Medical Student Research Fellowship for Summer 2007

Mentor: Ahamed Idris, MD, FACEP , FAHA
Department: Emergency Medicine
Room number: CS 2.102
Mail Code: 8579
Phone number: 214-648-8652
E-mail: Ahamed.Idris@utsouthwestern.edu

Project title: Resuscitation Outcomes Consortium Registry: Assessment of Quality of CPR and Outcome for out-of-hospital cardiac arrest.

Human subjects IRB approved project number (where applicable): 102005-054

Project Type: Patient Based Research

Brief Description of Project: 1. To determine chest compression rate and ventilation rate in cardiac arrest patients who receive CPR in the out-of-hospital setting. 2. To assess the relationship between quality of CPR and survival.

Role of Medical student: Analyze data from the Dallas ROC Epistry database for 2006: 2000 cardiac arrest patients and 1000 trauma patients. Specific data elements to be analyzed include chest compression (n/min) and ventilation (n/min) during CPR, CPR fraction, time interval from 911 call to arrival of paramedics, cardiac rhythm, patient demographics, and survival to hospital discharge

Previous Research Activities or Publications with Medical Students:
Cody Starnes MS 2009 - Functional Outcomes Study
Kunal Jain MS 2009 - Acquisition and review of CPR process data
Anson Tang MS 2009 - Acquisition and review of CPR process data

Abstracts
Kunal Jain, BS, Ahamed Idris, MD. Quality of cardiopulmonary resuscitation during out-of-hospital cardiac arrest and trauma. Medical Student Research Forum, UTSW 2007.

Roppolo LP, Westfall A, Pepe PE, Idris AH. Assessment of agonal breathing improves detection of cardiac arrest. Circulation 2004;110(Suppl III):III-456.

Idris AH, Roppolo LP, Kulkarni H, Ohman K, Pepe PE. A Five-minute Training Program for Automated External Defibrillator Use is More Effective Than a 4-Hour Course. Circulation 2005,112(Suppl II):II-326.

Roppolo LP, Ohman K, Pepe PE, Idris AH. The Effectiveness of a Short Cardiopulmonary Resuscitation Course for Laypersons. Circulation 2005; 112(Suppl II):II-325.

Manuscript
Ropollo LP, Pepe PE, Campbell L, Ohman K, Kulkarni H, Idris A, Bean L, Bettes TN, Idris AH. Prospective, randomized trial of the effectiveness and retention of 30-minute layperson training for cardiopulmonary resuscitation and automated external defibrillators: The American Airlines Study. Resuscitation 2007; in press.

Bold Underlined names are/were UTSW medical students

Resuscitation Outcomes Consortium Registry: Assessment of Quality of CPR and Outcome for out-of-hospital cardiac arrest.

Outcomes The primary outcome is survival to discharge. Ventilation per minute will be considered a key covariate.

Background: Positive pressure ventilation (PPV) decreases cardiac preload and output, especially in hypovolemic patients. Both animal models and human studies of severe hemorrhage, TBI, and cardiac arrest have demonstrated that perfusion and survival are significantly improved with lower ventilatory rates (VR). However, emergency care personnel sometimes use high VR in hypotensive patients, either inadvertently or intentionally. Hence, uncontrolled high rates of PPV may have deleterious effects on outcomes after out-of-hospital cardiac arrest. Reducing ventilation rates may be a simple, feasible means to improve outcome from cardiac arrest.

Specific Aims:

1. To determine VR in cardiac arrest patients who receive assisted ventilation in the out-of-hospital setting.
2. To assess the relationship between hyper- and hypoventilation and ETCO2 values, hemodynamics and outcome after out-of-hospital cardiac arrest.

Hypothesis 1: Cardiac arrest patients are frequently hyperventilated with rates that exceed the recommended rate of 8 -10 breaths/min.

Hypothesis 2: Out-of-hospital cardiac arrest patients who are ventilated at a low rate will more frequently have higher ETCO2 values when compared with those who receive hyperventilation.

Hypothesis 3: To test whether survival to hospital discharge after out-of-hospital cardiac arrest is significantly greater when emergency care providers use low VR compared to higher VR.

Design This ancillary study will supplement optional and mandatory data elements from the ROC Epistry with supplementary data to describe end tidal CO2 waveforms.

Setting EMS agencies participating in the ROC Epistry

Population Included will be individuals who experience non-traumatic cardiac arrest, and receive any of the following airway management techniques in the field: bag-mask ventilation, endotracheal intubation, nasotracheal intubation, cricothyrotomy, Combitube insertion, and laryngeal mask airway (LMA) insertion. Excluded will be those aged less than local age of consent, or with EMS response time interval of >15 minutes from 911 call to arrival at patient's side.

Analysis Associations between prehospital ventilatory rates and patient outcomes will be explored using logistic regression. Ventilatory rate will be evaluated both as categorical variables indicating adherence to the recommended ventilation rate (VR 8-10) (reference group) by including dummy variables for hyperventilation (VR10-20/min), severe hyperventilation (VR>20/min), and hypoventilation (VR<8).

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