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Ahn JY, Ryoo HW, Jung H, Ro YS, Park JH. Impact of emergency medical service with advanced life support training for adults with out-of-hospital cardiac arrest in the Republic of Korea: A retrospective multicenter study. PLoS One 2023; 18:e0286047. [PMID: 37289771 PMCID: PMC10249873 DOI: 10.1371/journal.pone.0286047] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 05/07/2023] [Indexed: 06/10/2023] Open
Abstract
Prehospital advanced life support (ALS) has been offered in many countries for patients experiencing out-of-hospital cardiac arrest (OHCA); however, its effectiveness remains unclear. This study aimed to determine the impact of emergency medical service (EMS) with ALS training as a nationwide pilot project for adults with OHCA in the Republic of Korea. This retrospective multicenter observational study was conducted between July 2019 and December 2020 using the Korean Cardiac Arrest Research Consortium registry. The patients were categorized into an intervention group that received EMS with ALS training and a control group that did not receive EMS with ALS training. Conditional logistic regression analysis was performed using matched data to compare clinical outcomes between the two groups. Compared with the control group, the intervention group had a lower rate of supraglottic airway usage (60.5% vs. 75.6%) and a higher rate of undergoing endotracheal intubation (21.7% vs. 6.1%, P < 0.001). In addition, the intervention group was administered more intravenous epinephrine (59.8% vs. 14.2%, P < 0.001) and used mechanical chest compression devices more frequently in prehospital settings than the control group (59.0% vs. 23.8%, P < 0.001). Based on the results of multivariable conditional logistic regression analysis, survival to hospital discharge (odds ratio: 0.48, 95% confidence interval: 0.27-0.87) of the intervention group was significantly lower than that of the control group; however, good neurological outcome was not significantly different between the two groups. In this study, survival to hospital discharge was worse in patients with OHCA who received EMS with ALS training than in those who did not.
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Affiliation(s)
- Jae Yun Ahn
- Department of Emergency Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Hyun Wook Ryoo
- Department of Emergency Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea
| | - Haewon Jung
- Department of Emergency Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Young Sun Ro
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea
- Department of Emergency Medicine, Seoul National University College of Medicine and Hospital, Seoul, Republic of Korea
| | - Jeong Ho Park
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea
- Department of Emergency Medicine, Seoul National University College of Medicine and Hospital, Seoul, Republic of Korea
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Ayrancı MK, Küçükceran K, Dündar ZD. Comparison of Endotracheal Intubations Performed With Direct Laryngoscopy and Video Laryngoscopy Scenarios With and Without Compression: A Manikin-Simulated Study. J Acute Med 2021; 11:90-98. [PMID: 34595092 DOI: 10.6705/j.jacme.202109_11(3).0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 08/25/2020] [Accepted: 10/29/2020] [Indexed: 11/14/2022]
Abstract
Background Optimal management for trauma-induced coagulopathy (TIC) is a clinical conundrum. In conjunction with the transfusion of fresh-frozen plasma (FFP), additional administration of prothrombin complex concentrate (PCC) was proposed to bring about further coagulative benefit. However, investigations evaluating the efficacy as well as corresponding side effects were scarce and inconsistent. The aim of this study was to systematically review current literature and to perform a meta-analysis comparing FFP+PCC with FFP alone. Methods Web search followed by manual interrogation was performed to identify relevant literatures fulfilling the following criteria, subjects as TIC patients taking no baseline anticoagulants, without underlying coagulative disorders, and reported clinical consequences. Those comparing FFP alone with PCC alone were excluded. Comprehensive Meta-analysis software was utilized, and statistical results were delineated with odd ratio (OR), mean difference (MD), and 95% confidence interval (CI). I2 was calculated to determine heterogeneity. The primary endpoint was set as all-cause mortality, while the secondary endpoint consisted of international normalized ratio (INR) correction, transfusion of blood product, and thrombosis rate. Results One hundred and sixty-four articles were included for preliminary evaluation, 3 of which were qualified for meta-analysis. A total of 840 subjects were pooled for assessment. Minimal heterogeneity was present in the comparisons (I2 < 25%). In the PCC + FFP cohort, reduced mortality rate was observed (OR: 0.631; 95% CI: 0.450-0.884, p = 0.007) after pooling. Meanwhile, INR correction time was shorter under PCC + FFP (MD: -608.300 mins, p < 0.001), whilst the rate showed no difference (p = 0.230). The PCC + FFP group is less likely to mandate transfusion of packed red blood cells (p < 0.001) and plasma (p < 0.001), but not platelet (p = 0.615). The incidence of deep vein thrombosis was comparable in the two groups (p = 0.460). Conclusions Compared with FFP only, PCC + FFP demonstrated better survival rate, favorable clinical recovery and no elevation of thromboembolism events after TIC.
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Affiliation(s)
- Mustafa Kürşat Ayrancı
- Necmettin Erbakan University Meram Faculty of Medicine Emergency Medicine Department Konya Turkey
| | - Kadir Küçükceran
- Necmettin Erbakan University Meram Faculty of Medicine Emergency Medicine Department Konya Turkey
| | - Zerrin Defne Dündar
- Necmettin Erbakan University Meram Faculty of Medicine Emergency Medicine Department Konya Turkey
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Fewer tracheal intubation attempts are associated with improved neurologically intact survival following out-of-hospital cardiac arrest. Resuscitation 2021; 167:289-296. [PMID: 34271128 DOI: 10.1016/j.resuscitation.2021.07.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 06/23/2021] [Accepted: 07/03/2021] [Indexed: 01/15/2023]
Abstract
BACKGROUND International guidelines emphasize advanced airway management during out-of-hospital cardiac arrest (OHCA). We hypothesized that increasing endotracheal intubation attempts during OHCA were associated with a lower likelihood of favorable neurologic survival at discharge. METHODS This retrospective, observational cohort evaluated the relationship between number of intubation attempts and favorable neurologic survival among non-traumatic OHCA patients receiving cardiopulmonary resuscitation (CPR) from January 1, 2015-June 30, 2019 in a large urban emergency medical services (EMS) system. Favorable neurologic status at hospital discharge was defined as a Cerebral Performance Category score of 1 or 2. Multivariable logistic regression, adjusted for age, sex, witness status, bystander CPR, initial rhythm, and time of EMS arrival, was performed using the number of attempts as a continuous variable. RESULTS Over 54 months, 1205 patients were included. Intubation attempts per case were 1 = 757(63%), 2 = 279(23%), 3 = 116(10%), ≥4 = 49(4%), and missing/unknown in 4(<1%). The mean (SD) time interval from paramedic arrival to intubation increased with the number of attempts: 1 = 4.9(2.4) min, 2 = 8.0(2.9) min, 3 = 10.9(3.3) min, and ≥4 = 15.5(4.4) min. Final advanced airway techniques employed were endotracheal intubation (97%), supraglottic devices (3%), and cricothyrotomy (<1%). Favorable neurologic outcome declined with each additional attempt: 11% with 1 attempt, 4% with 2 attempts, 3% with 3 attempts, and 2% with 4 or more attempts (AOR = 0.41, 95% CI 0.25-0.68). CONCLUSIONS Increasing number of intubation attempts during OHCA resuscitation was associated with lower likelihood of favorable neurologic outcome.
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Krzyżanowski K, Ślęzak D, Dąbrowski S, Żuratyński P, Mędrzycka-Dąbrowska W, Buca P, Jastrzębski P, Robakowska M. Comparative Analysis of the Effectiveness of Performing Advanced Resuscitation Procedures Undertaken by Two- and Three- Person Basic Medical Rescue Teams in Adults under Simulated Conditions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094834. [PMID: 33946551 PMCID: PMC8124675 DOI: 10.3390/ijerph18094834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/25/2021] [Accepted: 04/26/2021] [Indexed: 11/23/2022]
Abstract
(1) Objective: Paramedics as a profession are a pillar of the State Medical Rescue system. The basic difference between a specialist and a basic team is the composition of members. The aim of the study was to benchmark the effectiveness of performing advanced resuscitation procedures undertaken by two- and three-person basic emergency medical teams in adults under simulated conditions. (2) Design: The research was observational. 200 two- and three-people basic emergency medical teams were analyzed during advanced resuscitation procedures, ALS (Advanced Life Support) in adults under simulated conditions. (3) Method: The study was carried out among professionally active and certified paramedics. It lasted over two years. The study took place under simulated conditions using prepared scenarios. (4) Results: In total, 463 people took part in the study. The analysis of the survey results indicates that the efficiency of three-person teams is superior to the activities performed by two-person teams. Three-person teams were quicker to perform rescue actions than two-person teams. The two-person teams were much quicker to assess the condition of victims than the three-person teams. The three-person teams were more likely to check an open airway. The three-person teams were more efficient in assessing the heart rhythm and current condition of victims. It was demonstrated that three-person teams were more effective during electrotherapy. The analysis demonstrated that three-person teams were significantly faster and more efficient in chest compressions. Three-person teams were less likely to use emergency airway techniques than two-person teams. The results indicate that three-person teams administered the first dose of adrenaline significantly faster than two-person teams. For the “call for help”, the three-person teams were found to be more effective. (5) Conclusion: Paramedics in three-person teams work more effectively, make a proper assessment of heart rhythm and monitor when taking advanced actions. The quality of ventilation and BLS in both groups studied is insufficient. Numerous errors have been observed in two-person teams during pharmacotherapy.
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Affiliation(s)
- Kamil Krzyżanowski
- Department of Medical Rescue, Faculty of Health Sciences with the Institute of Maritime and Tropical Medicine, Medical University of Gdańsk, Dębinki 7, 80-211 Gdańsk, Poland; (K.K.); (S.D.); (P.Ż.)
| | - Daniel Ślęzak
- Department of Medical Rescue, Faculty of Health Sciences with the Institute of Maritime and Tropical Medicine, Medical University of Gdańsk, Dębinki 7, 80-211 Gdańsk, Poland; (K.K.); (S.D.); (P.Ż.)
- Correspondence:
| | - Sebastian Dąbrowski
- Department of Medical Rescue, Faculty of Health Sciences with the Institute of Maritime and Tropical Medicine, Medical University of Gdańsk, Dębinki 7, 80-211 Gdańsk, Poland; (K.K.); (S.D.); (P.Ż.)
| | - Przemysław Żuratyński
- Department of Medical Rescue, Faculty of Health Sciences with the Institute of Maritime and Tropical Medicine, Medical University of Gdańsk, Dębinki 7, 80-211 Gdańsk, Poland; (K.K.); (S.D.); (P.Ż.)
| | - Wioletta Mędrzycka-Dąbrowska
- Department of Anaesthesiology and Intensive Care Nursing, Faculty of Health Sciences with the Institute of Maritime and Tropical Medicine, Institute of Nursing and Midwifery, Medical University of Gdańsk, Dębinki 7, 80-211 Gdańsk, Poland;
| | - Paulina Buca
- Division of Hyperbaric Medicine & Maritime Rescue—National Centre for Hyperbaric Medicine, Faculty of Health Sciences with the Institute of Maritime and Tropical Medicine, Institute of Maritime and Tropical Medicine, Medical University of Gdańsk, Powstania Styczniowego 9b, 81-519 Gdynia, Poland;
| | - Paweł Jastrzębski
- Departament of Emergency Medicine, Faculty of Health Science, University of Warmia and Mazury, Żołnierska 18, 10-561 Olsztyn, Poland;
| | - Marlena Robakowska
- Division of Public Health and Social Medicine, Faculty of Health Sciences with the Institute of Maritime and Tropical Medicine, Medical University of Gdańsk, Tuwima 15, 80-210 Gdańsk, Poland;
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Bag-Valve-Mask versus Laryngeal Mask Airway Ventilation in Cardiopulmonary Resuscitation with Continuous Compressions: A Simulation Study. Prehosp Disaster Med 2021; 36:189-194. [PMID: 33517953 DOI: 10.1017/s1049023x21000054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
INTRODUCTION The 2017 International Liaison Committee on Resuscitation (ILCOR) guideline recommends that Emergency Medical Service (EMS) providers can perform cardiopulmonary resuscitation (CPR) with synchronous or asynchronous ventilation until an advanced airway has been placed. In the current literature, limited data on CPR performed with continuous compressions and asynchronous ventilation with bag-valve-mask (BVM) are available. STUDY OBJECTIVE In this study, researchers aimed to compare the effectiveness of asynchronous BVM and laryngeal mask airway (LMA) ventilation during CPR with continuous chest compressions. METHODS Emergency medicine residents and interns were included in the study. The participants were randomly assigned to resuscitation teams with two rescuers. The cross-over simulation study was conducted on two CPR scenarios: asynchronous ventilation via BVM during a continuous chest compression and asynchronous ventilation via LMA during a continuous chest compression in cardiac arrest patient with asystole. The primary endpoints were the ventilation-related measurements. RESULTS A total of 92 volunteers were included in the study and 46 CPRs were performed in each group. The mean rate of ventilations of the LMA group was significantly higher than that of the BVM group (13.7 [11.7-15.7] versus 8.9 [7.5-10.3] breaths/minute; P <.001). The mean volume of ventilations of the LMA group was significantly higher than that of the BVM group (358.4 [342.3-374.4] ml versus 321.5 [303.9-339.0] ml; P = .002). The mean minute ventilation volume of the LMA group was significantly higher than that of the BVM group (4.88 [4.15-5.61] versus 2.99 [2.41-3.57] L/minute; P <.001). Ventilations exceeding the maximum volume limit occurred in two (4.3%) CPRs in the BVM group and in 11 (23.9%) CPRs in the LMA group (P = .008). CONCLUSION The results of this study show that asynchronous BVM ventilation with continuous chest compressions is a reliable and effective strategy during CPR under simulation conditions. The clinical impact of these findings in actual cardiac arrest patients should be evaluated with further studies at real-life scenes.
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Hinkelbein J, Schmitz J, Mathes A, DE Robertis E. Performance of the laryngeal tube for airway management during cardiopulmonary resuscitation. Minerva Anestesiol 2020; 87:580-590. [PMID: 33300320 DOI: 10.23736/s0375-9393.20.14446-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Sudden cardiac arrest is one of the leading causes of death in Europe and the whole world. Effective chest compressions and advanced airway management have been shown to improve survival rates. Supraglottic airway devices such as the laryngeal tube (LT) are a well-known strategy for patients with cardiac arrest during both basic (BLS) and advanced life support (ALS). This systematic literature review aimed to summarize current data for using the LT when performing BLS and ALS. EVIDENCE ACQUISITION Recent data on the use of the LT during cardiopulmonary resuscitation (CPR) was gathered by using the Medline database and a specific search strategy. Terms were used in various order and combinations without time restrictions. A total of N.=1005 studies were identified and screened by two experienced anesthesiologists/emergency physicians independently. Altogether, data of N.=19 relevant papers were identified and included in the analysis. EVIDENCE SYNTHESIS Using the LT showed fast and easy placement with high success rates (76% to 94%) and was associated with higher short-term survival as compared to other strategies for initial airway management (2.2% vs. 1.4%). Quality of CPR such as chest compression fraction (CCF) before and after LT-insertion is improved (75% vs. 59%). For long-term survival, the LT showed lower survival rates. CONCLUSIONS Especially as initial device of airway management (for inexperienced staff), the use of a LT is easy and results in a fast insertion. The advantages of the LT as compared to bag mask ventilation and endotracheal intubation are inhomogeneous in recent literature.
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Affiliation(s)
- Jochen Hinkelbein
- Department for Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany -
| | - Jan Schmitz
- Department for Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany
| | - Alexander Mathes
- Department for Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany
| | - Edoardo DE Robertis
- Department of Surgical and Biomedical Sciences, Division of Anesthesia, Analgesia, and Intensive Care, University of Perugia, Perugia, Italy
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Hanisch JR, Counts CR, Latimer AJ, Rea TD, Yin L, Sayre MR. Causes of Chest Compression Interruptions During Out-of-Hospital Cardiac Arrest Resuscitation. J Am Heart Assoc 2020; 9:e015599. [PMID: 32151219 PMCID: PMC7335529 DOI: 10.1161/jaha.119.015599] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Background Interruptions in chest compressions contribute to poor outcomes in out‐of‐hospital cardiac arrest. The objective of this retrospective observational cohort study was to characterize the frequency, reasons, and duration of interruptions in chest compressions and to determine if interruptions changed over time. Methods and Results All out‐of‐hospital cardiac arrests treated by the Seattle Fire Department (Seattle, WA, United States) from 2007 to 2016 with capture of recordings from automated external defibrillators and manual defibrillators were included. Compression interruptions >1 second were classified into categories using audio recordings. Among the 3601 eligible out‐of‐hospital cardiac arrests, we analyzed 74 584 minutes, identifying 30 043 pauses that accounted for 6621 minutes (8.9% of total resuscitation duration). The median total interruption duration per case decreased from 115 seconds in 2007 to 72 seconds in 2016 (P<0.0001). Median individual interruption duration decreased from 14 seconds in 2007 to 7 seconds in 2016 (P<0.0001). Among interruptions >10 seconds, median interruption duration decreased from 20 seconds in 2007 to 16 seconds in 2016 (P<0.0001). Cardiac rhythm analysis accounted for most compression interruptions. Manual ECG rhythm analysis and pulse checks accounted for 41.6% of all interruption time (median individual interruption, 8 seconds), automated external defibrillator rhythm analysis for 13.7% (median, 17 seconds), and manual rhythm analysis and shock delivery for 8.0% (median, 9 seconds). Conclusions Median duration of chest compression interruptions decreased by half from 2007 to 2016, indicating that care teams can significantly improve performance. Reducing compression interruptions is an evidence‐based benchmark that provides a modifiable process quality improvement goal.
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Affiliation(s)
| | | | - Andrew J Latimer
- Department of Emergency Medicine University of Washington Seattle WA
| | - Thomas D Rea
- Department of Medicine University of Washington Seattle WA.,King County Emergency Medical Services Seattle WA
| | - Lihua Yin
- King County Emergency Medical Services Seattle WA
| | - Michael R Sayre
- Department of Emergency Medicine University of Washington Seattle WA.,Seattle Fire Department Seattle WA
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Benger JR, Kirby K, Black S, Brett SJ, Clout M, Lazaroo MJ, Nolan JP, Reeves BC, Robinson M, Scott LJ, Smartt H, South A, Stokes EA, Taylor J, Thomas M, Voss S, Wordsworth S, Rogers CA. Effect of a Strategy of a Supraglottic Airway Device vs Tracheal Intubation During Out-of-Hospital Cardiac Arrest on Functional Outcome: The AIRWAYS-2 Randomized Clinical Trial. JAMA 2018; 320:779-791. [PMID: 30167701 PMCID: PMC6142999 DOI: 10.1001/jama.2018.11597] [Citation(s) in RCA: 257] [Impact Index Per Article: 42.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
IMPORTANCE The optimal approach to airway management during out-of-hospital cardiac arrest is unknown. OBJECTIVE To determine whether a supraglottic airway device (SGA) is superior to tracheal intubation (TI) as the initial advanced airway management strategy in adults with nontraumatic out-of-hospital cardiac arrest. DESIGN, SETTING, AND PARTICIPANTS Multicenter, cluster randomized clinical trial of paramedics from 4 ambulance services in England responding to emergencies for approximately 21 million people. Patients aged 18 years or older who had a nontraumatic out-of-hospital cardiac arrest and were treated by a participating paramedic were enrolled automatically under a waiver of consent between June 2015 and August 2017; follow-up ended in February 2018. INTERVENTIONS Paramedics were randomized 1:1 to use TI (764 paramedics) or SGA (759 paramedics) as their initial advanced airway management strategy. MAIN OUTCOMES AND MEASURES The primary outcome was modified Rankin Scale score at hospital discharge or 30 days after out-of-hospital cardiac arrest, whichever occurred sooner. Modified Rankin Scale score was divided into 2 ranges: 0-3 (good outcome) or 4-6 (poor outcome; 6 = death). Secondary outcomes included ventilation success, regurgitation, and aspiration. RESULTS A total of 9296 patients (4886 in the SGA group and 4410 in the TI group) were enrolled (median age, 73 years; 3373 were women [36.3%]), and the modified Rankin Scale score was known for 9289 patients. In the SGA group, 311 of 4882 patients (6.4%) had a good outcome (modified Rankin Scale score range, 0-3) vs 300 of 4407 patients (6.8%) in the TI group (adjusted risk difference [RD], -0.6% [95% CI, -1.6% to 0.4%]). Initial ventilation was successful in 4255 of 4868 patients (87.4%) in the SGA group compared with 3473 of 4397 patients (79.0%) in the TI group (adjusted RD, 8.3% [95% CI, 6.3% to 10.2%]). However, patients randomized to receive TI were less likely to receive advanced airway management (3419 of 4404 patients [77.6%] vs 4161 of 4883 patients [85.2%] in the SGA group). Two of the secondary outcomes (regurgitation and aspiration) were not significantly different between groups (regurgitation: 1268 of 4865 patients [26.1%] in the SGA group vs 1072 of 4372 patients [24.5%] in the TI group; adjusted RD, 1.4% [95% CI, -0.6% to 3.4%]; aspiration: 729 of 4824 patients [15.1%] vs 647 of 4337 patients [14.9%], respectively; adjusted RD, 0.1% [95% CI, -1.5% to 1.8%]). CONCLUSIONS AND RELEVANCE Among patients with out-of-hospital cardiac arrest, randomization to a strategy of advanced airway management with a supraglottic airway device compared with tracheal intubation did not result in a favorable functional outcome at 30 days. TRIAL REGISTRATION ISRCTN Identifier: 08256118.
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Affiliation(s)
| | - Kim Kirby
- University of the West of England, Glenside Campus, Bristol
- South Western Ambulance Service NHS Foundation Trust, Exeter, England
| | - Sarah Black
- South Western Ambulance Service NHS Foundation Trust, Exeter, England
| | - Stephen J. Brett
- Department of Surgery and Cancer, Imperial College Healthcare NHS Trust, London, England
| | - Madeleine Clout
- Clinical Trials and Evaluation Unit, Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, England
| | - Michelle J. Lazaroo
- Clinical Trials and Evaluation Unit, Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, England
| | - Jerry P. Nolan
- Bristol Medical School, University of Bristol, Bristol, England
- Department of Anaesthesia, Royal United Hospital, Bath, England
| | - Barnaby C. Reeves
- Clinical Trials and Evaluation Unit, Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, England
| | - Maria Robinson
- South Western Ambulance Service NHS Foundation Trust, Exeter, England
| | - Lauren J. Scott
- Clinical Trials and Evaluation Unit, Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, England
- CLAHRC West, Whitefriars, Bristol, England
| | - Helena Smartt
- Clinical Trials and Evaluation Unit, Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, England
| | - Adrian South
- South Western Ambulance Service NHS Foundation Trust, Exeter, England
| | - Elizabeth A. Stokes
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, England
| | - Jodi Taylor
- Clinical Trials and Evaluation Unit, Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, England
- Bristol Medical School, University of Bristol, Bristol, England
| | - Matthew Thomas
- Intensive Care Unit, University Hospitals Bristol NHS Foundation Trust, Bristol, England
| | - Sarah Voss
- University of the West of England, Glenside Campus, Bristol
| | - Sarah Wordsworth
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, England
| | - Chris A. Rogers
- Clinical Trials and Evaluation Unit, Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, England
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Han S, Choi P, Hong C, Shin D, Na J, Hwang S, Cho J. Can use of video Laryngoscopes by Emergency Medical Technicians Facilitate Endotracheal Intubation during Continuous Chest Compression? A Manikin Study. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791402100505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction We conducted this study to evaluate the utility of two video laryngoscopes (VLs) [Pentax-AWS (AWS), GlideScope (GVL)], compared to the conventional Macintosh laryngoscope (ML), on endotracheal intubation (ETI) involving chest compressions by Level 1 Korean emergency medical technicians (EMTs) who are the equivalent of EMT-I in the United States. Methods This was a randomised crossover simulation study. Fifty EMTs performed endotracheal intubation in randomised sequence following two different scenarios: normal airway and difficult airway. Results In normal airway scenario, overall success rate did not differ between the three devices. However AWS required a shorter run-time (14.1 [10.9-19.8] seconds) to complete ETI (TC) than ML (17.7 [13.5-21.3] seconds) (p=0.017). And both VLs showed a significant superiority over ML in time required to visualise vocal cords (TVC), percentage of glottic opening (POGO) score, and incidence of dental compression (IDC). In difficult airway scenario, overall success rate of both VLs was significantly higher than ML. The TC of AWS (13.7 [11.2-16.9] seconds) and GVL (20.7 [15.1-25.9] seconds) was shorter than that of ML (24.7 [18.1-34.5] seconds) (p<0.001). The TVC of GVL was significantly shorter than that of AWS and ML. The POGO score, IDC, and ease of intubation were significantly superior with AWS, GVL, and ML, respectively. Conclusions Video laryngoscopes can facilitate EMT performing a faster and easier intubation without interrupting chest compressions. Moreover, AWS improves the success rate comparing to ML in difficult airway management. (Hong Kong j.emerg.med. 2014;21:308-315)
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Affiliation(s)
- Sk Han
- Kangwon National University Hospital, Department of Emeregncy Medicine, Institute of Medical Sciences, School of Medicine, Kangwon National University, 1 Gangwondaehak-gil, Chuncheon-si, Gangwon-do, South Korea
| | | | - Ck Hong
- Bundang Jesaeng General Hospital, Department of Emeregncy Medicine, 255-2 Seohyun-dong, Bundang-gu, Seongnam, South Korea
| | - Dh Shin
- Kangwon National University Hospital, Department of Emeregncy Medicine, Institute of Medical Sciences, School of Medicine, Kangwon National University, 1 Gangwondaehak-gil, Chuncheon-si, Gangwon-do, South Korea
| | | | - Sy Hwang
- Samsung Changwon Hospital, Department of Emeregncy Medicine, Sungkyunkwan University School of Medicine, 158 Palyoung-ro, MasanHoiwon-gu, Changwon, South Korea
| | - Jh Cho
- Kangwon National University Hospital, Department of Emeregncy Medicine, Institute of Medical Sciences, School of Medicine, Kangwon National University, 1 Gangwondaehak-gil, Chuncheon-si, Gangwon-do, South Korea
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Sulzgruber P, Datler P, Sterz F, Poppe M, Lobmeyr E, Keferböck M, Zeiner S, Nürnberger A, Schober A, Hubner P, Stratil P, Wallmueller C, Weiser C, Warenits AM, Zajicek A, Ettl F, Magnet I, Uray T, Testori C, van Tulder R. The impact of airway strategy on the patient outcome after out-of-hospital cardiac arrest: A propensity score matched analysis. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2017; 7:423-431. [PMID: 28948850 DOI: 10.1177/2048872617731894] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND While guidelines mentioned supraglottic airway management in the case of out-of- hospital cardiac arrest, robust data of their impact on the patient outcome remain scare and results are inconclusive. METHODS To assess the impact of the airway strategy on the patient outcome we prospectively enrolled 2224 individuals suffering cardiac arrest who were treated by the Viennese municipal emergency medical service. To control for potential confounders, propensity score matching was performed. Patients were matched in four groups with a 1:1:1:1 ratio ( n=210/group) according to bag-mask-valve, laryngeal tube, endotracheal intubation and secondary endotracheal intubation after primary laryngeal tube ventilation. RESULTS The laryngeal tube subgroup showed the lowest 30-day survival rate among all tested devices ( p<0.001). However, in the case of endotracheal intubation after primary laryngeal tube ventilation, survival rates were comparable to the primary endotracheal tube subgroup. The use of a laryngeal tube was independently and directly associated with mortality with an adjusted odds ratio of 1.97 (confidence interval: 1.14-3.39; p=0.015). Additionally, patients receiving laryngeal tube ventilation showed the lowest rate of good neurological performance (6.7%; p<0.001) among subgroups. However, if patients received endotracheal intubation after initial laryngeal tube ventilation, the outcome proved to be significantly better (9.5%; p<0.001). CONCLUSION We found that the use of a laryngeal tube for airway management in cardiac arrest was significantly associated with poor 30-day survival rates and unfavourable neurological outcome. A primary endotracheal airway management needs to be considered at the scene, or an earliest possible secondary endotracheal intubation during both pre-hospital and in-hospital post-return of spontaneous circulation critical care seems crucial and most beneficial for the patient outcome.
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Affiliation(s)
- Patrick Sulzgruber
- 1 Department of Emergency Medicine, Medical University of Vienna, Austria.,2 Ludwig Boltzman Institute, Cluster for Cardiovascular Research, Austria
| | - Philip Datler
- 3 Department of Anaesthesia, Medical University of Vienna, Austria
| | - Fritz Sterz
- 1 Department of Emergency Medicine, Medical University of Vienna, Austria
| | - Michael Poppe
- 1 Department of Emergency Medicine, Medical University of Vienna, Austria
| | - Elisabeth Lobmeyr
- 1 Department of Emergency Medicine, Medical University of Vienna, Austria
| | - Markus Keferböck
- 1 Department of Emergency Medicine, Medical University of Vienna, Austria
| | - Sebastian Zeiner
- 1 Department of Emergency Medicine, Medical University of Vienna, Austria
| | | | - Andreas Schober
- 1 Department of Emergency Medicine, Medical University of Vienna, Austria
| | - Pia Hubner
- 1 Department of Emergency Medicine, Medical University of Vienna, Austria
| | - Peter Stratil
- 1 Department of Emergency Medicine, Medical University of Vienna, Austria
| | | | - Christoph Weiser
- 1 Department of Emergency Medicine, Medical University of Vienna, Austria
| | | | | | - Florian Ettl
- 1 Department of Emergency Medicine, Medical University of Vienna, Austria
| | - Ingrid Magnet
- 1 Department of Emergency Medicine, Medical University of Vienna, Austria
| | - Thomas Uray
- 1 Department of Emergency Medicine, Medical University of Vienna, Austria
| | - Christoph Testori
- 1 Department of Emergency Medicine, Medical University of Vienna, Austria
| | - Raphael van Tulder
- 1 Department of Emergency Medicine, Medical University of Vienna, Austria
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Soar J, Nolan J, Böttiger B, Perkins G, Lott C, Carli P, Pellis T, Sandroni C, Skrifvars M, Smith G, Sunde K, Deakin C. Erweiterte Reanimationsmaßnahmen für Erwachsene („adult advanced life support“). Notf Rett Med 2017. [DOI: 10.1007/s10049-017-0330-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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12
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Andersen LW, Granfeldt A, Callaway CW, Bradley SM, Soar J, Nolan JP, Kurth T, Donnino MW. Association Between Tracheal Intubation During Adult In-Hospital Cardiac Arrest and Survival. JAMA 2017; 317:494-506. [PMID: 28118660 PMCID: PMC6056890 DOI: 10.1001/jama.2016.20165] [Citation(s) in RCA: 137] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Tracheal intubation is common during adult in-hospital cardiac arrest, but little is known about the association between tracheal intubation and survival in this setting. OBJECTIVE To determine whether tracheal intubation during adult in-hospital cardiac arrest is associated with survival to hospital discharge. DESIGN, SETTING, AND PARTICIPANTS Observational cohort study of adult patients who had an in-hospital cardiac arrest from January 2000 through December 2014 included in the Get With The Guidelines-Resuscitation registry, a US-based multicenter registry of in-hospital cardiac arrest. Patients who had an invasive airway in place at the time of cardiac arrest were excluded. Patients intubated at any given minute (from 0-15 minutes) were matched with patients at risk of being intubated within the same minute (ie, still receiving resuscitation) based on a time-dependent propensity score calculated from multiple patient, event, and hospital characteristics. EXPOSURE Tracheal intubation during cardiac arrest. MAIN OUTCOMES AND MEASURES The primary outcome was survival to hospital discharge. Secondary outcomes included return of spontaneous circulation (ROSC) and a good functional outcome. A cerebral performance category score of 1 (mild or no neurological deficit) or 2 (moderate cerebral disability) was considered a good functional outcome. RESULTS The propensity-matched cohort was selected from 108 079 adult patients at 668 hospitals. The median age was 69 years (interquartile range, 58-79 years), 45 073 patients (42%) were female, and 24 256 patients (22.4%) survived to hospital discharge. Of 71 615 patients (66.3%) who were intubated within the first 15 minutes, 43 314 (60.5%) were matched to a patient not intubated in the same minute. Survival was lower among patients who were intubated compared with those not intubated: 7052 of 43 314 (16.3%) vs 8407 of 43 314 (19.4%), respectively (risk ratio [RR] = 0.84; 95% CI, 0.81-0.87; P < .001). The proportion of patients with ROSC was lower among intubated patients than those not intubated: 25 022 of 43 311 (57.8%) vs 25 685 of 43 310 (59.3%), respectively (RR = 0.97; 95% CI, 0.96-0.99; P < .001). Good functional outcome was also lower among intubated patients than those not intubated: 4439 of 41 868 (10.6%) vs 5672 of 41 733 (13.6%), respectively (RR = 0.78; 95% CI, 0.75-0.81; P < .001). Although differences existed in prespecified subgroup analyses, intubation was not associated with improved outcomes in any subgroup. CONCLUSIONS AND RELEVANCE Among adult patients with in-hospital cardiac arrest, initiation of tracheal intubation within any given minute during the first 15 minutes of resuscitation, compared with no intubation during that minute, was associated with decreased survival to hospital discharge. Although the study design does not eliminate the potential for confounding by indication, these findings do not support early tracheal intubation for adult in-hospital cardiac arrest.
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Affiliation(s)
- Lars W Andersen
- Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark2Department of Anesthesiology, Aarhus University Hospital, Aarhus, Denmark3Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Asger Granfeldt
- Department of Anesthesiology, Aarhus University Hospital, Aarhus, Denmark
| | - Clifton W Callaway
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Steven M Bradley
- Division of Cardiology, Department of Medicine, VA Eastern Colorado Health Care System, Denver6Now with Minneapolis Heart Institute, Minneapolis, Minnesota
| | - Jasmeet Soar
- Anaesthesia and Intensive Care Medicine, Southmead Hospital, Bristol, England
| | - Jerry P Nolan
- University of Bristol, Bristol, England9Department of Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, England
| | - Tobias Kurth
- Institute of Public Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Michael W Donnino
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts11Division of Pulmonary and Critical Care Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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13
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Soar J, Nolan JP, Böttiger BW, Perkins GD, Lott C, Carli P, Pellis T, Sandroni C, Skrifvars MB, Smith GB, Sunde K, Deakin CD. European Resuscitation Council Guidelines for Resuscitation 2015: Section 3. Adult advanced life support. Resuscitation 2016; 95:100-47. [PMID: 26477701 DOI: 10.1016/j.resuscitation.2015.07.016] [Citation(s) in RCA: 926] [Impact Index Per Article: 115.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Jasmeet Soar
- Anaesthesia and Intensive Care Medicine, Southmead Hospital, Bristol, UK.
| | - Jerry P Nolan
- Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, UK; School of Clinical Sciences, University of Bristol, UK
| | - Bernd W Böttiger
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Germany
| | - Gavin D Perkins
- Warwick Medical School, University of Warwick, Coventry, UK; Heart of England NHS Foundation Trust, Birmingham, UK
| | - Carsten Lott
- Department of Anesthesiology, University Medical Center, Johannes Gutenberg-University, Mainz, Germany
| | - Pierre Carli
- SAMU de Paris, Department of Anaesthesiology and Intensive Care, Necker University Hospital, Paris, France
| | - Tommaso Pellis
- Anaesthesia, Intensive Care and Emergency Medical Service, Santa Maria degli Angeli Hospital, Pordenone, Italy
| | - Claudio Sandroni
- Department of Anaesthesiology and Intensive Care, Catholic University School of Medicine, Rome, Italy
| | - Markus B Skrifvars
- Division of Intensive Care, Department of Anaesthesiology, Intensive Care and Pain Medicine, Helsinki University Hospital and Helsinki University, Helsinki, Finland
| | - Gary B Smith
- Centre of Postgraduate Medical Research & Education, Bournemouth University, Bournemouth, UK
| | - Kjetil Sunde
- Department of Anaesthesiology, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Charles D Deakin
- Cardiac Anaesthesia and Cardiac Intensive Care, NIHR Southampton Respiratory Biomedical Research Unit, University Hospital Southampton, Southampton, UK
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Hiltunen P, Jäntti H, Silfvast T, Kuisma M, Kurola J. Airway management in out-of-hospital cardiac arrest in Finland: current practices and outcomes. Scand J Trauma Resusc Emerg Med 2016; 24:49. [PMID: 27071823 PMCID: PMC4830072 DOI: 10.1186/s13049-016-0235-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 04/04/2016] [Indexed: 11/13/2022] Open
Abstract
Background Though airway management methods during out-of-hospital cardiac arrest (OHCA) remain controversial, no studies on the topic from Finland have examined adherence to OHCA recommendations in real life. In response, the aim of this study was to document the interventions, success rates, and adverse events in airway management processes in OHCA, as well as to analyse survival at hospital discharge and at follow-up a year later. Methods During a 6-month study period in 2010, data regarding all patients with OHCA and attempted resuscitation in southern and eastern Finland were prospectively collected. Emergency medical services (EMS) documented the airway techniques used and all adverse events related to the process. Study endpoints included the frequency of different techniques used, their success rates, methods used to verify the correct placement of the endotracheal tube, overall adverse events, and survival at hospital discharge and at follow-up a year later. Results A total of 614 patients were included in the study. The incidence of EMS-attempted resuscitation was determined to be 51/100,000 inhabitants per year. The final airway technique was endotracheal intubation (ETI) in 413 patients (67.3 %) and supraglottic airway device (SAD) in 188 patients (30.2 %). The overall success rate of ETI was 92.5 %, whereas that of SAD was 85.0 %. Adverse events were reported in 167 of the patients (27.2 %). Having a prehospital EMS physician on the scene (p < .001, OR 5.05, 95 % CI 2.94–8.68), having a primary shockable rhythm (p < .001, OR 5.23, 95 % CI 3.05–8.98), and being male (p = .049, OR 1.80, 95 % CI 1.00–3.22) were predictors for survival at hospital discharge. Conclusions This study showed acceptable ETI and SAD success rates among Finnish patients with OHCA. Adverse events related to airway management were observed in more than 25 % of patients, and overall survival was 17.8 % at hospital discharge and 14.0 % after 1 year.
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Affiliation(s)
- Pamela Hiltunen
- Centre for Prehospital Emergency Care, Kuopio University Hospital, PO Box 1777, FIN-70210, Kuopio, Finland.
| | - Helena Jäntti
- Centre for Prehospital Emergency Care, Kuopio University Hospital, PO Box 1777, FIN-70210, Kuopio, Finland
| | - Tom Silfvast
- EMS, Department of Emergency Care, Helsinki University Hospital, Stenbäckinkatu 9, 000209 HUS, Helsinki, Finland
| | - Markku Kuisma
- EMS, Department of Emergency Care, Helsinki University Hospital, Stenbäckinkatu 9, 000209 HUS, Helsinki, Finland
| | - Jouni Kurola
- Centre for Prehospital Emergency Care, Kuopio University Hospital, PO Box 1777, FIN-70210, Kuopio, Finland
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15
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Kim W, Lee Y, Kim C, Lim TH, Oh J, Kang H, Lee S. Comparison of the Pentax Airwayscope, Glidescope Video Laryngoscope, and Macintosh Laryngoscope During Chest Compression According to Bed Height. Medicine (Baltimore) 2016; 95:e2631. [PMID: 26844477 PMCID: PMC4748894 DOI: 10.1097/md.0000000000002631] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
We aimed to investigate whether bed height affects intubation performance in the setting of cardiopulmonary resuscitation and which type of laryngoscope shows the best performance at each bed height.A randomized crossover manikin study was conducted. Twenty-one participants were enrolled, and they were randomly allocated to 2 groups: group A (n = 10) and group B (n = 11). The participants underwent emergency endotracheal intubation (ETI) using the Airwayscope (AWS), Glidescope video laryngoscope, and Macintosh laryngoscope in random order while chest compression was performed. Each ETI was conducted at 2 levels of bed height (minimum bed height: 68.9 cm and maximum bed height: 101.3 cm). The primary outcomes were the time to intubation (TTI) and the success rate of ETI. The P value for statistical significance was set at 0.05 and 0.017 in post-hoc test.The success rate of ETI was always 100% regardless of the type of laryngoscope or the bed height. TTI was not significantly different between the 2 bed heights regardless of the type of laryngoscope (all P > 0.05). The time for AWS was the shortest among the 3 laryngoscopes at both bed heights (13.7 ± 3.6 at the minimum bed height and 13.4 ± 4.7 at the maximum bed height) (all P < 0.017). The TTI of Glidescope video laryngoscope was not significantly shorter than that of Macintosh laryngoscope at the minimum height (17.6 ± 4.0 vs 19.6 ± 4.8; P = 0.02).The bed height, whether adjusted to the minimum or maximum setting, did not affect intubation performance. In addition, regardless of the bed height, the intubation time with the video laryngoscopes, especially AWS, was significantly shorter than that with the direct laryngoscope during chest compression.
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Affiliation(s)
- Wonhee Kim
- From the Department of Emergency Medicine, Kangnam Sacred Heart Hospital, Hallym University, Republic of Korea (WK); Department of Emergency Medicine, Guri Hospital, Hanyang University, Republic of Korea (YL, CK); and Department of Emergency Medicine, Seoul Hospital, Hanyang University, Republic of Korea (THL, JO, HK, SL)
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16
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Soar J, Nolan J, Böttiger B, Perkins G, Lott C, Carli P, Pellis T, Sandroni C, Skrifvars M, Smith G, Sunde K, Deakin C. Erweiterte Reanimationsmaßnahmen für Erwachsene („adult advanced life support“). Notf Rett Med 2015. [DOI: 10.1007/s10049-015-0085-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Tijssen JA, Prince DK, Morrison LJ, Atkins DL, Austin MA, Berg R, Brown SP, Christenson J, Egan D, Fedor PJ, Fink EL, Meckler GD, Osmond MH, Sims KA, Hutchison JS. Time on the scene and interventions are associated with improved survival in pediatric out-of-hospital cardiac arrest. Resuscitation 2015; 94:1-7. [PMID: 26095301 PMCID: PMC4540668 DOI: 10.1016/j.resuscitation.2015.06.012] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 05/26/2015] [Accepted: 06/11/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Survival is less than 10% for pediatric patients following out-of-hospital cardiac arrest. It is not known if more time on the scene of the cardiac arrest and advanced life support interventions by emergency services personnel are associated with improved survival. AIM This study was performed to determine which times on the scene and which prehospital interventions were associated with improved survival. METHODS We studied patients aged 3 days to 19 years old with out-of-hospital cardiac arrest, using the Resuscitation Outcomes Consortium cardiac arrest database from 11 North American regions, from 2005 to 2012. We evaluated survival to hospital discharge according to on-scene times (<10, 10 to 35 and >35 min). RESULTS Data were available for 2244 patients (1017 infants, 594 children and 633 adolescents). Infants had the lowest rate of survival (3.7%) compared to children (9.8%) and adolescents (16.3%). Survival improved over the 7 year study period especially among adolescents. Survival was highest in the 10 to 35 min on-scene time group (10.2%) compared to the >35 min. group (6.9%) and the <10 min. group (5.3%, p=0.01). Intravenous or intra-osseous access attempts and fluid administration were associated with improved survival, whereas advanced airway attempts were not associated with survival and resuscitation drugs were associated with worse survival. CONCLUSIONS In this observational study, a scene time of 10 to 35 min was associated with the highest survival, especially among adolescents. Access for fluid resuscitation was associated with increased survival but advanced airway and resuscitation drugs were not.
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Affiliation(s)
- Janice A Tijssen
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, London Health Sciences Centre, University of Western Ontario, London, ON, Canada; The Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada.
| | - David K Prince
- Data Coordinating Center, Resuscitation Outcomes Consortium, University of Washington, Seattle, WA, United States
| | - Laurie J Morrison
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada; Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Dianne L Atkins
- Stead Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, IA, United States
| | - Michael A Austin
- Department of Emergency Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Robert Berg
- Departments of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, PA, United States
| | - Siobhan P Brown
- Data Coordinating Center, Resuscitation Outcomes Consortium, University of Washington, Seattle, WA, United States
| | - Jim Christenson
- Department of Emergency Medicine, University of British Columbia Faculty of Medicine, Vancouver, BC, Canada
| | - Debra Egan
- Division of Cardiovascular Sciences, Heart Failure and Arrhythmias Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, United States
| | - Preston J Fedor
- Division of Emergency Medicine, Department of Surgery, University of Texas Southwestern, Dallas, TX, United States
| | - Ericka L Fink
- Department of Critical Care Medicine, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Centre, Pittsburgh, PA, United States
| | - Garth D Meckler
- Division of Emergency Medicine, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada; British Columbia Children's Hospital, Vancouver, BC, Canada
| | - Martin H Osmond
- Division of Emergency Medicine, Department of Pediatrics, The University of Ottawa, Ottawa, ON, Canada; Children's Hospital of Eastern Ontario, The University of Ottawa, Ottawa, ON, Canada
| | - Kathryn A Sims
- Data Coordinating Center, Resuscitation Outcomes Consortium, University of Washington, Seattle, WA, United States
| | - James S Hutchison
- Department of Critical Care and Neuroscience and Mental Health Research Program, The Hospital for Sick Children, Toronto, ON, Canada; Interdepartmental Division of Critical Care Medicine, Faculty of Medicine and Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada.
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18
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Maignan M, Koch FX, Kraemer M, Lehodey B, Viglino D, Monnet MF, Pham D, Roux C, Genty C, Rolland C, Bosson JL, Danel V, Debaty G. Impact of laryngeal tube use on chest compression fraction during out-of-hospital cardiac arrest. A prospective alternate month study. Resuscitation 2015; 93:113-7. [PMID: 26070831 DOI: 10.1016/j.resuscitation.2015.06.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 05/28/2015] [Accepted: 06/01/2015] [Indexed: 11/18/2022]
Abstract
AIM Supraglottic devices are thought to allow efficient ventilation and continuous chest compressions during cardiac arrest. Therefore, the use of supraglottic devices could increase the chest compression fraction (CCF), a critical determinant of patient survival. The aim of this study was to assess the CCF in out-of-hospital cardiac arrest (OHCA) patients ventilated with a supraglottic device. METHODS We conducted an open prospective multicenter study with temporal clusters. OHCA patients treated by emergency nurses received either intermittent chest compressions with bag-valve mask ventilations (30:2 rhythm; BVM group); or continuous chest compressions with asynchronous ventilations by laryngeal tube (LT group). The primary endpoint was the CCF assessed using an accelerometer connected to the defibrillator. We also investigated the ease of use of the laryngeal tube. RESULTS Eighty-two patients were included (41 in each group); 68% were male and the median age was 68 (54-80) years. Patients and cardiac arrest characteristics did not differ between groups. The CCF was 75% (68-79%) in the LT group and 59% (51-68%) in the BVM group (p<0.01). LT insertion failed in nine out of 40 cases (23%). The median time of LT insertion was 26s (11-56 s). CCF was significantly lower when LT insertion failed (58% (48-74%) vs. 76% (72-80%) when LT insertion succeeded; p=0.01). CONCLUSION The use of the LT during OHCA increases the CCF when compared to standard BVM ventilation. However, the impact of LT use on mortality remains unclear.
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Affiliation(s)
- Maxime Maignan
- University Grenoble Alps - Emergency Department and Mobile Intensive Care Unit, CHU Michallon, Grenoble, France; University Grenoble Alps, CNRS UMR 5525, TIMC-IMAG Laboratory, Team PRETA, Grenoble, France.
| | - François-Xavier Koch
- University Grenoble Alps - Emergency Department and Mobile Intensive Care Unit, CHU Michallon, Grenoble, France
| | - Marie Kraemer
- University Grenoble Alps - Emergency Department and Mobile Intensive Care Unit, CHU Michallon, Grenoble, France
| | - Bruno Lehodey
- University Grenoble Alps - Emergency Department and Mobile Intensive Care Unit, CHU Michallon, Grenoble, France
| | - Damien Viglino
- University Grenoble Alps - Emergency Department and Mobile Intensive Care Unit, CHU Michallon, Grenoble, France; INSERM U1042, HP2 Laboratory, University Grenoble Alps, Grenoble, France
| | | | | | | | - Céline Genty
- University Grenoble Alps - Center for Clinical Investigation, CHU Michallon, Grenoble, France
| | - Carole Rolland
- University Grenoble Alps - Center for Clinical Investigation, CHU Michallon, Grenoble, France
| | - Jean-Luc Bosson
- University Grenoble Alps - Center for Clinical Investigation, CHU Michallon, Grenoble, France
| | - Vincent Danel
- University Grenoble Alps - Emergency Department and Mobile Intensive Care Unit, CHU Michallon, Grenoble, France
| | - Guillaume Debaty
- University Grenoble Alps - Emergency Department and Mobile Intensive Care Unit, CHU Michallon, Grenoble, France; University Grenoble Alps, CNRS UMR 5525, TIMC-IMAG Laboratory, Team PRETA, Grenoble, France
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Busch CW, Qalanawi M, Kersten JF, Kalwa TJ, Scotti NA, Reip W, Doehn C, Maisch S, Nitzschke R. Providers with Limited Experience Perform Better in Advanced Life Support with Assistance Using an Interactive Device with an Automated External Defibrillator Linked to a Ventilator. J Emerg Med 2015; 49:455-63. [PMID: 26037479 DOI: 10.1016/j.jemermed.2015.03.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 03/09/2015] [Accepted: 03/24/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Medical teams with limited experience in performing advanced life support (ALS) or with a low frequency of cardiopulmonary resuscitation (CPR) while on duty, often have difficulty complying with CPR guidelines. OBJECTIVE This study evaluated whether the quality of CPR of trained medical students, who served as an example of teams with limited experience in ALS, could be improved with device assistance. The primary outcome was the hands-off time (i.e., the percentage of the entire CPR time without chest compressions). The secondary outcome was seven time intervals, which should be as short as possible, and the quality of ventilations and chest compressions on the mannequin. METHODS We compared standard CPR equipment to an interactive device with visual and acoustic instructions for ALS workflow measures to guide briefly trained medical students through the ALS algorithm in a full-scale mannequin simulation study with a randomized crossover study design. The study equipment consisted of an automatic external defibrillator and ventilator that were electronically linked and communicating as a single system. Included were regular medical students in the third to sixth years of medical school of one class who provided written informed consent for voluntary participation and for the analysis of their CPR performance data. No exclusion criteria were applied. For statistical measures of evaluation we used an analysis of variance for crossover trials accounting for treatment effect, sequence effect, and carry-over effect, with adjustment for prior practical experience of the participants. RESULTS Forty-two medical students participated in 21 CPR sessions, each using the standard and study equipment. Regarding the primary end point, the study equipment reduced the hands-off time from 40.1% (95% confidence interval [CI] 36.9-43.4%) to 35.6% (95% CI 32.4-38.9%, p = 0.031) compared with the standard equipment. Within the prespecified secondary end points, study equipment reduced the time interval until the first rescuer changeover from 273 s (95% CI 244-302 s) to 223 s (95% CI 194-253 s, p = 0.001) and increased the percentage of ventilations with a correct tidal volume of 400-600 mL from 34.3% (95% CI 19.0-49.6%) to 60.9% (95% CI 45.6-76.2%, p = 0.018). CONCLUSIONS The assist device increased the rescuers' CPR quality. CPR providers with limited experience or a limited frequency of CPR performance (i.e., rural Emergency Medical Services crew) may potentially benefit from this assist device.
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Affiliation(s)
- Christian Werner Busch
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Mohammed Qalanawi
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Jan Felix Kersten
- Department of Medical Biometry and Epidemiology of the University Medical Center, Hamburg-Eppendorf, Hamburg, Germany
| | | | | | - Wikhart Reip
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph Doehn
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Maisch
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Rainer Nitzschke
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Hospital Hamburg-Eppendorf, Hamburg, Germany
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Ayala U, Eftestøl T, Alonso E, Irusta U, Aramendi E, Wali S, Kramer-Johansen J. Automatic detection of chest compressions for the assessment of CPR-quality parameters. Resuscitation 2014; 85:957-63. [PMID: 24746788 DOI: 10.1016/j.resuscitation.2014.04.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Revised: 02/17/2014] [Accepted: 04/09/2014] [Indexed: 10/25/2022]
Abstract
AIM Accurate chest compression detection is key to evaluate cardiopulmonary resuscitation (CPR) quality. Two automatic compression detectors were developed, for the compression depth (CD), and for the thoracic impedance (TI). The objective was to evaluate their accuracy for compression detection and for CPR quality assessment. METHODS Compressions were manually annotated using the force and ECG in 38 out-of-hospital resuscitation episodes, comprising 869 min and 67,402 compressions. Compressions were detected using a negative peak detector for the CD. For the TI, an adaptive peak detector based on the amplitude and duration of TI fluctuations was used. Chest compression rate (CC-rate) and chest compression fraction (CCF) were calculated for the episodes and for every minute within each episode. CC-rate for rescuer feedback was calculated every 8 consecutive compressions. RESULTS The sensitivity and positive predictive value were 98.4% and 99.8% using CD, and 94.2% and 97.4% using TI. The mean CCF and CC-rate obtained from both detectors showed no significant differences with those obtained from the annotations (P>0.6). The Bland-Altman analysis showed acceptable 95% limits of agreement between the annotations and the detectors for the per-minute CCF, per-minute CC-rate, and CC-rate for feedback. For the detector based on TI, only 3.7% of CC-rate feedbacks had an error larger than 5%. CONCLUSION Automatic compression detectors based on the CD and TI signals are very accurate. In most cases, episode review could safely rely on these detectors without resorting to manual review. Automatic feedback on rate can be accurately done using the impedance channel.
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Affiliation(s)
- U Ayala
- Department of Electrical Engineering and Computer Science, Faculty of Science and Technology, University of Stavanger, 4036 Stavanger, Norway; Communications Engineering Department, University of the Basque Country UPV/EHU, Alameda Urquijo S/N, 48013 Bilbao, Spain.
| | - T Eftestøl
- Department of Electrical Engineering and Computer Science, Faculty of Science and Technology, University of Stavanger, 4036 Stavanger, Norway
| | - E Alonso
- Communications Engineering Department, University of the Basque Country UPV/EHU, Alameda Urquijo S/N, 48013 Bilbao, Spain
| | - U Irusta
- Communications Engineering Department, University of the Basque Country UPV/EHU, Alameda Urquijo S/N, 48013 Bilbao, Spain
| | - E Aramendi
- Communications Engineering Department, University of the Basque Country UPV/EHU, Alameda Urquijo S/N, 48013 Bilbao, Spain
| | - S Wali
- Department of Electrical Engineering and Computer Science, Faculty of Science and Technology, University of Stavanger, 4036 Stavanger, Norway
| | - J Kramer-Johansen
- Norwegian Centre for Prehospital Emergency Care (NAKOS), OsloUniversity Hospital and University of Oslo, Pb 4956 Nydalen, 0424 Oslo, Norway
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Melissopoulou T, Stroumpoulis K, Sampanis MA, Vrachnis N, Papadopoulos G, Chalkias A, Xanthos T. Comparison of blind intubation through the I-gel and ILMA Fastrach by nurses during cardiopulmonary resuscitation: A manikin study. Heart Lung 2014; 43:112-6. [DOI: 10.1016/j.hrtlng.2013.12.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Revised: 12/30/2013] [Accepted: 12/31/2013] [Indexed: 10/25/2022]
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Park SO, Baek KJ, Hong DY, Kim SC, Lee KR. Feasibility of the video-laryngoscope (GlideScope®) for endotracheal intubation during uninterrupted chest compressions in actual advanced life support: A clinical observational study in an urban emergency department. Resuscitation 2013; 84:1233-7. [DOI: 10.1016/j.resuscitation.2013.03.026] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Revised: 03/15/2013] [Accepted: 03/18/2013] [Indexed: 11/17/2022]
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Ruiz J, Ayala U, de Gauna SR, Irusta U, González-Otero D, Alonso E, Kramer-Johansen J, Eftestøl T. Feasibility of automated rhythm assessment in chest compression pauses during cardiopulmonary resuscitation. Resuscitation 2013; 84:1223-8. [DOI: 10.1016/j.resuscitation.2013.01.034] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Revised: 01/17/2013] [Accepted: 01/29/2013] [Indexed: 10/27/2022]
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Bjørshol CA, Sunde K, Myklebust H, Assmus J, Søreide E. Decay in chest compression quality due to fatigue is rare during prolonged advanced life support in a manikin model. Scand J Trauma Resusc Emerg Med 2011; 19:46. [PMID: 21827652 PMCID: PMC3169466 DOI: 10.1186/1757-7241-19-46] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2011] [Accepted: 08/09/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this study was to measure chest compression decay during simulated advanced life support (ALS) in a cardiac arrest manikin model. METHODS 19 paramedic teams, each consisting of three paramedics, performed ALS for 12 minutes with the same paramedic providing all chest compressions. The patient was a resuscitation manikin found in ventricular fibrillation (VF). The first shock terminated the VF and the patient remained in pulseless electrical activity (PEA) throughout the scenario. Average chest compression depth and rate was measured each minute for 12 minutes and divided into three groups based on chest compression quality; good (compression depth ≥ 40 mm, compression rate 100-120/minute for each minute of CPR), bad (initial compression depth < 40 mm, initial compression rate < 100 or > 120/minute) or decay (change from good to bad during the 12 minutes). Changes in no-flow ratio (NFR, defined as the time without chest compressions divided by the total time of the ALS scenario) over time was also measured. RESULTS Based on compression depth, 5 (26%), 9 (47%) and 5 (26%) were good, bad and with decay, respectively. Only one paramedic experienced decay within the first two minutes. Based on compression rate, 6 (32%), 6 (32%) and 7 (37%) were good, bad and with decay, respectively. NFR was 22% in both the 1-3 and 4-6 minute periods, respectively, but decreased to 14% in the 7-9 minute period (P = 0.002) and to 10% in the 10-12 minute period (P < 0.001). CONCLUSIONS In this simulated cardiac arrest manikin study, only half of the providers achieved guideline recommended compression depth during prolonged ALS. Large inter-individual differences in chest compression quality were already present from the initiation of CPR. Chest compression decay and thereby fatigue within the first two minutes was rare.
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Affiliation(s)
- Conrad A Bjørshol
- Department of Anaesthesiology and Intensive Care, Stavanger University Hospital, Stavanger, Norway.
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Briassoulis G, Briassoulis P, Briassouli E. Educational polymorphisms of basic life support algorithms. J Eval Clin Pract 2011; 17:462-70. [PMID: 20553365 DOI: 10.1111/j.1365-2753.2010.01450.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND A systematic review of the pooled effect of articles presenting current basic life support (BLS) algorithms for the treatment of cardiac arrest has never been carried. AIMS We aimed to record and classify potential inherent factors influencing simplicity negatively in teaching, learning and retention of cardiopulmonary resuscitation (CPR) delivered by health care providers or lay persons. METHODS We performed a search of the relevant literature exploring MEDLINE, COCHRANE LIBRARY and SCOPUS databases. Potential inhibitory factors in the structure of available algorithms influencing simplicity in teaching, learning and retention of BLS were recorded and stratified accordingly. In a second phase of this study, we tested the hypothesis that different options of a BLS algorithm might influence CPR retention negatively, by asking 348 health care provider participants of our CPR seminars to describe their predicted response in an emergency to: (1) a real-time model implicating the various victims and rescuers; and (2) a hypothetical challenging 'all-in-one' BLS algorithm model. RESULTS Fifteen articles presenting current BLS algorithms evidenced 163 suggestions that produced 23 different CPR options: five contrasting algorithms (21.8%); three two-option models (13%); six vague technical or scientific suggestions (26%); and nine multiple choices of action (39.1%). Identified references contributed differently in the development of educationally polymorphic BLS options in each of the four categories (P < 0.0001) and were all brought about by variants of victims and rescuers. Participants of CPR seminars answered that in an emergency they could remember the hypothetical BLS model (90%, P = 0.007) rather than a current BLS algorithm for adults (42.2%) or children (36%). CONCLUSIONS Educational polymorphisms of BLS algorithms could build unpredictable barriers between rescuers and cardiac arrest victims and might seriously limit instructors' educational effectiveness. These findings might support an alternative trial hypothesis of a simple 'all-in-one algorithm' educational approach in future.
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Affiliation(s)
- George Briassoulis
- School of Health Sciences, University of Crete, Heraklion, Crete, Greece.
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European Resuscitation Council Guidelines for Resuscitation 2010 Section 4. Adult advanced life support. Resuscitation 2011; 81:1305-52. [PMID: 20956049 DOI: 10.1016/j.resuscitation.2010.08.017] [Citation(s) in RCA: 751] [Impact Index Per Article: 57.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Deakin CD, Morrison LJ, Morley PT, Callaway CW, Kerber RE, Kronick SL, Lavonas EJ, Link MS, Neumar RW, Otto CW, Parr M, Shuster M, Sunde K, Peberdy MA, Tang W, Hoek TLV, Böttiger BW, Drajer S, Lim SH, Nolan JP. Part 8: Advanced life support: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Resuscitation 2011; 81 Suppl 1:e93-e174. [PMID: 20956032 DOI: 10.1016/j.resuscitation.2010.08.027] [Citation(s) in RCA: 167] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Bjørshol CA, Myklebust H, Nilsen KL, Hoff T, Bjørkli C, Illguth E, Søreide E, Sunde K. Effect of socioemotional stress on the quality of cardiopulmonary resuscitation during advanced life support in a randomized manikin study*. Crit Care Med 2011; 39:300-4. [DOI: 10.1097/ccm.0b013e3181ffe100] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Neumar RW, Otto CW, Link MS, Kronick SL, Shuster M, Callaway CW, Kudenchuk PJ, Ornato JP, McNally B, Silvers SM, Passman RS, White RD, Hess EP, Tang W, Davis D, Sinz E, Morrison LJ. Part 8: adult advanced cardiovascular life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2010; 122:S729-67. [PMID: 20956224 DOI: 10.1161/circulationaha.110.970988] [Citation(s) in RCA: 888] [Impact Index Per Article: 63.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The goal of therapy for bradycardia or tachycardia is to rapidly identify and treat patients who are hemodynamically unstable or symptomatic due to the arrhythmia. Drugs or, when appropriate, pacing may be used to control unstable or symptomatic bradycardia. Cardioversion or drugs or both may be used to control unstable or symptomatic tachycardia. ACLS providers should closely monitor stable patients pending expert consultation and should be prepared to aggressively treat those with evidence of decompensation.
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Morrison LJ, Deakin CD, Morley PT, Callaway CW, Kerber RE, Kronick SL, Lavonas EJ, Link MS, Neumar RW, Otto CW, Parr M, Shuster M, Sunde K, Peberdy MA, Tang W, Hoek TLV, Böttiger BW, Drajer S, Lim SH, Nolan JP, Adrie C, Alhelail M, Battu P, Behringer W, Berkow L, Bernstein RA, Bhayani SS, Bigham B, Boyd J, Brenner B, Bruder E, Brugger H, Cash IL, Castrén M, Cocchi M, Comadira G, Crewdson K, Czekajlo MS, Davies SR, Dhindsa H, Diercks D, Dine CJ, Dioszeghy C, Donnino M, Dunning J, El Sanadi N, Farley H, Fenici P, Feeser VR, Foster JA, Friberg H, Fries M, Garcia-Vega FJ, Geocadin RG, Georgiou M, Ghuman J, Givens M, Graham C, Greer DM, Halperin HR, Hanson A, Holzer M, Hunt EA, Ishikawa M, Ioannides M, Jeejeebhoy FM, Jennings PA, Kano H, Kern KB, Kette F, Kudenchuk PJ, Kupas D, La Torre G, Larabee TM, Leary M, Litell J, Little CM, Lobel D, Mader TJ, McCarthy JJ, McCrory MC, Menegazzi JJ, Meurer WJ, Middleton PM, Mottram AR, Navarese EP, Nguyen T, Ong M, Padkin A, Ferreira de Paiva E, Passman RS, Pellis T, Picard JJ, Prout R, Pytte M, Reid RD, Rittenberger J, Ross W, Rubertsson S, Rundgren M, Russo SG, Sakamoto T, Sandroni C, Sanna T, Sato T, Sattur S, Scapigliati A, Schilling R, Seppelt I, Severyn FA, Shepherd G, Shih RD, Skrifvars M, Soar J, Tada K, Tararan S, Torbey M, Weinstock J, Wenzel V, Wiese CH, Wu D, Zelop CM, Zideman D, Zimmerman JL. Part 8: Advanced Life Support. Circulation 2010; 122:S345-421. [DOI: 10.1161/circulationaha.110.971051] [Citation(s) in RCA: 250] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Martin-Gill C, Guyette FX, Rittenberger JC. Effect of crew size on objective measures of resuscitation for out-of-hospital cardiac arrest. PREHOSP EMERG CARE 2010; 14:229-34. [PMID: 20128704 DOI: 10.3109/10903120903572293] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND There is no consensus among emergency medical services (EMS) systems as to the optimal numbers and training of EMS providers who respond to the scene of prehospital cardiac arrests. Increased numbers of providers may improve the performance of cardiopulmonary resuscitation (CPR), but this has not been studied as part of a comprehensive resuscitation scenario. OBJECTIVE To compare different all-paramedic crew size configurations on objective measures of patient resuscitation using a high-fidelity human simulator. METHODS We compared two-, three-, and four-person all-paramedic crew configurations in the effectiveness and timeliness of performing basic life support (BLS) and advanced life support (ALS) skills during the first 8 minutes of a simulated cardiac arrest scenario. Crews were compared to determine differences in no-flow fraction (NFF) as a measure of effectiveness of CPR and time to defibrillation, endotracheal intubation, establishment of intravenous access, and medication administration. RESULTS There was no significant difference in mean NFF among the two-, three-, and four-provider crew configurations (0.32, 0.26, and 0.27, respectively; p = 0.105). More three- and four-person groups completed ALS procedures during the scenario, but there was no significant difference in time to performance of BLS or ALS procedures among the crew size configurations for completed procedures. There was a trend toward lower time to intubation with increasing group size, though this was not significant using a Bonferroni-corrected p-value of 0.01 (379, 316, and 263 seconds, respectively; p = 0.018). CONCLUSION This study found no significant difference in effectiveness of CPR or in time to performance of BLS or ALS procedures among crew size configurations, though there was a trend toward decreased time to intubation with increased crew size. Effectiveness of CPR may be hindered by distractions related to the performance of ALS procedures with increasing group size, particularly with an all-paramedic provider model. We suggest a renewed emphasis on the provision of effective CPR by designated providers independent of any ALS interventions being performed.
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Affiliation(s)
- Christian Martin-Gill
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania 15261, USA
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Wayne MA, McDonnell M. Comparison of Traditional versus Video Laryngoscopy in Out-of-Hospital Tracheal Intubation. PREHOSP EMERG CARE 2010; 14:278-82. [DOI: 10.3109/10903120903537189] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Airway and Ventilation during CPR. Intensive Care Med 2010. [DOI: 10.1007/978-1-4419-5562-3_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Ødegaard S, Olasveengen T, Steen PA, Kramer-Johansen J. The effect of transport on quality of cardiopulmonary resuscitation in out-of-hospital cardiac arrest. Resuscitation 2009; 80:843-8. [PMID: 19477573 DOI: 10.1016/j.resuscitation.2009.03.032] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2008] [Revised: 01/18/2009] [Accepted: 03/13/2009] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Most manikin and clinical studies have found decreased quality of CPR during transport to hospital. We wanted to study quality of CPR before and during transport for out-of-hospital cardiac arrest patients and also whether quality of CPR before initiation of transport was different from the quality in patients only receiving CPR on scene. MATERIALS AND METHODS Quality of CPR was prospectively registered with a modified defibrillator for consecutive cases of out-of-hospital cardiac arrest in three ambulance services during 2002-2005. Ventilations were registered via changes in transthoracic impedance and chest compressions were measured with an extra chest compression pad placed on the patients' sternum. Paired t-tests were used to analyse quality of CPR before vs. during transport with ongoing CPR. Unpaired t-tests were used to compare CPR quality prior to transport to CPR quality in patients with CPR terminated on site. RESULTS Quality of CPR did not deteriorate during transport, but as previously reported overall quality of CPR was substandard. Quality of CPR performed on site was significantly better when transport was not initiated with ongoing CPR compared to episodes with initiation of transport during CPR: fraction of time without chest compressions was 0.45 and 0.53 (p<0.001), compression depth 37 mm and 34 mm (p=0.04), and number of chest compressions per minute 61 and 56 (p=0.01), respectively. CONCLUSION CPR quality was sub-standard both before and during transport. Early decision to transport might have negatively affected CPR quality from the early stages of resuscitation.
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Affiliation(s)
- Silje Ødegaard
- Institute for Experimental Medical Research, Ulleval University Hospital, N-0407 Oslo, Norway.
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Olasveengen TM, Samdal M, Steen PA, Wik L, Sunde K. Progressing from initial non-shockable rhythms to a shockable rhythm is associated with improved outcome after out-of-hospital cardiac arrest. Resuscitation 2009; 80:24-9. [DOI: 10.1016/j.resuscitation.2008.09.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2008] [Revised: 08/18/2008] [Accepted: 09/03/2008] [Indexed: 11/30/2022]
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Bayley R, Weinger M, Meador S, Slovis C. Impact of ambulance crew configuration on simulated cardiac arrest resuscitation. PREHOSP EMERG CARE 2008; 12:62-8. [PMID: 18189180 DOI: 10.1080/10903120701708011] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Despite the widespread use of both two paramedic and single paramedic ambulance crews, there is little evidence regarding differences between these two staffing configurations in the delivery of patient care. OBJECTIVES To determine potential differences in care provided by each of these ambulance configurations in the resuscitation of a cardiac arrest victim in ventricular fibrillation. METHODS Fifteen paramedic-paramedic and 15 paramedic-EMT crews were recruited to perform resuscitation on a high-fidelity human simulator (Laerdal SimMan). Errors and their nature, time to critical interventions, and compliance with continuous cardiopulmonary resuscitation (CPR) were captured by the simulator and videotape. RESULTS Two paramedic crews averaged 0.7 +/- 0.5 more errors of commission, 0.5 +/- 0.4 more errors of sequence, and 0.8 +/- 0.8 more total errors per resuscitation (+/- 95% CI; p = 0.008, 0.017, and 0.036, respectively). For all interventions analyzed, only time required to achieve intubation differed between the two configurations, with two paramedic crews intubating 63.9 +/- 45.8 seconds more quickly (p = 0.009). CPR compliance was highly variable, and a meaningful statistical difference could not be determined, although performance overall was poor, with both configurations averaging less than 50% compliance. CONCLUSION Two paramedic crews were more error-prone and did not perform most interventions more rapidly with the exception of intubation. These data do not support the proposition that two paramedic crews provide higher quality cardiac care than paramedic-EMT crews in a simulated ventricular fibrillation arrest.
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Affiliation(s)
- Ryan Bayley
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee 37232-4700, USA.
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Trabold B, Schmidt C, Schneider B, Akyol D, Gutsche M. Application of three airway devices during emergency medical training by health care providers—a manikin study. Am J Emerg Med 2008; 26:783-8. [DOI: 10.1016/j.ajem.2007.11.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2007] [Revised: 11/05/2007] [Accepted: 11/06/2007] [Indexed: 11/30/2022] Open
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Abstract
PURPOSE OF REVIEW There is correlation between quality of bystander cardiopulmonary resuscitation and patient survival. Recent developments in defibrillator technology enable recording of cardiopulmonary resuscitation quality, and have shown quality of professional cardiopulmonary resuscitation far from guidelines' levels for factors such as chest compression depth and rate, ventilation rate, and pauses in chest compressions. The effects of cardiopulmonary resuscitation quality factors on patient survival are presently under scrutiny. RECENT FINDINGS Factors such as depth of and pauses in chest compressions immediately before defibrillation attempts affect outcome. Both immediate automated feedback on cardiopulmonary resuscitation quality and use of the same quality data during postevent debriefing improve cardiopulmonary resuscitation quality, and the combination appears to improve outcome. The increased awareness of quality problems, particularly unwanted pauses in chest compressions, has caused more emphasis on chest compressions in cardiopulmonary resuscitation protocols including the 2005 Guidelines. There is a growing number of reports of increased survival with these new protocols. SUMMARY Cardiopulmonary resuscitation quality affects survival after cardiac arrest. Reporting cardiopulmonary resuscitation quality data should be standard in all studies of cardiac arrest as effects of studied interventions can depend on or influence cardiopulmonary resuscitation quality. These data are also valuable in quality improvement processes both in-hospital and out-of-hospital.
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Abstract
PURPOSE OF REVIEW Numerous recent reports have described limitations in the quality of cardiopulmonary resuscitation. Thus, there has been increasing interest in the techniques available to monitor quality. This review focuses on the major publications since the review published by the International Liaison Committee on Resuscitation in 2005. Some key articles published prior to this time period have also been included. RECENT FINDINGS A number of devices can monitor various components of the quality of cardiopulmonary resuscitation. End-tidal CO2 measurement assists in confirming placement of endotracheal tubes, correlates with cardiac output and detects the return of spontaneous circulation. Turbine flow-meters monitor respiratory rate and tidal volume. Transthoracic impedance monitoring measures respiratory rate, and may assist in confirmation of endotracheal tube placement. A new mechanical device (CPREzy) and a new defibrillator/monitor allow estimation of depth (and rate) of compressions. Ventricular-fibrillation waveform analysis may facilitate better timing of defibrillation. Echocardiography detects conditions that may impair the quality of cardiopulmonary resuscitation. SUMMARY Many options are available to monitor the quality of cardiopulmonary resuscitation. Some have significant limitations, and others are only readily available in hospital. The use of the information from this more intensive monitoring promises to improve outcomes of cardiopulmonary resuscitation.
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Affiliation(s)
- Peter T Morley
- Intensive Care Unit, Royal Melbourne Hospital, Parkville, Victoria, Australia.
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Time used for ventilation in two-rescuer CPR with a bag-valve-mask device during out-of-hospital cardiac arrest. Resuscitation 2008; 77:57-62. [PMID: 18164533 DOI: 10.1016/j.resuscitation.2007.11.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2007] [Revised: 10/02/2007] [Accepted: 11/02/2007] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Professional rescuers only deliver chest compressions 39% of the available time before intubation during out-of-hospital cardiac arrest. In manikin-studies lay rescuers need approximately 15s to deliver two ventilations. It is not known how much time professional rescuers use for two ventilations and we hypothesised that the time used for two ventilations with a bag-valve-mask device before tracheal intubation is longer than recommended and that the extended time contributes to the high no flow time. METHODS Quality of CPR was available for analysis in 628 cases of out-of-hospital cardiac arrest in the ambulance service in Oslo, Akershus, London, and Stockholm from 2002 to 2005. The 2000 Guidelines were used as the reference. Ventilations were registered from changes in transthoracic impedance as measured through the standard defibrillation pads. We included episodes only with CPR with a 15:2 pattern for at least 1 min and identified all pauses between chest compressions before intubation. RESULTS In the remaining 172 episodes we identified 3097 chest compression pauses. In 1587 (51%) of the pauses we identified two ventilations and a mean pause length for each episode was calculated. The median of these means was 5.5s (IQR; 4.5, 7). These pauses comprised a median 9% (IQR; 4%, 15%) of the time before intubation in these episodes. In 892 (29%) of the pauses we identified a different number of ventilations, or other interventions in addition to ventilation. In the remaining 618 pauses (20%) no ventilations were registered. CONCLUSIONS Professional rescuers delivered two bag-valve-mask ventilations within the 5-6s as indicated in the 2000 Guidelines, slightly longer than the 3-4s recommended in the 2005 Guidelines. However, only half the pauses were used for two ventilations, and the total time for two ventilations accounted for only 27% of the time without chest compressions. Excessive time for ventilation cannot explain the high no-flow time during CPR by professional rescuers before intubation.
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Pichon N, Amiel JB, François B, Dugard A, Etchecopar C, Vignon P. Efficacy of and tolerance to mild induced hypothermia after out-of-hospital cardiac arrest using an endovascular cooling system. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2008; 11:R71. [PMID: 17598898 PMCID: PMC2206437 DOI: 10.1186/cc5956] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2007] [Revised: 05/22/2007] [Accepted: 06/28/2007] [Indexed: 11/29/2022]
Abstract
Introduction We evaluated the efficacy of and tolerance to mild therapeutic hypothermia achieved using an endovascular cooling system, and its ability to reach and maintain a target temperature of 33°C after cardiac arrest. Methods This study was conducted in the medical-surgical intensive care unit of an urban university hospital. Forty patients admitted to the intensive care unit following out-of-hospital cardiac arrest underwent mild induced hypothermia (MIH). Core temperature was monitored continuously for five days using a Foley catheter equipped with a temperature sensor. Any equipment malfunction was noted and all adverse events attributable to MIH were recorded. Neurological status was evaluated daily using the Pittsburgh Cerebral Performance Category (CPC). We also recorded the mechanism of cardiac arrest, the Simplified Acute Physiologic Score II on admission, standard biological variables, and the estimated time of anoxia. Nosocomial infections during and after MIH until day 28 were recorded. Results Six patients (15%) died during hypothermia. Among the 34 patients who completed the period of MIH, hypothermia was steadily maintained in 31 patients (91%). Post-rewarming 'rebound hyperthermia', defined as a temperature of 38.5°C or greater, was observed in 25 patients (74%) during the first 24 hours after cessation of MIH. Infectious complications were observed in 18 patients (45%), but no patient developed severe sepsis or septic shock. The biological changes that occurred during MIH manifested principally as hypokalaemia (< 3.5 mmol/l; in 75% of patients). Conclusion The intravascular cooling system is effective, safe and allows a target temperature to be reached fairly rapidly and steadily over a period of 36 hours.
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Affiliation(s)
- Nicolas Pichon
- Intensive Care Unit, Dupuytren University Hospital, 2 Avenue Martin Luther King, 87000, Limoges, France
| | - Jean Bernard Amiel
- Intensive Care Unit, Dupuytren University Hospital, 2 Avenue Martin Luther King, 87000, Limoges, France
| | - Bruno François
- Intensive Care Unit, Dupuytren University Hospital, 2 Avenue Martin Luther King, 87000, Limoges, France
| | - Anthony Dugard
- Intensive Care Unit, Dupuytren University Hospital, 2 Avenue Martin Luther King, 87000, Limoges, France
| | - Caroline Etchecopar
- Department of Cardiology, Dupuytren University Hospital, 2 Avenue Martin Luther King, 87000, Limoges, France
| | - Philippe Vignon
- Intensive Care Unit, Dupuytren University Hospital, 2 Avenue Martin Luther King, 87000, Limoges, France
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Kramer-Johansen J, Eilevstjønn J, Olasveengen TM, Tomlinson AE, Dorph E, Steen PA. Transthoracic impedance changes as a tool to detect malpositioned tracheal tubes. Resuscitation 2008; 76:11-6. [PMID: 17719166 DOI: 10.1016/j.resuscitation.2007.07.021] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2007] [Revised: 06/27/2007] [Accepted: 07/04/2007] [Indexed: 11/27/2022]
Abstract
BACKGROUND Undetected malpositioned or dislodged ventilation tubes during cardiac arrest have fatal consequences, and no single method can detect the tube position reliably during such low-flow states. We wanted to test the ability of impedance changes as measured across the chest via the standard defibrillation pads to distinguish between oesophageal and tracheal ventilations in non-circulated patients. MATERIALS AND METHODS After the end of futile resuscitation transthoracic impedance was measured with a prototype defibrillator, and ventilation variables were collected with a spirometer-capnography unit during tracheal ventilations and after repositioning of the tube; during oesophageal ventilations for paired comparisons. RESULTS We registered 123 oesophageal and 178 tracheal ventilations in nine patients. Transthoracic impedance changes associated with ventilations were always larger during tracheal than oesophageal ventilations (mean difference 1.3 ohms (95% CI 1.0, 1.5), P<0.001), and all such changes above 1.2 ohms were associated with tracheal ventilations, while changes below 0.4 ohms always were associated with oesophageal ventilations. By subtracting 0.5 ohms from the individual mean transthoracic change associated with tracheal ventilations, tube position was predicted with sensitivity 0.99 and specificity 0.97. CONCLUSION Transthoracic impedance changes may be used to detect malpositioned and dislodged tubes also during situations without spontaneous circulation. Our predictive values must be retested in another population.
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Affiliation(s)
- Jo Kramer-Johansen
- Institute for Experimental Medical Research, Ullevål University Hospital, N-0407 Oslo, Norway.
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Nolan J. Strategies to prevent unrecognised oesophageal intubation during out-of-hospital cardiac arrest. Resuscitation 2008; 76:1-2. [DOI: 10.1016/j.resuscitation.2007.11.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Jäntti H, Kuisma M, Uusaro A. The effects of changes to the ERC resuscitation guidelines on no flow time and cardiopulmonary resuscitation quality: A randomised controlled study on manikins. Resuscitation 2007; 75:338-44. [PMID: 17628319 DOI: 10.1016/j.resuscitation.2007.05.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2007] [Revised: 04/30/2007] [Accepted: 05/02/2007] [Indexed: 11/30/2022]
Abstract
AIM OF THE STUDY The European Resuscitation Council (ERC) guidelines changed in 2005. We investigated the impact of these changes on no flow time and on the quality of cardiopulmonary resuscitation (CPR). MATERIALS AND METHODS Simulated cardiac arrest (CA) scenarios were managed randomly in manikins using ERC 2000 or 2005 guidelines. Pairs of paramedics/paramedic students treated 34 scenarios with 10min of continuous ventricular fibrillation. The rhythm was analysed and defibrillation shocks were delivered with a semi-automatic defibrillator, and breathing was assisted with a bag-valve-mask; no intravenous medication was given. Time factors related to human intervention and time factors related to device, rhythm analysis, charging and defibrillation were analysed for their contribution to no flow time (time without chest compression). Chest compression quality was also analysed. RESULTS No flow time (mean+/-S.D.) was 66+/-3% of CA time with ERC 2000 and 32+/-4% with ERC 2005 guidelines (P<0.001). Human factor interventions occupied 114+/-4s (ERC 2000) versus 107+/-4s (ERC 2005) during 600-s scenarios (P=0.237). Device factor interventions took longer using ERC 2000 guidelines: 290+/-19s versus 92+/-15s (P<0.001). The total number of chest compressions was higher with ERC 2005 guidelines (808+/-92s versus 458+/-90s, P<0.001), but the quality of CPR did not differ between the groups. CONCLUSIONS The use of a single shock sequence with guidelines 2005 has decreased the no flow time during CPR when compared with guidelines 2000 with multiple shocks.
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Affiliation(s)
- H Jäntti
- Department of Anaesthesia and Intensive Care, Kuopio University Hospital, PO Box 1777, FIN-70210 Kuopio, Finland.
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Kramer-Johansen J, Edelson DP, Losert H, Köhler K, Abella BS. Uniform reporting of measured quality of cardiopulmonary resuscitation (CPR). Resuscitation 2007; 74:406-17. [PMID: 17391831 DOI: 10.1016/j.resuscitation.2007.01.024] [Citation(s) in RCA: 168] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2006] [Revised: 01/11/2007] [Accepted: 01/17/2007] [Indexed: 11/25/2022]
Abstract
BACKGROUND CPR quality is an important determinant of cardiac arrest outcome. Recent investigations have demonstrated that quality of clinical CPR is variable and often not in compliance with international consensus guidelines. The 2005 update of these guidelines included new recommendations for the measurement of resuscitation and CPR performance and the institution of measures to improve resuscitation care. Common definitions and reporting templates need to be established for the variables of CPR quality. This will allow for meaningful comparisons between treatment groups in clinical trials as well as a common system for quality improvement and documentation of this improvement. METHODS/RESULTS In this report, we present the results from an international consensus working group to propose common definitions and criteria for reporting variables of CPR quality, based on the best available data for the importance of various CPR variables. The recommendations are discussed in light of the different purposes outlined above.
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Affiliation(s)
- Jo Kramer-Johansen
- Institute for Experimental Medical Research, Ullevaal University Hospital, N-0407 Oslo, Norway.
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Brucke M, Helm M, Schwartz A, Lampl L. Two rescuer resuscitation—Mission impossible? Resuscitation 2007; 74:317-24. [PMID: 17367912 DOI: 10.1016/j.resuscitation.2006.12.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2006] [Revised: 12/08/2006] [Accepted: 12/13/2006] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Advanced life support (ALS) in a cardiac arrest is usually performed by a team consisting of three people. The medical team of a Helicopter Emergency Medical Service (HEMS) often consists of two rescuers only. Due to that reason an algorithm was developed to provide ALS with two people. During the initial phase the rescuer in the over-the-head position provides one man CPR while the second rescuer prepares all advanced measures. When all preparations are complete both rescuers are able to provide ALS. MATERIAL AND METHODS A computer controlled manikin (Ambu Mega Code Simulator System MCS with online documentation was used to test the entire medical staff during 10 min of persistent VF. RESULTS The 20 teams were tested. Following data were recorded: no-flow-time 96.4+/-11s (16.1+/-1.8%), chest compression frequency 120.1+/-5.1 min (-1), ventilation frequency=9 min (-1), number of chest compressions per session 1013.7+/-45.9, depth of chest compressions 46.6+/-2.5mm, total number of chest compressions=20,274, total number of ventilations=1893. For ALS measures the following data were recorded: tracheal intubation (TI) was finished after 60.7+/-9.8s, duration of TI : maneuver = 15.7+/-4.4s, end of initial phase=188.9+/-26.3s, i.v. administration of adrenaline after 387.7+/-33.6s, i.v. administration of amiodarone after 507.9+/-36.9s and four shocks after: 138.0+/-15.9, 266.8+/-16.1, 398.0+/-20.1 and 526.8+/-23.6s. CONCLUSION We proved the feasibility of the algorithm in a manikin setting. Further observations have to prove the algorithm in real CPR situations.
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Affiliation(s)
- Markus Brucke
- German Armed Forces Medical Centre, Department of Anaesthesiology and Intensive Care Medicine, Ulm, Germany.
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Pytte M, Olasveengen TM, Steen PA, Sunde K. Misplaced and dislodged endotracheal tubes may be detected by the defibrillator during cardiopulmonary resuscitation. Acta Anaesthesiol Scand 2007; 51:770-2. [PMID: 17465971 DOI: 10.1111/j.1399-6576.2007.01317.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We present two cases of unrecognized endotracheal tube misplacements in out-of-hospital cardiopulmonary resuscitation recognized by the analysis of transthoracic impedance. In Case 1, ventilation-induced changes in transthoracic impedance disappeared after an intubation attempt corresponding to oesophageal intubation. This was clinically recognized after several minutes, the endotracheal tube was repositioned and alterations in transthoracic impedance resumed. In Case 2, the initial ventilation-induced signal change following endotracheal intubation weakened after a few minutes. At that time, the defibrillator gave vocal and visual feedback to the rescuers on ventilatory inactivity, a pharyngeal air leak was discovered simultaneously and the tube was found to be dislodged. Continuous monitoring of transthoracic impedance provided by the defibrillator during cardiopulmonary resuscitation may contribute to the early detection of an initially misplaced or later dislodged endotracheal tube.
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Affiliation(s)
- M Pytte
- Institute for Experimental Medical Research, Ullevål University Hospital, Oslo, Norway.
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Tomlinson AE, Nysaether J, Kramer-Johansen J, Steen PA, Dorph E. Compression force–depth relationship during out-of-hospital cardiopulmonary resuscitation. Resuscitation 2007; 72:364-70. [PMID: 17141936 DOI: 10.1016/j.resuscitation.2006.07.017] [Citation(s) in RCA: 131] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2006] [Revised: 07/08/2006] [Accepted: 07/13/2006] [Indexed: 11/26/2022]
Abstract
BACKGROUND Recent clinical studies reporting the high frequency of inadequate chest compression depth (<38 mm) during CPR, have prompted the question if adult human chest characteristics render it difficult to attain the recommended compression depth in certain patients. MATERIAL AND METHODS Using a specially designed monitor/defibrillator equipped with a sternal pad fitted with an accelerometer and a pressure sensor, compression force and depth was measured during CPR in 91 adult out-of-hospital cardiac arrest patients. RESULTS There was a strong non-linear relationship between the force of compression and depth achieved. Mean applied force for all patients was 30.3+/-8.2 kg and mean absolute compression depth 42+/-8 mm. For 87 of 91 patients 38 mm compression depth was obtained with less than 50 kg. Stiffer chests were compressed more forcefully than softer chests (p<0.001), but softer chests were compressed more deeply than stiffer chests (p=0.001). The force needed to reach 38 mm compression depth (F38) and mean compression force were higher for males than for females: 29.8+/-14.5 kg versus 22.5+/-10.2 kg (p<0.02), and 32.0+/-8.3 kg versus 27.0+/-7.0 kg (p<0.01), respectively. There was no significant variation in F38 or compression depth with age, but a significant 1.5 kg mean decrease in applied force for each 10 years increase in age (p<0.05). Chest stiffness decreased significantly (p<0.0001) with an increasing number of compressions performed. Average residual force during decompression was 1.7+/-1.0 kg, corresponding to an average residual depth of 3+/-2 mm. CONCLUSION In most out-of-hospital cardiac arrest victims adequate chest compression depth can be achieved by a force<50 kg, indicating that an average sized and fit rescuer should be able to perform effective CPR in most adult patients.
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Affiliation(s)
- A E Tomlinson
- Institute for Experimental Medical Research, Ulleval University Hospital, N-0407 Oslo, Norway
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