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Keselica M, Peřan D, Renza M, Duška F, Omáčka D, Schnaubelt S, Lulic I, Sýkora R. Efficiency of two-member crews in delivering prehospital advanced life support cardiopulmonary resuscitation: A scoping review. Resusc Plus 2024; 18:100661. [PMID: 38784406 PMCID: PMC11111834 DOI: 10.1016/j.resplu.2024.100661] [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: 03/04/2024] [Revised: 04/29/2024] [Accepted: 05/06/2024] [Indexed: 05/25/2024] Open
Abstract
Background Advanced Life Support (ALS) during cardiopulmonary resuscitation (CPR) for out-of-hospital cardiac arrest (OHCA) is frequently administered by two-member crews. However, ALS CPR is mostly designed for larger crews, and the feasibility and efficacy of implementing ALS guidelines for only two rescuers remain unclear. Objective This scoping review aims to examine the existing evidence and identify knowledge gaps in the efficiency of pre-hospital ALS CPR performed by two-member teams. Design A comprehensive search was undertaken across the following databases: PubMed, Web of Science, SCOPUS, Cochrane Library Trials, and ClinicalTrials.gov. The search covered publications in English or German from January 1, 2005, to November 30, 2023. The review included studies that focused on ALS CPR procedures carried out by two-member teams in adult patients in either simulated or clinical settings. Results A total of 22 articles were included in the qualitative synthesis. Seven topics in two-person prehospital ALS/CPR delivery were identified: 1) effect of team configuration on clinical outcome and CPR quality, 2) early airway management and ventilation techniques, 3) mechanical chest compressions, 4) prefilled syringes, 5) additional equipment, 6) adaptation of recommended ALS/CPR protocols, and 7) human factors. Conclusion There is a lack of comprehensive data regarding the adaptation of the recommended ALS algorithm in CPR for two-member crews. Although simulation studies indicate potential benefits arising from the employment of mechanical chest compression devices, prefilled syringes, and automation-assisted protocols, the current evidence is too limited to support specific modifications to existing guidelines.
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Affiliation(s)
- Miroslav Keselica
- Department of Anesthesia and Intensive Care, Third Faculty of Medicine, Charles University and FNKV University Hospital, Šrobárova 1150/50, Prague 100 34, Czech Republic
| | - David Peřan
- Department of Anesthesia and Intensive Care, Third Faculty of Medicine, Charles University and FNKV University Hospital, Šrobárova 1150/50, Prague 100 34, Czech Republic
- Emergency Medical Services of the Karlovy Vary Region, Závodní 390/98C, 360 06 Karlovy Vary, Czech Republic
| | - Metoděj Renza
- Department of Anesthesia and Intensive Care, Third Faculty of Medicine, Charles University and FNKV University Hospital, Šrobárova 1150/50, Prague 100 34, Czech Republic
| | - František Duška
- Department of Anesthesia and Intensive Care, Third Faculty of Medicine, Charles University and FNKV University Hospital, Šrobárova 1150/50, Prague 100 34, Czech Republic
| | - David Omáčka
- Department of Anesthesia and Intensive Care, Third Faculty of Medicine, Charles University and FNKV University Hospital, Šrobárova 1150/50, Prague 100 34, Czech Republic
| | - Sebastian Schnaubelt
- Department of Emergency Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
- PULS - Austrian Cardiac Arrest Awareness Association, Vienna, Austria
| | - Ileana Lulic
- Department of Anesthesiology, Intensive Care and Pain Medicine, Clinical Hospital Merkur, Zajceva 19, 10000 Zagreb, Croatia
| | - Roman Sýkora
- Department of Anesthesia and Intensive Care, Third Faculty of Medicine, Charles University and FNKV University Hospital, Šrobárova 1150/50, Prague 100 34, Czech Republic
- Emergency Medical Services of the Karlovy Vary Region, Závodní 390/98C, 360 06 Karlovy Vary, Czech Republic
- Air Rescue Service and Emergency Medicine Department Pilsen-Line, Military Medical Agency, U Letiště, 330 21 Líně, Czech Republic
- Medical College, Duškova 7, 150 00 Prague, Czech Republic
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Missel AL, Dowker SR, Dzierwa D, Krein SL, Coulter‐Thompson EI, Williams M, Trumpower B, Swor R, Hunt N, Friedman CP. Factors Impacting Treatment of Out-of-Hospital Cardiac Arrest: A Qualitative Study of Emergency Responders. J Am Heart Assoc 2023; 12:e027756. [PMID: 37158071 PMCID: PMC10227317 DOI: 10.1161/jaha.122.027756] [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: 08/11/2022] [Accepted: 03/03/2023] [Indexed: 05/10/2023]
Abstract
Background Of the more than 250 000 emergency medical services-treated out-of-hospital cardiac arrests that occur each year in the United States, only about 8% survive to hospital discharge with good neurologic function. Treatment for out-of-hospital cardiac arrest involves a system of care that includes complex interactions among multiple stakeholders. Understanding the factors inhibiting optimal care is fundamental to improving outcomes. Methods and Results We conducted group interviews with emergency responders including 911 telecommunicators, law enforcement officers, firefighters, and transporting emergency medical services personnel (ie, emergency medical technicians and paramedics) who responded to the same out-of-hospital cardiac arrest incident. We used the American Heart Association System of Care as the framework for our analysis to identify themes and their contributory factors from these interviews. We identified 5 themes under the structure domain, which included workload, equipment, prehospital communication structure, education and competency, and patient attitudes. In the process domain, 5 themes were identified focusing on preparedness, field response and access to patient, on-scene logistics, background information acquisition, and clinical interventions. We identified 3 system themes including emergency responder culture; community support, education, and engagement; and stakeholder relationships. Three continuous quality improvement themes were identified, which included feedback provision, change management, and documentation. Conclusions We identified structure, process, system, and continuous quality improvement themes that may be leveraged to improve outcomes for out-of-hospital cardiac arrest. Interventions or programs amenable to rapid implementation include improving prearrival communication between agencies, appointing patient care and logistical leadership on-scene, interstakeholder team training, and providing more standardized feedback to all responder groups.
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Affiliation(s)
- Amanda L. Missel
- Department of Learning Health SciencesUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Stephen R. Dowker
- Department of Learning Health SciencesUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
- Department of Internal Medicine, Division of Cardiovascular MedicineUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
- Department of Emergency MedicineUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Drake Dzierwa
- Department of Internal Medicine, Division of Cardiovascular MedicineUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Sarah L. Krein
- Institute for Healthcare Policy and Innovation, University of MichiganAnn ArborMichiganUSA
- Center For Clinical Management ResearchVeterans Affairs Ann Arbor Health SystemAnn ArborMichiganUSA
- Department of Internal Medicine, Division of General MedicineUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Emilee I. Coulter‐Thompson
- Department of Learning Health SciencesUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
- Institute for Healthcare Policy and Innovation, University of MichiganAnn ArborMichiganUSA
| | - Michelle Williams
- Department of Learning Health SciencesUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Brad Trumpower
- Department of Internal Medicine, Division of Cardiovascular MedicineUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Robert Swor
- Department of Emergency MedicineCorewell East William Beaumont University HospitalRoyal OakMichiganUSA
| | - Nathaniel Hunt
- Department of Emergency MedicineUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
- Max Harry Weil Institute for Critical Care Research and Innovation, University of MichiganAnn ArborMichiganUSA
| | - Charles P. Friedman
- Department of Learning Health SciencesUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
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Valdez RS, Holden RJ, Rivera AJ, Ho CH, Madray CR, Bae J, Wetterneck TB, Beasley JW, Carayon P. Remembering Ben-Tzion Karsh's scholarship, impact, and legacy. APPLIED ERGONOMICS 2021; 92:103308. [PMID: 33253977 DOI: 10.1016/j.apergo.2020.103308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 11/10/2020] [Accepted: 11/11/2020] [Indexed: 06/12/2023]
Abstract
Dr. Ben-Tzion (Bentzi) Karsh was a mentor, collaborator, colleague, and friend who profoundly impacted the fields of human factors and ergonomics (HFE), medical informatics, patient safety, and primary care, among others. In this paper we honor his contributions by reflecting on his scholarship, impact, and legacy in three ways: first, through an updated simplified bibliometric analysis in 2020, highlighting the breadth of his scholarly impact from the perspective of the number and types of communities and collaborators with which and whom he engaged; second, through targeted reflections on the history and impact of Dr. Karsh's most cited works, commenting on the particular ways they impacted our academic community; and lastly, through quotes from collaborators and mentees, illustrating Dr. Karsh's long-lasting impact on his contemporaries and students.
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Affiliation(s)
- Rupa S Valdez
- Department of Public Health Sciences, University of Virginia, VA, USA; Department of Engineering Systems and Environment, University of Virginia, VA, USA.
| | - Richard J Holden
- Department of Medicine, Indiana University, IN, USA; Indiana University Center for Aging Research, Regenstrief Institute Inc, IN, USA; Center for Health Innovation and Implementation Science, Indiana Clinical and Translational Sciences Institute, IN, USA
| | - A Joy Rivera
- Department of Patient Safety, Froedtert Hospital, WI, USA.
| | - Chi H Ho
- Department of Public Health Sciences, University of Virginia, VA, USA.
| | - Cristalle R Madray
- Department of Community Development and Planning, University of Maryland Medical System, MD, USA.
| | - Jiwoon Bae
- Department of Public Health Sciences, University of Virginia, VA, USA.
| | - Tosha B Wetterneck
- Department of Family Medicine and Community Health, University of Wisconsin, WI, USA; Department of Industrial and Systems Engineering, University of Wisconsin, WI, USA.
| | - John W Beasley
- Department of Family Medicine and Community Health, University of Wisconsin, WI, USA; Department of Industrial and Systems Engineering, University of Wisconsin, WI, USA.
| | - Pascale Carayon
- Department of Industrial and Systems Engineering, University of Wisconsin, WI, USA; Center for Quality and Productivity Improvement, Wisconsin Institute for Healthcare Systems Engineering, WI, USA.
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The Implementation of Digital Ergonomics Modeling to Design a Human-Friendly Working Process in a Postal Branch. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10249124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
In today’s business world, there are two very important health issues that the employees in the service sector are faced with: Spinal disease, especially in the lower back, and carpal tunnel syndrome. These are well-known musculoskeletal disorders. To preserve the health of its employees and prevent professional illnesses, and to thus maximize their efficiency, companies must use knowledge from the field of ergonomics. This study aims to examine the work-related health problems that the workers in transportation companies are faced with. As a case study, a postal company from Serbia is considered, with particular attention paid to the counter clerks. The research was carried out in one branch of the postal operator. All six postal clerks working at the considered branch were subjects of the study. The workers were observed visually by the researchers and recorded while performing their job tasks. Based on the analysis of their movements and body positions, the evaluation of their level of risk exposure was determined using the Ergo Fellow software, specifically with five packages within this program (Rapid Upper Limb Assessment, Rapid Entire Body Assessment, Ovako working posture analysis system, Moore and Garg, and Suzanne Rodgers). As a result of the implemented tools, the analysts are in a position to conclude what should be changed in the work organization.
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Cardiac arrest: An interdisciplinary scoping review of the literature from 2019. Resusc Plus 2020; 4:100037. [PMID: 34223314 PMCID: PMC8244427 DOI: 10.1016/j.resplu.2020.100037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 09/29/2020] [Accepted: 10/04/2020] [Indexed: 01/09/2023] Open
Abstract
Objectives The Interdisciplinary Cardiac Arrest Research Review (ICARE) group was formed in 2018 to conduct a systematic annual search of peer-reviewed literature relevant to cardiac arrest. Now in its second year, the goals of the review are to illustrate best practices in research and help reduce compartmentalization of knowledge by disseminating clinically relevant advances in the field of cardiac arrest across disciplines. Methods An electronic search of PubMed using keywords related to cardiac arrest was conducted. Title and abstracts retrieved by these searches were screened for relevance, classified by article type (original research or review), and sorted into 7 categories. Screened manuscripts underwent standardized scoring of overall methodological quality and impact on the categorized fields of study by reviewer teams lead by a subject-matter expert editor. Articles scoring higher than 99 percentiles by category-type were selected for full critique. Systematic differences between editors’ and reviewers’ scores were assessed using Wilcoxon signed-rank test. Results A total of 3348 articles were identified on initial search; of these, 1364 were scored after screening for relevance and deduplication, and forty-five underwent full critique. Epidemiology & Public Health represented 24% of fully reviewed articles with Prehospital Resuscitation, Technology & Care, and In-Hospital Resuscitation & Post-Arrest Care Categories both representing 20% of fully reviewed articles. There were no significant differences between editor and reviewer scoring. Conclusions The sheer number of articles screened is a testament to the need for an accessible source calling attention to high-quality and impactful research and serving as a high-yield reference for clinicians and scientists seeking to follow the ever-growing body of cardiac arrest-related literature. This will promote further development of the unique and interdisciplinary field of cardiac arrest medicine.
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