Undertaking clinical trials in the pre-hospital environment allows us to expand the evidence base surrounding pre-hospital emergency care.
Our MICA paramedics are currently enrolling patients in the POLAR Trial, the
PATCH Study and are also currently undertaking a feasibility study of the EXACT Study.
Heart attack is one of the leading causes of death in Australia. For over one hundred years supplemental oxygen has been administered to patients with suspected heart attack as an initial first aid therapeutic measure by paramedics, doctors and nurses, in the thought that oxygen provides benefit.
Recently, however, there has been increasing concerns with the effects of high concentrations of oxygen in potentially reducing blood flow in the heart. The effect of oxygen in patients with heart attack has not been studied in the era of rapid ambulance treatments, modern therapies and surgery to treat heart attack patients.
The Air Versus Oxygen in Myocardial Infarction (AVOID) study was an investigator initiated multicentre, randomised trial designed to investigate the effect of oxygen on patients with heart attack. The study was conducted by Ambulance Victoria and nine metropolitan hospitals that provide 24 hour percutaneous coronary intervention (PCI) services in Melbourne, Australia, with collaborations from Monash University and Baker IDI Heart and Diabetes institute, between October 2011 and July 2014.
The AVOID study found that supplemental oxygen in patients experiencing heart attack with initial normal oxygen levels, did not relieve their pain or minimise heart damage. Instead supplemental oxygen was found to increase heart injury and dangerous rhythms both in hospital and at 6 months on testing with heart MRI.
The findings of the AVOID study has led to dramatic change in practice for all care providers of patients with heart attack both in Australia and around the world.
The AVOID study did not demonstrate any significant benefit of routine oxygen therapy for reducing myocardial infarct size, improving patient hemodynamics or alleviating symptoms.
Instead, supplemental oxygen was associated with increased early myocardial injury, increased major arrhythmias and larger myocardial infarct size assessed at six months.
The AVOID study was presented as a late breaking trial at The American Heart Association meeting and published in the leading cardiac journal Circulation in June 2015. The study’s findings have major implications for all health care providers in the management of patients with suspected acute myocardial infarction during both their prehospital and in-hospital treatment pathways. Despite only recent publication, the widespread clinical impact of the AVOID study is evidenced by it being cited more than 50 times, including in the 2015 European Society of Cardiology Acute Coronary Syndrome guidelines and 2015 International Resuscitation guidelines. The study has led to changes in oxygen delivery in Ambulance Victoria, and other emergency medical services both locally and internationally. Whilst the role of oxygen therapy in hospital has also come under significant scrutiny and led to changes in clinical practice.
The study was recently recognized in the Medical Republic as one of the most influential health research studies in the last 100 years: http://www.medicalrepublic.com.au/influential-healthresearch-last-100-years/. It was also recognised as a finalist for trial of the year at the Australian Clinical Trials Alliance Awards.
Other Research Projects
Ambulance Victoria also contributes to numerous other research projects. For example, we are currently working with Turning Point Alcohol and Drug Centre on its National Ambulance Project which is funded by the Movember Foundation. We are also working with the University of Sydney on improving outcomes for people with Spinal Cord Injury, a project that is funded by the National Health and Medical Research Council. For more information about research at Ambulance Victoria, please email email@example.com.