Pragmatic, Randomized Optimal Platelet and Plasma Ratios (PROPPR)
PROPPR was a multicenter, randomized trial which compared different ratios of blood products given to trauma patients who were predicted to require a massive transfusion within the first 24 hours. The patients who had been predicted to require a massive transfusion received blood products based on a 1:1:1 or 1:1:2 ratio of platelets, plasma and red blood cells. Study results were published in JAMA (The Journal of the American Medical Association) in 2015.
Continuous Compressions versus Standard CPR in Patients with Out-Of-Hospital Cardiac Arrest
The primary aim of the trial was to compare survival at hospital discharge after continuous chest compressions versus standard American Heart Association-recommended cardiopulmonary resuscitation with interrupted chest compressions in patients with out-of-hospital cardiac arrest. Almost 125 fire and EMS organizations, involving more than 20,000 fire and emergency medical service (EMS) providers who serve a combined population of nearly 15 million people from diverse urban, suburban and rural regions participated in the study. Approximately 23,600 patients were enrolled in the United States and Canada. Results of the CCC study were published in the New England Journal of Medicine.
Amiodarone (PM101), Lidocaine or Neither for Out-of-Hospital Cardiac Arrest Due to Ventricular Fibrillation or Tachycardia(ALPS: Amiodarone, Lidocaine or Placebo Study)
The goal of ALPS was to determine if survival to hospital discharge is improved with early (and if necessary) repeated therapeutic administration of a new Captisol-Enabled formulation of IV amiodarone (PM101) compared to no antiarrhythmic drug (placebo) or lidocaine. It compared the benefit of what was believed to be the most effective antiarrhythmic drug (amiodarone) against the traditional standard drug (lidocaine) and against neither (placebo) in shock-resistant cardiac arrest. This trial was designed to fill a gap in knowledge between our understanding of these drugs’ mechanisms of action and whether their use actually improves survival after cardiac arrest. No pharmacologic agent had previously ever been demonstrated to improve survival to hospital discharge after cardiac arrest. Read the study results, as published in 2014 in the American Heart Journal.
Prehospital Lactate for the Identification of Shock in Trauma
Previous studies demonstrated an association between hypotension in patients who are seriously injured and the need for emergent interventions. Research that preceded this trial suggested that heart rate (HR) and hypotension (systolic blood pressure ≤ 90 mmHg) was less specific than previously thought. Serum lactate is a known byproduct of anaerobic metabolism, and lactate values were widely used in North American EDs to identify patients in the early stages of hemorrhagic shock. This study used hand-held lactate analyzers to measure prehospital lactate level, and compare that to a systolic blood pressure to predict the need for resuscitative care, emergent interventions or death within 6 hours of ED arrival. Study results were published in 2015 in the Journal of Trauma and Acute Care Surgery; see the abstract here.