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Chen CB, Wang MF, Seak CJ, Chien LT, Chaou CH, Chang YT, Ng CJ, Tsai LH, Huang CH, Cheng TH, Yen CC, Chung PL, Chien CY. Installation of Public Access Defibrillators for Out-of-Hospital Cardiac Arrests: Identifying Suitable Locations by Using a Geographic Information System. J Am Heart Assoc 2024; 13:e034045. [PMID: 39377202 DOI: 10.1161/jaha.123.034045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 08/29/2024] [Indexed: 10/09/2024]
Abstract
BACKGROUND Survival following an out-of-hospital cardiac arrest depends on prompt defibrillation. Despite the efforts made to install automated external defibrillators (AEDs) in crowded areas, their usage rate remains suboptimal. This study evaluated the efficiency of installing AEDs at key landmarks in Taoyuan City to enhance accessibility and usage. METHODS AND RESULTS This retrospective cohort study analyzed nontraumatic public out-of-hospital cardiac arrest cases in Taoyuan City from 2017 to 2021, using data from the Taoyuan Fire Department and a regional registry. AED data were collected for 1163 devices. A geographic information system mapped target locations within the city, and real-world walking routes were examined to assess coverage. The primary outcome was actual coverage and the coverage efficiency ratio, calculated as the actual coverage divided by the number of facilities at a location. The coverage efficiency ratio compared the coverage efficiency of target locations with existing public access defibrillators (PADs). Top locations for superior coverage in both downtown and outside downtown areas were bus stops and convenience stores (7-Eleven and FamilyMart), which outperformed existing PADs. Convenience stores had a higher coverage efficiency ratio than the public service sector. Bus stops showed high AED usage rates before ambulance arrival. CONCLUSIONS The current PAD locations in Taoyuan City offer limited coverage, which highlights the need for strategically installed AEDs, particularly in convenience stores. Policymakers should consider using the cultural relevance and accessibility of convenience stores, particularly 7-Eleven branches, to enhance AED usage rates.
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Affiliation(s)
- Chen-Bin Chen
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou and College of Medicine Chang Gung University Taoyuan Taiwan
- Department of Emergency Medicine New Taipei Municipal TuCheng Hospital and Chang Gung University New Taipei City Taiwan
| | - Ming-Fang Wang
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou and College of Medicine Chang Gung University Taoyuan Taiwan
- Department of Emergency Medicine Chang Gung Memorial Hospital Taipei Branch Taipei Taiwan
| | - Chen-June Seak
- Department of Emergency Medicine New Taipei Municipal TuCheng Hospital and Chang Gung University New Taipei City Taiwan
- Department of Emergency Medicine Chang Gung Memorial Hospital Taipei Branch Taipei Taiwan
| | - Liang-Tien Chien
- Graduate Institute of Management, College of Management, Chang Gung University Taoyuan Taiwan
- Taoyuan Fire Department Taoyuan Taiwan
| | - Chung-Hsien Chaou
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou and College of Medicine Chang Gung University Taoyuan Taiwan
| | - Yu-Tung Chang
- College of Health Technology National Taipei University of Nursing and Health Sciences Taipei Taiwan
| | - Chip-Jin Ng
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou and College of Medicine Chang Gung University Taoyuan Taiwan
- Department of Nursing Chang Gung University of Science and Technology Taoyuan Taiwan
- Department of Emergency Medicine New Taipei City Hospital New Taipei City Taiwan
| | - Li-Heng Tsai
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou and College of Medicine Chang Gung University Taoyuan Taiwan
| | - Chien-Hsiung Huang
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou and College of Medicine Chang Gung University Taoyuan Taiwan
- Graduate Institute of Management, College of Management, Chang Gung University Taoyuan Taiwan
| | - Tzu-Heng Cheng
- Department of Emergency Medicine New Taipei Municipal TuCheng Hospital and Chang Gung University New Taipei City Taiwan
| | - Chieh-Ching Yen
- Department of Emergency Medicine New Taipei Municipal TuCheng Hospital and Chang Gung University New Taipei City Taiwan
| | - Pei-Li Chung
- Department of Emergency Medicine Ton-Yen General Hospital Zhubei Taiwan
| | - Cheng-Yu Chien
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou and College of Medicine Chang Gung University Taoyuan Taiwan
- Department of Emergency Medicine Chang Gung Memorial Hospital Taipei Branch Taipei Taiwan
- Department of Emergency Medicine Ton-Yen General Hospital Zhubei Taiwan
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University Taipei Taiwan
- Department of Senior Service Industry Management Minghsin University of Science and Technology Hsinchu Taiwan
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Yang H, Luo L, Song Y, Cao J, Chen J, Zhang F, Tan Y, Zheng Y, Sun Z, Qian J, Huang Z, Ge J. ECMO versus IABP for STEMI Patients Complicated by Cardiogenic Shock undergoing Primary PCI: A Chinese National Study and Propensity-matched Analysis. Hellenic J Cardiol 2024:S1109-9666(24)00209-4. [PMID: 39384141 DOI: 10.1016/j.hjc.2024.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2024] [Accepted: 09/29/2024] [Indexed: 10/11/2024] Open
Abstract
OBJECTIVES This study investigated the association between the utilization of extracorporeal membrane oxygenation (ECMO) or intra-aortic balloon pump (IABP) and in-hospital mortality among patients with ST-segment elevation myocardial infarction (STEMI) complicated by cardiogenic shock undergoing primary percutaneous coronary intervention (PCI). METHODS Data encompassing 9635 cases of STEMI complicated by cardiogenic shock and treated with primary PCI using ECMO/IABP support were retrieved from the Chinese Cardiovascular Association database (2019-2021). We conducted an analysis to assess in-hospital survival disparities among percutaneous mechanical circulatory device recipients and explore the potential advantages of ECMO through multivariable logistic regression analysis within a propensity score-matched (1:2) cohort population. RESULTS ECMO was administered to 2028 patients, while IABP was utilized in 7607 patients. Patients supported by ECMO showed a lower in-hospital mortality compared with those supported by IABP (7.2% vs. 15.1%, p<0.001). Within the propensity-matched (case : control=1:2) cohort, we noted a 34% reduced risk of in-hospital mortality among patients supported by ECMO compared to those supported by IABP (7.7% vs. 11.7%; odds ratio = 0.66; 95% CI, 0.53-0.80; p< 0.001) independent of age, sex, systolic blood pressure, obesity, smoke, hypertension, diabetes, dyslipidaemia, family history of coronary artery disease, coronary artery disease, stroke, atrial filiation, peripheral artery disease, chronic kidney disease, vascular lesion sites, 3A-grade hospital, and regional distributions in China. CONCLUSIONS Among patients undergoing primary PCI for STEMI complicated by cardiogenic shock, ECMO was associated with better in-hospital survival than IABP.
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Affiliation(s)
- Hongbo Yang
- Department of Cardiology, Zhongshan Hospital, Fudan University; Shanghai Institute of Cardiovascular Diseases, Shanghai; National Clinical Research Centre for Interventional Medicine, China
| | - Lingfeng Luo
- Human Phenome Institute, Fudan University, Shanghai 200433, China
| | - Yanan Song
- Department of Cardiology, Zhongshan Hospital, Fudan University; Shanghai Institute of Cardiovascular Diseases, Shanghai; National Clinical Research Centre for Interventional Medicine, China
| | - Jiatian Cao
- Department of Cardiology, Zhongshan Hospital, Fudan University; Shanghai Institute of Cardiovascular Diseases, Shanghai; National Clinical Research Centre for Interventional Medicine, China
| | - Jing Chen
- Department of Cardiology, Zhongshan Hospital, Fudan University; Shanghai Institute of Cardiovascular Diseases, Shanghai; National Clinical Research Centre for Interventional Medicine, China
| | - Feng Zhang
- Department of Cardiology, Zhongshan Hospital, Fudan University; Shanghai Institute of Cardiovascular Diseases, Shanghai; National Clinical Research Centre for Interventional Medicine, China
| | - Yiwen Tan
- Department of Cardiology, Zhongshan Hospital, Fudan University; Shanghai Institute of Cardiovascular Diseases, Shanghai; National Clinical Research Centre for Interventional Medicine, China
| | - Yan Zheng
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China; State Key Laboratory of Genetic Engineering, School of Life Sciences and Human Phenome Institute, Fudan University, Shanghai, China
| | - Zhonghan Sun
- Human Phenome Institute, Fudan University, Shanghai 200433, China; State Key Laboratory of Genetic Engineering, School of Life Sciences and Human Phenome Institute, Fudan University, Shanghai, China.
| | - Juying Qian
- Department of Cardiology, Zhongshan Hospital, Fudan University; Shanghai Institute of Cardiovascular Diseases, Shanghai; National Clinical Research Centre for Interventional Medicine, China.
| | - Zheyong Huang
- Department of Cardiology, Zhongshan Hospital, Fudan University; Shanghai Institute of Cardiovascular Diseases, Shanghai; National Clinical Research Centre for Interventional Medicine, China.
| | - Junbo Ge
- Department of Cardiology, Zhongshan Hospital, Fudan University; Shanghai Institute of Cardiovascular Diseases, Shanghai; National Clinical Research Centre for Interventional Medicine, China
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Kanter E, Kayalı A, Çınaroğlu OS, Yamanoğlu A, Bora ES, Tekindal MA, Efgan MG, Karakaya Z, Topal FE. Is It Possible to Detect Return of Spontaneous Circulation during Chest Compression? Evaluation of a Novel Method: Carotid Artery Compression Ultrasound. Diagnostics (Basel) 2024; 14:2213. [PMID: 39410617 PMCID: PMC11482614 DOI: 10.3390/diagnostics14192213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2024] [Revised: 09/24/2024] [Accepted: 10/02/2024] [Indexed: 10/19/2024] Open
Abstract
Objectives: To evaluate the diagnostic accuracy of carotid artery compression using a point-of-care ultrasound probe (POCUS-CAC) in reducing pulse check times and facilitating the detection of the return of spontaneous circulation (ROSC) during cardiopulmonary resuscitation (CPR) compared to manual palpation (MP). The secondary aim of the study is to assess the ability of POCUS-CAC to detect ROSC during ongoing chest compressions. Methods: This prospective study was conducted in a tertiary emergency department between January and June 2023. During CPR, POCUS-CAC was performed by placing a linear ultrasound probe transversely on the lateral neck to assess the compressibility of the carotid artery. Complete compression of the artery without any visible pulsation indicated no ROSC, while resistance to compression or partial compression suggested the presence of ROSC. Simultaneously, another clinician performed manual palpation of the femoral artery. The primary outcome assessed in this study was comparing ROSC detection between POCUS-CAC and traditional methods, and the secondary outcome was comparing the time taken to detect ROSC with each method, and the ability to detect ROSC during ongoing chest compressions. Results: The study included 41 cardiac arrest patients and analyzed 496 MP pulse and 1984 POCUS-CAC checks. The mean time to identify a pulse using POCUS-CAC was significantly shorter, at 2.3 (0.5-7.8, SD ± 1.2, 95% CI [2.25, 2.35]) s, compared to 4.7 (2.0-10.5, SD ± 1.8, 95% CI [4.54, 4.86]) s with MP (p = 0.004). Additionally, 52.9% of ROSC cases were detected earlier using POCUS-CAC, even during ongoing chest compressions. The sensitivity of POCUS-CAC was 100% (95% CI [80.5-100%]) and the specificity was 87.5% (95% CI [67.6-97.3%]). The POCUS-CAC method required less than 5 s in 99.996% of cases. Conclusions: POCUS-CAC significantly reduces pulse check times and enhances the early detection of ROSC during CPR, offering a reliable and rapid alternative to traditional manual palpation methods in emergency settings.
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Affiliation(s)
- Efe Kanter
- Department of Emergency Medicine, Faculty of Medicine, Izmir Katip Çelebi University, 35620 Izmir, Turkey; (E.K.); (A.K.); (O.S.Ç.); (A.Y.); (M.G.E.); (Z.K.); (F.E.T.)
| | - Ahmet Kayalı
- Department of Emergency Medicine, Faculty of Medicine, Izmir Katip Çelebi University, 35620 Izmir, Turkey; (E.K.); (A.K.); (O.S.Ç.); (A.Y.); (M.G.E.); (Z.K.); (F.E.T.)
| | - Osman Sezer Çınaroğlu
- Department of Emergency Medicine, Faculty of Medicine, Izmir Katip Çelebi University, 35620 Izmir, Turkey; (E.K.); (A.K.); (O.S.Ç.); (A.Y.); (M.G.E.); (Z.K.); (F.E.T.)
| | - Adnan Yamanoğlu
- Department of Emergency Medicine, Faculty of Medicine, Izmir Katip Çelebi University, 35620 Izmir, Turkey; (E.K.); (A.K.); (O.S.Ç.); (A.Y.); (M.G.E.); (Z.K.); (F.E.T.)
| | - Ejder Saylav Bora
- Department of Emergency Medicine, Faculty of Medicine, Izmir Katip Çelebi University, 35620 Izmir, Turkey; (E.K.); (A.K.); (O.S.Ç.); (A.Y.); (M.G.E.); (Z.K.); (F.E.T.)
| | - Mustafa Agah Tekindal
- Department of Basic Medical Sciences Biostatistics, Faculty of Medicine, İzmir Katip Çelebi University, 35620 Izmir, Türkiye;
| | - Mehmet Göktuğ Efgan
- Department of Emergency Medicine, Faculty of Medicine, Izmir Katip Çelebi University, 35620 Izmir, Turkey; (E.K.); (A.K.); (O.S.Ç.); (A.Y.); (M.G.E.); (Z.K.); (F.E.T.)
| | - Zeynep Karakaya
- Department of Emergency Medicine, Faculty of Medicine, Izmir Katip Çelebi University, 35620 Izmir, Turkey; (E.K.); (A.K.); (O.S.Ç.); (A.Y.); (M.G.E.); (Z.K.); (F.E.T.)
| | - Fatih Esad Topal
- Department of Emergency Medicine, Faculty of Medicine, Izmir Katip Çelebi University, 35620 Izmir, Turkey; (E.K.); (A.K.); (O.S.Ç.); (A.Y.); (M.G.E.); (Z.K.); (F.E.T.)
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Romain J, Marie CL, Daniel J, Stéphane T. Bolus intravenous potassium chloride for recurrent ventricular fibrillation. Am J Emerg Med 2024; 84:191.e5-191.e7. [PMID: 36797168 DOI: 10.1016/j.ajem.2023.01.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 01/23/2023] [Accepted: 01/30/2023] [Indexed: 02/11/2023] Open
Abstract
We report the feasibility and recommend the potential efficacy of a bolus intravenous potassium chloride during out-of-hospital cardiac arrest with recurrent ventricular fibrillation following an acute coronary syndrome in a man in his 40's.
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Affiliation(s)
- Jouffroy Romain
- Paris Fire Brigade, Emergency Medicine department, 1 place Jules Renard, 75017 Paris, France.
| | - Couetoux Louis Marie
- Paris Fire Brigade, Emergency Medicine department, 1 place Jules Renard, 75017 Paris, France
| | - Jost Daniel
- Paris Fire Brigade, Emergency Medicine department, 1 place Jules Renard, 75017 Paris, France
| | - Travers Stéphane
- Paris Fire Brigade, Emergency Medicine department, 1 place Jules Renard, 75017 Paris, France
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Agostinucci JM, Alhéritière A, Metzger J, Nadiras P, Martineau L, Bertrand P, Gentilhomme A, Petrovic T, Adnet F, Lapostolle F. Evolution of the use of intraosseous vascular access in prehospital advanced cardiopulmonary resuscitation: The IOVA-CPR study. Int J Nurs Pract 2024; 30:e13244. [PMID: 38409923 DOI: 10.1111/ijn.13244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 12/05/2023] [Accepted: 01/26/2024] [Indexed: 02/28/2024]
Abstract
INTRODUCTION Obtaining vascular access is crucial in critically ill patients. The EZ-IO® device is easy to use and has a high insertion success rate. Therefore, the use of intraosseous vascular access (IOVA) has gradually increased. AIM We aim to determine how IOVA was integrated into management of vascular access during out-of-hospital cardiac arrest (OHCA) resuscitation. METHODS Analysing the data from the OHCA French registry for events occurring between 1 January 2013 and 15 March 2021, we studied: demography, circumstances of occurrence and management including vascular access, delays and evolution. The primary outcome was the rate of IOVA implantation. RESULTS Among the 7156 OHCA included in the registry, we analysed the 3964 (55%) who received cardiopulmonary resuscitation. The vascular access was peripheral in 3122 (79%) cases, intraosseous in 775 (20%) cases and central in 12 (<1%) cases. The use of IOVA has increased linearly (R2 = 0.61) during the 33 successive trimesters studied representing 7% of all vascular access in 2013 and 33% in 2021 (p = 0.001). It was significantly more frequent in traumatic cardiac arrest: 12% versus 5%; p < 0.0001. The first epinephrine bolus occurred significantly later in the IOVA group, at 6 (4-10) versus 5 (3-8) min; p < 0.0001. Survival rate in the IOVA group was significantly lower, at 1% versus 7%; p < 0.0001. CONCLUSION The insertion rate of IOVA significantly increased over the studied period, to reach 30% of all vascular access in the management OHCA patients. The place of the intraosseous route in the strategy of venous access during the management of prehospital cardiac arrest has yet to be determined.
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Affiliation(s)
- Jean-Marc Agostinucci
- SAMU 93 - UF Recherche-Enseignement-Qualité Université Paris 13, Sorbonne Paris Cité, Inserm U942, Hôpital Avicenne, Bobigny, France
| | - Armelle Alhéritière
- SAMU 93 - UF Recherche-Enseignement-Qualité Université Paris 13, Sorbonne Paris Cité, Inserm U942, Hôpital Avicenne, Bobigny, France
| | - Jacques Metzger
- SAMU 93 - UF Recherche-Enseignement-Qualité Université Paris 13, Sorbonne Paris Cité, Inserm U942, Hôpital Avicenne, Bobigny, France
- Service Mobile d'Urgence et de Réanimation, Centre Hospitalier Delafontaine, Saint-Denis, France
| | - Pierre Nadiras
- Service Mobile d'Urgence et de Réanimation, Groupe Hospitalier Intercommunal Le Raincy-Montfermeil, Montfermeil, France
| | - Laurence Martineau
- Service Mobile d'Urgence et de Réanimation, Centre Hospitalier Intercommunal Robert Ballanger, Aulnay-sous-Bois, France
| | - Philippe Bertrand
- SAMU 93 - UF Recherche-Enseignement-Qualité Université Paris 13, Sorbonne Paris Cité, Inserm U942, Hôpital Avicenne, Bobigny, France
| | - Angélie Gentilhomme
- SAMU 93 - UF Recherche-Enseignement-Qualité Université Paris 13, Sorbonne Paris Cité, Inserm U942, Hôpital Avicenne, Bobigny, France
| | - Tomislav Petrovic
- SAMU 93 - UF Recherche-Enseignement-Qualité Université Paris 13, Sorbonne Paris Cité, Inserm U942, Hôpital Avicenne, Bobigny, France
| | - Frédéric Adnet
- SAMU 93 - UF Recherche-Enseignement-Qualité Université Paris 13, Sorbonne Paris Cité, Inserm U942, Hôpital Avicenne, Bobigny, France
| | - Frédéric Lapostolle
- SAMU 93 - UF Recherche-Enseignement-Qualité Université Paris 13, Sorbonne Paris Cité, Inserm U942, Hôpital Avicenne, Bobigny, France
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Ćwiertnia M, Dutka M, Białoń P, Szlagor M, Stasicki A, Mikulska M, Hajduga MB, Bobiński R, Kawecki M, Ilczak T. What Mistakes Can Be Made When Performing the Electrical Cardioversion Procedure?-Analysis of Emergency Medical Team Performance during the Championships in Emergency Medicine. Healthcare (Basel) 2024; 12:1724. [PMID: 39273748 PMCID: PMC11394996 DOI: 10.3390/healthcare12171724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2024] [Revised: 08/27/2024] [Accepted: 08/28/2024] [Indexed: 09/15/2024] Open
Abstract
BACKGROUND Medical personnel carrying out electrical cardioversion (EC) procedures must remember to have the R-wave sync mode switched on, use the correct energy and maintain personal safety. The defibrillators used by medical response teams most often switch out of cardioversion mode once a shock is delivered. Therefore, this mode must be switched on again before subsequent shocks are delivered. The main aim of the study was to assess the ability of emergency medical teams participating in emergency medicine championships to perform EC. METHODS The research was a retrospective observational study and was based on an analysis of the evaluation sheets from two tasks simulating the management of a patient with unstable tachycardia conducted during the International Winter Emergency Medicine Championships. Three-person teams consisting of paramedics and representing the Polish emergency services were included in the study. The team representing the championship organiser and the few foreign teams participating in the competition were excluded from the study. RESULTS The decision to conduct EC was taken by 36 teams (83.72%) in 2015 and 27 teams (87.10%) in 2019. In both editions of the championships, during consecutive shocks, the percentage of actions performed correctly decreased significantly-switching on synchronisation mode in 2015 (94.4%, 83.33%, 72.22%) and in 2019 (100%, 88.89%, 81.48%); correct energies in 2015 (91.67%, 80.56%, 77.78%) and in 2019 (92.59%, 85.19%, 81.48%); shocks in a safe manner in 2015 (94.44%, 94.44%, 91.67%) and in 2019 (100%, 96.30%, 96.30%). CONCLUSIONS Teams participating in the assessed tasks in a significant majority of cases correctly qualified the patient for EC, and correctly carried out the actions required for this procedure. It is of particular note that with every subsequent shock, the percentage of shocks carried out without the sync mode increased significantly.
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Affiliation(s)
- Michał Ćwiertnia
- Department of Emergency Medicine, Faculty of Health Sciences, University of Bielsko-Biala, Willowa 2, 43-309 Bielsko-Biała, Poland
- European Pre-Hospital Research Network, Nottingham NG11 8NS, UK
| | - Mieczysław Dutka
- Department of Biochemistry and Molecular Biology, Faculty of Health Sciences, University of Bielsko-Biala, Willowa 2, 43-309 Bielsko-Biała, Poland
| | - Piotr Białoń
- Department of Emergency Medicine, Faculty of Health Sciences, University of Bielsko-Biala, Willowa 2, 43-309 Bielsko-Biała, Poland
| | - Michał Szlagor
- Department of Emergency Medicine, Faculty of Health Sciences, University of Bielsko-Biala, Willowa 2, 43-309 Bielsko-Biała, Poland
| | - Arkadiusz Stasicki
- Department of Emergency Medicine, Faculty of Health Sciences, University of Bielsko-Biala, Willowa 2, 43-309 Bielsko-Biała, Poland
| | - Monika Mikulska
- Department of Emergency Medicine, Faculty of Health Sciences, University of Bielsko-Biala, Willowa 2, 43-309 Bielsko-Biała, Poland
| | - Maciej B Hajduga
- Department of Biochemistry and Molecular Biology, Faculty of Health Sciences, University of Bielsko-Biala, Willowa 2, 43-309 Bielsko-Biała, Poland
| | - Rafał Bobiński
- Department of Biochemistry and Molecular Biology, Faculty of Health Sciences, University of Bielsko-Biala, Willowa 2, 43-309 Bielsko-Biała, Poland
| | - Marek Kawecki
- Department of Emergency Medicine, Faculty of Health Sciences, University of Bielsko-Biala, Willowa 2, 43-309 Bielsko-Biała, Poland
| | - Tomasz Ilczak
- Department of Emergency Medicine, Faculty of Health Sciences, University of Bielsko-Biala, Willowa 2, 43-309 Bielsko-Biała, Poland
- European Pre-Hospital Research Network, Nottingham NG11 8NS, UK
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Kill C, Manegold RK, Fistera D, Risse J. Airway management and ventilation techniques in resuscitation during advanced life support: an update. JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE 2024; 4:58. [PMID: 39182146 PMCID: PMC11344389 DOI: 10.1186/s44158-024-00195-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 08/18/2024] [Indexed: 08/27/2024]
Abstract
For many years, ventilation has been an essential part of advanced life support (ALS) in cardiopulmonary resuscitation (CPR). Nevertheless, there is little evidence about the best method of ventilation during resuscitation for both out-of-hospital cardiac arrest (OHCA) and inhospital cardiac arrest (IHCA) patients. Effective ventilation is one of the two main keys to successful resuscitation. In this context, the question always arises as to which airway management, along with which ventilation mode, constitutes the best strategy. Conventional ventilation modes are not designed for cardiac arrest and show important limitations that must be considered when used in CPR. Manual ventilation without the use of an automated transport ventilator (ATV) could be shown to be uncontrolled in applied volumes and pressures and should be avoided. Mechanical ventilation with an ATV is therefore superior to manual ventilation, but both volume- and pressure-controlled ventilation modes are significantly influenced by chest compressions. With the newly designed chest compression synchronized ventilation (CCSV), a special ventilation mode for resuscitation is available. Further research should be conducted to obtain more evidence of the effect of ventilation during CPR on outcomes following OHCA and not only about how to secure the airway for ventilation during CPR.
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Affiliation(s)
- Clemens Kill
- Center of Emergency Medicine, University Hospital Essen, Essen, D-45147, Germany
- Center of Emergency Medicine, University Hospital Essen, Hufelandstrasse 55, Essen, 45122, Germany
| | - Randi Katrin Manegold
- Center of Emergency Medicine, University Hospital Essen, Essen, D-45147, Germany
- Center of Emergency Medicine, University Hospital Essen, Hufelandstrasse 55, Essen, 45122, Germany
| | - David Fistera
- Center of Emergency Medicine, University Hospital Essen, Essen, D-45147, Germany
- Center of Emergency Medicine, University Hospital Essen, Hufelandstrasse 55, Essen, 45122, Germany
| | - Joachim Risse
- Center of Emergency Medicine, University Hospital Essen, Essen, D-45147, Germany.
- Center of Emergency Medicine, University Hospital Essen, Hufelandstrasse 55, Essen, 45122, Germany.
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Hanna DP, Erika B, Ellinor B, Sofia S, Leif S, Anette N, Jacob H, Andreas C. Dispatcher nurses' experiences of handling drones equipped with automated external defibrillators in suspected out-of-hospital cardiac arrest - a qualitative study. Scand J Trauma Resusc Emerg Med 2024; 32:74. [PMID: 39169425 PMCID: PMC11337748 DOI: 10.1186/s13049-024-01246-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 08/07/2024] [Indexed: 08/23/2024] Open
Abstract
BACKGROUND Reducing the time to treatment by means of cardiopulmonary resuscitation (CPR) and defibrillation is essential to increasing survival after cardiac arrest. A novel method of dispatching drones for delivery of automated external defibrillators (AEDs) to the site of a suspected out-of-hospital cardiac arrest (OHCA) has been shown to be feasible, with the potential to shorten response times compared with the emergency medical services. However, little is known of dispatchers' experiences of using this novel methodology. METHODS A qualitative semi-structured interview study with a phenomenological approach was used. Ten registered nurses employed at an emergency medical dispatch centre in Gothenburg, Sweden, were interviewed and the data was analysed by qualitative content analysis. The purpose was to explore dispatcher nurses' experiences of deliveries of AEDs by drones in cases of suspected OHCA. RESULTS Three categories were formed. Nurses expressed varying compliance to the telephone-assisted protocol for dispatch of AED-equipped drones. They experienced uncertainty as to how long would be an acceptable interruption from the CPR protocol in order to retrieve a drone-delivered AED. The majority experienced that collegial support was important. Technical support, routines and training need to be improved to further optimise action in cases of drone-delivered AEDs handled by dispatcher nurses. CONCLUSIONS Although telephone-assisted routines for drone dispatch in cases of OHCA were available, their use was rare. Registered nurses showed variable degrees of understanding of how to comply with these protocols. Collegial and technical support was considered important, alongside routines and training, which need to be improved to further support bystander use of drone-delivered AEDs. As the possibilities of using drones to deliver AEDs in cases of OHCA are explored more extensively globally, there is a good possibility that this study could be of benefit to other nations implementing similar methods. We present concrete aspects that are important to take into consideration when implementing this kind of methodology at dispatch centres.
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Affiliation(s)
- Dalby-Pedersen Hanna
- Emergency Medical Services, Sjukhusen i Väster, Region Västra Götaland, Dumpergatan 3, Kungälv, Kungälv, 442 40, Sweden
| | - Bergström Erika
- Emergency Medical Services, Premedic Ånge, Region Västernorrland, Spångbrovägen 1, Ånge, 841 32, Sweden
| | - Berglund Ellinor
- Centre for Resuscitation Science, Department of Clinical Science and Education, Karolinska Institutet, Sjukhusbacken 10, Södersjukhuset, Stockholm, S-118 83, Sweden
| | - Schierbeck Sofia
- Centre for Resuscitation Science, Department of Clinical Science and Education, Karolinska Institutet, Sjukhusbacken 10, Södersjukhuset, Stockholm, S-118 83, Sweden
| | - Svensson Leif
- Department of Medicine, Karolinska Institutet, Solna, Stockholm, S-171 77, Sweden
| | - Nord Anette
- Centre for Resuscitation Science, Department of Clinical Science and Education, Karolinska Institutet, Sjukhusbacken 10, Södersjukhuset, Stockholm, S-118 83, Sweden
| | - Hollenberg Jacob
- Centre for Resuscitation Science, Department of Clinical Science and Education, Karolinska Institutet, Sjukhusbacken 10, Södersjukhuset, Stockholm, S-118 83, Sweden
| | - Claesson Andreas
- Centre for Resuscitation Science, Department of Clinical Science and Education, Karolinska Institutet, Sjukhusbacken 10, Södersjukhuset, Stockholm, S-118 83, Sweden.
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9
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Lee HY, Kuo PC, Qian F, Li CH, Hu JR, Hsu WT, Jhou HJ, Chen PH, Lee CH, Su CH, Liao PC, Wu IJ, Lee CC. Prediction of In-Hospital Cardiac Arrest in the Intensive Care Unit: Machine Learning-Based Multimodal Approach. JMIR Med Inform 2024; 12:e49142. [PMID: 39051152 PMCID: PMC11287234 DOI: 10.2196/49142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 02/11/2024] [Accepted: 04/23/2024] [Indexed: 07/27/2024] Open
Abstract
Background Early identification of impending in-hospital cardiac arrest (IHCA) improves clinical outcomes but remains elusive for practicing clinicians. Objective We aimed to develop a multimodal machine learning algorithm based on ensemble techniques to predict the occurrence of IHCA. Methods Our model was developed by the Multiparameter Intelligent Monitoring of Intensive Care (MIMIC)-IV database and validated in the Electronic Intensive Care Unit Collaborative Research Database (eICU-CRD). Baseline features consisting of patient demographics, presenting illness, and comorbidities were collected to train a random forest model. Next, vital signs were extracted to train a long short-term memory model. A support vector machine algorithm then stacked the results to form the final prediction model. Results Of 23,909 patients in the MIMIC-IV database and 10,049 patients in the eICU-CRD database, 452 and 85 patients, respectively, had IHCA. At 13 hours in advance of an IHCA event, our algorithm had already demonstrated an area under the receiver operating characteristic curve of 0.85 (95% CI 0.815-0.885) in the MIMIC-IV database. External validation with the eICU-CRD and National Taiwan University Hospital databases also presented satisfactory results, showing area under the receiver operating characteristic curve values of 0.81 (95% CI 0.763-0.851) and 0.945 (95% CI 0.934-0.956), respectively. Conclusions Using only vital signs and information available in the electronic medical record, our model demonstrates it is possible to detect a trajectory of clinical deterioration up to 13 hours in advance. This predictive tool, which has undergone external validation, could forewarn and help clinicians identify patients in need of assessment to improve their overall prognosis.
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Affiliation(s)
- Hsin-Ying Lee
- Department of Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Po-Chih Kuo
- Department of Computer Science, National Tsing Hua University, Hsinchu, Taiwan
| | - Frank Qian
- Section of Cardiovascular Medicine, Boston Medical Center, Boston, MA, United States
- Section of Cardiovascular Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
| | - Chien-Hung Li
- Department of Computer Science, National Tsing Hua University, Hsinchu, Taiwan
| | - Jiun-Ruey Hu
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Wan-Ting Hsu
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Hong-Jie Jhou
- Department of Neurology, Changhua Christian Hospital, Changhua, Taiwan
| | - Po-Huang Chen
- Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Cho-Hao Lee
- Division of Hematology and Oncology Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chin-Hua Su
- Department of Emergency Medicine, National Taiwan University Hospital, No. 7, Zhongshan S Rd, Zhongzheng District, Taipei, 100886 0223123456, Taiwan
| | - Po-Chun Liao
- Department of Emergency Medicine, National Taiwan University Hospital, No. 7, Zhongshan S Rd, Zhongzheng District, Taipei, 100886 0223123456, Taiwan
| | - I-Ju Wu
- Department of Emergency Medicine, National Taiwan University Hospital, No. 7, Zhongshan S Rd, Zhongzheng District, Taipei, 100886 0223123456, Taiwan
| | - Chien-Chang Lee
- Department of Emergency Medicine, National Taiwan University Hospital, No. 7, Zhongshan S Rd, Zhongzheng District, Taipei, 100886 0223123456, Taiwan
- Department of Information Management, Ministry of Health and Welfare, Taipei, Taiwan
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10
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Madanat L, France J, Shoukri N, Bilolikar AN, Walsh D, Kutinsky I, Gundlapalli S, Zhao L, Goel A, Williamson B, Cami E, Gallagher M, Bloomingdale R, Dixon S, Haines D, Mehta N. Impact of Defibrillator Electrode Placement on Outcome of Electrical Cardioversion of Atrial Fibrillation: A Pilot Observational Study. J Am Heart Assoc 2024; 13:e034817. [PMID: 38934869 PMCID: PMC11255716 DOI: 10.1161/jaha.123.034817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 05/03/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Anterior-posterior electrode placement is preferred in electrical cardioversion of atrial fibrillation. However, the optimal anterior-posterior electrode position in relation to the heart is not studied. METHODS AND RESULTS We performed a prospective observational study on patients presenting for cardioversion of atrial fibrillation. Electrodes were placed in the anterior-posterior position and shock was delivered in a step-up approach (100 J→200 J→360 J). Fluoroscopic images were obtained, and distances were measured from points A, midanterior electrode; and B, midposterior electrode, to midpoint of the cardiac silhouette. Patients requiring one 100 J shock for cardioversion success (group I) were compared with those requiring >1 shock/100 J (group II). Logistic regression was used to determine the impact of electrode distance on low energy (100 J) cardioversion success. Computed tomography scans from this cohort were analyzed for anatomic landmark correlation to the cardiac silhouette. Of the 87 patients included, 54 (62%) comprised group I and 33 (38%) group II. Group I had significantly lower distances from the mid-cardiac silhouette to points A (5.0±2.4 versus 7.4±3.3 cm; P<0.001) and B (7.3±3.0 versus 10.0±3.8 cm; P=0.002) compared with group II. On multivariate analysis, higher distances from the mid-cardiac silhouette to point A (odds ratio, 1.33 [95% CI, 1.07-1.70]; P=0.01) and B (odds rsatio, 1.24 [95% CI, 1.05-1.50]; P=0.01) were independent predictors of low energy (100 J) cardioversion failure. Based on review of computed tomography scans, we suggest that the xiphoid process may be an easy landmark to guide proximity to the myocardium. CONCLUSIONS In anterior-posterior electrode placement, closer proximity to the cardiac silhouette predicts successful 100 J cardioversion irrespective of clinical factors.
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Affiliation(s)
- Luai Madanat
- Department of Cardiovascular Medicine, William Beaumont University HospitalCorewell Health EastRoyal OakMIUSA
| | - Josh France
- Oakland University William Beaumont School of MedicineRochesterMIUSA
| | - Nolan Shoukri
- Oakland University William Beaumont School of MedicineRochesterMIUSA
| | - Abhay N. Bilolikar
- Department of Cardiovascular Medicine, William Beaumont University HospitalCorewell Health EastRoyal OakMIUSA
| | - Daniel Walsh
- Department of Cardiovascular Medicine, William Beaumont University HospitalCorewell Health EastRoyal OakMIUSA
| | - Ilana Kutinsky
- Department of Cardiovascular Medicine, William Beaumont University HospitalCorewell Health EastRoyal OakMIUSA
| | - Sujana Gundlapalli
- Department of Cardiovascular Medicine, William Beaumont University HospitalCorewell Health EastRoyal OakMIUSA
| | - Lili Zhao
- Department of Biostatistics and Health InformaticsBeaumont Research InstituteRoyal OakMIUSA
| | - Anil Goel
- Department of Cardiovascular Medicine, William Beaumont University HospitalCorewell Health EastRoyal OakMIUSA
| | - Brian Williamson
- Department of Cardiovascular Medicine, William Beaumont University HospitalCorewell Health EastRoyal OakMIUSA
| | - Elvis Cami
- Department of Cardiovascular Medicine, William Beaumont University HospitalCorewell Health EastRoyal OakMIUSA
| | - Michael Gallagher
- Department of Cardiovascular Medicine, William Beaumont University HospitalCorewell Health EastRoyal OakMIUSA
| | - Richard Bloomingdale
- Department of Cardiovascular Medicine, William Beaumont University HospitalCorewell Health EastRoyal OakMIUSA
| | - Simon Dixon
- Department of Cardiovascular Medicine, William Beaumont University HospitalCorewell Health EastRoyal OakMIUSA
| | - David Haines
- Department of Cardiovascular Medicine, William Beaumont University HospitalCorewell Health EastRoyal OakMIUSA
| | - Nishaki Mehta
- Department of Cardiovascular Medicine, William Beaumont University HospitalCorewell Health EastRoyal OakMIUSA
- University of VirginiaCharlottesvilleVAUSA
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11
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Hoehne SN, Hopper K, Rezende ML, Borchers A, Epstein SE. Serial paired arterial and jugular venous point-of-care values in dogs undergoing manual basic life support. J Vet Emerg Crit Care (San Antonio) 2024; 34:368-375. [PMID: 38971981 DOI: 10.1111/vec.13406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 05/22/2023] [Accepted: 06/03/2023] [Indexed: 07/08/2024]
Abstract
OBJECTIVE To evaluate differences in point-of-care (POC) variables obtained from arterial and jugular venous blood in dogs undergoing manual basic life support (BLS) and report changes over time. DESIGN Experimental study. SETTING Small animal research facility. ANIMALS Twenty-four purpose-bred research dogs. INTERVENTIONS Dogs were anesthetized, and arterial catheters were placed before euthanasia. One minute after cardiopulmonary arrest, BLS consisting of manual chest compressions and ventilation delivered via endotracheal intubation, face mask, mouth-to-nose, or no ventilation was initiated. Paired arterial and jugular venous blood samples were obtained for POC testing before euthanasia (T0), at 3 minutes (T3), and at 6 minutes (T6) into BLS. MEASUREMENTS AND MAIN RESULTS The association of POC variables with arterial or venous sample type while controlling for type of ventilation and sampling timepoint was determined using a generalized linear mixed model. Variables obtained from arterial and venous blood samples were compared over time using repeated measures ANOVA or Friedman test. Pao2, anion gap, potassium, chloride, glucose concentration, and PCV were significantly higher in arterial blood samples compared with venous samples (P < 0.03). By T6, arterial glucose concentration, arterial and venous base excess, venous pH, and plasma lactate, potassium, creatinine, bicarbonate, and sodium concentrations were significantly increased, and arterial and venous Po2, ionized calcium concentration, PCV, and total plasma protein concentration were significantly decreased from T0 (P < 0.05). CONCLUSIONS Although statistically significant, arteriovenous differences and changes in POC blood variables during BLS were small and not clinically relevant over time. Given the challenges of arterial blood sampling, it may be reasonable to pursue venous blood sampling during CPR. Further studies in dogs undergoing BLS and advanced life support are needed to better understand the potential clinical role of POC testing during CPR.
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Affiliation(s)
- Sabrina N Hoehne
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, Washington, USA
| | - Kate Hopper
- Department of Veterinary Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, California, USA
| | - Marlis L Rezende
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Angela Borchers
- Department of Pathobiological Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Steven E Epstein
- Department of Veterinary Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, California, USA
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12
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Belda-Hofheinz S, Gómez-de-Quero P. Adrenaline in Resuscitation for Shockable Rhythms: Are We Barking the Wrong Tree? Crit Care Med 2024; 52:976-978. [PMID: 38752814 DOI: 10.1097/ccm.0000000000006234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2024]
Affiliation(s)
- Sylvia Belda-Hofheinz
- PICU University Hospital 12 de Octubre, Complutense University Madrid, Mother-Child Health and Development Network (Red SAMID), ISCIII Instituto de Investigación Hospital 12 de Octubre (imas12), Madrid, Spain
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13
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Tamsett Z, Douglas N, King C, Johnston T, Bentley C, Hao B, Prinsloo D, Bourke EM. Does the choice of induction agent in rapid sequence intubation in the emergency department influence the incidence of post-induction hypotension? Emerg Med Australas 2024; 36:340-347. [PMID: 38018391 DOI: 10.1111/1742-6723.14355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 10/26/2023] [Accepted: 11/14/2023] [Indexed: 11/30/2023]
Abstract
OBJECTIVE To describe the effects of different induction agents on the incidence of post-induction hypotension (PIH) and its associated interventions during rapid sequence intubation (RSI) in the ED. METHODS A single centre retrospective study of patients intubated between 2018 and 2021 was conducted in a regional Australian ED. The impact of induction agent choice, in addition to demographic and clinical factors on the incidence of PIH were determined using descriptive statistics and a multivariate analysis presented as adjusted odds ratios (aORs) and their 95% confidence intervals (CIs). RESULTS Ketamine and propofol, used either individually or in conjunction with fentanyl, were significantly associated with PIH (ketamine aOR 4.5, 95% CI 1.35-14.96; propofol aOR 4.88, 95% CI 1.46-16.29). Age >60 years was associated with a greater requirement for vasopressors (aOR 4.46, 95% CI 2.49-7.97) and a higher risk of mortality after RSI (aOR 4.2, 95% CI 1.87-9.40). Patients with a shock index >1.0 were significantly more likely to require vasopressors (aOR 5.13, 95% CI 2.35-11.2) and have a cardiac arrest within 15 min of RSI (aOR 3.56, 95% CI 1.07-11.8). CONCLUSIONS Exposure to both propofol and ketamine is significantly associated with PIH after RSI, alongside age and shock index. PIH is likely multifactorial in nature, and this data supports the sympatholytic effect of induction agents as the underlying cause of PIH rather than the choice of agent itself. Further prospective work including a randomised controlled trial between induction agents is justified to further clarify this important clinical question.
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Affiliation(s)
- Zacchary Tamsett
- Department of Emergency Medicine, Grampians Health, Ballarat, Victoria, Australia
| | - Ned Douglas
- Department of Anaesthesia, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Critical Care, The University of Melbourne, Melbourne, Victoria, Australia
| | - Cathy King
- Department of Emergency Medicine, Grampians Health, Ballarat, Victoria, Australia
- School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - Tanya Johnston
- Department of Emergency Medicine, Grampians Health, Ballarat, Victoria, Australia
| | - Connor Bentley
- Department of Emergency Medicine, Grampians Health, Ballarat, Victoria, Australia
| | - Brian Hao
- Department of Emergency Medicine, Grampians Health, Ballarat, Victoria, Australia
| | - Duron Prinsloo
- Department of Emergency Medicine, Grampians Health, Ballarat, Victoria, Australia
| | - Elyssia M Bourke
- Department of Emergency Medicine, Grampians Health, Ballarat, Victoria, Australia
- Department of Critical Care, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Emergency Medicine, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
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14
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Alhenaki A, Alqudah Z, Williams B, Nehme E, Nehme Z. Temporal trends in the incidence and outcomes of shock-refractory ventricular fibrillation out-of-hospital cardiac arrest. Resusc Plus 2024; 18:100597. [PMID: 38495223 PMCID: PMC10943038 DOI: 10.1016/j.resplu.2024.100597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 02/21/2024] [Accepted: 02/22/2024] [Indexed: 03/19/2024] Open
Abstract
Aim We aimed to describe trends in the incidence and outcomes of refractory ventricular fibrillation (RVF) compared to non-refractory ventricular fibrillation (non-RVF) in out-of-hospital cardiac arrest (OHCA). Methods Between 2010 and 2019, we included all OHCA cases involving adults ≥ 16 years old with an initial shockable rhythm and who received an attempted resuscitation by Emergency Medical Services (EMS) or a bystander shock prior to EMS arrival in Victoria, Australia. Trends in incidence and survival outcomes over the study period were examined. Adjusted logistic regression analyses were conducted to examine factors associated with RVF, as well as the association of RVF on survival to hospital discharge. RVF refers to patients receiving three or more consecutive shocks without a return of spontaneous circulation (ROSC). Results Of the 57,749 OHCA attended by EMS, 7,267 met the inclusion criteria. Of these, 4,168 (57.4%) were non-RVF and 3,099 (42.6%) were RVF. The incidence of RVF decreased significantly from 7.7 per 100,000 population in 2010 to 5.6 per 100,000 population in 2019 (p-trend = 0.01). Survival to hospital discharge increased significantly for both the RVF and non-RVF groups (26% vs 41% in 2010 to 31% vs 53% in 2019, p-trend = 0.004 for RVF; and p-trend = 0.01 for non-RVF). Compared to non-RVF, RVF was associated with reduced odds of survival to hospital discharge (Odds Ratio = 0.503 [95% confidence interval 0.448 - 0.565]). Factors associated with a lower likelihood of RVF and improved survival to hospital discharge included being witnessed to arrest by EMS, receiving bystander defibrillation and bystander cardiopulmonary resuscitation (CPR). Conclusion The incidence of RVF is declining, and survival rates are improving. Early treatment of VF patients with bystander CPR and defibrillation is likely to reduce RVF incidence.
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Affiliation(s)
- Abdulrahman Alhenaki
- Department of Paramedicine, Monash University, Frankston, Victoria, Australia
- Prince Sultan ibn Abdulaziz College for Emergency Medical Services, King Saud University, Riyadh, Saudi Arabia
| | - Zainab Alqudah
- Department of Paramedicine, Monash University, Frankston, Victoria, Australia
- Faculty of Allied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - Brett Williams
- Department of Paramedicine, Monash University, Frankston, Victoria, Australia
- Faculty of Allied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - Emily Nehme
- Centre for Research and Evaluation, Ambulance Victoria, Blackburn North, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, St Kilda., Victoria, Australia
| | - Ziad Nehme
- Department of Paramedicine, Monash University, Frankston, Victoria, Australia
- Centre for Research and Evaluation, Ambulance Victoria, Blackburn North, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, St Kilda., Victoria, Australia
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15
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Brede JR, Skjærseth EÅ, Rehn M. Prehospital anaesthesiologists experience with cardiopulmonary resuscitation-induced consciousness in Norway - A national cross-sectional survey. Resusc Plus 2024; 18:100591. [PMID: 38439932 PMCID: PMC10910154 DOI: 10.1016/j.resplu.2024.100591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 02/11/2024] [Accepted: 02/15/2024] [Indexed: 03/06/2024] Open
Abstract
Background During cardiopulmonary resuscitation (CPR) cerebral blood flow may be sufficient to restore some cerebral function, and CPR-induced consciousness (CPRIC) may occur. CPRIC includes signs of life such as gasping, breathing efforts, eye opening, movements of extremities or communication with the rescuers. There is a lack in evidence for prevalence, experience, and possible treatment strategies for CPRIC. This survey aimed to assess prehospital anaesthesiologists experience with CPRIC in Norway. Methods A web-based cross-sectional survey. All physicians working at a Norwegian air ambulance, search-and-rescue base or physician-staffed rapid response car were invited to participate. Result Out of 177 invited, 115 responded. All were anaesthesiologist, with mean 12.7 (SD 7.2) years of prehospital experience, and 25% had attended more than 200 out-of-hospital cardiac arrests (OHCA). CPRIC was known amongst most physicians prior to the survey and experienced by 91%. Mechanical compression device was used in 79% of cases. The CPRIC were CPR-interfering in 31% of cases. Next-of-kin reported the CPRIC as upsetting in 5% of cases. Medication and/or physical restraint were administered in 75% patients. For patients with CPRIC 50% answered that sedation was needed. If sedation should be provided, 62% answered that this should only be performed by a physician, while 25% answered that both ambulance crew and physicians could provide sedation. Fentanyl, ketamine, and midazolam were suggested as the most appropriate sedation agents. Conclusion This nationwide survey indicates that CPRIC during OHCA are well known amongst prehospital anaesthesiologist in Norway. Most patients with CPRIC were treated with chest compression device. Most physicians recommend sedation of patients with CPRIC during resuscitation.
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Affiliation(s)
- Jostein Rødseth Brede
- Department of Emergency Medicine and Pre-Hospital Services, St. Olav University Hospital, Trondheim, Norway
- Norwegian Air Ambulance Foundation, Department of Research and Development, Oslo, Norway
- Department of Anaesthesiology and Intensive Care Medicine, St. Olav́s University Hospital, Trondheim, Norway
| | - Eivinn Årdal Skjærseth
- Department of Emergency Medicine and Pre-Hospital Services, St. Olav University Hospital, Trondheim, Norway
| | - Marius Rehn
- Norwegian Air Ambulance Foundation, Department of Research and Development, Oslo, Norway
- Air Ambulance Department, Division of Prehospital Services, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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16
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Ali S, Moors X, van Schuppen H, Mommers L, Weelink E, Meuwese CL, Kant M, van den Brule J, Kraemer CE, Vlaar APJ, Akin S, Lansink-Hartgring AO, Scholten E, Otterspoor L, de Metz J, Delnoij T, van Lieshout EMM, Houmes RJ, Hartog DD, Gommers D, Dos Reis Miranda D. A national multi centre pre-hospital ECPR stepped wedge study; design and rationale of the ON-SCENE study. Scand J Trauma Resusc Emerg Med 2024; 32:31. [PMID: 38632661 PMCID: PMC11022459 DOI: 10.1186/s13049-024-01198-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 03/16/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND The likelihood of return of spontaneous circulation with conventional advanced life support is known to have an exponential decline and therefore neurological outcome after 20 min in patients with a cardiac arrest is poor. Initiation of venoarterial ExtraCorporeal Membrane Oxygenation (ECMO) during resuscitation might improve outcomes if used in time and in a selected patient category. However, previous studies have failed to significantly reduce the time from cardiac arrest to ECMO flow to less than 60 min. We hypothesize that the initiation of Extracorporeal Cardiopulmonary Resuscitation (ECPR) by a Helicopter Emergency Medical Services System (HEMS) will reduce the low flow time and improve outcomes in refractory Out of Hospital Cardiac Arrest (OHCA) patients. METHODS The ON-SCENE study will use a non-randomised stepped wedge design to implement ECPR in patients with witnessed OHCA between the ages of 18-50 years old, with an initial presentation of shockable rhythm or pulseless electrical activity with a high suspicion of pulmonary embolism, lasting more than 20, but less than 45 min. Patients will be treated by the ambulance crew and HEMS with prehospital ECPR capabilities and will be compared with treatment by ambulance crew and HEMS without prehospital ECPR capabilities. The primary outcome measure will be survival at hospital discharge. The secondary outcome measure will be good neurological outcome defined as a cerebral performance categories scale score of 1 or 2 at 6 and 12 months. DISCUSSION The ON-SCENE study focuses on initiating ECPR at the scene of OHCA using HEMS. The current in-hospital ECPR for OHCA obstacles encompassing low survival rates in refractory arrests, extended low-flow durations during transportation, and the critical time sensitivity of initiating ECPR, which could potentially be addressed through the implementation of the HEMS system. When successful, implementing on-scene ECPR could significantly enhance survival rates and minimize neurological impairment. TRIAL REGISTRATION Clinicaltyrials.gov under NCT04620070, registration date 3 November 2020.
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Affiliation(s)
- Samir Ali
- Department of Intensive Care, Erasmus University Medical Centre, Dr. Molewaterplein 40, Rotterdam, 3015 GD, the Netherlands.
- Department of Anaesthesiology, Erasmus Medical Centre, Rotterdam, 3015 GD, the Netherlands.
- Ministry of Defence, Royal Netherlands Air Force, Breda, 4820 ZB, the Netherlands.
| | - Xavier Moors
- Department of Anaesthesiology, Erasmus Medical Centre, Rotterdam, 3015 GD, the Netherlands
- Helicopter Emergency Medical Services, Trauma Centre Zuid-West Nederland, Erasmus University Medical Centre, Rotterdam, 3045 AS, the Netherlands
| | - Hans van Schuppen
- Helicopter Emergency Medical Services, Netwerk Acute Zorg Noordwest, Amsterdam University Medical Centre, Amsterdam, 1081 HV, the Netherlands
| | - Lars Mommers
- Helicopter Emergency Medical Service, Radboud University Medical Centre, Nijmegen, 6525 GA, the Netherlands
- Department of Anaesthesiology, Maastricht University Medical Centre, Maastricht, 6229 HX, the Netherlands
| | - Ellen Weelink
- Helicopter Emergency Medical Service, University Medical Centre Groningen, Groningen, 9713 GZ, the Netherlands
| | - Christiaan L Meuwese
- Department of Intensive Care, Erasmus University Medical Centre, Dr. Molewaterplein 40, Rotterdam, 3015 GD, the Netherlands
| | - Merijn Kant
- Department of Intensive Care, Amphia Hospital, Breda, 4818 CK, the Netherlands
| | - Judith van den Brule
- Department of Intensive Care Medicine, Radboud University Medical Centre, Nijmegen, 6525 GA, the Netherlands
| | - Carlos Elzo Kraemer
- Department of Intensive Care Medicine, Leiden University Medical Centre, Leiden, 2333 ZA, the Netherlands
| | - Alexander P J Vlaar
- Department of Intensive Care Medicine, Amsterdam University Medical Centre, Amsterdam, 1105 AZ, the Netherlands
| | - Sakir Akin
- Department of Intensive Care, Haga Teaching Hospital, the Hague, 2545 AA, the Netherlands
| | | | - Erik Scholten
- Department of Intensive Care, St. Antonius Hospital, Nieuwegein, 3435 CM, the Netherlands
| | - Luuk Otterspoor
- Department of Intensive Care, Catharina Hospital, Eindhoven, 5623 EJ, the Netherlands
| | - Jesse de Metz
- Department of Intensive Care, OLVG, 1091 AC, Amsterdam, the Netherlands
| | - Thijs Delnoij
- Department of Intensive Care, Maastricht University Medical Centre, Maastricht, 6229 HX, the Netherlands
| | - Esther M M van Lieshout
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, 3015 GD, the Netherlands
| | - Robert-Jan Houmes
- Helicopter Emergency Medical Services, Trauma Centre Zuid-West Nederland, Erasmus University Medical Centre, Rotterdam, 3045 AS, the Netherlands
| | - Dennis den Hartog
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, 3015 GD, the Netherlands
| | - Diederik Gommers
- Department of Intensive Care, Erasmus University Medical Centre, Dr. Molewaterplein 40, Rotterdam, 3015 GD, the Netherlands
| | - Dinis Dos Reis Miranda
- Department of Intensive Care, Erasmus University Medical Centre, Dr. Molewaterplein 40, Rotterdam, 3015 GD, the Netherlands
- Helicopter Emergency Medical Services, Trauma Centre Zuid-West Nederland, Erasmus University Medical Centre, Rotterdam, 3045 AS, the Netherlands
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17
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Hilderink BN, Crane RF, van den Bogaard B, Pillay J, Juffermans NP. Hyperoxemia and hypoxemia impair cellular oxygenation: a study in healthy volunteers. Intensive Care Med Exp 2024; 12:37. [PMID: 38619625 PMCID: PMC11018572 DOI: 10.1186/s40635-024-00619-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 03/28/2024] [Indexed: 04/16/2024] Open
Abstract
INTRODUCTION Administration of oxygen therapy is common, yet there is a lack of knowledge on its ability to prevent cellular hypoxia as well as on its potential toxicity. Consequently, the optimal oxygenation targets in clinical practice remain unresolved. The novel PpIX technique measures the mitochondrial oxygen tension in the skin (mitoPO2) which allows for non-invasive investigation on the effect of hypoxemia and hyperoxemia on cellular oxygen availability. RESULTS During hypoxemia, SpO2 was 80 (77-83)% and PaO2 45(38-50) mmHg for 15 min. MitoPO2 decreased from 42(35-51) at baseline to 6(4.3-9)mmHg (p < 0.001), despite 16(12-16)% increase in cardiac output which maintained global oxygen delivery (DO2). During hyperoxic breathing, an FiO2 of 40% decreased mitoPO2 to 20 (9-27) mmHg. Cardiac output was unaltered during hyperoxia, but perfused De Backer density was reduced by one-third (p < 0.01). A PaO2 < 100 mmHg and > 200 mmHg were both associated with a reduction in mitoPO2. CONCLUSIONS Hypoxemia decreases mitoPO2 profoundly, despite complete compensation of global oxygen delivery. In addition, hyperoxemia also decreases mitoPO2, accompanied by a reduction in microcirculatory perfusion. These results suggest that mitoPO2 can be used to titrate oxygen support.
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Affiliation(s)
- Bashar N Hilderink
- Department of Intensive Care, OLVG Hospital, Amsterdam, The Netherlands.
| | - Reinier F Crane
- Department of Intensive Care, OLVG Hospital, Amsterdam, The Netherlands
| | | | - Janesh Pillay
- Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Nicole P Juffermans
- Department of Intensive Care, OLVG Hospital, Amsterdam, The Netherlands
- Laboratory of Translational Intensive Care, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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18
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Ali S, Meuwese CL, Moors XJR, Donker DW, van de Koolwijk AF, van de Poll MCG, Gommers D, Dos Reis Miranda D. Extracorporeal cardiopulmonary resuscitation for refractory cardiac arrest: an overview of current practice and evidence. Neth Heart J 2024; 32:148-155. [PMID: 38376712 PMCID: PMC10951133 DOI: 10.1007/s12471-023-01853-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2023] [Indexed: 02/21/2024] Open
Abstract
Cardiac arrest (CA) is a common and potentially avoidable cause of death, while constituting a substantial public health burden. Although survival rates for out-of-hospital cardiac arrest (OHCA) have improved in recent decades, the prognosis for refractory OHCA remains poor. The use of veno-arterial extracorporeal membrane oxygenation during cardiopulmonary resuscitation (ECPR) is increasingly being considered to support rescue measures when conventional cardiopulmonary resuscitation (CPR) fails. ECPR enables immediate haemodynamic and respiratory stabilisation of patients with CA who are refractory to conventional CPR and thereby reduces the low-flow time, promoting favourable neurological outcomes. In the case of refractory OHCA, multiple studies have shown beneficial effects in specific patient categories. However, ECPR might be more effective if it is implemented in the pre-hospital setting to reduce the low-flow time, thereby limiting permanent brain damage. The ongoing ON-SCENE trial might provide a definitive answer regarding the effectiveness of ECPR. The aim of this narrative review is to present the most recent literature available on ECPR and its current developments.
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Affiliation(s)
- Samir Ali
- Department of Intensive Care, Erasmus University Medical Centre, Rotterdam, The Netherlands.
- Department of Anaesthesiology, Erasmus Medical Centre, Rotterdam, The Netherlands.
- Ministry of Defence, Royal Netherlands Air Force, Breda, The Netherlands.
| | - Christiaan L Meuwese
- Department of Intensive Care, Erasmus University Medical Centre, Rotterdam, The Netherlands
- Department of Cardiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Xavier J R Moors
- Department of Anaesthesiology, Erasmus Medical Centre, Rotterdam, The Netherlands
- Helicopter Emergency Medical Services, Trauma Centre Zuid-West Nederland, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Dirk W Donker
- Cardiovascular and Respiratory Physiology, Faculty of Science and Technology, University of Twente, Enschede, The Netherlands
- Department of Intensive Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Anina F van de Koolwijk
- Department of Intensive Care, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Marcel C G van de Poll
- Department of Intensive Care, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Diederik Gommers
- Department of Intensive Care, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Dinis Dos Reis Miranda
- Department of Intensive Care, Erasmus University Medical Centre, Rotterdam, The Netherlands
- Helicopter Emergency Medical Services, Trauma Centre Zuid-West Nederland, Erasmus University Medical Centre, Rotterdam, The Netherlands
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19
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Behringer W, Böttiger BW, Biasucci DG, Chalkias A, Connolly J, Dodt C, Khoury A, Laribi S, Leach R, Ristagno G. Temperature control after successful resuscitation from cardiac arrest in adults: a joint statement from the European Society for Emergency Medicine (EUSEM) and the European Society of Anaesthesiology and Intensive Care (ESAIC). Eur J Emerg Med 2024; 31:86-89. [PMID: 38126247 PMCID: PMC10901227 DOI: 10.1097/mej.0000000000001106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 10/24/2023] [Indexed: 12/23/2023]
Affiliation(s)
- Wilhelm Behringer
- Department of Emergency Medicine, Medical University Vienna, Vienna General Hospital, Vienna, Austria
| | - Bernd W. Böttiger
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Cologne, Cologne, Germany
| | - Daniele G. Biasucci
- Department of Clinical Science and Translational Medicine, ‘Tor Vergata’ University of Rome, Rome, Italy
| | - Athanasios Chalkias
- Institute for Translational Medicine and Therapeutics, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
- Outcomes Research Consortium, Cleveland, Ohio, USA
| | - Jim Connolly
- Accident and Emergency, Great North Trauma and Emergency Care, Newcastle-upon-Tyne, UK
| | - Christoph Dodt
- Department of Emergency Medicine, München Klinik, Munich, Germany
| | - Abdo Khoury
- Department of Emergency Medicine and Critical Care, Besançon University Hospital, Besançon
| | - Said Laribi
- Department of Emergency Medicine, Tours University Hospital, Tours, France
| | - Robert Leach
- Department of Emergency Medicine, Centre Hospitalier de Wallonie Picarde, Tournai, Belgium
| | - Giuseppe Ristagno
- Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
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20
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Behringer W, Böttiger BW, Biasucci DG, Chalkias A, Connolly J, Dodt C, Khoury A, Laribi S, Leach R, Ristagno G. Temperature control after successful resuscitation from cardiac arrest in adults: A joint statement from the European Society for Emergency Medicine and the European Society of Anaesthesiology and Intensive Care. Eur J Anaesthesiol 2024; 41:278-281. [PMID: 38126249 PMCID: PMC10906202 DOI: 10.1097/eja.0000000000001948] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
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21
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Vanwulpen M, Cornelis R, Bouillon A, Hachimi-Idrissi S. Is the occurrence of reversed airflow in manual ventilation during cardiopulmonary resuscitation associated with reduced net tidal volumes? Resusc Plus 2024; 17:100557. [PMID: 38323137 PMCID: PMC10844850 DOI: 10.1016/j.resplu.2024.100557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024] Open
Abstract
Background During cardiopulmonary resuscitation, following advanced airway placement, chest compressions and ventilations are performed simultaneously. During inspiration, chest compressions and positive pressure ventilation exert opposite forces on the respiratory system, frequently resulting in reversed airflow. Methods Following endotracheal intubation, a flow sensor was connected to the respiratory circuit of intubated, adult out-of-hospital cardiac arrest patients receiving manual chest compressions and manual ventilations. Chest compression parameters were measured using an accelerometer. Inspiratory and expiratory volumes during the inspiratory phase of positive pressure ventilations were quantified. Duration of the inspiratory and expiratory phases was calculated. Results In this study, 25 patients were included, 682 ventilations were analyzed. Reversed airflow was observed in 23 patients, occurring 389 times during 270 ventilations. Median volume of reversed airflow was 2 mL (IQR 1.4-7 mL). There was no difference between net tidal volumes of ventilations during which reversed airflow did (median 420 mL, IQR 315-549) or did not occur (median 406 mL, IQR 308-530). When reversed airflow occurred, the duration of the inspiratory phase was longer (median 1.2 sec, IQR 0.9-1.4) compared to ventilations without reversed airflow (median 0.9 sec, IQR 0.9-1.4). Univariate analysis showed a weak correlation between chest compression depth and volume of reversed airflow. Conclusion Reversed airflow frequently occurs during cardiopulmonary resuscitation. Volumes of reversed airflow were small, showing a weak correlation with chest compression depth. The occurrence of reversed airflow was not associated with reduced net tidal volumes.
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Affiliation(s)
- Maxim Vanwulpen
- Department of Emergency Medicine, Ghent University Hospital, Corneel Heymanslaan 10, Ghent, Belgium
- Faculty of Medicine and Health Sciences, Ghent University, Sint-Pietersnieuwstraat 25, Ghent, Belgium
| | - Ruben Cornelis
- Faculty of Medicine and Health Sciences, Ghent University, Sint-Pietersnieuwstraat 25, Ghent, Belgium
| | - Arthur Bouillon
- Faculty of Medicine and Health Sciences, Ghent University, Sint-Pietersnieuwstraat 25, Ghent, Belgium
| | - Saïd Hachimi-Idrissi
- Department of Emergency Medicine, Ghent University Hospital, Corneel Heymanslaan 10, Ghent, Belgium
- Faculty of Medicine and Health Sciences, Ghent University, Sint-Pietersnieuwstraat 25, Ghent, Belgium
- Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, 1090 Brussels, Belgium
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22
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Riva G, Boberg E, Ringh M, Jonsson M, Claesson A, Nord A, Rubertsson S, Blomberg H, Nordberg P, Forsberg S, Rosenqvist M, Svensson L, Andréll C, Herlitz J, Hollenberg J. Compression-Only or Standard Cardiopulmonary Resuscitation for Trained Laypersons in Out-of-Hospital Cardiac Arrest: A Nationwide Randomized Trial in Sweden. Circ Cardiovasc Qual Outcomes 2024; 17:e010027. [PMID: 38445487 DOI: 10.1161/circoutcomes.122.010027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 11/08/2023] [Indexed: 03/07/2024]
Abstract
BACKGROUND The ongoing TANGO2 (Telephone Assisted CPR. AN evaluation of efficacy amonGst cOmpression only and standard CPR) trial is designed to evaluate whether compression-only cardiopulmonary resuscitation (CPR) by trained laypersons is noninferior to standard CPR in adult out-of-hospital cardiac arrest. This pilot study assesses feasibility, safety, and intermediate clinical outcomes as part of the larger TANGO2 survival trial. METHODS Emergency medical dispatch calls of suspected out-of-hospital cardiac arrest were screened for inclusion at 18 dispatch centers in Sweden between January 1, 2017, and March 12, 2020. Inclusion criteria were witnessed event, bystander on the scene with previous CPR training, age above 18 years of age, and no signs of trauma, pregnancy, or intoxication. Cases were randomized 1:1 at the dispatch center to either instructions to perform compression-only CPR (intervention) or instructions to perform standard CPR (control). Feasibility included evaluation of inclusion, randomization, and adherence to protocol. Safety measures were time to emergency medical service dispatch CPR instructions, and to start of CPR, intermediate clinical outcome was defined as 1-day survival. RESULTS Of 11 838 calls of suspected out-of-hospital cardiac arrest screened for inclusion, 2168 were randomized and 1250 (57.7%) were out-of-hospital cardiac arrests treated by the emergency medical service. Of these, 640 were assigned to intervention and 610 to control. Crossover from intervention to control occurred in 16.3% and from control to intervention in 18.5%. The median time from emergency call to ambulance dispatch was 1 minute and 36 s (interquartile range, 1.1-2.2) in the intervention group and 1 minute and 30 s (interquartile range, 1.1-2.2) in the control group. Survival to 1 day was 28.6% versus 28.4% (P=0.984) for intervention and control, respectively. CONCLUSIONS In this national randomized pilot trial, compression-only CPR versus standard CPR by trained laypersons was feasible. No differences in safety measures or short-term survival were found between the 2 strategies. Efforts to reduce crossover are important and may strengthen the ongoing main trial that will assess differences in long-term survival. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT02401633.
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Affiliation(s)
- Gabriel Riva
- Department of Clinical Science and Education, Södersjukhuset, Center for Resuscitation Science, Karolinska Institute, Stockholm, Sweden (G.R., E.B., M. Ringh, M.J., A.C., A.N., P.N., S.F., M. Rosenqvist, J. Hollenberg)
- Department of Cardiology, S:t Göran's Hospital, Stockholm, Sweden (G.R.)
| | - Erik Boberg
- Department of Clinical Science and Education, Södersjukhuset, Center for Resuscitation Science, Karolinska Institute, Stockholm, Sweden (G.R., E.B., M. Ringh, M.J., A.C., A.N., P.N., S.F., M. Rosenqvist, J. Hollenberg)
| | - Mattias Ringh
- Department of Clinical Science and Education, Södersjukhuset, Center for Resuscitation Science, Karolinska Institute, Stockholm, Sweden (G.R., E.B., M. Ringh, M.J., A.C., A.N., P.N., S.F., M. Rosenqvist, J. Hollenberg)
| | - Martin Jonsson
- Department of Clinical Science and Education, Södersjukhuset, Center for Resuscitation Science, Karolinska Institute, Stockholm, Sweden (G.R., E.B., M. Ringh, M.J., A.C., A.N., P.N., S.F., M. Rosenqvist, J. Hollenberg)
| | - Andreas Claesson
- Department of Clinical Science and Education, Södersjukhuset, Center for Resuscitation Science, Karolinska Institute, Stockholm, Sweden (G.R., E.B., M. Ringh, M.J., A.C., A.N., P.N., S.F., M. Rosenqvist, J. Hollenberg)
| | - Anette Nord
- Department of Clinical Science and Education, Södersjukhuset, Center for Resuscitation Science, Karolinska Institute, Stockholm, Sweden (G.R., E.B., M. Ringh, M.J., A.C., A.N., P.N., S.F., M. Rosenqvist, J. Hollenberg)
| | - Sten Rubertsson
- Department of Surgical Sciences, Anesthesiology and Intensive Care Medicine, Uppsala University, Sweden (S.R., H.B.)
| | - Hans Blomberg
- Department of Surgical Sciences, Anesthesiology and Intensive Care Medicine, Uppsala University, Sweden (S.R., H.B.)
| | - Per Nordberg
- Department of Surgical Sciences, Anesthesiology and Intensive Care Medicine, Uppsala University, Sweden (S.R., H.B.)
| | - Sune Forsberg
- Department of Clinical Science and Education, Södersjukhuset, Center for Resuscitation Science, Karolinska Institute, Stockholm, Sweden (G.R., E.B., M. Ringh, M.J., A.C., A.N., P.N., S.F., M. Rosenqvist, J. Hollenberg)
| | - Mårten Rosenqvist
- Department of Clinical Science and Education, Södersjukhuset, Center for Resuscitation Science, Karolinska Institute, Stockholm, Sweden (G.R., E.B., M. Ringh, M.J., A.C., A.N., P.N., S.F., M. Rosenqvist, J. Hollenberg)
| | - Leif Svensson
- Department of Medicine, Solna Karolinska Institutet, Stockholm, Sweden (L.S.)
| | - Cecilia Andréll
- Department of Anesthesiology and Intensive Care, Lund University, Sweden (C.A.)
| | - Johan Herlitz
- Department of Caring Science, University of Borås, Sweden (J. Herlitz)
| | - Jacob Hollenberg
- Department of Clinical Science and Education, Södersjukhuset, Center for Resuscitation Science, Karolinska Institute, Stockholm, Sweden (G.R., E.B., M. Ringh, M.J., A.C., A.N., P.N., S.F., M. Rosenqvist, J. Hollenberg)
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Magon F, Longhitano Y, Savioli G, Piccioni A, Tesauro M, Del Duca F, Napoletano G, Volonnino G, Maiese A, La Russa R, Di Paolo M, Zanza C. Point-of-Care Ultrasound (POCUS) in Adult Cardiac Arrest: Clinical Review. Diagnostics (Basel) 2024; 14:434. [PMID: 38396471 PMCID: PMC10887671 DOI: 10.3390/diagnostics14040434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 02/10/2024] [Accepted: 02/12/2024] [Indexed: 02/25/2024] Open
Abstract
Point-of-Care Ultrasound (POCUS) is a rapid and valuable diagnostic tool available in emergency and intensive care units. In the context of cardiac arrest, POCUS application can help assess cardiac activity, identify causes of arrest that could be reversible (such as pericardial effusion or pneumothorax), guide interventions like central line placement or pericardiocentesis, and provide real-time feedback on the effectiveness of resuscitation efforts, among other critical applications. Its use, in addition to cardiovascular life support maneuvers, is advocated by all resuscitation guidelines. The purpose of this narrative review is to summarize the key applications of POCUS in cardiac arrest, highlighting, among others, its prognostic, diagnostic, and forensic potential. We conducted an extensive literature review utilizing PubMed by employing key search terms regarding ultrasound and its use in cardiac arrest. Apart from its numerous advantages, its limitations and challenges such as the potential for interruption of chest compressions during image acquisition and operator proficiency should be considered as well and are discussed herein.
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Affiliation(s)
- Federica Magon
- Department of Anesthesia and Critical Care, Bicocca University of Milano, 20126 Milano, Italy;
| | - Yaroslava Longhitano
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA 15261, USA;
| | - Gabriele Savioli
- Departement of Emergency, IRCCS Fondazione Policlinico San Matteo, 27100 Pavia, Italy;
| | - Andrea Piccioni
- Department of Emergency Medicine, Gemelli Hospital, Catholic University of Rome, 00168 Rome, Italy;
| | - Manfredi Tesauro
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy;
- Geriatric Medicine Residency Program, University of Rome “Tor Vergata”, 00133 Rome, Italy;
| | - Fabio Del Duca
- Department of Anatomical, Histological, Forensic and Orthopedical Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy; (F.D.D.); (G.N.); (G.V.)
| | - Gabriele Napoletano
- Department of Anatomical, Histological, Forensic and Orthopedical Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy; (F.D.D.); (G.N.); (G.V.)
| | - Gianpietro Volonnino
- Department of Anatomical, Histological, Forensic and Orthopedical Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy; (F.D.D.); (G.N.); (G.V.)
| | - Aniello Maiese
- Department of Surgical Pathology, Medical, Molecular and Critical Area, Institute of Legal Medicine, University of Pisa, 56126 Pisa, Italy
| | - Raffaele La Russa
- Department of Clinical Medicine, Public Health, Life Sciences, and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy;
| | - Marco Di Paolo
- Department of Surgical Pathology, Medical, Molecular and Critical Area, Institute of Legal Medicine, University of Pisa, 56126 Pisa, Italy
| | - Christian Zanza
- Geriatric Medicine Residency Program, University of Rome “Tor Vergata”, 00133 Rome, Italy;
- Italian Society of Prehospital Emergency Medicine (SIS 118), 74121 Taranto, Italy
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24
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Kim JH, Kim JG, Kang GH, Jang YS, Kim W, Choi HY, Lee Y, Ahn C. Target Temperature Management Effect on the Clinical Outcome of Patients with Out-of-Hospital Cardiac Arrest Treated with Extracorporeal Cardiopulmonary Resuscitation: A Nationwide Observational Study. J Pers Med 2024; 14:185. [PMID: 38392618 PMCID: PMC10890305 DOI: 10.3390/jpm14020185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 01/28/2024] [Accepted: 02/05/2024] [Indexed: 02/24/2024] Open
Abstract
This study aimed to investigate whether targeted temperature management (TTM) could enhance outcomes in patients with out-of-hospital cardiac arrest (OHCA) treated with extracorporeal cardiopulmonary resuscitation (ECPR) for refractory cardiac arrest. Using a nationwide OHCA registry, adult patients with witnessed OHCA of presumed cardiac origin who underwent ECPR at the emergency department between 2008 and 2021 were included. We examined the effect of ECPR with TTM on survival and neurological outcomes at hospital discharge using propensity score matching and multivariable logistic regression compared with patients treated with ECPR without TTM. Odds ratios and 95% confidence intervals were determined. A total of 399 ECPR cases were analyzed among 380,239 patients with OHCA. Of these, 330 underwent ECPR without TTM and 69 with TTM. After propensity score matching, 69 matched pairs of patients were included in the analysis. No significant differences in survival and good neurological outcomes between the two groups were observed. In the multivariable logistic regression, no significant differences were observed in survival and neurological outcomes between ECPR with and without TTM. Among the patients who underwent ECPR after OHCA, ECPR with TTM did not improve outcomes compared with ECPR without TTM.
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Affiliation(s)
- Jae-Hee Kim
- Department of Emergency Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, 1, Singil-ro, Yeongdeungpo-gu, Seoul 07441, Republic of Korea
| | - Jae-Guk Kim
- Department of Emergency Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, 1, Singil-ro, Yeongdeungpo-gu, Seoul 07441, Republic of Korea
| | - Gu-Hyun Kang
- Department of Emergency Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, 1, Singil-ro, Yeongdeungpo-gu, Seoul 07441, Republic of Korea
| | - Yong-Soo Jang
- Department of Emergency Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, 1, Singil-ro, Yeongdeungpo-gu, Seoul 07441, Republic of Korea
| | - Wonhee Kim
- Department of Emergency Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, 1, Singil-ro, Yeongdeungpo-gu, Seoul 07441, Republic of Korea
| | - Hyun-Young Choi
- Department of Emergency Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, 1, Singil-ro, Yeongdeungpo-gu, Seoul 07441, Republic of Korea
| | - Yoonje Lee
- Department of Emergency Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, 1, Singil-ro, Yeongdeungpo-gu, Seoul 07441, Republic of Korea
| | - Chiwon Ahn
- Department of Emergency Medicine, College of Medicine, Chung-Ang University, Seoul 06974, Republic of Korea
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25
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Alkhalil R, Ouersighni A, Kenway P, Breque C, Oriot D, Ghazali DA. Impact of a Multidisciplinary Simulation-Based Training Program on the Multiple Techniques of Intraosseous Access: A Prospective Multicentric Study. Simul Healthc 2024; 19:35-40. [PMID: 36342841 DOI: 10.1097/sih.0000000000000699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVES The aim of this study was to assess intraosseous (IO) access placement performance during a multidisciplinary simulation-based training (SBT) program according to the professional status, experience of caregivers, and the setting of the course. METHOD This prospective, multicentric study included emergency physicians, residents, certified registered nurse anesthetists, registered nurses, and students. It was carried out between April 6, 2020 and April 30, 2021 in emergency medical services, an emergency department, and a simulation center. Trainee performance was evaluated by 2 independent observers using a validated scale, before and after SBT. Self-assessment of satisfaction was carried out. Interobserver reproducibility was analyzed by intraclass correlation coefficient. The continuous variables were compared using a Student t test or a nonparametric Mann-Whitney U test. Comparative analysis between the different groups used analysis of variance. Correlation analysis was performed by a nonparametric Spearman test. A P value of 0.05 was considered significant. RESULTS Ninety-eight participants were included. Intraclass correlation coefficient between the 2 observers was 0.96. Performance significantly increased after training, regardless of the site or device used (for the semiautomatic device, P = 0.004 in tibia and P = 0.001 in humeral; for the manual device, P < 0.001). Simulation-based training significantly reduced time for IO access ( P = 0.02). After SBT, no difference was found according to professional status and the setting of the course. Performance was not correlated with professional experience. All trainees were satisfied with the training. CONCLUSIONS Simulation-based training improved the IO access using a semiautomatic or a manual device, regardless of the experience or status of the trainees. Simulation-based training would work for many disciplines regardless of locations (simulation or clinical facilities).
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Affiliation(s)
- Rania Alkhalil
- From the Emergency Department and EMS (R.A., P.K.), University Hospital of Bichat, Paris, France; Emergency Medical Services (A.O.), University Hospital of Beaujon, AP-HP, Clichy, France; Anesthesiology Department (A.O.), University Hospital of Beaujon, AP-HP, Clichy, France; ABS Lab (C.B., D.O.), Anatomy and Simulation Center of Poitiers University, Poitiers, France; Pediatric Emergency Department (D.O.), University Hospital of Poitiers, Poitiers, France; Emergency Department and EMS (D.A.G.), University Hospital of Amiens, Amiens, France; and DREAMS - Department of Research in Emergency Medicine and Simulation (D.A.G.), University Hospital of Amiens, Amiens, France
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26
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Battaglini D, Bogossian EG, Anania P, Premraj L, Cho SM, Taccone FS, Sekhon M, Robba C. Monitoring of Brain Tissue Oxygen Tension in Cardiac Arrest: a Translational Systematic Review from Experimental to Clinical Evidence. Neurocrit Care 2024; 40:349-363. [PMID: 37081276 DOI: 10.1007/s12028-023-01721-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 03/24/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND Cardiac arrest (CA) is a sudden event that is often characterized by hypoxic-ischemic brain injury (HIBI), leading to significant mortality and long-term disability. Brain tissue oxygenation (PbtO2) is an invasive tool for monitoring brain oxygen tension, but it is not routinely used in patients with CA because of the invasiveness and the absence of high-quality data on its effect on outcome. We conducted a systematic review of experimental and clinical evidence to understand the role of PbtO2 in monitoring brain oxygenation in HIBI after CA and the effect of targeted PbtO2 therapy on outcomes. METHODS The search was conducted using four search engines (PubMed, Scopus, Embase, and Cochrane), using the Boolean operator to combine mesh terms such as PbtO2, CA, and HIBI. RESULTS Among 1,077 records, 22 studies were included (16 experimental studies and six clinical studies). In experimental studies, PbtO2 was mainly adopted to assess the impact of gas exchanges, drugs, or systemic maneuvers on brain oxygenation. In human studies, PbtO2 was rarely used to monitor the brain oxygen tension in patients with CA and HIBI. PbtO2 values had no clear association with patients' outcomes, but in the experimental studies, brain tissue hypoxia was associated with increased inflammation and neuronal damage. CONCLUSIONS Further studies are needed to validate the effect and the threshold of PbtO2 associated with outcome in patients with CA, as well as to understand the physiological mechanisms influencing PbtO2 induced by gas exchanges, drug administration, and changes in body positioning after CA.
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Affiliation(s)
- Denise Battaglini
- Anesthesiology and Critical Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy
- Department of Medicine, University of Barcelona, Barcelona, Spain
| | - Elisa Gouvea Bogossian
- Department of Intensive Care, Hospital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Pasquale Anania
- Department of Neurosurgery, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy.
| | - Lavienraj Premraj
- Griffith University School of Medicine, Gold Coast, QLD, Australia
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Sung-Min Cho
- Departments of Neurology, Surgery, and Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Fabio Silvio Taccone
- Department of Intensive Care, Hospital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Mypinder Sekhon
- Division of Critical Care Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Chiara Robba
- Anesthesiology and Critical Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
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Assouline B, Mentha N, Wozniak H, Donner V, Looyens C, Suppan L, Larribau R, Banfi C, Bendjelid K, Giraud R. Improved Extracorporeal Cardiopulmonary Resuscitation (ECPR) Outcomes Is Associated with a Restrictive Patient Selection Algorithm. J Clin Med 2024; 13:497. [PMID: 38256631 PMCID: PMC10816028 DOI: 10.3390/jcm13020497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/09/2024] [Accepted: 01/11/2024] [Indexed: 01/24/2024] Open
Abstract
INTRODUCTION Out-of-hospital cardiac arrest (OHCA) is a leading cause of mortality. Despite decades of intensive research and several technological advancements, survival rates remain low. The integration of extracorporeal cardiopulmonary resuscitation (ECPR) has been recognized as a promising approach in refractory OHCA. However, evidence from recent randomized controlled trials yielded contradictory results, and the criteria for selecting eligible patients are still a subject of debate. METHODS This study is a retrospective analysis of refractory OHCA patients treated with ECPR. All adult patients who received ECPR, according to the hospital algorithm, from 2013 to 2021 were included. Two different algorithms were used during this period. A "permissive" algorithm was used from 2013 to mid-2016. Subsequently, a revised algorithm, more "restrictive", based on international guidelines, was implemented from mid-2016 to 2021. Key differences between the two algorithms included reducing the no-flow time from less than three minutes to zero minutes (implying that the cardiac arrests must occur in the presence of a witness with immediate CPR initiation), reducing low-flow duration from 100 to 60 min, and lowering the age limit from 65 to 55 years. The aim of this study is to compare these two algorithms (permissive (1) and restrictive (2)) to determine if the use of a restrictive algorithm was associated with higher survival rates. RESULTS A total of 48 patients were included in this study, with 23 treated under Algorithm 1 and 25 under Algorithm 2. A significant difference in survival rate was observed in favor of the restrictive algorithm (9% vs. 68%, p < 0.05). Moreover, significant differences emerged between algorithms regarding the no-flow time (0 (0-5) vs. 0 (0-0) minutes, p < 0.05). Survivors had a significantly shorter no-flow and low-flow time (0 (0-0) vs. 0 (0-3) minutes, p < 0.01 and 40 (31-53) vs. 60 (45-80) minutes, p < 0.05), respectively. CONCLUSION The present study emphasizes that a stricter selection of OHCA patients improves survival rates in ECPR.
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Affiliation(s)
- Benjamin Assouline
- Intensive Care Unit, Geneva University Hospitals, 1205 Geneva, Switzerland; (B.A.); (N.M.); (H.W.); (V.D.); (C.L.); (K.B.)
- Faculty of Medicine, University of Geneva, 1205 Geneva, Switzerland; (L.S.); (R.L.)
- Geneva Hemodynamic Research Group, Faculty of Medicine, University of Geneva, 1211 Geneva, Switzerland;
| | - Nathalie Mentha
- Intensive Care Unit, Geneva University Hospitals, 1205 Geneva, Switzerland; (B.A.); (N.M.); (H.W.); (V.D.); (C.L.); (K.B.)
| | - Hannah Wozniak
- Intensive Care Unit, Geneva University Hospitals, 1205 Geneva, Switzerland; (B.A.); (N.M.); (H.W.); (V.D.); (C.L.); (K.B.)
| | - Viviane Donner
- Intensive Care Unit, Geneva University Hospitals, 1205 Geneva, Switzerland; (B.A.); (N.M.); (H.W.); (V.D.); (C.L.); (K.B.)
| | - Carole Looyens
- Intensive Care Unit, Geneva University Hospitals, 1205 Geneva, Switzerland; (B.A.); (N.M.); (H.W.); (V.D.); (C.L.); (K.B.)
| | - Laurent Suppan
- Faculty of Medicine, University of Geneva, 1205 Geneva, Switzerland; (L.S.); (R.L.)
- Emergency Department, Geneva University Hospitals, 1205 Geneva, Switzerland
| | - Robert Larribau
- Faculty of Medicine, University of Geneva, 1205 Geneva, Switzerland; (L.S.); (R.L.)
- Emergency Department, Geneva University Hospitals, 1205 Geneva, Switzerland
| | - Carlo Banfi
- Geneva Hemodynamic Research Group, Faculty of Medicine, University of Geneva, 1211 Geneva, Switzerland;
| | - Karim Bendjelid
- Intensive Care Unit, Geneva University Hospitals, 1205 Geneva, Switzerland; (B.A.); (N.M.); (H.W.); (V.D.); (C.L.); (K.B.)
- Faculty of Medicine, University of Geneva, 1205 Geneva, Switzerland; (L.S.); (R.L.)
- Geneva Hemodynamic Research Group, Faculty of Medicine, University of Geneva, 1211 Geneva, Switzerland;
| | - Raphaël Giraud
- Intensive Care Unit, Geneva University Hospitals, 1205 Geneva, Switzerland; (B.A.); (N.M.); (H.W.); (V.D.); (C.L.); (K.B.)
- Faculty of Medicine, University of Geneva, 1205 Geneva, Switzerland; (L.S.); (R.L.)
- Geneva Hemodynamic Research Group, Faculty of Medicine, University of Geneva, 1211 Geneva, Switzerland;
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Pey V, Doumard E, Komorowski M, Rouget A, Delmas C, Vardon-Bounes F, Poette M, Ratineau V, Dray C, Ader I, Minville V. A locally optimised machine learning approach to early prognostication of long-term neurological outcomes after out-of-hospital cardiac arrest. Digit Health 2024; 10:20552076241234746. [PMID: 38628633 PMCID: PMC11020739 DOI: 10.1177/20552076241234746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2024] [Indexed: 04/19/2024] Open
Abstract
Background Out-of-hospital cardiac arrest (OHCA) represents a major burden for society and health care, with an average incidence in adults of 67 to 170 cases per 100,000 person-years in Europe and in-hospital survival rates of less than 10%. Patients and practitioners would benefit from a prognostication tool for long-term good neurological outcomes. Objective We aim to develop a machine learning (ML) pipeline on a local database to classify patients according to their neurological outcomes and identify prognostic features. Methods We collected clinical and biological data consecutively from 595 patients who presented OHCA and were routed to a single regional cardiac arrest centre in the south of France. We applied recursive feature elimination and ML analyses to identify the main features associated with a good neurological outcome, defined as a Cerebral Performance Category score less than or equal to 2 at six months post-OHCA. Results We identified 12 variables 24 h after admission, capable of predicting a six-month good neurological outcome. The best model (extreme gradient boosting) achieved an AUC of 0.96 and an accuracy of 0.92 in the test cohort. Conclusion We demonstrated that it is possible to build accurate, locally optimised prediction and prognostication scores using datasets of limited size and breadth. We proposed and shared a generic machine-learning pipeline which allows external teams to replicate the approach locally.
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Affiliation(s)
- Vincent Pey
- RESTORE Research Center, University Toulouse 3-Paul Sabatier, INSERM, CNRS, EFS, ENVT, Toulouse, France
- Department of Anaesthesiology and Critical Care, University Hospital of Toulouse, University Toulouse 3-Paul Sabatier, Toulouse, France
| | - Emmanuel Doumard
- RESTORE Research Center, University Toulouse 3-Paul Sabatier, INSERM, CNRS, EFS, ENVT, Toulouse, France
| | - Matthieu Komorowski
- Division of Anaesthetics, Pain Medicine, and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Antoine Rouget
- Department of Anaesthesiology and Critical Care, University Hospital of Toulouse, University Toulouse 3-Paul Sabatier, Toulouse, France
| | - Clément Delmas
- Department of Cardiology, University Hospital of Rangueil, Toulouse, France
| | - Fanny Vardon-Bounes
- Department of Anaesthesiology and Critical Care, University Hospital of Toulouse, University Toulouse 3-Paul Sabatier, Toulouse, France
| | - Michaël Poette
- Department of Anaesthesiology and Critical Care, University Hospital of Toulouse, University Toulouse 3-Paul Sabatier, Toulouse, France
| | - Valentin Ratineau
- Department of Anaesthesiology and Critical Care, University Hospital of Toulouse, University Toulouse 3-Paul Sabatier, Toulouse, France
| | - Cédric Dray
- RESTORE Research Center, University Toulouse 3-Paul Sabatier, INSERM, CNRS, EFS, ENVT, Toulouse, France
| | - Isabelle Ader
- RESTORE Research Center, University Toulouse 3-Paul Sabatier, INSERM, CNRS, EFS, ENVT, Toulouse, France
| | - Vincent Minville
- RESTORE Research Center, University Toulouse 3-Paul Sabatier, INSERM, CNRS, EFS, ENVT, Toulouse, France
- Department of Anaesthesiology and Critical Care, University Hospital of Toulouse, University Toulouse 3-Paul Sabatier, Toulouse, France
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Ubben JFH, Suverein MM, Delnoij TSR, Heuts S, Winkens B, Gabrio A, van der Horst ICC, Maessen JG, Lorusso R, van de Poll MCG. Early extracorporeal CPR for refractory out-of-hospital cardiac arrest - A pre-planned per-protocol analysis of the INCEPTION-trial. Resuscitation 2024; 194:110033. [PMID: 37923112 DOI: 10.1016/j.resuscitation.2023.110033] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/20/2023] [Accepted: 10/20/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Evidence for extracorporeal cardiopulmonary resuscitation (CPR) in refractory out-of-hospital cardiac arrest (OHCA) remains inconclusive. Recently, the INCEPTION-trial, comparing extracorporeal with conventional CPR, found no statistically significant difference in neurologically favorable survival. Since protocol deviations were anticipated, a pre-specified per-protocol analysis was foreseen. METHODS The per-protocol analysis of the INCEPTION trial excluded patients not meeting inclusion or exclusion criteria, amongst which time-to-cannulation of >60 minutes, and achieving a return of spontaneous circulation before hospital arrival. Crossovers were excluded as well. The primary outcome (30-day survival in a neurologically favorable condition; cerebral performance category [CPC] 1-2) was primarily analyzed under a frequentist statistical framework. In addition, Bayesian analysis under a minimally informative prior was performed. RESULTS Eighty-one patients were included in the per-protocol analysis (extracorporeal CPR n = 33, conventional CPR n = 48). Thirty-day survival with CPC1-2 was 15% in the extracorporeal CPR group versus 9% in the conventional CPR group (adjusted OR 1.9; 95% CI 0.4-9.3; p-value 0.393). Bayesian analysis showed an 84% posterior probability of any ECPR benefit and a 61% posterior probability of a 5% absolute risk reduction for the primary outcome. CONCLUSION A pre-planned, pre-specified per-protocol analysis of the INCEPTION-trial, found a higher survival with favorable neurological in patients undergoing ECPR versus CCPR for refractory shockable OHCA. This difference did not reach statistical significance, but results should be interpreted with care, in the light of the small remaining sample size.
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Affiliation(s)
- Johannes F H Ubben
- Department of Intensive Care Medicine, Maastricht University Medical Center, Maastricht, the Netherlands; Department of Anesthesiology and Pain Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Martje M Suverein
- Department of Intensive Care Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Thijs S R Delnoij
- Department of Intensive Care Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Samuel Heuts
- Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, the Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands
| | - Bjorn Winkens
- Department of Methodology and Statistics, Maastricht University, Maastricht, the Netherlands; Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - Andrea Gabrio
- Department of Methodology and Statistics, Maastricht University, Maastricht, the Netherlands; Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - Iwan C C van der Horst
- Department of Intensive Care Medicine, Maastricht University Medical Center, Maastricht, the Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands
| | - Jos G Maessen
- Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, the Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands
| | - Roberto Lorusso
- Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, the Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands
| | - Marcel C G van de Poll
- Department of Intensive Care Medicine, Maastricht University Medical Center, Maastricht, the Netherlands; School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, the Netherlands
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Meng L, Wang C, Liu X, Bi Y, Zhu K, Yue Y, Wang C, Song X. Temperature management in the intensive care unit: a practical survey from China. Libyan J Med 2023; 18:2275416. [PMID: 37905303 PMCID: PMC11018322 DOI: 10.1080/19932820.2023.2275416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 10/22/2023] [Indexed: 11/02/2023] Open
Abstract
Introduction: Temperature management is an important aspect of the treatment of critically ill patients, but there are differences in the measurement and management of temperature in different Intensive Care Units (ICUs). The objective of this study was to understand the current situation of temperature measurement and management in ICUs in China, and to provide a basis for standardized temperature management in ICUs.Methods: A 20-question survey was used to gather information on temperature management strategies from ICUs across China. Data such as method and frequency of temperature measurement, management goals, cooling measures, and temperature management recommendations were collected.Results: A total of 425 questionnaires from unique ICUs were included in the study, with responses collected from all provinces and autonomous regions in China. Mercury thermometers were the most widely used measurement tool (82.39%) and the axilla was the most common measurement site (96.47%). There was considerable variability in the frequency of temperature measurement, the temperature at which intervention should begin, intervention duration, and temperature management goals. While there was no clearly preferred drug-based cooling method, the most widely used equipment-based cooling method was the ice blanket machine (93.18%). The most frequent recommendations for promoting temperature management were continuous monitoring and targeted management.Conclusion: Our investigation revealed a high level of variability in the methods of temperature measurement and management among ICUs in China. Since fever is a common clinical symptom in critically ill patients and can lead to prolonged ICU stays, we propose that standardized guidelines are urgently needed for the management of body temperature (BT) in these patients.
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Affiliation(s)
- Lingyang Meng
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chaofan Wang
- Intensive Care Medicine, Shandong First Medical University, Jinan, Shandong, China
| | - Xinyan Liu
- Intensive Care Unit, Dong E Hospital, Liaocheng, Shandong, China
| | - Yang Bi
- Intensive Care Medicine, Shandong First Medical University, Jinan, Shandong, China
| | - Kehan Zhu
- Intensive Care Medicine, Shandong First Medical University, Jinan, Shandong, China
| | - Yanru Yue
- Intensive Care Medicine, Shandong First Medical University, Jinan, Shandong, China
| | - Chunting Wang
- Intensive Care Unit, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Xuan Song
- Intensive Care Unit, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Shandong Institute of Endocrine and Metabolic Diseases, Jinan Key Laboratory of Translational Medicine on Metabolic Diseases, Endocrine and Metabolic Diseases Hospital of Shandong First Medical University, Jinan, Shandong, China
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Busch HJ, Behringer W, Biever P, Böttiger BW, Eisenburger P, Fink K, Herkner H, Kreimeier U, Pin M, Wolfrum S. [Hypothermic temperature control after successful resuscitation of out-of-hospital cardiac arrest in adults : Statement from the resuscitation and postresuscitation treatment working groups of the German Society of Medical Intensive Care and Emergency Medicine (DGIIN) and the German Interdisciplinary Association for Intensive Care and Emergency Medicine (DIVI), the German Society for Interdisciplinary Emergency and Acute Medicine (DGINA) and the Austrian Association of Emergency Medicine (AAEM)]. Med Klin Intensivmed Notfmed 2023; 118:59-63. [PMID: 38051382 DOI: 10.1007/s00063-023-01092-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2023] [Indexed: 12/07/2023]
Abstract
In Germany per year approximately 60,000 and in Austria 5,000 adult patients suffer from out-of-hospital cardiac arrest. Only 10-15% of these patients survive without neurological damage. For decades hypothermic temperature control has been a central component of post-resuscitation treatment, but is controversial due to recently published studies.
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Affiliation(s)
- Hans-Jörg Busch
- Zentrum für Notfall- und Rettungsmedizin, Universitätsnotfallzentrum, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität, Sir Hans-A-Krebs-Straße, 79180, Freiburg, Deutschland.
| | - Wilhelm Behringer
- Universitätsklinik für Notfallmedizin, MedUni Wien, Wien, Österreich
| | - Paul Biever
- Medizinische Interdisziplinäre Intensivtherapie Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland
| | - Bernd W Böttiger
- Klinik für Anästhesiologie und Operative Intensivmedizin, Universität zu Köln, Köln, Deutschland
| | | | - Katrin Fink
- Zentrum für Notfall- und Rettungsmedizin, Universitätsnotfallzentrum, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität, Sir Hans-A-Krebs-Straße, 79180, Freiburg, Deutschland
| | - Harald Herkner
- Universitätsklinik für Notfallmedizin, MedUni Wien, Wien, Österreich
| | - Uwe Kreimeier
- Klinik für Anästhesiologie, LMU Klinikum, LMU München, München, Deutschland
| | - Martin Pin
- Zentrale Interdisziplinäre Notaufnahme und Akutstation, Florence-Nightingale-Krankenhaus, Kaiserswerther Diakonie, Düsseldorf, Deutschland
| | - Sebastian Wolfrum
- Interdisziplinäre Notaufnahme, Universitätsklinikum Schleswig-Holstein, Lübeck, Deutschland
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Perlman R, Tsai K, Lo J. Trauma Anesthesiology Perioperative Management Update. Adv Anesth 2023; 41:143-162. [PMID: 38251615 DOI: 10.1016/j.aan.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
Anesthesia for patients with life-threatening injuries is an essential part of post-accident care. Unfortunately, there is variability in trauma anesthesia care and numerous nonstandardized methods of working with patients remain. Uncertainty exists as to when and how best to intubate trauma patients, the use of vasopressors, and the appropriate management of severe traumatic brain injury. Some physicians recommend prehospital rapid sequence intubation, whereas others use bag-mask ventilation at lower pressures with no cricoid pressure and early transport to a trauma center. Overall, the absence of uniformity in trauma anesthesia care underlines the need for continued study and dialogue to define best practices and optimize patient outcomes.
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Affiliation(s)
- Ryan Perlman
- Trauma Anesthesia, Department of Anaesthesia, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, North Tower, Suite 8211, Los Angeles, CA 90048, USA.
| | - Kevin Tsai
- Department of Anaesthesia, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, North Tower, Suite 8211, Los Angeles, CA 90048, USA
| | - Jessie Lo
- Trauma Education Program, Department of Anaesthesia, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, North Tower, Suite 8211, Los Angeles, CA 90048, USA
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Grundgeiger T, Michalek A, Hahn F, Wurmb T, Meybohm P, Happel O. Guiding Attention via a Cognitive Aid During a Simulated In-Hospital Cardiac Arrest Scenario: A Salience Effort Expectancy Value Model Analysis. HUMAN FACTORS 2023; 65:1689-1701. [PMID: 34957862 DOI: 10.1177/00187208211060586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To investigate the effect of a cognitive aid on the visual attention distribution of the operator using the Salience Effort Expectancy Value (SEEV) model. BACKGROUND Cognitive aids aim to support an operator during the execution of a task. The effect of cognitive aids on performance is frequently evaluated but whether a cognitive aid improved, for example, attention distribution has not been considered. METHOD We built the Expectancy Value (EV) model version which can be considered to indicate optimal attention distribution for a given event. We analyzed the eye tracking data of emergency physicians while using a cognitive aid application versus no application during a simulated in-hospital cardiac arrest scenario. RESULTS The EV model could fit the attention distribution in such a simulated emergency situation. Partially supporting our hypothesis, the cognitive aid application group showed a significantly better EV model fit than the no application group in the first phases of the event, but a worse fit in the last phase. CONCLUSION We demonstrated that a cognitive aid affected attention distribution and that the SEEV model provides the means of capturing these effects. We suggest that the aid supported and improved visual attention distribution in the stressful first phases of a cardiopulmonary resuscitation but may have focused attention on objects that are relevant for lower priority goals in the last phase. APPLICATION The SEEV model can provide insights into expected and unexpected effects of cognitive aids on visual attention distribution and may help to design better artifacts.
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Affiliation(s)
- Tobias Grundgeiger
- Institute Human-Computer-Media, Julius-Maximilians-Universität Würzburg, Würzburg, Germany
| | - Annabell Michalek
- Institute Human-Computer-Media, Julius-Maximilians-Universität Würzburg, Würzburg, Germany
| | - Felix Hahn
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Thomas Wurmb
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Patrick Meybohm
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Oliver Happel
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, Würzburg, Germany
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Olsen MH, Petersen PB, Møller K. (Re)animation of a stuffed plush bunny: A case report. Eur J Anaesthesiol 2023; 40:946-950. [PMID: 37909157 DOI: 10.1097/eja.0000000000001918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
An expressed and constant wish of the first author's oldest daughter to enhance interaction with her favourite toy animal led to a (re)animation/resuscitation attempt of a 1½-year-old stuffed plush bunny. Initial physical examination found no vital signs. Based on the lack of identifiable airways, we hypothesised that tissue oxygenation might be caused by passive diffusion throughout the body. Hence, animation was attempted by mechanical chest compressions without including airway management or positive-pressure ventilation. Multimodal monitoring of arterial blood pressure (by proxy), intra-'cranial' pressure and oxygen tension, near-infrared spectroscopy of the head and laser-Doppler blood flow was successfully initiated, whereas an attempt at intracranial microdialysis was unsuccessful. Despite achieving measurable arterial blood pressure (by proxy) (12/3 mmHg) and an increase of cerebral perfusion by 30 points, spontaneous circulation or diffusion was not achieved apparently, and ultimately, animation attempts were ceased. Clinical experience, as well as common sense, forces us to conclude that our measurements were contaminated by the intervention, and that we must rethink the method for the animation of stuffed plush bunnies.
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Affiliation(s)
- Markus Harboe Olsen
- From the Department of Neuroanaesthesiology, Rigshospitalet, University Hospital of Copenhagen, Denmark (MHO, KM), Section for Surgical Pathophysiology 7621, Rigshospitalet, University Hospital of Copenhagen, Denmark (PBP)
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Prekker ME, Robinson AE. Implementing a smaller-volume adult ventilation bag: Is the juice worth the squeeze? Resuscitation 2023; 193:110034. [PMID: 37926291 DOI: 10.1016/j.resuscitation.2023.110034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 10/29/2023] [Indexed: 11/07/2023]
Affiliation(s)
- Matthew E Prekker
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota, USA; Department of Medicine, Division of Pulmonary, Allergy, and Critical Care, Hennepin County Medical Center, Minneapolis, Minnesota, USA.
| | - Aaron E Robinson
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota, USA; Hennepin Emergency Medical Services, Hennepin Healthcare, Minneapolis, Minnesota, USA.
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Bollucuoğlu K, Baytar Ç, Küçükosman G, Ayoğlu H. The placement of four different supraglottic airway devices by medical students: a manikin study. Ann Med 2023; 55:2282746. [PMID: 37983542 PMCID: PMC10836238 DOI: 10.1080/07853890.2023.2282746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 11/03/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Although endotracheal intubation is the gold standard in airway management, this procedure requires both technical training and experience. Supraglottic airway devices are an alternative to endotracheal intubation and are simpler, less invazive, and require less time for placement compared with endotrakeal intubation. Aim of the study was to evaluate the success rates, ease of use, duration of application, and maneuver performance of different supraglottic airway devices (SADs) used by term-5 medical students on a manikin. MATERIALS AND METHODS This cross-sectional study was conducted in Zonguldak Bülent Ecevit University Hospital, Turkey, between April and June 2022. Term 5 Medical students (n = 111) were asked to place four different SAD [classical laryngeal mask, suprema laryngeal mask, ProSeal laryngeal mask (pLMA), I-gel] on an adult airway manikin. After the students were trained in the use of the devices, the ease of use for each, duration of successful application, success of application and use of optimization maneuvers were recorded. The participants were asked to distinguish the device they felt most confident to place and the most difficult to implement. RESULTS There was a significant difference between the groups in ease and duration of application (p < 0.001). The most difficult and longest application time was with pLMA and the easiest and shortest was with I-gel (p < 0.05). The number of application failure was also highest for pLMA (p < 0.001). It was found that the participants distinguished (41%) I-gel as the most confident device to use, (84%) pLMA as the most difficult device to use for airway control. CONCLUSIONS I-gel was found to be superior to others in terms of ease of use, duration and success of application.
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Affiliation(s)
- Keziban Bollucuoğlu
- Department of Anesthesiology and Reanimation, Zonguldak Bülent Ecevit University Medicine Faculty, Zonguldak, Turkey
| | - Çağdaş Baytar
- Department of Anesthesiology and Reanimation, Zonguldak Bülent Ecevit University Medicine Faculty, Zonguldak, Turkey
| | - Gamze Küçükosman
- Department of Anesthesiology and Reanimation, Zonguldak Bülent Ecevit University Medicine Faculty, Zonguldak, Turkey
| | - Hilal Ayoğlu
- Department of Anesthesiology and Reanimation, Zonguldak Bülent Ecevit University Medicine Faculty, Zonguldak, Turkey
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Košir M, Možina H, Podbregar M. Skeletal muscle oxygenation during cardiopulmonary resuscitation as a predictor of return of spontaneous circulation: a pilot study. Eur J Med Res 2023; 28:418. [PMID: 37821950 PMCID: PMC10566100 DOI: 10.1186/s40001-023-01393-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 09/23/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Near-infrared spectroscopy (NIRS) provides regional tissue oxygenation (rSO2) even in pulseless states, such as out-of-hospital cardiac arrest (OHCA). Brain rSO2 seems to be important predictor of return of spontaneous circulation (ROSC) during cardiopulmonary resuscitation (CPR). Aim of our study was to explore feasibility for monitoring and detecting changes of skeletal muscle rSO2 during resuscitation. METHODS Skeletal muscle and brain rSO2 were measured by NIRS (SenSmart Model X-100, Nonin, USA) during CPR in adult patient with OHCA. Start (basal) rSO2, maximal during CPR (maximal) and difference between maximal-minimal rSO2 (delta-rSO2), were recorded. Patients were divided into ROSC and NO-ROSC group. RESULTS 20 patients [age: 66.0ys (60.5-79.5), 65% male] with OHCA [50% witnessed, 70% BLS, time to ALS 13.5 min (11.0-19.0)] were finally analyzed. ROSC was confirmed in 5 (25%) patients. Basal and maximal skeletal muscle rSO2 were higher in ROSC compared to NO-ROSC group [49.0% (39.7-53.7) vs. 15.0% (12.0-25.2), P = 0.006; 76.0% (52.7-80.5) vs. 34.0% (18.0-49.5), P = 0.005, respectively]. There was non-linear cubic relationship between time of collapse and basal skeletal muscle rSO2 in witnessed OHCA and without BLS (F-ratio = 9.7713, P = 0.0261). There was correlation between maximal skeletal muscle and brain rSO2 (n = 18, rho: 0.578, P = 0.0121). CONCLUSIONS Recording of skeletal muscle rSO2 during CPR in patients with OHCA is feasible. Basal and maximal skeletal muscle rSO2 were higher in ROSC compared to NO-ROSC group. Clinical trial registration number ClinicalTrials.gov, NCT04058925, registered on: 16th August 2019. URL of trial registry record: https://www. CLINICALTRIALS gov/ct2/show/NCT04058925?titles=Tissue+Oxygenation+During+Cardiopulmonary+Resuscitation+as+a+Predictor+of+Return+of+Spontaneous+Circulation&draw=2&rank=1 .
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Affiliation(s)
- Miha Košir
- Faculty of Medicine, University of Ljubljana, Vrazov Trg 2, 1000, Ljubljana, Slovenia
- Unit SNMP, Community Health Centre Ljubljana, Bohoričeva Ulica 4, 1000, Ljubljana, Slovenia
| | - Hugon Možina
- Faculty of Medicine, University of Ljubljana, Vrazov Trg 2, 1000, Ljubljana, Slovenia
- Emergency Department, University Medical Center Ljubljana, Zaloška Cesta 4, 1000, Ljubljana, Slovenia
| | - Matej Podbregar
- Faculty of Medicine, University of Ljubljana, Vrazov Trg 2, 1000, Ljubljana, Slovenia.
- Department for Internal Intensive Care, General Hospital Celje, Oblakova Ulica 5, 3000, Celje, Slovenia.
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Hasegawa T, Watanabe Y. Changes in vital signs during adrenaline administration for hemostasis in intracordal injection: an observational study with a hypothetical design of endotracheal adrenaline administration in cardiopulmonary arrest. J Cardiothorac Surg 2023; 18:271. [PMID: 37803400 PMCID: PMC10559520 DOI: 10.1186/s13019-023-02376-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 09/29/2023] [Indexed: 10/08/2023] Open
Abstract
BACKGROUND The background is that intravenous adrenaline administration is recommended for advanced cardiovascular life support in adults and endotracheal administration is given low priority. The reason is that the optimal dose of adrenaline in endotracheal administration is unknown, and it is ethically difficult to design studies of endotracheal adrenaline administration with non-cardiopulmonary arrest. We otolaryngologists think so because we administered adrenaline to the vocal folds for hemostasis after intracordal injection under local anesthesia, but have had few cases of vital changes. We hypothesized that examining vital signs before and after adrenaline administration for hemostasis would help determine the optimal dose of endotracheal adrenaline. METHODS We retrospectively examined the medical records of 79 patients who visited our hospital from January 2018 to December 2020 and received adrenaline in the vocal folds and trachea for hemostasis by intracordal injection under local anesthesia to investigate changes in heart rate and systolic blood pressure before and after the injection. RESULTS The mean heart rates before and after injection were 83.96 ± 18.51 (standard deviation) beats per minute (bpm) and 81.50 ± 15.38 (standard deviation) bpm, respectively. The mean systolic blood pressure before and after the injection were 138.13 ± 25.33 (standard deviation) mmHg and 135.72 ± 22.19 (standard deviation) mmHg, respectively. Heart rate and systolic blood pressure had P-values of 0.136, and 0.450, respectively, indicating no significant differences. CONCLUSIONS Although this study was an observational, changes in vital signs were investigated assuming endotracheal adrenaline administration. The current recommended dose of adrenaline in endotracheal administration with cardiopulmonary arrest may not be effective. In some cases of cardiopulmonary arrest, intravenous and intraosseous routes of adrenaline administration may be difficult and the opportunity for resuscitation may be missed. Therefore, it is desirable to have many options for adrenaline administration. Therefore, if the optimal dose and efficacy of endotracheal adrenaline administration can be clarified, early adrenaline administration will be possible, which will improve return of spontaneous circulation (ROSC) and survival discharge rates.
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Affiliation(s)
- Tomohiro Hasegawa
- Tokyo Voice Center, International University of Health and Welfare, 8-5-35 Akasaka, Minato-ku, Tokyo, 107-0052, Japan
| | - Yusuke Watanabe
- Tokyo Voice Center, International University of Health and Welfare, 8-5-35 Akasaka, Minato-ku, Tokyo, 107-0052, Japan.
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Herold J, Notov D, Reeps C, Schaser KD, Kamin K, Mäder M, Kleber C. Limb salvage in traumatic hemipelvectomy: case series with surgical management and review of the literature. Arch Orthop Trauma Surg 2023; 143:6177-6192. [PMID: 37314526 PMCID: PMC10491572 DOI: 10.1007/s00402-023-04913-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 05/19/2023] [Indexed: 06/15/2023]
Abstract
BACKGROUND Traumatic hemipelvectomies are rare and serious injuries. The surgical management was described in several case studies, with primary amputation often performed to save the patient's life. METHODS We report of two survivors with complete traumatic hemipelvectomy resulting in ischemia and paralyzed lower extremity. Due to modern emergency medicine and reconstructive surgery, limb salvage could be attained. Long-term outcome with quality of life was assessed one year after the initial accident. RESULTS AND CONCLUSIONS The patients were able to mobilize themselves and live an independent life. The extremities remained without function and sensation. Urinary continence and sexual function were present and the colostomy could be relocated in both patients. Both patients support limb salvage, even having difficulties and follow-up treatments. Concomitant cases are required to consolidate the findings. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- J Herold
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, Dresden, Germany.
| | - D Notov
- Department of Orthopedic, Trauma and Plastic Surgery, University Hospital of Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
| | - C Reeps
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Dresden, Germany
| | - K D Schaser
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, Dresden, Germany
| | - K Kamin
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, Dresden, Germany
| | - M Mäder
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, Dresden, Germany
| | - C Kleber
- Department of Orthopedic, Trauma and Plastic Surgery, University Hospital of Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
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Gupta S, Mishra S, Behl S, Srikant N, Mascarenhas R. Knowledge of handling medical emergencies among general dental practitioners pan India: a cross-sectional survery. BMC Res Notes 2023; 16:221. [PMID: 37710327 PMCID: PMC10503061 DOI: 10.1186/s13104-023-06477-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 08/25/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND Medical emergency situations in dental clinics have been contemplated to be an issue in most of the countries by reason of dentist's lack of knowledge and preparedness to attend emergency situations in dental offices. The aim of this paper is to observe the knowledge, attitude, and perceived confidence of the general dental practitioners regarding emergency medical care and its practical application. Questionnaire on knowledge assessment was circulated among 500 dentists using printed questionnaire formats and various social media platforms. The questionnaire included details on treating hypertensive patients, cardiopulmonary resuscitation training, accessibility of medical emergency equipments in the dental clinics, prevalence of medical emergency cases in the dental office and the self-assessed competence to handle medical emergency situations in the dental clinics. Data was surveyed and scrutinized using the Statistical Package for Social Sciences (SPSS), version 17 (SPSS Inc., Chicago IL). Descriptive statistics was tabulated and Chi square tests was applied. FINDINGS 500 general dental practitioners pan India were involved in the study (294 were females and 207 were males). They were grouped into different age groups (20-30 yrs, 30-40 yrs, 40-50 yrs, 50 and above) and experience (0-5 yrs, 5-10 yrs and more than 10 years). 279 participants did not attend any medical emergency training whereas, 222 participants from all groups attended training program. It was observed that with increased experience in the field, the knowledge, awareness and confidence to treat medical emergency situation in the dental clinics was better. Dentists should update themselves from time-to-time with the latest technologies in the field and need to attend training programs to handle any medical emergency situations in the dental offices. Medical emergencies in a dental clinic can be encountered at any point of time and the clinician should have apt knowledge in handling such situations. Majority of the dentists feel subdued in managing medical situations in dental offices. Training and workshops for handling medical situations in the dental offices should be mandated at the undergraduate and postgraduate levels. This will help the dentist to shape one's confidence in managing such situations without apprehension. Availability of proper infrastructure and equipments is recommended in every dental clinics so as to ease the handling of the situation. CONCLUSION This paper enlightens the need of basic life support training on regular basis among the dentists to improve the competence among them and to improve the confidence in handling such situations.
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Affiliation(s)
- Shubhangi Gupta
- Department of Oral and Maxillofacial Surgery, Sri Dharmasthala, Manjuatheswara College of Dental Sciences, Dharwad, India
| | - Stuti Mishra
- Department of Prosthodontics and Crown and Bridge, Manipal College of Dental Sciences, Manipal, Karnataka, India
| | - Shubhangi Behl
- Department of Periodontolgy, Bharati Vidyapeeth Dental College and Hospital, Pune, India
| | - N Srikant
- Department of Prosthodontics and Crown and Bridge, Manipal College of Dental Sciences, Manipal, Karnataka, India
- Department of Oral Pathology and Microbiology, Manipal College of Dental Sciences, Mangalore Affliliated to Manipal Academy of Higher Education, Manipal, India
| | - Roma Mascarenhas
- Department of Prosthodontics and Crown and Bridge, Manipal College of Dental Sciences, Manipal, Karnataka, India.
- Department of Conservative Dentistry and Endodontics, Manipal College of Dental Sciences, Mangalore Affliliated to Manipal Academy of Higher Education, Manipal, India.
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Tuyishime E, Mossenson A, Livingston P, Irakoze A, Seneza C, Ndekezi JK, Skelton T. Resuscitation team training in Rwanda: A mixed method study exploring the combination of the VAST course with Advanced Cardiac Life Support training. Resusc Plus 2023; 15:100415. [PMID: 37363124 PMCID: PMC10285628 DOI: 10.1016/j.resplu.2023.100415] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 06/01/2023] [Accepted: 06/06/2023] [Indexed: 06/28/2023] Open
Abstract
Introduction The influence of non-technical skills training on resuscitation performance in low-resource settings is unknown. This study investigates combining the Vital Anaesthesia Simulation Training Course with Advanced Cardiac Life Support training on resuscitation performance in Rwanda. Methods Participants in this mixed method study are members of resuscitation teams in three district hospitals in Rwanda. The intervention was participation in a 2-day Advanced Cardiac Life Support course followed by the 3-day Vital Anaesthesia Simulation Training Course. Quantitative primary endpoints were time to initiation of cardiopulmonary resuscitation, time to epinephrine administration, and time to defibrillation. Qualitative data on workplace implementation were gathered during focus groups held 3-months post-intervention. Results Forty-seven participants were recruited. Quantitative data showed a statistically significant decrease in time to cardiopulmonary resuscitation, epinephrine administration, and defibrillation from pre- to post-Advanced Cardiac Life Support, with times of [43.3 (49.7) seconds] versus [16.5 (20) sec], p = <0.001; [137.3 (108.9) sec] versus [51.3 (37.9)], p = <0.001; and [218.5 (105.8) sec] versus [110.8 (87.1) sec], p = <0.001; respectively. These improvements were maintained following the Vital Anaesthesia Simulation Training Course, and at 3-month retention testing. Qualitative analysis highlighted five key themes: ability to initiate cardiopulmonary resuscitation; team coordination for task allocation; empowerment; desire for training and mentorship; and advocacy for system improvement. Conclusion A modified 2-day Advanced Cardiac Life Support course improved resuscitation time indicators with retention 3-months later. Combining the Vital Anaesthesia Simulation Training Course and Advanced Cardiac Life Support led to better team coordination, empowerment to act, and advocacy for system improvement. This pairing of courses has promise for improving Advanced Cardiac Life Support skills amongst healthcare workers in low-resource settings.ClinicalTrials.gov Identifier: NCT05278884.
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Affiliation(s)
- Eugene Tuyishime
- Department Anesthesia, Critical Care, and Emergency Medicine, University of Rwanda, Rwanda
- Department Anesthesia and Critical Care, University of Botswana, Botswana
- Department of Anesthesia and Perioperative Medicine, Western University, Ontario, Canada
| | - Adam Mossenson
- Department of Anaesthesia, SJOG Public and Private Hospital, Perth, Western Australia
- Department of Anesthesia, Pain Management, and Perioperative Medicine, Dalhousie University, Nova Scotia, Canada
- Curtin University, Perth, Western Australia, Australia
| | - Patricia Livingston
- Department of Anesthesia, Pain Management, and Perioperative Medicine, Dalhousie University, Nova Scotia, Canada
| | - Alain Irakoze
- Department Anesthesia, Critical Care, and Emergency Medicine, University of Rwanda, Rwanda
| | | | | | - Teresa Skelton
- Department of Anesthesia and Pain Medicine, the Hospital for Sick Children, University of Toronto, Canada
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Gupte D, Assaf M, Miller MR, McKenzie K, Loosley J, Tijssen JA. Evaluation of hospital management of paediatric out-of-hospital cardiac arrest. Resusc Plus 2023; 15:100433. [PMID: 37555196 PMCID: PMC10405089 DOI: 10.1016/j.resplu.2023.100433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 06/22/2023] [Accepted: 07/11/2023] [Indexed: 08/10/2023] Open
Abstract
INTRODUCTION Pediatric out of hospital cardiac arrest (POHCA) is rare, with high mortality and neurological morbidity. Adherence to Pediatric Advanced Life Support guidelines standardizes in-hospital care and improves outcomes. We hypothesized that in-hospital care of POHCA patients was variable and deviations from guidelines were associated with higher mortality. METHODS POHCA patients in the London-Middlesex region between January 2012 and June 2020 were included. The care of children with ongoing arrest (intra-arrest) and post-arrest outcomes were reviewed using the Children's Hospital, London Health Sciences Centre (LHSC) patient database and the Adverse Event Management System. RESULTS 50 POHCA patients arrived to hospital, with 15 (30%) patients admitted and 2 (4.0%) surviving to discharge, both with poor neurological outcomes and no improvement at 90 days. Deviations occurred at every event with intra-arrest care deviations occurring mostly in medication delivery and defibrillation (98%). Post-arrest deviations occurred mostly in temperature monitoring (60%). Data missingness was 15.9% in the intra-arrest and 1.7% in the post-arrest group. DISCUSSION Deviations commonly occurred in both in-hospital arrest and post-arrest care. The study was under-powered to identify associations between DEVs and outcomes. Future work includes addressing specific deviations in intra-arrest and post-arrest care of POHCA patients and standardizing electronic documentation.
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Affiliation(s)
- Dhruv Gupte
- Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St, London, ON N6A 5C1, Canada
| | - Maysaa Assaf
- Department of Paediatrics, London Health Sciences Centre, 800 Commissioners Rd. E., London, ON N6A 5W9, Canada
| | - Michael R. Miller
- Department of Paediatrics, London Health Sciences Centre, 800 Commissioners Rd. E., London, ON N6A 5W9, Canada
- Children’s Health Research Institute, 800 Commissioners Rd. E., London, ON N6C 2V5, Canada
| | - Kate McKenzie
- Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St, London, ON N6A 5C1, Canada
| | - Jay Loosley
- Middlesex-London Paramedic Service, 1035 Adelaide St. S., London, ON N6E 1R4, Canada
| | - Janice A. Tijssen
- Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St, London, ON N6A 5C1, Canada
- Department of Paediatrics, London Health Sciences Centre, 800 Commissioners Rd. E., London, ON N6A 5W9, Canada
- Children’s Health Research Institute, 800 Commissioners Rd. E., London, ON N6C 2V5, Canada
- Lawson Health Research Institute, 750 Base Line Rd. E., London, ON N6C 2R5, Canada
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Qureshi T, Hutton P, Pandit JJ. Sharpening PUMA's teeth: improving guidance for capnography to confirm tracheal intubation in cardiopulmonary resuscitation. Anaesthesia 2023; 78:937-942. [PMID: 36947864 DOI: 10.1111/anae.16002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2023] [Indexed: 03/24/2023]
Affiliation(s)
- T Qureshi
- Nuffield Department of Anaesthesia, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - P Hutton
- University of Birmingham, UK
- Guy's and St Thomas' NHS Foundation Trust (Heart, Lung and Critical Care Clinical Group), London, UK
| | - J J Pandit
- Nuffield Department of Anaesthesia, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- University of Oxford, UK
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Abstract
Cardiac arrest is the loss of organized cardiac activity. Unfortunately, survival to hospital discharge is poor, despite recent scientific advances. The goals of cardiopulmonary resuscitation (CPR) are to restore circulation and identify and correct an underlying etiology. High-quality compressions remain the foundation of CPR, optimizing coronary and cerebral perfusion pressure. High-quality compressions must be performed at the appropriate rate and depth. Interruptions in compressions are detrimental to management. Mechanical compression devices are not associated with improved outcomes but can assist in several situations.
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Affiliation(s)
- Brit Long
- Brooke Army Medical Center, Fort Sam Houston, TX, USA.
| | - Michael Gottlieb
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, USA. https://twitter.com/MGottliebMD
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Haertel F, Lehmann T, Heller T, Fritzenwanger M, Pfeifer R, Kretzschmar D, Otto S, Bogoviku J, Westphal J, Bruening C, Gecks T, Kaluza M, Moebius-Winkler S, Schulze PC. Impact of a VA-ECMO in Combination with an Extracorporeal Cytokine Hemadsorption System in Critically Ill Patients with Cardiogenic Shock-Design and Rationale of the ECMOsorb Trial. J Clin Med 2023; 12:4893. [PMID: 37568295 PMCID: PMC10420280 DOI: 10.3390/jcm12154893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/12/2023] [Accepted: 07/17/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Cardiogenic shock and arrest present as critical, life-threatening emergencies characterized by severely compromised tissue perfusion and inadequate oxygen supply. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) serves as a mechanical support system for patients suffering shock refractory to conventional resuscitation. Despite the utilization of VA-ECMO, clinical deterioration due to systemic inflammatory response syndrome (SIRS) resulting from the underlying shock and exposure of blood cells to the artificial surfaces of the ECMO circuit may occur. To address this issue, cytokine adsorbers offer a valuable solution by eliminating blood proteins, thereby controlling SIRS and potentially improving hemodynamics. Consequently, a prospective, randomized, blinded clinical trial will be carried out with ECMOsorb. METHODS AND STUDY DESIGN ECMOsorb is a single-center, controlled, randomized, triple-blinded trial that will compare the hemodynamic effects of treatment with a VA-ECMO in combination with a cytokine adsorber (CytoSorb®, intervention) to treatment with VA-ECMO only (control) in patients with cardiogenic shock (with or without prior cardiopulmonary resuscitation (CPR)) requiring extracorporeal, hemodynamic support. Fifty-four patients will be randomized in a 1:1 fashion to the intervention or control group over a 36-month period. The primary endpoint of ECMOsorb is the improvement of the Inotropic Score (IS) 72 h after the intervention. Prognostic indicators, including mortality rates, hemodynamic parameters, laboratory findings, echocardiographic assessments, quality of life measurements, and clinical parameters, will serve as secondary outcome measures. The safety evaluation encompasses endpoints such as air embolisms, allergic reactions, peripheral ischemic complications, vascular complications, bleeding incidents, and stroke occurrences. CONCLUSIONS The ECMOsorb trial seeks to assess the efficacy of a cytokine adsorber (CytoSorb®; CytoSorbents Europe GmbH, Berlin, Germany) in reducing SIRS and improving hemodynamics in patients with cardiogenic shock who are receiving VA-ECMO. We hypothesize that a reduction in cytokine levels can lead to faster weaning from inotropic and mechanical circulatory support, and ultimately to improved recovery.
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Affiliation(s)
- Franz Haertel
- Department of Cardiology and Intensive Care, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany
| | - Thomas Lehmann
- Center of Clinical Studies, University Hospital Jena, Salvador-Allende-Platz 27, 07747 Jena, Germany
| | - Tabitha Heller
- Center of Clinical Studies, University Hospital Jena, Salvador-Allende-Platz 27, 07747 Jena, Germany
| | - Michael Fritzenwanger
- Department of Cardiology and Intensive Care, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany
| | - Ruediger Pfeifer
- Department of Cardiology and Intensive Care, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany
| | - Daniel Kretzschmar
- Department of Cardiology and Intensive Care, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany
| | - Sylvia Otto
- Department of Cardiology and Intensive Care, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany
| | - Jurgen Bogoviku
- Department of Cardiology and Intensive Care, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany
| | - Julian Westphal
- Department of Cardiology and Intensive Care, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany
| | - Christiane Bruening
- Department of Cardiology and Intensive Care, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany
| | - Thomas Gecks
- Department of Cardiology and Intensive Care, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany
| | - Mirko Kaluza
- Department of Cardiothoracic Surgery, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany
| | - Sven Moebius-Winkler
- Department of Cardiology and Intensive Care, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany
| | - P. Christian Schulze
- Department of Cardiology and Intensive Care, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany
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Shaath H, Salman B, Daghistani D, Koutaich R, Alhammadi A, Yakoub N, Awad MA. A Pilot Study of Preparedness of Dentists in the United Arab Emirates to Deal with Medical Emergencies. Eur J Dent 2023; 17:749-755. [PMID: 37059445 PMCID: PMC10569866 DOI: 10.1055/s-0042-1755628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2023] Open
Abstract
OBJECTIVES The purpose of this pilot study is to assess the United Arab Emirates dentists' preparedness to manage medical emergencies. MATERIALS AND METHODS Ninety-seven licensed dentists participated in this study. Dentists responded to self-administrated questionnaires that contained 23 questions divided into five parts. The first part collected data on participants' sex, years of experience, and whether they are general dental practitioner (GDP) or specialists. The second part included seven questions that asked participants to indicate if they took medical history, obtained vital signs, and attended basic life support courses. The third part included six multiple choice questions regarding the availability of emergency drugs in the dental clinic. The fourth part consisted of three multiple-choice questions that assessed the dentists' immediate response to a medical emergency. Finally, the fifth part comprised four questions to evaluate the dentists' knowledge of proper treatment of special emergency cases they may encounter in the dental offices. RESULTS Out of the 97 participants, only 51% (N = 49) indicated that they can handle emergencies such as anaphylactic shock and syncope in the dental office. The majority of the dentists (80%) indicated that they have emergency kits. Only 46% of the specialists and 42% of the GDPs were able to correctly plan extractions in a patient with a prosthetic heart valve. Less than half of the participants (N = 35, 36%) were able to correctly answer the question regarding management of a foreign-body aspiration by attempting Heimlich/Triple maneuver. CONCLUSIONS Within the limitations of this study, dentists need further hands-on training to improve their skills and knowledge about medical emergencies that could occur in the dental settings. Furthermore, we recommend that guidelines should be available in the clinic to strengthen the dentists' ability to deal with medical emergencies.
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Affiliation(s)
- Helmi Shaath
- College of Dental Medicine, Department of Preventive and Restorative Dentistry, University of Sharjah, Sharjah, United Arab Emirates
| | - Basheer Salman
- Department of Oral and Craniofacial Health Sciences, College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Dalia Daghistani
- College of Dental Medicine, Department of Preventive and Restorative Dentistry, University of Sharjah, Sharjah, United Arab Emirates
| | - Rayan Koutaich
- College of Dental Medicine, Department of Preventive and Restorative Dentistry, University of Sharjah, Sharjah, United Arab Emirates
| | - Alya Alhammadi
- College of Dental Medicine, Department of Preventive and Restorative Dentistry, University of Sharjah, Sharjah, United Arab Emirates
| | - Nermeen Yakoub
- College of Dental Medicine, Department of Preventive and Restorative Dentistry, University of Sharjah, Sharjah, United Arab Emirates
| | - Manal A. Awad
- College of Dental Medicine, Department of Preventive and Restorative Dentistry, University of Sharjah, Sharjah, United Arab Emirates
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Kluj P, Fedorczak M, Gaszyński T, Ratajczyk P. A pilot, prospective trial of IntuBrite® versus Macintosh direct laryngoscopy for paramedic endotracheal intubation in out of hospital cardiac arrest. BMC Emerg Med 2023; 23:70. [PMID: 37349703 PMCID: PMC10288703 DOI: 10.1186/s12873-023-00845-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 06/15/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND Intubation in the case of out-of-hospital cardiac arrest (OHCA) is one of the most difficult procedures for Emergency Medical Services (EMS). The use of a laryngoscope with a dual light source is an interesting alternative to classic laryngoscopes. However, there are as yet no prospective data concerning the use of double light direct laryngoscopy (DL) by paramedics in traditional ground ambulance agencies in OHCA. METHODS We performed a non-blinded trial in a single EMS in Poland within ambulances crews, comparing time and first pass success (FPS) for endotracheal intubation (ETI) in DL using the IntuBrite® (INT) and Macintosh laryngoscope (MCL) during cardiopulmonary resuscitation (CPR). We collected both patient and provider demographic information along with intubation details. The time and success rates were compared using an intention-to-treat analysis. RESULTS Over a period of 40 months, a total of 86 intubations were performed using 42 INT and 44 MCL based on an intention-to-treat analysis. The FPS time of the ETI attempt (13.49 vs. 15.55 s) using an INT which was shorter than MCL was used (p < 0.05). First attempt success (34/42, 80.9% vs. 29/44, 64.4%) was comparable for INT and MCL with no statistical significance. CONCLUSIONS We found a statistically significant difference in intubation attempt time when the INT laryngoscope was used. Intubation first attempt success rates with INT and MCL were comparable with no statistical significance during CPR performed by paramedics. TRIAL REGISTRATION Trial was registered in Clinical Trials: NCT05607836 (10/28/2022).
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Affiliation(s)
- Przemysław Kluj
- Department of Anesthesiology and Intensive Therapy, Medical University of Lodz, Lodz, Poland
| | - Michał Fedorczak
- Department of Anesthesiology and Intensive Therapy, Medical University of Lodz, Lodz, Poland
| | - Tomasz Gaszyński
- Department of Anesthesiology and Intensive Therapy, Medical University of Lodz, Lodz, Poland
| | - Paweł Ratajczyk
- Department of Anesthesiology and Intensive Therapy, Medical University of Lodz, Lodz, Poland
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Müller F, Schröder D, Schäning J, Schmid S, Noack EM. Lost in translation? Information quality in pediatric pre-hospital medical emergencies with a language barrier in Germany. BMC Pediatr 2023; 23:312. [PMID: 37344777 DOI: 10.1186/s12887-023-04121-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 06/08/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND In pediatric medical emergencies, paramedics and emergency physicians must often rely on the information of third parties, often caregivers, to gather information. Failing to obtain relevant information may lead to misinterpretation of symptoms and subsequent errors in decision making and clinical treatment. Thus, children and/or caregivers with limited proficiency of the locally spoken language may be at risk for medical errors. This study analyzes logs of rescue missions to determine whether paramedics could obtain essential information from German-speaking and foreign-language children and their caregivers. METHODS We conducted a secondary data analysis based on retrospective data on pediatric patients of four emergency medical services (EMS) stations in Northern Germany. We defined language discordance with communication difficulties as main exposure. We used documentation quality as outcome defined as existing information on (a) pre-existing conditions, (b) current medication, and (c) events prior to the medical emergency. Statistical analyses include descriptive statistics, simple regression and multivariable regression. As multivariable regression model, a logistic regression was applied with documentation quality as dependent variable and language discordance with communication difficulties as independent variable adjusted for age, sex and Glasgow Coma Scale (GCS). RESULTS Data from 1,430 pediatric rescue missions were analyzed with 3.1% (n = 45) having a language discordance with communication difficulties. Patients in the pediatric foreign-language group were younger compared to German-speaking patients. Thorough documentation was more frequent in German-speaking patients than in patients in the foreign-language group. Pre-existing conditions and events prior to the medical emergency were considerably more often documented in German-speaking than for foreign-language patients. Documentation of medication did not differ between these groups. The adjustment of sex, age and GCS in the multivariable analysis did not change the results. CONCLUSION Language barriers are hindering paramedics to obtain relevant information in pediatric pre-hospital emergencies. This jeopardizes the safe provision of paramedic care to children who themselves or their caregivers are not fluent in German language. Further research should focus on feasible ways to overcome language barriers in pre-hospital emergencies. TRIAL REGISTRATION This is a retrospective secondary data analysis of a study that was registered at the German Clinical Trials Register (No. DRKS00016719), 08/02/2019.
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Affiliation(s)
- Frank Müller
- Department of General Practice, University Medical Center Göttingen, Humboldtallee 38, 37073, Göttingen, DE, Germany.
| | - Dominik Schröder
- Department of General Practice, University Medical Center Göttingen, Humboldtallee 38, 37073, Göttingen, DE, Germany
| | - Jennifer Schäning
- Department of General Practice, University Medical Center Göttingen, Humboldtallee 38, 37073, Göttingen, DE, Germany
| | - Sybille Schmid
- Fire Department, City of Braunschweig, Brunswick, DE, Germany
| | - Eva Maria Noack
- Department of General Practice, University Medical Center Göttingen, Humboldtallee 38, 37073, Göttingen, DE, Germany
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Haxhija Z, Seder DB, May TL, Hassager C, Friberg H, Lilja G, Ceric A, Nielsen N, Dankiewicz J. External validation of the CREST model to predict early circulatory-etiology death after out-of-hospital cardiac arrest without initial ST-segment elevation myocardial infarction. BMC Cardiovasc Disord 2023; 23:311. [PMID: 37340361 DOI: 10.1186/s12872-023-03334-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 06/06/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND The CREST model is a prediction model, quantitating the risk of circulatory-etiology death (CED) after cardiac arrest based on variables available at hospital admission, and intend to guide the triage of comatose patients without ST-segment-elevation myocardial infarction after successful cardiopulmonary resuscitation. This study assessed performance of the CREST model in the Target Temperature Management (TTM) trial cohort. METHODS We retrospectively analyzed data from resuscitated out-of-hospital cardiac arrest (OHCA) patients in the TTM-trial. Demographics, clinical characteristics, and CREST variables (history of coronary artery disease, initial heart rhythm, initial ejection fraction, shock at admission and ischemic time > 25 min) were assessed in univariate and multivariable analysis. The primary outcome was CED. The discriminatory power of the logistic regression model was assessed using the C-statistic and goodness of fit was tested according to Hosmer-Lemeshow. RESULTS Among 329 patients eligible for final analysis, 71 (22%) had CED. History of ischemic heart disease, previous arrhythmia, older age, initial non-shockable rhythm, shock at admission, ischemic time > 25 min and severe left ventricular dysfunction were variables associated with CED in univariate analysis. CREST variables were entered into a logistic regression model and the area under the curve for the model was 0.73 with adequate calibration according to Hosmer-Lemeshow test (p = 0.602). CONCLUSIONS The CREST model had good validity and a discrimination capability for predicting circulatory-etiology death after resuscitation from cardiac arrest without ST-segment elevation myocardial infarction. Application of this model could help to triage high-risk patients for transfer to specialized cardiac centers.
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Affiliation(s)
- Zana Haxhija
- Department of Clinical Sciences, Anesthesia and Intensive Care, Lund University, Skane University Hospital, Malmo, Sweden.
- Division of Anesthesia and Intensive Care, Department of Clinical sciences Lund, Lund University, Skane University Hospital, Carl Bertil Laurells gata 9, Malmo, 205 02, Sweden.
| | - David B Seder
- Department of Critical Care Services, Maine Medical Center, Portland Maine, USA
| | - Teresa L May
- Department of Critical Care Services, Maine Medical Center, Portland Maine, USA
| | - Christian Hassager
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Hans Friberg
- Department of Clinical Sciences, Anesthesia and Intensive Care, Lund University, Skane University Hospital, Malmo, Sweden
| | - Gisela Lilja
- Department of Clinical sciences, Neurology, Lund University, Skane University Hospital, Lund, Sweden
| | - Ameldina Ceric
- Department of Clinical Sciences, Anesthesia and Intensive Care, Lund University, Skane University Hospital, Malmo, Sweden
| | - Niklas Nielsen
- Department of Clinical Sciences, Anesthesia and Intensive Care, Lund University, Helsingborg Hospital, Helsingborg, Sweden
| | - Josef Dankiewicz
- Department of Clinical Sciences, Cardiology, Lund University, Skane University Hospital, Lund, Sweden
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50
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Choi S, Hong KJ, Lee SGW, Kim TH, Shin SD, Song KJ, Ro YS, Jeong J, Park JH, Lee GM. Association between Case Volumes of Extracorporeal Life Support and Clinical Outcome in Out-of-Hospital Cardiac Arrest. PREHOSP EMERG CARE 2023; 28:139-146. [PMID: 37216581 DOI: 10.1080/10903127.2023.2216786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 04/17/2023] [Accepted: 05/05/2023] [Indexed: 05/24/2023]
Abstract
AIM Extracorporeal life support (ECLS) for out-of-hospital cardiac arrest (OHCA) is increasing. There is little evidence identifying the association between hospital ECLS case volumes and outcomes in different populations receiving ECLS or conventional cardiopulmonary resuscitation (CPR). The goal of this investigation was to identify the association between ECLS case volumes and clinical outcomes of OHCA patients. METHODS This cross-sectional observational study used the National OHCA Registry for adult OHCA cases in Seoul, Korea between January 2015 and December 2019. If the ECLS volume during the study period was >20, the institution was defined as a high-volume ECLS center. Others were defined as low-volume ECLS centers. Outcomes were good neurologic recovery (cerebral performance category 1 or 2) and survival to discharge. We performed multivariate logistic regression and interaction analyses to assess the association between case volume and clinical outcome. RESULTS Of the 17,248 OHCA cases, 3,731 were transported to high-volume centers. Among the patients who underwent ECLS, those at high-volume centers had a higher neurologic recovery rate than those at low-volume centers (17.0% vs. 12.0%), and the adjusted OR for good neurologic recovery was 2.22 (95% confidence interval (CI): 1.15-4.28) in high-volume centers compared to low-volume centers. For patients who received conventional CPR, high-volume centers also showed higher survival-to-discharge rates (adjusted OR of 1.16, 95%CI: 1.01-1.34). CONCLUSIONS High-volume ECLS centers showed better neurological recovery in patients who underwent ECLS. High-volume centers also had better survival-to-discharge rates than low-volume centers for patients not receiving ECLS.
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Affiliation(s)
- Seulki Choi
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, South Korea
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, South Korea
| | - Ki Jeong Hong
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, South Korea
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, South Korea
- Department of Emergency Medicine, Seoul National University, Seoul, South Korea
| | - Stephen Gyung Won Lee
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, South Korea
- Department of Emergency Medicine, Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Tae Han Kim
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, South Korea
- Department of Emergency Medicine, Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Sang Do Shin
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, South Korea
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, South Korea
- Department of Emergency Medicine, Seoul National University, Seoul, South Korea
| | - Kyoung Jun Song
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, South Korea
- Department of Emergency Medicine, Seoul National University, Seoul, South Korea
- Department of Emergency Medicine, Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Young Sun Ro
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, South Korea
- Department of Emergency Medicine, Seoul National University, Seoul, South Korea
| | - Joo Jeong
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, South Korea
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seoul, South Korea
| | - Jeong Ho Park
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, South Korea
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, South Korea
- Department of Emergency Medicine, Seoul National University, Seoul, South Korea
| | - Gyeong Min Lee
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, South Korea
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