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Out-of-hospital shock in non-injured patients: risk stratification and early resuscitation

PI:  Christopher W. Seymour

Co-investigators:  Thomas Rea, Paul Hebert, Susan Heckbert, John A. Spertus, Don Yealy

Funding:  American Heart Association Clinical Research Program Grant

Early intervention by EMS personnel in acute cardiovascular disease improves outcomes in cardiac arrest, stroke, and ST elevation myocardial infarction. However, the definition, risk stratification, and treatments for field shock are unclear. This project seeks to develop classification models by shock etiology for high risk emergency patients, and test the effectiveness of field resuscitation on patient outcomes. We hypothesize that the benefit for early fluid resuscitation may be most compelling for non-cardiovascular shock, while potentially harmful for those with acute cardiovascular compromise. We will use advanced comparative effectiveness estimators to determine treatment effects across shock etiology.


1. Seymour CW, Cooke CR, Heckbert SR, Spertus JA, Callaway CW, Martin-Gill C, Yealy DM, Rea TD, Angus DC. Prehospital intravenous access and fluid resuscitation in severe sepsis: an observational cohort study. Crit Care. 2014 Sep 27;18(5):533. [Epub ahead of print] PubMed PMID: 25260233

2. Seymour CW, Cooke CR, Heckbert SR, Copass MK, Yealy DM, Spertus JA, Rea TD.  Prehospital systolic blood pressure thresholds: a community-based outcomes studyAcad Emerg Med 2013 Jun; 20 (6):597-604. PMID: 23758307

3. Seymour CW, Cooke CR, Hebert PM, Rea TD.  Intravenous Access During Out-of-Hospital Emergency Care of Noninjured Patients: A Population-Based Outcome Study. Ann Emerg Med. 2011 Aug 26.  PMID: 21872970. PMCID: PMC3227749