NEW ORLEANS — Much of the current trials in resuscitation and trauma care are based on observation rather than randomized controlled trials. That needs to change, according to the winners of the 2016 Lifetime Achievement Awards in Resuscitation Science.
“We have dozens of interventions on every ambulance for sudden arrest and we don’t know for sure which, if any, of those interventions actually make a difference in outcomes. We have a huge number of observational studies with multiple outcomes. What we really need are prospective trials,” said Jerry Nolan, MD, a recipient of the award and consultant in anesthesia and intensive care medicine at the Royal United Hospital in Bath, England.
Karim Brohi, a professor of trauma sciences at Barts Hospital and the London School of Medicine and a clinical director of the London Major Traua System, also received the lifetime achievement honor.
He said that traditional trauma care focuses on reducing the time to surgery while traditional trauma resuscitation focuses on stabilizing patients long enough to get to surgery. This often can involve massive fluid infusions, which can exacerbate trauma issues.
“We often make them worse with our resuscitation efforts,” he said. “We have to rethink trauma resuscitation.”
Rethinking trauma resuscitation is a complex task and new research is needed, Brohi said, adding that such research is difficult, but can be tremendously effective.
Research embedded in usual care for emergency medical services in London has slashed the 24-hour mortality rate by 61 percent.
A single new intervention, giving trauma victims red blood cells pre-hospital, produced the greatest benefit. In 2009, 34 percent of trauma victims in the London trauma system died of hemorrhage.
In 2015, mortality from post-trauma hemorrhage was down to 18 percent. The key difference was a decision in 2012 that put red blood cells on every ambulance and directions to administer them as early in the care process as possible.
“Whatever we do for these patients needs to be pushed in the pre-hospital phase, pushed to the ambulance, pushed to the very first medical team on the scene,” Brohi said. “There is still a lot to be done.”