1
|
Nawathe P, Garland J, Cuzzolina J, Salinas N, Dodd B, Grein J. Simulation as Proof of Concept to Assess the Feasibility and Address Uncertainties Regarding Cardiopulmonary Resuscitation in an Adolescent Patient With Viral Hemorrhagic Fever. Simul Healthc 2024:01266021-990000000-00140. [PMID: 39133109 DOI: 10.1097/sih.0000000000000820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/13/2024]
Abstract
INTRODUCTION While general management guidelines exist for patients with viral hemorrhagic fevers (VHF), uncertainty surrounds the extent to which critical care interventions should be provided. There has been significant concern in providing cardiopulmonary resuscitation (CPR) to a patient with VHF due to concerns regarding CPR efficiency and the safety of the healthcare team. However, data on CPR feasibility, efficiency, and latent safety threats (LSTs) to the healthcare team in patients with VHF needing CPR are lacking. Our team proactively studied this in the simulation environment as the first step to guiding evidence-based and ethically informed decisions about CPR for these patients. METHODS We studied CPR metrics, times to critical interventions, and LSTs using systems-focused debriefing in an adolescent patient with VHF who had pulseless electrical activity. This exercise included 3 members inside the patient room in full PPE and special pathogens team members in modified PPE outside the room. RESULTS We found that CPR is feasible in full PPE. The chest compression fraction was 72%, with an average manual rate of 129 compressions per minute and an average manual depth of 2.1 inches. We identified multiple LSTs in the debriefing and video analysis. CONCLUSIONS This simulation study showed that CPR in a patient with VHF is possible in full PPE with a minimum of 3 team members. However, we identified physical and psychological LSTs with the systems-focused debriefing. Therefore, refining roles and responsibilities would be necessary to improve the safety of the healthcare team and improve the quality of CPR.
Collapse
Affiliation(s)
- Pooja Nawathe
- From the Guerin Children's, Department of Pediatrics (P.W.); Special Pathogens Program (J.G., J.C.); Department of Emergency Medicine (N.S.); Women's Guild Simulation Center for Advanced Clinical Skills and Innovation (B.D.); and Hospital Epidemiology (J.G.), Cedars-Sinai Medical Center, Los Angeles, CA
| | | | | | | | | | | |
Collapse
|
2
|
Barros AJ, Enfield KB. In-Hospital Cardiac Arrest. Emerg Med Clin North Am 2023; 41:455-464. [PMID: 37391244 PMCID: PMC10549775 DOI: 10.1016/j.emc.2023.03.003] [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] [Indexed: 07/02/2023]
Abstract
This article reviews the epidemiology and management of in-hospital cardiac arrest.
Collapse
Affiliation(s)
- Andrew Julio Barros
- Department of Medicine, Division of Pulmonary and Critical Care, University of Virginia School of Medicine, PO Box 800546, Charlottesville, VA 22908, USA.
| | - Kyle B Enfield
- Department of Medicine, Division of Pulmonary and Critical Care, University of Virginia School of Medicine, PO Box 800546, Charlottesville, VA 22908, USA. https://twitter.com/KBEnfieldMD
| |
Collapse
|
3
|
Abstract
Cardiopulmonary resuscitation (CPR) is an emergency lifesaving endeavor, performed in either the hospital or outpatient settings, that significantly improves outcomes and survival rates when performed in a timely fashion. As with any other medical procedure, CPR can bear potential risks not only for the patient but also for the rescuer. Among those risks, transmission of an infectious agent has been one of the most compelling triggers of reluctance to perform CPR among providers. The concern for transmission of an infection from the resuscitated subject may impede prompt initiation and implementation of CPR, compromising survival rates and neurological outcomes of the patients. Infections during CPR can be potentially acquired through airborne, droplet, contact, or hematogenous transmission. However, only a few cases of infection transmission have been actually reported globally. In this review, we present the available epidemiological findings on transmission of different pathogens during CPR and data on reluctance of health care workers to perform CPR. We also outline the levels of personal protective equipment and other protective measures according to potential infectious hazards that providers are potentially exposed to during CPR and summarize current guidelines on protection of CPR providers from international societies and stakeholders.
Collapse
|
4
|
Vindigni SM, Lessing JN, Carlbom DJ. Hospital resuscitation teams: a review of the risks to the healthcare worker. J Intensive Care 2017; 5:59. [PMID: 29046809 PMCID: PMC5637256 DOI: 10.1186/s40560-017-0253-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 10/03/2017] [Indexed: 11/11/2022] Open
Abstract
Background “Code blue” events and related resuscitation efforts involve multidisciplinary bedside teams that implement specialized interventions aimed at patient revival. Activities include performing effective chest compressions, assessing and restoring a perfusing cardiac rhythm, stabilizing the airway, and treating the underlying cause of the arrest. While the existing critical care literature has appropriately focused on the patient, there has been a dearth of information discussing the various stresses to the healthcare team. This review summarizes the available literature regarding occupational risks to medical emergency teams, characterizes these risks, offers preventive strategies to healthcare workers, and highlights further research needs. Methods We performed a literature search of PubMed for English articles of all types (randomized controlled trials, case-control and cohort studies, case reports and series, editorials and commentaries) through September 22, 2016, discussing potential occupational hazards during resuscitation scenarios. Of the 6266 articles reviewed, 73 relevant articles were included. Results The literature search identified six potential occupational risk categories to members of the resuscitation team—infectious, electrical, musculoskeletal, chemical, irradiative, and psychological. Retrieved articles were reviewed in detail by the authors. Conclusion Overall, we found there is limited evidence detailing the risks to healthcare workers performing resuscitation. We identify these risks and offer potential solutions. There are clearly numerous opportunities for further study in this field.
Collapse
Affiliation(s)
- Stephen M Vindigni
- Division of Gastroenterology, Department of Medicine, University of Washington, 1959 NE Pacific Street, Box 356424, Seattle, WA 98195-6424 USA
| | - Juan N Lessing
- Division of General Internal Medicine, Department of Medicine, University of Colorado, 13001 E 17th Place, Aurora, CO 80045 USA
| | - David J Carlbom
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195-6424 USA
| |
Collapse
|
5
|
Bossaert L, Perkins G, Askitopoulou H, Raffay V, Greif R, Haywood K, Mentzelopoulos S, Nolan J, Van de Voorde P, Xanthos T. Ethik der Reanimation und Entscheidungen am Lebensende. Notf Rett Med 2017. [DOI: 10.1007/s10049-017-0329-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
6
|
Monsieurs K, Nolan J, Bossaert L, Greif R, Maconochie I, Nikolaou N, Perkins G, Soar J, Truhlář A, Wyllie J, Zideman D. Kurzdarstellung. Notf Rett Med 2015. [DOI: 10.1007/s10049-015-0097-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
|
7
|
Ethik der Reanimation und Entscheidungen am Lebensende. Notf Rett Med 2015. [DOI: 10.1007/s10049-015-0083-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
8
|
Monsieurs KG, Nolan JP, Bossaert LL, Greif R, Maconochie IK, Nikolaou NI, Perkins GD, Soar J, Truhlář A, Wyllie J, Zideman DA, Alfonzo A, Arntz HR, Askitopoulou H, Bellou A, Beygui F, Biarent D, Bingham R, Bierens JJ, Böttiger BW, Bossaert LL, Brattebø G, Brugger H, Bruinenberg J, Cariou A, Carli P, Cassan P, Castrén M, Chalkias AF, Conaghan P, Deakin CD, De Buck ED, Dunning J, De Vries W, Evans TR, Eich C, Gräsner JT, Greif R, Hafner CM, Handley AJ, Haywood KL, Hunyadi-Antičević S, Koster RW, Lippert A, Lockey DJ, Lockey AS, López-Herce J, Lott C, Maconochie IK, Mentzelopoulos SD, Meyran D, Monsieurs KG, Nikolaou NI, Nolan JP, Olasveengen T, Paal P, Pellis T, Perkins GD, Rajka T, Raffay VI, Ristagno G, Rodríguez-Núñez A, Roehr CC, Rüdiger M, Sandroni C, Schunder-Tatzber S, Singletary EM, Skrifvars MB, Smith GB, Smyth MA, Soar J, Thies KC, Trevisanuto D, Truhlář A, Vandekerckhove PG, de Voorde PV, Sunde K, Urlesberger B, Wenzel V, Wyllie J, Xanthos TT, Zideman DA. European Resuscitation Council Guidelines for Resuscitation 2015: Section 1. Executive summary. Resuscitation 2015; 95:1-80. [PMID: 26477410 DOI: 10.1016/j.resuscitation.2015.07.038] [Citation(s) in RCA: 568] [Impact Index Per Article: 63.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Koenraad G Monsieurs
- Emergency Medicine, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium.
| | - Jerry P Nolan
- Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, UK; School of Clinical Sciences, University of Bristol, Bristol, UK
| | | | - Robert Greif
- Department of Anaesthesiology and Pain Medicine, University Hospital Bern, Bern, Switzerland; University of Bern, Bern, Switzerland
| | - Ian K Maconochie
- Paediatric Emergency Medicine Department, Imperial College Healthcare NHS Trust and BRC Imperial NIHR, Imperial College, London, UK
| | | | - Gavin D Perkins
- Warwick Medical School, University of Warwick, Coventry, UK; Heart of England NHS Foundation Trust, Birmingham, UK
| | - Jasmeet Soar
- Anaesthesia and Intensive Care Medicine, Southmead Hospital, Bristol, UK
| | - Anatolij Truhlář
- Emergency Medical Services of the Hradec Králové Region, Hradec Králové, Czech Republic; Department of Anaesthesiology and Intensive Care Medicine, University Hospital Hradec Králové, Hradec Králové, Czech Republic
| | - Jonathan Wyllie
- Department of Neonatology, The James Cook University Hospital, Middlesbrough, UK
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Bossaert LL, Perkins GD, Askitopoulou H, Raffay VI, Greif R, Haywood KL, Mentzelopoulos SD, Nolan JP, Van de Voorde P, Xanthos TT, Georgiou M, Lippert FK, Steen PA. European Resuscitation Council Guidelines for Resuscitation 2015. Resuscitation 2015; 95:302-11. [DOI: 10.1016/j.resuscitation.2015.07.033] [Citation(s) in RCA: 256] [Impact Index Per Article: 28.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|