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
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
"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
"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
"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."
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