The Prior Hypothesis at the first Edinburgh Conversation

29 Nov 2017

On Friday 17th November, the Resuscitation Research Group held the first of the new series of Edinburgh Conversations.

The theme of the Conversation was the ‘Prior Hypothesis’. Experts met to discuss the effects of capillary pore size, pulse waves and osmotic pressure on fluid exchange, with a view to thinking about implications for future research and clinical practice.

It was the opportunity to release the initials results of the Prior Study, which was led by Allan MacRaild, Senior Research Nurse in EMERGE.

Dr Frank Prior was joined by Dr Colin Robertson, Dr Gordon Drummond, Mr Peter Jones, Mr Allan MacRaild and Dr Gareth Clegg. Discussions from the event will help strengthen the hypothesis and uncover unexplored areas.

The Prior Hypothesis – an update to the Starling Hypothesis – offers a new model of fluid balance and exchange.

Fluid balance and exchange are driven by the balance of two opposing pressures, the blood pressure which filters fluid out of the capillary and the osmotic pressure which draws fluid back into the plasma. Our physico chemical studies show that osmotic pressure is dependent on both concentration and membrane pore size. Increasing the concentration increases the osmotic pressure. Increasing pore size causes a fall in osmotic pressure. These three major factors determine osmosis. A knowledge of two of them should enable the third to be calculated. To test this concept we have measured membrane osmotic pressures (MOPx) and calculated capillary pore sizes during lying and standing, temperature stress, arm occlusion and simulated dives in human volunteers. We have also calculated pore size during anaesthetic induction, throughout Major GI surgery, and during pulsatile and non pulsatile cardiac bypass.


These results are included in our book entitled The Prior Hypothesis, which is in the final proof reading phase.

Holyrood Magazine hosts a round table exercise to discuss OHCA

09 Oct 2017

In October 2017 the Holyrood magazine hosted a British Heart Foundation sponsored round table event  gathering policy makers and experts to discuss OHCA.

The meeting was a great chance to air some of the most important issues relevant to OHCA in Scotland today. The resulting article published in the Holyrood Magazine can be downloaded here: Holyrood Magazine October 2017 pp42-45.


OHCA Data Linkage Report produced by RRG

29 Aug 2017

Solving the problem of OHCA is difficult, but in broad terms it is not complicated. There is a high level of international consensus about the steps required. The first of these is to create a registry. To build a mechanism to measure current system performance, identify areas for improvement and track progress. This is not a straightforward process, as the system delivering care to victims of OHCA spans multiple agencies and so assembling meaningful data requires the synthesis of information from a range of ‘silos’.

This report, produced by the Resuscitation Research Group and published by the Scottish Government illustrates how the unique health data architecture in Scotland allows data from a range of discrete sources to be linked, enabling a powerful perspective on OHCA.

A copy of the report can be found here.


Minister for Public Health, Aileen Campbell, launched OHCA review on a visit to Beeslack High School in Penicuik

24 Nov 2016

[You can download a copy of the report at]

More than a dozen organisations including emergency services, defence, third sector and Scottish Government have come together in an unprecedented collaboration to save lives in Scotland.

Scotland’s five-year strategy for out-of-hospital cardiac arrest aims to save 1,000 extra lives by 2020 and equip an additional half a million people in Scotland with CPR skills.

A Scottish Government report published today reviews progress in the first year of Scotland’s Out of Hospital Cardiac Arrest Strategy including the news that over 60,000 people have been trained in CPR skills since the strategy launched in October 2015.

Minister for Public Health, Aileen Campbell, launched the review on a visit to Beeslack High School in Penicuik, where she joined P7 and S1 pupils in a CPR training session.

Ms Campbell said: “Each year in Scotland there are around 3,000 cardiac arrests out-of-hospital. Cardiac arrest is when a person’s heart completely stops and, if this happens, CPR must be administered within minutes or the person will likely die.

“That is why CPR training and education is so vitally important.

“Indeed we know that over three-quarters of people believe that everyone should be trained in CPR, although only half of people have had the training.

“Our strategy aims to equip as many people as possible with these life-saving skills as well as looking at how our healthcare and emergency services can support a rapid and effective response to out-of-hospital cardiac arrest.

“Over the last year some very promising progress has been made. This is thanks, in no small part, to the great efforts of all of our partners involved in this work.

“We are now looking to build on these solid foundations going into next year, with a focus in 2017 on raising awareness amongst young people about the importance of CPR.”

The report, Out of Hospital Cardiac Arrest – A Strategy for Scotland Review 2015-16, details a series of key results achieved in the strategy’s first year as well as setting out the priorities for 2017.

The key achievements include:

  • The establishment of Save a Life for Scotland as the banner under which all partner organisations are raising awareness of CPR activity and signposting to, and delivering training activities.
  • The training of over 60,000 people in CPR skills since the strategy launched in October 2015.
  • The British Heart Foundation supplied ‘Call-Push-Rescue’ training kits to all 356 Scottish Fire and Rescue stations, which local communities can access.
  • In November 2015, the Scottish Ambulance Service and Scottish Fire and Rescue Service began trialling a co-response system for out-of-hospital cardiac arrest at ten stations. Initial evidence suggests that this has contributed to a reduction in response times and improved patient outcomes.
  • Numerous CPR training events held in schools, shopping malls and at major events like the Royal Highland Show and the Edinburgh Military Tattoo.

Nynke brings Epidemiology to the party…

03 Jun 2016

We are very pleased that Dr Nynke Halbesma is joining RRG whilst on secondment from the Usher Institute at the University of Edinburgh. Nynke is an expert in renal epidemiology, and is helping the Health Analytical Services Division at the Scottish Government to prepare and analyse linked data pertaining to OHCA in Scotland. Using datasets from the whole patient journey we plan to drill down into the geographic, social, biological and clinical factors affecting the function of the chain of survival. Visualising this data will help drive improvement and track change as we implement the Scottish Strategy for OHCA.