Milwaukee Regional Clinical Center

描述（由申请人提供）： 这三部分提案介绍了选择Froedtert纪念路德医院（FMLH）急诊医学部（DEM）、威斯康星州医学院（MCW）和密尔沃基县急诊医疗服务系统（MCEMS）的完善基础设施作为PULSE联盟的区域临床中心（称为密尔沃基区域临床中心（MRCC））的理由，导演：Tom P. Aufderheide，M.D.（PI）. 第一部分：位于毗邻的FMLH和威斯康星州儿童医院（CHW）国家认可的创伤中心内，FMLH DEM协调MCEMS，包括生命飞行直升机和15家护理人员接收医院，每年治疗3，207名城市，郊区和农村心脏骤停和创伤患者。 这种精心策划和经过验证的基础设施提供了集中的急诊医生医疗控制和现场监控，以实现MCEMS护理的一致交付和院外研究方案的实施。 Aufderheide博士创立并领导密尔沃基急诊医学研究联盟（MEMRC），这是一个经验丰富的院外研究协会，支持IRC互动，继续研究干预，监测和所有护理人员接收医院的病历审查。 Aufderheide博士进行了两项院外试验，要求知情同意例外，在整个密尔沃基社区对这种方法产生了熟悉和支持。 第二部分：心肺骤停方案提案“用于改善心脏骤停结果的主动按压减压CPR和阻抗阈值装置（ACD/ITD CPR）”是一项随机临床试验，比较了接受标准手动CPR与ACD/ITD CPR治疗的患者的出院生存率和神经系统结局。初步人体数据显示短期生存率显著改善，支持多中心研究。通过这种方法增加心肺复苏术期间的血流量，每年有可能挽救全球36，000人的生命。第三部分：创伤方案提案“出血性休克后的功能性生活质量”是一项前瞻性、随机、双盲研究，比较了创伤休克患者的功能结局和生活质量，这些患者随机接受高渗盐水与乳酸林格氏液作为初始复苏液。复苏的类型和质量影响失血性休克后的死亡率、生活质量和神经学结局，因为创伤性损伤每年导致约15万人死亡，60万人永久致残，社会成本约为4690亿美元。结合临床和基础科学，这项转化研究将通过解决这一重要的国家医疗保健问题产生重大影响。

DESCRIPTION (provided by applicant): This three-part proposal presents the rationale for choosing the well-established infrastructure of the Department of Emergency Medicine (DEM) of Froedtert Memorial Lutheran Hospital (FMLH), the Medical College of Wisconsin (MCW), and the Milwaukee County Emergency Medical Services System (MCEMS) as a Regional Clinical Center for the PULSE consortium, to be known as the Milwaukee Regional Clinical Center (MRCC), directed by Tom P. Aufderheide, M.D. (PI). PART 1: Housed within the adjoining FMLH and Children's Hospital of Wisconsin (CHW) nationally recognized Trauma Centers, FMLH DEM coordinates MCEMS, including the Flight For Life Helicopter and 15 paramedic-receiving hospitals, treating 3,207 urban, suburban, and rural cardiac arrest and trauma patients annually. This well-orchestrated and proven infrastructure provides centralized emergency physician medical control and on-scene monitoring for consistent delivery of MCEMS care and the implementation of out-of-hospital research protocols. Dr. Aufderheide founded and leads the Milwaukee Emergency Medicine Research Consortium (MEMRC), an experienced out-of-hospital research association, supporting IRC interactions, continued research interventions, monitoring, and medical record review at all paramedic-receiving hospitals. Dr. Aufderheide has conducted two out-of-hospital trials requiring exception to informed consent, engendering familiarity and support for this approach throughout the Milwaukee community. PART 2: The Cardiopulmonary Arrest protocol proposal, "Active Compression Decompression CPR and the Impedance Threshold Device (ACD/ITD CPR) for Improving Outcome in Cardiac Arrest," is a randomized clinical trial comparing hospital discharge survival rates and neurological outcome in patients treated with standard manual CPR versus ACD/ITD CPR. Pilot human data demonstrating significantly improved short-term survival supports the multicenter study. Increasing blood flow during CPR with this approach has the potential to save 36,000 lives worldwide each year. PART 3: The Trauma protocol proposal, "Functional Quality of Life After Hemorrhagic Shock," is a prospective, randomized, double-blind study comparing functional outcome and quality of life in trauma patients with shock, randomized to receive hypertonic saline versus lactated Ringers as the initial resuscitation fluid. The type and quality of resuscitation affect mortality, quality of life, and neurologic outcome after hemorrhagic shock, as traumatic injury annually kills approximately 150,000 people, permanently disables 600,000, and costs society approximately $469 billion. Combining clinical and basic science, this translational research study will have significant impact by addressing this important national healthcare issue.