This is an application for a Regional Clinical Center which will participate in a Clinical Research Consortium to improve resuscitation outcomes. The overall aim of the consortium is to conduct clinical research in primary cardiopulmonary arrest and in traumatic injury leading to or threatening cardiopulmonary collapse. In this application we address two areas where present resuscitation practices are inadequate: 1) establishing and securing an emergency airway during cardiopulmonary arrest and 2) treatment of traumatic brain injuries with hypotension. We propose two hypotheses which will be tested in randomized controlled clinical trials in prehospital cardiac arrest/head injuries: 1) a new emergency airway, the laryngeal tube airway, will be easier to insert successfully in prehospital cardiac arrest than the endotracheal tube, and will provide ventilatory capability equivalent to the endotracheal tube. 2) Intravenous administration of 7.5% (hypertonic) saline to patients with traumatic brain injuries and hypotension will result in lower intracranial pressures, improved initial Glasgow coma scores on arrival at the emergency department and improved survival with less neurologic damage. If our hypotheses are correct, the emergency treatment of cardiac arrest and traumatic brain injury patients will be significantly more effective, with fewer deaths and less long-term disability.
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