Risk of fires when using defibrillators in an oxygen enriched atmosphere

Analysis of Emergency Medical Response Team Performance during the International Winter Championships in Emergency Medicine

Background and Objectives: Conducting advanced life support (ALS) according to the guidelines of the European Resuscitation Council (ERC) requires medical personnel to implement the appropriate emergency actions. In particular, these actions include chest compressions, airway management, artificial ventilation, defibrillation and the administering of medicines. An appropriate training system enables members of medical response teams (MRT) to acquire the essential knowledge and skills necessary to correctly conduct cardiopulmonary resuscitation (CPR). One way to improve the quality of interventions by MRT personnel is participation in emergency medicine championships. Materials and Methods: The research analysed assessment cards for tasks carried out during the International Winter Championships in Emergency Medicine in the years 2013–2020. The assessed tasks were prepared and led by European Resuscitation Council instructors of advanced life support. During ten-minute scenarios of simulated sudden cardiac arrest (SCA) in adults, the judges assessed the compliance of procedures with current ERC guidelines. This research analysed the performance of 309 teams from Poland made up of paramedics from medical response units from all over the country. Results: In most cases, the study showed significant differences in the percentage of correctly performed procedures between years. Most often, the highest percentage of correctly performed procedures was recorded in 2019 and 2020. The lowest percentage of correctly performed procedures was most often recorded in 2013. In subsequent years, the percentage of use of tracheal intubation decreased (from 54.76% to 31.25%) in favour of an increase in the use of supraglottic airway device SAD (from 35.71% to 59.38%). Conclusions: The research has shown that in subsequent years of the Championships, the quality of the majority of assessed procedures carried out by members of MRT gradually improved. The research authors also observed that in subsequent years, the percentage of intubations decreased in favour of SAD.

[Adult advanced life support]

These European Resuscitation Council Advanced Life Support guidelines are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. This section provides guidelines on the prevention of and ALS treatments for both in-hospital cardiac arrest and out-of-hospital cardiac arrest.

European Resuscitation Council Guidelines 2021: Adult advanced life support

These European Resuscitation Council Advanced Life Support guidelines, are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. This section provides guidelines on the prevention of and ALS treatments for both in-hospital cardiac arrest and out-of-hospital cardiac arrest.

Ambient oxygen concentrations resulting from use of the Lund University Cardiopulmonary Assist System (LUCAS) device during simulated cardiopulmonary resuscitation

INTRODUCTION

Supplementary oxygen is used routinely during cardiopulmonary resuscitation (CPR). High ambient oxygen levels from ventilation circuits have caused fatal fires and explosions. The Lund University Cardiopulmonary Assist System (LUCAS) device is driven by > 70 l min(-1) oxygen which is also likely to increase ambient oxygen concentrations and cause similar risk of fire and explosion. This study used simulated CPR with a LUCAS device to measure resulting ambient oxygen concentrations and assess safety of the device.

MATERIAL AND METHODS

Simulated manikin CPR using a LUCAS device was performed outdoors, inside an ambulance (ventilation off and ventilation on full power), and in a resuscitation bay. Ambient oxygen concentrations were measured over the apical and sternal defibrillation sites and midway between the two, at the head and 1m horizontally above the head. Recordings were made for 5 min when the LUCAS device was turned on and for a further 5 min when turned off.

RESULTS

Ambient oxygen concentration increased quickly in all four scenarios. Peak oxygen levels over the chest were highest in the resuscitation bay (36.7%) and lowest in the ambulance with ventilation on full power (33.8%). Oxygen levels decreased to baseline within 5 min of turning off the LUCAS device.

CONCLUSION

The use of oxygen to drive the LUCAS device results in a rapid increase in ambient oxygen concentration to levels likely to risk injury or death from fire. Ambulance services and hospitals using the device must be alerted to these dangers immediately.