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

3. Funding Agencies

4. Resuscitation Outcomes Consortium

5. ROC Sites

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

7. Toronto Regional RESCUeNET Sites l Durham l Hamilton l Muskoka l Ontario Air Ambulance Program l Peel l Simcoe l Toronto l York

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

9. Registry Protocol

10. Registry l Epidemiological Databank (  registry) of: –Out-of-Hospital Cardiac Arrests –Major trauma l Population based (includes all cases) l In-hospital outcomes l Regional specific information to the Service / Base Hospital –Web-based and password protected l Form the basis of a Canadian Registry of Out-of-Hospital Resuscitation l CIHI – linkage with other data sets (trauma, cardiac care, stroke, oncology)

11. Proposed Protocols Cardiac

12. CPR: Back to the Basics

13. Compelling Evidence Negative Impact NeutraII mpact Positive Impact

14. More Compelling Evidence l 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%) l Wik – randomized - 2003 (200 pts) –3 minutes of CPR –survival to hosp discharge (22% vs 15%) l Abella – prospective observational study – 2005 (67 pts) –Ventilations rates of 20/min (61%) (AHA guidelines are 10 to 12/min) l 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)

15. Three-Phases of VF ShockCPR?

16. Analyze Later versus Analyze Early

17. Impedance Threshold Valve

18. ResQPOD

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

20. Monitoring the Quality of CPR

21. Trauma

22. Hypertonic Saline and Dextran

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

24. Goal l ↑Survival l ↑ Cognitive Performance l ↓ Multi Organ Dysfunction (MOD)

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

26. Who? TBI Cohort Inclusion Criteria: l Blunt trauma l Prehospital GCS 90 mmHg l Age >15yrs or >50kg

27. What is Being Asked of the You? l Registry: Identify Registry patients l CPR: Pads on patient; 50 or 300 compressions / analyze l ITV: Attach valve to mask or ET tube l Hypertonic Saline: Piggy back 250 ml bag / bolus l Common to all Studies: Data Collection Sheet

28. Keeping You in the Loop

29. The Research Wire

30. www.prehospitalresearch.com

31. Username & Password

32. Paramedic Resources

33. Thank You!