EMS Responders to Test Increasing Heart Attack, Trauma Survival

Injecting heart attack victims with a small dose of insulin isn't standard protocol among ambulance or hospital personnel.

But it might be some day be if a research program to be launched in the Dallas area and nine other U.S. and Canadian cities in 2006 is as successful as officials say it will be.

It's one part of a multipronged research program to test methods that have proven in smaller studies to improve the survival rates of victims of cardiac arrest, hemorrhagic shock from trauma and brain injury.

And patients treated by emergency medical personnel in 13 local cities will be part of the study.

Those cities are Dallas, Carrollton, Farmers Branch, Irving, Garland, Highland Park, University Park, DeSoto, Duncanville, Lancaster, Mesquite, Wills Point and Sunnyvale, all part of the BioTel system. BioTel provides medical direction for the nearly 3,000 firefighters, emergency medical technicians and paramedics in those cities.

More than 100 U.S. and Canadian cities applied to participate in the Resuscitation Outcomes Consortium Project, sponsored by the National Heart, Lung and Blood Institute, the U.S. Department of Defense, the National Institutes of Health and other agencies on both sides of the border.

The project consists of 10 regional clinical centers, including the Dallas Center for Resuscitation Research. Among those coordinating and directing the local study are Dr. Paul Pepe, head of emergency medicine for UT Southwestern Medical Center and the Parkland Health and Hospital System, and Dr. Ray Fowler, assistant professor of surgery at UT Southwestern.

Dr. Pepe is also the medical director for the BioTel System. Dr. Fowler is deputy medical director.

"We believe the case for participating is so compelling," Dr. Fowler said. "We believe it has been clearly proven these treatments actually will improve the care for the citizens."

Dr. Fowler said the studies will look at improving blood flow during cardiopulmonary resuscitation; use of a special intravenous fluid on patients who are bleeding to death from trauma; and use of a combination of insulin and other medications to minimize damage during a heart attack.

One of those studies will include placing a device in the airway during CPR.

"We believe we can improve the survival from cardiac arrest occurring outside the hospital from 20 percent to about 30 percent, which would be an astonishing improvement."

In cases of hemorrhagic shock, uncontrollable bleeding resulting from trauma, part of standard treatment has been to pump lots of intravenous fluid into the patient.

But that seems to decrease chances the patient would survive, Dr. Fowler said, because it prevents clotting and increases chlorine levels in the bloodstream.

"We have on board several quarts of extra fluid," he said. "It's sterile, has the right electrolyte concentration. What if we can send a signal to the blood stream that says you're in shock, suck some of that fluid out and maintain the blood pressure."

In the study, about a cup of hypertonic saline would be given to the patient intravenously. That would stimulate the body to use its own natural fluids.

"We feel very strongly this gives us the opportunity to bring the Dallas area to the forefront of emergency care," Dr. Fowler said. "And as soon as we have proved these therapies indeed do what we are sure they will do, then they will rapidly become part of our standard treatment protocols."

Carrollton Fire Chief John Murphy said his department is eager to be part of the study, which will begin using the test procedures on patients sometime next summer.

"Any time there's a possibility of increasing the chances of survival, whether from heart attack or traumatic injury, we would like to do the very most we can," he said.

E-mail ssandoval@dallasnews.com.

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