London Trauma Conference 2013


London Cardiac Arrest SymposiumThe conference kicked off with a discussion from Dr Richard Lyon on the TOPCAT study. Looking at the rationale behind the trial and some of the problems that arose, the interim results presented by Dr Lyon suggested a number of indicators for potential improvements in the management of pre-hospital cardiac arrest.Prof Simon Redwood spoke on post-cardiac arrest syndrome, outlining its cause, how it should be treated and how it can be prevented. Prof Redwood emphasised the need to develop and adopt a systems approach to all events of pathophysiological processes.Prof Tim Harris then gave a talk on the use of ultrasound (USS) in cardiac arrest. Considering whether USS can aid resuscitation, Prof Harris illustrated training requirements for its use and its potential application in the pre-hospital setting.After the first coffee break, Prof Charles Deakin delivered a presentation on cardiogenic shock after return of spontaneous circulation (ROSC). The key elements of his talk looked at how cardiogenic shock should be treated pharmacologically, how it should be treated mechanically, and what treatments are on the horizon—suggestions he alluded to included synchronised pacing, therapeutic hypothermia, extrathoracic ventilation and gene therapy.Prof Bryan McNally spoke on the Cardiac Arrest Registry to Enhance Survival (CARES), considering evidence for whether cardiac arrest registries improve survival and whether they should be implemented regionally, nationally or locally. He outlined how registries allow for communities to determine OHCA outcomes and identify risk groups and neighbourhoods, as well as enabling clinical benchmarking to identify opportunities and track the diffusion of new therapy.The Douglas Chamberlain Lecture was given by Dr David Zideman on the challenges of providing field of play (FOP) medical care at the London Olympics. Dr Zideman was the lead clinician for the emergency medical services at the London Organising Committee of the Olympic and Paralympic games. He outlined how FOP care is different depending on the sport and so knowledge, preparation and training was essential in providing the best care at London 2012.LEEPARKERFollowing lunch, Prof Karim Brohi discussed open chest cardiac massage. After alluding to the fact that external chest compressions have been around since the 1960s, Prof Brohi went on to question whether they are the best way to generate a cardiac output. In canine models, coronary perfusion pressure has been seen to be five times better with internal cardiac massage, although there are few studies showing the outcome in humans. Prof Brohi therefore questioned whether it is time to do a trial of open cardiac massage.Dr David Menzies then spoke on community first responder schemes, considering challenges they face and their potential solutions. One of the predominant issues concerns the maintenance of skills and interest, especially as training is not always standardised. Given the high level of cardiac arrests that occur at home, the continued need for CFR schemes is evident.After the afternoon coffee break, Dr Matt Thomas spoke on neuroprotective strategies for post-cardiac arrest syndrome. Dr Thomas highlighted the importance of controlled re-oxygenation as well as considering therapeutic hypothermia, a treatment that has received much debate recently. The main take home message from the talk was to not prognosticate too early, as improvements patients following OHCA can be seen as late as 72 hours.Dr Eldar Soreide spoke on recent advances in improving OHCA in the Stavanger region of Norway. Dr Soreide mentioned how we are obsessed with medical breakthroughs rather than follow-throughs, and how focusing on bystanders can improve outcomes of OHCA.Prof Daniel Davis gave the final talk of the day on what makes up a high-performing hospital team. Highlighting the work of the UC San Diego Center for Resuscitation Science, he emphasised the importance of advanced resuscitation training, inpatient/technology-specific algorithms and the need for an organised approach to data analysis.

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