Friday, December 3, 2010

ERC in Porto

The 2010 Cardiac Resuscitation Guidelines were released a month ago, detailing the best thinking on how to save victims of sudden cardiac arrest.  It’s a dynamic field: there are always new ideas alongside old ones, evidence pro and con, all working towards improving the dismal survival rates of out-of-hospital events (currently less than 7%).  The European Resuscitation Council, an umbrella organization for the national groups setting practice standards and training methods, sponsors this meeting to review the latest studies and products ever two years. This year’s meeting is being held in Porto, along the northern Portuguese coast.

Porto is an old and fascinating city, sprawled along steep riverbanks, graced with winding, vertical streets and blue-tiled churches.  The city is best known for port wine and salt cod, distinctive river boats and wildly variable weather.  Torrential rainstorms develop in moments, then vanish in minutes; quick refuge in sweet shops or bars is the only (and appreciated) alternative during a walk.

The conference is being held in an old transport barn along the river, with huge rooms, stone walls, and colored lights.  Its a unusual venue, filled with over 2000 attendees   A lot of Dutch are down for this one: they all claim to be fleeing the snow.

The conference is showcasing a lot of good science from centers worldwide: several pet theories of mine have already been shot down (and a few have been elevated).  I always believed the the electrocardiogram held valuable information to guide care: a large study of mathematical waveform analyses shows that there’s nothing useful in the techniques I’d championed ten years ago.  Unfortunate (especially since this costs me a bet with a colleague).  At the same time, advances in cooling patients (therapeutic hypothermia) and emergency alerting using GPS-enabled mobile phones are saving lives, as I have long thought they could.

Again, it speaks to the difficult diffusion of innovation from idea prototype to practice. It’s a long and twisting road: a lot of good ideas fall along the wayside or never get tried until decades after they are conceived.  How can we get good ideas accelerated, bad ones eliminated, earlier in the process?

It’s a bit of an odd show for me because I meet a lot of friends and colleagues from the company I worked for a decade ago.  It’s tempting to spend time in familiar surroundings catching up with old friends.

So it’s been even more important  to execute on key reasons for being here.  There are people and companies that I need to meet, and a story that I have to write with other’s help. Renewing the network and staying engaged with the community is important, but secondary.

Funny, it used to be the other way around back in corporate days.  Connecting and strengthening bonds and brands was the word of the day.  Interesting, again, how things change because I’m running a business,  not just a product  or project.


Jules: said...

That sounds ilke an interesting conference (mostly because I'm actually working in cardiology). I didn't know that the survival rate of out-of-hospital events was still so dismal, though...does that have more to do with the time to get to a hospital, or the care you get on an ambulance?

Dave Hampton said...

I'm sitting in a session led by Graham Nicols from Seattle now: he is saying that the 7% OOH rates are improving to 10% with better CPR and to 14% with hypothermia. But that's the best systems, worldwide, and it is not clear, according to his presentation, whether the improvements are physiologic effects, training effects, or Hawthorne effects. An interesting problem.

He believes that we are on the cusp of major improvements if we address the subsequent in-hospital mortality. He's especailly concerned aobut withdrawal of life support too early from patients in hypothermia - no neurologic prediction should be done until 72 hours when cooling is withdrawn.

Dave Hampton said...

Sorry, I got that wrong - it is to assess 72 hours after restoration of normothermia, with ongoing prevention of fever. They are also advocating neuro monitoring in addition to cardiac, pulmonary and renal monitoring, as is customary.