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NIH Trials to Assess Emergency Cardiac Arrest Treatments

Ambulance (Michael Gil/Flickr)NIH’s National Heart, Lung, and Blood Institute has begun two clinical trials to evaluate treatments for out-of-hospital cardiac arrest:

A comparison of continuous chest compressions (CCC) combined with pause-free rescue breathing, to standard cardiopulmonary resuscitation (CPR) that includes a combination of chest compressions and pauses for rescue breathing, and

Treatment with the drug amiodarone, another drug called lidocaine, or a placebo in participants with shock-resistant ventricular fibrillation, a condition in which the heart beats chaotically instead of pumping blood.

University of Washington in Seattle will coordinate both trials. The studies are expected to include medical centers in Birmingham in Alabama, Portland in Oregon, San Diego, Pittsburgh, Dallas, Seattle, and Milwaukee. Canadian institutions taking part include those in Ottawa and Toronto in Ontario and Vancouver, B.C.

During a cardiac arrest, the heart stops beating, and unless it is restarted within minutes, the person usually dies.  The majority of the approximately 350,000 people who have cardiac arrest in the United States each year are assessed by emergency medical service providers. Nonetheless, more than 90 percent of people who experience a cardiac arrest outside of a hospital die before reaching a hospital or soon thereafter.

The CCC trial will enroll 23,600 participants in eight cities and compare survival-to-hospital-discharge rates for two CPR approaches delivered by paramedics and fire fighters. Trained emergency personnel will give all participants in the CCC trial three cycles of CPR followed by heart rhythm analysis and, if needed, an electrical shock (defibrillation), applied to the chest.  Half will be randomly assigned to receive continuous compressions combined with pause-free rescue breathing and half will receive standard professional CPR.

Standard CPR that includes chest compressions with short pauses for assisted breathing has been called into question by emerging data suggesting that stopping chest compressions to provide assisted breathing interrupts overall blood flow, thereby lowering survival.

The Amiodarone, Lidocaine, or Placebo Study (ALPS) will enroll up to 3,000 participants at nine locations across the U.S. and Canada. The trial determine whether amiodarone or lidocaine improves survival-to-hospital-discharge rates for participants with shock-resistant ventricular fibrillation.  Participants will receive one or the other drug or a placebo.

About a quarter of cardiac arrests are due to ventricular fibrillation, a severely abnormal heart rhythm  or arrhythmia.  When shock treatment with a defibrillator fails to restore normal heart rhythm during ventricular fibrillation, medications such as amiodarone or lidocaine are often given, but their effectiveness in improving survival is unknown.

Read more: iPhone App Helps Doctors Deal with Cardiac Emergencies

Photo: Michael Gil/Flickr

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