Trauma and massive haemorrhage are associated with coagulopathy secondary to tissue injury, hypoperfusion, dilution, and consumption of clotting factors and platelets occurring already at the scene of the accident. Concepts of damage control surgery have evolved prioritizing early control of the cause of bleeding by non-definitive means, while haemostatic control resuscitation seeks early control of coagulopathy. Haemostatic resuscitation provides transfusions with plasma and platelets in addition to red blood cells in an immediate and sustained manner as part of the transfusion protocol for massively bleeding patients and consequently limiting the amount of crystalloids and colloids are crucial for avoiding further impairment of haemostatic competence. Transfusion of red blood cells, plasma and platelets in a similar proportion as in whole blood prevents both hypovolaemia and coagulopathy. Results from recent before-and-after studies in massively bleeding patients indicate that trauma exsanguination protocols involving early administration of plasma and platelets are associated with improved survival. Furthermore, viscoelastic whole blood assays, such as thrombelastography (TEG) appear advantageous for identifying coagulopathy in trauma patients with severe haemorrhage as opposed the conventional coagulation assays. In our view, patients with uncontrolled bleeding, including trauma patients, should be treated with goal-directed haemostatic control resuscitation involving early administration of plasma and platelets and based on the results of TEG analysis. The aim of the goal-directed therapy should be to maintain a normal haemostatic competence until surgical haemostasis is achieved, as this appears to be associated with reduced mortality.
Pediatric cardiorespiratory arrest (CRA) is a rare event that leads to death or survival with neurological sequelae in many cases. CRA in children usually occurs at home, and therefore the training of paramedics and lay people is essential in order to improve the victim's outcome, regardless of their age. Simple and inexpensive ways of improving bystanders' quality of cardiopulmonary resuscitation should be implemented. We hypothesized that a very popular song, with a rhythm that fits the CPR chest compressions rate target would be an effective audio guidance to train schoolchildren in CPR.
The Pan-Asian Resuscitation Outcomes Study (PAROS) Clinical Research Network is a unique, low-cost, self-funded model of a collaborative research network in the Asia-Pacific region formed in 2010. Currently, research into pre-hospital and emergency care in the Asia-Pacific region is largely inadequate and poorly coordinated owing to the marked variations in Emergency Medical Services (EMS) systems and outcomes reporting. With conditions such as Out-of-Hospital Cardiac Arrest (OHCA) being one of the leading causes of death worldwide, the dearth in the understanding of trends and research in pre-hospital and emergency care underscores the urgent need for more collaborative research in this area. By creating a platform to connect serious researchers, PAROS Clinical Research Network fosters an environment conducive for intellectual exchanges and for research ideas to be shared and implemented. This article describes the enablers pertaining to governance, frameworks and people in the formation and development of the PAROS Clinical Research Network. The Network has concentrated on building a supportive environment through having proper governance structure, efforts to harmonize the data dictionary for the registry, supportive frameworks that promote ethical and proper collection and use of data, and efforts in seeking opportunities to educate and equip its members with relevant knowledge and research capabilities. These descriptions are presented to provide a research framework for others in the field and to increase international collaboration for research in pre-hospital and emergency care.