Milwaukee Regional Clinical Center

描述(由申请人提供)： 这份由三部分组成的建议书介绍了选择弗罗德特纪念路德医院(FMLH)急诊科(DEM)、威斯康星医学院(MCW)和密尔沃基县紧急医疗服务系统(MCEMS)作为PULSE财团的地区临床中心的理由，该财团将被称为密尔沃基地区临床中心(MRCC)，由Tom P.Aufderheide，M.D.(PI)指导。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，包括生命之旅直升机和15家接受护理人员的医院，每年治疗3,207名城市、郊区和农村的心脏骤停和创伤患者。这一精心设计和经过验证的基础设施提供集中的急诊医生医疗控制和现场监控，以实现MCEMS护理的持续交付和医院外研究方案的实施。Aufderheide博士创立并领导了密尔沃基急救医学研究联盟(MEMRC)，这是一个经验丰富的院外研究协会，在所有接受辅助医疗的医院支持IRC互动、持续研究干预、监测和病历审查。奥夫德海德博士已经进行了两项要求知情同意例外的院外试验，这在密尔沃基社区引起了对这种方法的熟悉和支持。 第二部分：心肺骤停方案建议，“主动按压减压CPR和阻抗阈值装置(ACD/ITD CPR)以改善心脏骤停的预后”，是一项随机临床试验，比较了接受标准手动CPR和ACD/ITD CPR治疗的患者的出院存活率和神经预后。飞行员的人类数据显示短期存活率显著提高，支持这项多中心研究。使用这种方法在心肺复苏期间增加血流量，每年有可能挽救全球3.6万人的生命。第3部分：创伤方案建议，“失血性休克后的功能生活质量”，这是一项前瞻性、随机、双盲研究，比较了创伤休克患者的功能结果和生活质量，随机接受高渗盐水和乳酸林格液作为初始复苏液。复苏的类型和质量影响失血性休克后的死亡率、生活质量和神经预后，因为创伤每年导致约15万人死亡，60万人永久残疾，社会损失约4690亿美元。结合临床和基础科学，这项转化性研究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.