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Resuscitation Outcomes Consortium expanded cardiac arrest research

ROC researchers and EMS study participants have made significant contributions to better care for out-of-hospital cardiac arrest

By Jason Buick

SAN DIEGO — The impact of the Resuscitation Outcomes Consortium 10-year study of out-of-hospital cardiac arrest was the highlight of a session at the National Association of EMS Physicians Annual Meeting.

If you asked paramedics, what is the first thing that comes to mind when someone mentions prehospital research, most would say cardiac arrest. In the last 15 years, out-of-hospital cardiac arrests research has been a hot topic nationally and internationally.

Despite a significant burden of disease, between 1985 and 2009, only 8 randomized trials were funded per 10,000 sudden cardiac arrest deaths. This was compared to 439 trials for myocardial infarctions and 349 trials related to heart failure. There was a clear deficiency in cardiac arrest research and that void was filled by the Resuscitation Outcomes Consortium.

About the ROC
Formed in 2006, the Resuscitation Outcomes Consortium was a huge undertaking with a massive infrastructure. ROC encompasses 18 sites across Canada and the United States, over 260 paramedic services and 36,000 prehospital providers. During its 10-year existence ROC received more than $114 million in grant funding.

ROC has conducted many large-scale randomized trials on out-of-hospital cardiac arrest and life-threatening trauma leading to over 75 peer reviewed publications. ROC has made a significant scientific contribution to the 2010 and 2015 American Heart Association CPR guidelines used daily by EMS providers. ROC has also grown into a leader in prehospital research and has helped evolve services into delivering high-quality prehospital care.

But beyond the science, ROC has shown that prehospital research is important and necessary. Mohamud Daya, MD, MS, professor of emergency medicine at Oregon Health and Science University and a ROC investigator, describes prehospital research as “the ultimate crème de la crème.”

Key lessons from ROC experience
Daya went on to describe some key lessons learned from the ROC experience including:

  • Engage paramedics, EMTs and hospitals early in the research design process.
  • Avoid complicated trial designs as it becomes challenging for providers.
  • Community benefits from prehospital research include better patient care.
  • Research networks are important and future work should focus on establishing these networks.
  • Technology is important.

Where we go from here
While the research funding for ROC has stopped, there are two final trials in progress. The Pragmatic Airway Resuscitation Trials (PART); evaluates whether endotracheal intubation or laryngeal tube airway management is superior for cardiac arrest patients. The other trial is aimed at determining the efficacy of TXA, an anti-fibrinylotic, in traumatic brain injury patients.

But ROC has just scratched the surface. There are numerous groups and organizations conducting prehospital research on a variety of topics that will undoubtedly change the paramedic profession improving our ability to deliver high-quality evidence based care.

About the author
Jason Buick is a paramedic in York Region, Ontario. He completed his graduate training at the Institute of Health Policy, Management and Evaluation at the University of Toronto and with the Rescu research program at St. Michael’s Hospital. Buick is currently a Paramedic Research Fellow with Rescu. His research interests include prehospital resuscitation of life-threatening emergencies and evidence based clinical practice and decision rules. Jason is also part of the educational faculty at the Sunnybrook Center for Prehospital Medicine and a faculty member at Centennial College. Connect with him on Twitter or email Jason Buick.