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Vancouver Fire Department Researching New Treatments of Out-of-Hospital Cardiac Arrest

The Vancouver Fire Department is participating in a National Institutes of Health (NIH) clinical trials to evaluate treatment for out-of-hospital cardiac arrest (OOHCA) under the direction of Dr. Lynn Wittwer, Medical Program Director for Clark County.

The trial will compare two drug treatments and a salt-water placebo in participants with "shock-resistant" ventricular fibrillation, a condition in which the heart beats chaotically instead of pumping blood.

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

"Increasing survival rates for people who experience out-of-hospital cardiac arrest is a major public health goal," said Susan B. Shurin, M.D., acting director of the NIH's National Heart, Lung, and Blood Institute, which is the lead federal sponsor of the studies.

The Vancouver Fire Department has over 60 paramedics who have been trained to participate in the study in cooperation with American Medical Response, the ambulance contractor for the City of Vancouver.

The Out-Of-Hospital Cardiac Arrest Due to Ventricular Fibrillation or Tachycardia study (ALPS) will determine whether either of the drugs studied improves survival-to-hospital-discharge rates for participants with shock-resistant ventricular fibrillation. Shock-resistant ventricular fibrillation is defined as ventricular fibrillation that persists after three defibrillation attempts.

About 25 percent of cardiac arrests are due to ventricular fibrillation. When shock treatment with a defibrillator fails to restore normal heart rhythm during ventricular fibrillation, medications are often given, but their effectiveness in improving survival is unknown.

Vancouver Fire Departments current survival rate for "shockable" rhythms is 23%. "We have made tremendous strides in improving the quality and effectiveness of our CPR over the past five years because of this kind of research, now it's time to assess the effectiveness of our drug therapies" said Captain Jay Getsfrid, EMS Administrator for the Vancouver Fire Department.

The ALPS trial will enroll up to 3,000 participants at nine locations across the U.S. and Canada. ALPS is part of the NIH-supported Resuscitation Outcomes Consortium (ROC), the first large-scale clinical research network in the world designed to study, improve, and standardize how EMS teams deliver very early, pre-hospital interventions to improve patient survival after cardiac arrest.

"Answering these questions is crucial and will determine the role of these drugs for patients who experience out-of-hospital cardiac arrest," said Peter Kudenchuk, M.D., principal investigator of the ALPS trial and the Seattle-King County Resuscitation Outcomes Consortium (ROC) clinical site, and professor of medicine and heart rhythm specialist at the University of Washington School of Medicine (UW Medicine).

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