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01 August 2011

Experts investigate best way to treat cardiac arrest

The University of the West of England, the Great Western Ambulance Service NHS Trust (GWAS) and University Hospitals Bristol NHS Foundation Trust, will conduct an investigation to ensure paramedics employ the best possible techniques when treating a patient who has suffered a cardiac arrest.

Over the next year, a pilot study funded by the National Institute for Health Research (NIHR) Research for Patient Benefit programme will take place to find out which approach to rescue breathing is most likely to improve patient survival. The results from this study will be used to inform a large national study that will determine future guidelines to be used nationally and internationally.

Working with paramedics from Great Western Ambulance Service NHS Trust (GWAS), the researchers will test the efficacy of three different approaches and/or tools to manage a patient's airway during cardiopulmonary resuscitation (CPR). CPR is a combination of rescue breathing and chest compression.

Professor Jonathan Benger from UWE and Consultant in Emergency Medicine at University Hospitals Bristol NHS Foundation Trust,  recently cited as one of the top emergency doctors in a Times survey, is leading the project. He explains, "When the heart stops outside hospital, this is a dire medical emergency and a major cause of sudden death. Emergency ambulance teams attend several calls daily to treat people in cardiac arrest and it is important that the most effective techniques are employed and best tools used to provide the best chance of patient survival.  At the moment outcomes remain poor with most patients not surviving.

"Prompt CPR saves lives by preventing damage to a patient's brain and other organs, and effective airway management is a fundamental component of this.

"Until now placing a breathing tube in the windpipe (tracheal intubation) has been considered the best form of pre-hospital airway management, but sometimes attempting intubation can cause significant complications and interruptions in chest compression.

"National recommendations advocate using newer supraglottic airway devices (SADs) which are quicker to insert and cause minimal interruption to chest compressions. The two most promising SADs used in hospitals, but not currently in pre hospital treatment, are the i-gel manufactured by Intersurgical and LMA Supreme®. The devices are used in the upper airway, they are easy to use and cause less disruption in chest compression.

Paramedic teams from GWAS will receive structured education on CPR and rescue breathing; one group will be taught how to use the Intersurgical i-gel, one group the LMA Supreme® and one group will continue as usual. Each group will have consented to taking part in the research project.

GWAS Medical Director and Chief Operating Officer Dr Ossie Rawstorne says:  "GWAS is keen to continue its involvement in research and this study will provide evidence to support the best care for patients suffering out-of-hospital cardiac arrest. Pre-hospital ambulance care has changed significantly in the last 30 years and continues to do so. GWAS is committed to remaining at the forefront of these developments and participation in such research ensures the service and its dedicated staff are able to provide the best care and treatment for patients wherever and whenever they need us."

Professor Benger concludes, "We will be pioneering a new research model on a small scale that will, if successful, be rolled out for a national study that will then  go on to shape future guidelines and be of benefit to cardiac arrest patients in the UK and internationally.

"The findings from this pilot study will teach us important lessons in conducting research in this way. We are interested to learn if we can answer our questions by trialling techniques in a challenging area of clinical care."