The Resuscitation Research Group are involved in a range of projects. These summaries provide a window on what we’re currently up to.
The Resuscitation Research Group oversees the Resuscitation Rapid Response Unit – 3RU – and is evaluating the impact of having a second-tier, elite response to out-of-hospital cardiac arrest. A squad of 12 paramedics from the Scottish Ambulance Service make up the 3RU response team, supported by doctors, nurses, dispatchers, medical students and a resuscitation officer. 3RU paramedics undergo extended training, both for technical and non-technical resuscitation skills.
Bystander CPR is key initial link in the chain of survival and will buy time until a life-saving defibrillatory shock can be delivered. The interactions between the 999 call-maker and the ambulance service call-taker influence the time taken for this initial CPR to begin. There is great variability in the time taken up by call-maker/call-taker interaction prior to CPR starting and we wanted to know why this is the case, and how we could minimise this time.
The primary aim of this project is to investigate the association between non-technical skills performance and technical performance within the ‘resuscitation rapid response’ paramedic unit (3RU) attending patients in out-of-hospital cardiac arrest (OHCA)
Video recording and review of resuscitation events has been used successfully to audit and develop the function of in-hospital resuscitation teams. We are piloting the use of the VideoBadge secure video recording system (www.edesix.com) to record pre-hospital resuscitation from OHCA by the 3RU team currently working in Edinburgh. These recordings are audited to provide information about resuscitation team performance, identify generic training requirements and measure the effect of training interventions.
Performing high quality CPR whilst extricating a patient from the scene, or whilst travelling in an ambulance, is difficult and can be dangerous. In order to maintain an uninterrupted Chain of Survival, the 3RU team are evaluating the use of mechanical CPR. Some out-of-hospital cardiac arrest patients either require specialist hospital intervention to achieve a return-of-spontaneous circulation, or may re-arrest during transport to hospital.
PUCA – Paramedic Ultrasound in Cardiac Arrest
Introducing point-of-care Echocardiography in Life Support (ELS) into cardiac arrest care.
Coronary artery disease can lead to a sudden occlusion of a coronary artery, causing out-of-hospital cardiac arrest. For some patients, unblocking the artery by emergency percutaneous coronary intervention (PCI) is the only chance they have of restoring spontaneous circulation. The Resuscitation Research Group is working closely with the Cardiology and Intensive Care teams at Edinburgh Royal Infirmary and has established a ‘Pavement-to-PCI’ pathway.
Paul Gowens is working up an MSc dissertation as part of his Health Foundation GenQ fellowship in leadership at Ashridge, looking at how leadership and improvement methodology can deliver a strategy for OHCA across Scotland. He is focussing on the key themes of Culture and Leadership to answer the question “how do we build a system which saves lives”.
This project seeks to trial the utility and acceptability of using a real-time, secure video-link to enhance existing telephone ‘professional to professional’ decision support currently available in Edinburgh. We propose initially to augment the existing clinical pathways for the management of chronic obstructive pulmonary disease (COPD) and out-of-hospital cardiac arrest (OHCA).
This study aims to provide a window into the experience of the OHCA bystander responder. These insights will allow us to identify ways we can improve the early steps in the “chain of survival” following OHCA — the steps often most likely to bring about the biggest improvements in patient survival and function after a cardiac arrest.