Oregon Health & Science University is part of a multi-site NIH funded prehospital study designed to determine if either of two airway management strategies currently used in the management of out-of-hospital cardiac arrest is better than the other. Cardiac arrest is defined as a severe malfunction or cessation of the electrical and mechanical activity of the heart. The heart essentially stops beating, blood does not circulate and a pulse cannot be felt. Cardiac arrest results in almost instantaneous loss of consciousness and collapse.
Oregon Health & Science University is part of a multi-site study testing whether people who have life threatening or life altering traumatic brain injury do better when they receive a medication called Tranexamic Acid (TXA) that is used to stabilize bleeding in the body. The study will be conducted at 10 Level 1 trauma centers in North America including OHSU. The research team will look at the results to determine if the study medication, TXA, given as soon as possible after injury improves the mental recovery after traumatic brain injury.
There are approximately half a million cardiac arrests which occur in the United States each year. Nearly two thirds or about 350,000 cardiac arrests occur outside the hospital. Nationally, only about 5% of cardiac arrest victims survive. Cardiac arrest occurs when the heart stops beating. When the heart stops beating, blood-containing oxygen does not get to vital organs, such as the brain, lungs, kidneys, and the heart itself. When oxygen is not available, organs may be permanently damaged or the patient may die. Life-supporting interventions must be given immediately in the field to save their life. Standard care for cardiac arrest includes providing chest compressions, breathing assistance and the use of heart rhythm medications (Amiodarone and/or Lidocaine) in some instances. Even with these treatments, only 10-15% of patients survive cardiac arrest with good brain function in our local community. This study is being done to figure out the best method of treating those who suffer from cardiac arrest outside of the hospital, in order to ensure the highest rate of survival.
Trauma is the leading cause of death for people between the ages of 1 and 44 years. Approximately 80% of trauma patients who die do so from severe brain injury, severe bleeding or a combination of the two. Over 50% of trauma deaths occur in the first 12 hours after injury and the most common cause of unnecessary death after trauma is severe bleeding.
If the amount of blood lost is too large, vital organs such as the brain, heart, lungs, and kidneys will not receive the blood they need to function properly. To help support the blood flowing to these vital organs, a special fluid called normal saline (0.9% sodium chloride injection) is routinely given through a tube into a blood vessel. Paramedics give normal saline to an injured person while the person is being safely removed from the scene and taken to the nearest hospital.
The purpose of this study is to determine if severely injured people do better when they are given small amounts of normal saline or if they do better when they are given large amounts of normal saline. Currently, giving large amounts of normal saline is the normal treatment.
Cardiac arrest is the sudden, abrupt loss of heart function. Death usually occurs within minutes unless cardiopulmonary resuscitation (CPR), rapid defibrillation, and paramedic interventions are available. CPR consists of pumping on the patient's chest and delivering breaths to produce some circulation until the heart can be restarted. When the chest is compressed, oxygen-rich blood is pumped forward. When the chest is released, oxygen-poor blood is brought back to the heart and lungs where it can be restored with oxygen before being pushed out to the body with another compression. Both actions -- pushing oxygen-rich blood forward and bringing oxygen-poor blood back to the heart and lungs -- are important. CPR however produces only about 30% of normal circulation. Methods to improve the circulation produced by CPR may lead to better survival.
This study involved ambulance patients and was in two parts - Study 1 was to see how a small amount of an IV fluid that had a higher concentration of salt than normal may help patients who have lost a significant amount of blood due to gunshot, stabbing, or blunt trauma injuries. Study 2 also involved the higher salt concentration IV fluid, but the patients involved were blunt trauma patients with a severe traumatic brain injury. Both studies were randomized trials comparing hypertonic saline and a sugar (called dextran) mix, hypertonic saline alone, and normal saline as the initial resuscitation fluid administered to these patients in the prehospital setting. Neither the paramedics administering the IV fluid nor the patient knew which fluid he or she was receiving.