April 20, 2007

Advancing Emergency Care

Genesis, MEDIC Emergecy Medical Services to evaluate new treatments

DAVENPORT, IOWA - Genesis Medical Center, Davenport and MEDIC Emergency Medical Services will participate in North American studies to evaluate new treatments given to those patients in cardiac arrest or with severe traumatic injuries during transport to the hospital.

The Resuscitation Outcomes Consortium, or ROC, involves public safety agencies, regional hospitals, community health-care institutions and medical centers in 11 regions in the United States and Canada.

The National Institutes of Health is funding a grant to establish the Iowa Resuscitation Network, headed by Richard Kerber, M.D., Professor of Cardiology and Internal Medicine in the University of Iowa Roy J. and Lucille A. Carver College of Medicine. J. Steven Hata, M.D. and Eric Dickson, M.D., also at the Carver College of Medicine, will co-direct the studies with Dr. Kerber. The Iowa studies will be coordinated by Linda Moss, R.N.

As many as 15,000 patients throughout North America will be involved over a three-year period.

A community meeting

Because the treatments will be given in an emergency situation, Genesis patients will enter into the studies without first giving their consent. A community meeting to explain the studies has been scheduled for 7 p.m. Monday, April 23 in the Adler Education Center in the lower level of the Genesis Heart Institute, 1236 E. Rusholme St., Davenport.

At the meeting, community members can learn more. They also can choose to exclude themselves from the studies in advance, in the event they are ever transported with cardiac arrest or severe trauma. They will receive a wristband to wear, identifying themselves as having opted out.

James Lehman, M.D., Genesis Vice President of Quality, said the two studies will be conducted simultaneously and involve treatment protocols administered during transportation to the hospital. “These are potentially life-saving interventions that will take place during transport to the hospital, but will end upon arrival at the hospital,’’ Dr. Lehman said. “The experimental part of the interventions will be done as patients are being transported. The hospital’s role will be to collect data about the patients and their response to the treatment during transport.’’

Joseph Lohmuller, M.D., Medical Director of Trauma Services for Genesis Medical Center, Davenport, will be the local principal investigator.

Genesis will participate in the two separate studies through the Iowa ROC:

Cardiac arrest patients

Patients will become part of the study testing a device to enhance blood flow during CPR. Another part of this study will compare immediately shocking patients with performing three minutes of CPR prior to administering the shocks. The device being studied is a one-way valve that fits between the ventilation device used to introduce air into a person in cardiac arrest and the flexible plastic tube that goes through the nose or mouth and into the lungs to help with breathing. It can also be done with a standard facemask used to administer CPR. During CPR, the oneway valve creates a small vacuum inside the patient’s chest, which increases the return flow of blood to the heart.

There are an estimated 330,000 out-ofhospital cardiac deaths each year in the United States. Most of these are from sudden cardiac arrest before arriving at a hospital. The study is trying to determine if the device to enhance blood flow to the heart will result in an even greater number of cardiac arrest patients who experience the return of a heartbeat, which should greatly improve their chances of survival.

Severe trauma patients

Prior to arriving at a hospital, trauma patients normally receive a saline solution intravenously to compensate for blood loss. In the trial, trauma patients with either signs of blood loss or severe brain trauma will receive one of three study solutions: a normal saline solution; a high concentration saline solution; and a high concentration saline solution with dextran, a circulation-enhancing substance.

The two concentrated solutions are designed to compensate for blood loss more effectively, lessen excessive inflammatory responses and prevent brain swelling. These benefits, in turn, could potentially lead to a reduction in organ failure for patients with major blood loss and improve function for patients with brain injury.

“With the trauma study, there has already been some preliminary use in battlefield situations with some success,’’ explained Dr. Lehman. In the severe trauma study, Genesis will likely receive all of the Quad Cities patients involved. Genesis Medical Center, Davenport is the only Level II, or regional trauma care facility, in Scott County and is one of five Level II trauma centers in the state.

“Our employees have gone through substantial training to make certain they understand and are compliant with all of the ROC requirements,’’ said Linda Frederiksen, Executive Director, MEDIC Emergency Medical Services.

“One of the most important pieces now is educating the public so that they know what the study is about and they have the opportunity to either participate or opt out of the study should they suffer cardiac arrest or a severe trauma.’’

Frederiksen said that because the trauma patient study is a blind study, crews transporting trauma patients will not know which saline solution they are administering to patients.

Alex Drum, NREMT-P and EMS Liaison for Iowa ROC, said the goal is to have 288 trauma patients entered into the study. He expects the study to continue for about 18 months. Frederiksen said MEDIC EMS transports about 50 patients each year with severe traumatic injuries.

The trauma study will begin in late April or May. The cardiac arrest study will start later in the year. “All First Responders, including our local fire department, will be part of the cardiac arrest study,’’ Frederiksen added.

Additional information on the Iowabased studies is available at www.iowarocs.org.

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