, where bleeding remains the first cause of death. A novel strategy proposes addressing coagulopathy by resuscitating massively bleeding patients with “whole blood” (1 red blood cell (RBC)1 plasma1 platelet). Initial clinical results are encouraging but come from retrospec- tive studies with major limitations. This is the first prospective randomized controlled trial (RCT) on the topic and compares 1:1:1 formula with conventional laboratory-guided resuscitation. This preliminary analysis reports the challenges of this feasibility RCT. Methods: Adults with blunt or penetrating trauma, hypotensive, bleeding and potentially requiring massive transfu- sion are randomized (under delayed informed consent) to either laboratory-guided or 1:1:1 resuscitation. Interventions are applied up to 12h post-trauma and/or bleeding stops. Blood products are continuously released in 1:1:1 ratio for the formula group and no laboratory tests are required. For the conventional control group, blood transfusions are guided by laboratory values. Primary outcome of this ongoing RCT is feasibility. Results: Thirty patients were randomized over the first 14 months. Three were excluded post-randomization (2 cardiac tamponade and 1 head injury, both with minimal bleeding) and 1 refused to participate. Three patients were missed for failure to activate the research team. Median (interquartile range) time to first RBC, plasma and platelet were 24 min (8, 145), 89 min (68, 195) and 98min (72, 235) respectively. In 1:1:1, median plasma:RBC and platelet:RBC ratios were 0.53 (0, 1.5) and 0.45 (0, 0.8), with protocols lasting 3.8h (median). For laboratory-guided patients, INR, PTT and fibrinogen were requested in 75%, 25% and 50% of the times and turn-around-time (TAT) was 20, 43 and 41min with 1/3 of TAT spent on transporting samples. Conclusion: Major challenges and strategies to implement massive transfusion protocols and randomize unstable patients were identified. The feasibility of conducting such a massive transfusion study relies mostly on prompt activation of research personnel (currently triggered by uncrossmatched blood request); simple inclusion criteria; Data Monitoring Board for post-randomization exclusions; readily available thawed plasma or fast thawing method (microwaves); delayed consent and fast TAT for laboratory tests or point-of-care testing.

Author Disclosures: S. Rizoli: None. B. Nascimento: None. H. Tien: None. Y. Lin: None. J. Callum: None.

HT2-302 Treatment of Out-of-Hospital Cardiac Arrest with an Impedance Threshold Device and Active Compression Decompression Cardiopulmonary Resuscitation Improves Survival with Good Neurologic Function: Results from the RESQTrial

HT4-304 A “Maintenance of Competence” Strategy for BLS Training Maintains or Improves BLS Skills Among Nursing Students Over 1 Year

Tom P Aufderheide, Medical Coll of Wisconsin, Milwaukee, WI; Ralph J Frascone, Marvin A Wayne, Brian D Mahoney, Regions Hosp Emergency Med Services, Oakdale, MN; Robert A Swor, Wm. Beaumont Hosp, Royal Oak, MI; Robert M Domeier, Michael L Olinger, Richard G Holcomb, David E Tupper, Regions Hosp Emergency Med Services, Oakdale, MN; Demetris Yannopoulos, Johns Hopkins Univ, Baltimore, MD; Keith G Lurie; Univ of Minnesota Health Ctr, Minneapolis, MN

Background: Adding an impedance threshold device (ITD) to active compression decompres- sion cardiopulmonary resuscitation (ACD-CPR) decreases intrathoracic pressure during the

Marilyn H Oermann, Univ of North Carolina at Chapel Hill, Chapel Hill, NC; Suzan E Kardong-Edgren, Tamara Odom-Maryon; Washington State Univ, Spokane, WA

Background: Nurses are typically the first health care providers to respond to an in-hospital cardiac arrest. For this reason they need to develop proficiency in CPR during their initial training and maintain their skills over time. Studies have documented, however, that without refreshers and practice, CPR skills deteriorate rapidly. The aim of this study was to examine the effects of brief monthly practice on nursing students’ CPR psychomotor skill performance at 3, 6, 9, and 12 months compared to a control group with no practice sessions. Methods:

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