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Hubble MW, Martin M, Houston S, Taylor S, Kaplan GR. Influence of Patient Weight on Prehospital Advanced Airway Procedure Success Rates. PREHOSP EMERG CARE 2024:1-8. [PMID: 38569075 DOI: 10.1080/10903127.2024.2338459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 03/18/2024] [Indexed: 04/05/2024]
Abstract
OBJECTIVE Previous investigations of the relationship between obesity and difficult airway management have provided mixed results. Almost universally, these studies were conducted in the hospital setting, and the influence of patient body weight on successful prehospital airway management remains unclear. Because patient weight could be one readily identifiable risk factor for problematic airway interventions, we sought to evaluate this relationship. METHODS We conducted a retrospective analysis using the 2020 ESO Data Collaborative dataset. The inclusion criteria consisted of adult patients weighing >30kg with an attempted orotracheal intubation (OTI) and/or blind insertion airway device (BIAD) placement. Separate logistic regression models were developed to determine the influence of weight (dichotomized at 100 kg) on cumulative procedure success for OTI and BIAD, and linear regression models were used to identify trends for each across weight strata. RESULTS A total of 45,344 patients met inclusionary criteria, among which 40,668(89.7%) suffered from a medical emergency, followed by 3,130(6.9%) with traumatic injuries, and 1,546(3.4%) attributable to a combined medical-trauma etiology. Cardiac arrest occurred either prior to EMS arrival or at some point during EMS care in 38,210(84.3%) patients. OTI was attempted in 18,153(40.0%) patients, while 21,597(47.6%) had a BIAD attempt and 5,594(12.3%) had both airway types attempted. The overall cumulative insertion success rates for OTI and BIAD were 79.5% and 92.7%, respectively. Altogether, 2,711(6.0%) had no advanced airway of any type successfully placed, which represents the overall failed advanced airway rate. After controlling for patient age, sex, minority status, and call type (medical vs. trauma), weight >100kg was associated with decreased likelihood of cumulative OTI success (OR = 0.64, p < 0.001), but higher likelihood of cumulative BIAD success (OR = 1.31, p < 0.001). Cumulative OTI success was associated with a negative 0.6% linear trend per 5 kg of body weight (p < 0.001) while cumulative BIAD success had a 0.2% positive trend (p < 0.001). CONCLUSION This retrospective analysis of a national EMS database revealed that increasing patient weight was negatively associated with intubation success. A positive, but smaller, linear trend was observed for BIAD placement. Patient weight may be an easily identifiable predictor of difficult oral intubation and may be a consideration when selecting an airway management strategy.
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Affiliation(s)
- Michael W Hubble
- Department of Emergency Medical Science, Wake Technical Community College, Raleigh, North Carolina
| | - Melisa Martin
- Department of Health Care Administration, Methodist University, Fayetteville, North Carolina
| | - Sara Houston
- Office of Emergency Services, Durham County EMS, Durham, North Carolina
| | - Stephen Taylor
- Emergency Medicine, East Carolina University, Greenville, North Carolina
| | - Ginny R Kaplan
- Department of Health Care Administration & Advanced Paramedicine, Methodist University, Fayetteville, North Carolina
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2
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Weigeldt M, Schulz-Drost S, Stengel D, Lefering R, Treskatsch S, Berger C. In-hospital mortality after prehospital endotracheal intubation versus alternative methods of airway management in trauma patients. A cohort study from the TraumaRegister DGU®. Eur J Trauma Emerg Surg 2024:10.1007/s00068-024-02498-8. [PMID: 38509186 DOI: 10.1007/s00068-024-02498-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 03/10/2024] [Indexed: 03/22/2024]
Abstract
PURPOSE Prehospital airway management in trauma is a key component of care and is associated with particular risks. Endotracheal intubation (ETI) is the gold standard, while extraglottic airway devices (EGAs) are recommended alternatives. There is limited evidence comparing their effectiveness. In this retrospective analysis from the TraumaRegister DGU®, we compared ETI with EGA in prehospital airway management regarding in-hospital mortality in patients with trauma. METHODS We included cases only from German hospitals with a minimum Abbreviated Injury Scale score ≥ 2 and age ≥ 16 years. All patients without prehospital airway protection were excluded. We performed a multivariate logistic regression to adjust with the outcome measure of hospital mortality. RESULTS We included n = 10,408 cases of whom 92.5% received ETI and 7.5% EGA. The mean injury severity score was higher in the ETI group (28.8 ± 14.2) than in the EGA group (26.3 ± 14.2), and in-hospital mortality was comparable: ETI 33.0%; EGA 30.7% (27.5 to 33.9). After conducting logistic regression, the odds ratio for mortality in the ETI group was 1.091 (0.87 to 1.37). The standardized mortality ratio was 1.04 (1.01 to 1.07) in the ETI group and 1.1 (1.02 to 1.26) in the EGA group. CONCLUSIONS There was no significant difference in mortality rates between the use of ETI or EGA, or the ratio of expected versus observed mortality when using ETI.
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Affiliation(s)
- Moritz Weigeldt
- Department of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany.
| | | | - Dirk Stengel
- BG Kliniken - Hospital Group of the German Federal Statutory Accident Insurance, Leipziger Platz 1, 10117, Berlin, Germany
| | - Rolf Lefering
- Institute for Research in Operative Medicine (IFOM), Faculty of Health, Witten/Herdecke University, 51109, Cologne, Germany
- Committee On Emergency Medicine, Intensive Care and Trauma Management (Sektion NIS) of the German Trauma Society (DGU), Berlin, Germany
| | - Sascha Treskatsch
- Department of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Christian Berger
- Department of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
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3
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Gómez-Ríos MÁ, Sastre JA, Onrubia-Fuertes X, López T, Abad-Gurumeta A, Casans-Francés R, Gómez-Ríos D, Garzón JC, Martínez-Pons V, Casalderrey-Rivas M, Fernández-Vaquero MÁ, Martínez-Hurtado E, Martín-Larrauri R, Reviriego-Agudo L, Gutierrez-Couto U, García-Fernández J, Serrano-Moraza A, Rodríguez Martín LJ, Camacho Leis C, Espinosa Ramírez S, Fandiño Orgeira JM, Vázquez Lima MJ, Mayo-Yáñez M, Parente-Arias P, Sistiaga-Suárez JA, Bernal-Sprekelsen M, Charco-Mora P. Spanish Society of Anesthesiology, Reanimation and Pain Therapy (SEDAR), Spanish Society of Emergency and Emergency Medicine (SEMES) and Spanish Society of Otolaryngology, Head and Neck Surgery (SEORL-CCC) Guideline for difficult airway management. Part II. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2024; 71:207-247. [PMID: 38340790 DOI: 10.1016/j.redare.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 08/28/2023] [Indexed: 02/12/2024]
Abstract
The Airway Management section of the Spanish Society of Anesthesiology, Resuscitation, and Pain Therapy (SEDAR), the Spanish Society of Emergency Medicine (SEMES), and the Spanish Society of Otorhinolaryngology and Head and Neck Surgery (SEORL-CCC) present the Guide for the comprehensive management of difficult airway in adult patients. Its principles are focused on the human factors, cognitive processes for decision-making in critical situations, and optimization in the progression of strategies application to preserve adequate alveolar oxygenation in order to enhance safety and the quality of care. The document provides evidence-based recommendations, theoretical-educational tools, and implementation tools, mainly cognitive aids, applicable to airway management in the fields of anesthesiology, critical care, emergencies, and prehospital medicine. For this purpose, an extensive literature search was conducted following PRISMA-R guidelines and was analyzed using the GRADE methodology. Recommendations were formulated according to the GRADE methodology. Recommendations for sections with low-quality evidence were based on expert opinion through consensus reached via a Delphi questionnaire.
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Affiliation(s)
- M Á Gómez-Ríos
- Anesthesiology and Perioperative Medicine, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain.
| | - J A Sastre
- Anesthesiology and Perioperative Medicine, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - X Onrubia-Fuertes
- Department of Anesthesiology, Hospital Universitary Dr Peset, Valencia, Spain
| | - T López
- Anesthesiology and Perioperative Medicine, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - A Abad-Gurumeta
- Department of Anesthesiology, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - R Casans-Francés
- Department of Anesthesiology, Hospital Universitario Infanta Elena, Valdemoro, Madrid, Spain
| | | | - J C Garzón
- Anesthesiology and Perioperative Medicine, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - V Martínez-Pons
- Department of Anesthesiology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - M Casalderrey-Rivas
- Department of Anesthesiology. Complejo Hospitalario Universitario de Ourense, Ourense, Spain
| | - M Á Fernández-Vaquero
- Department of Anesthesiology, Hospital Clínica Universitaria de Navarra, Madrid, Spain
| | - E Martínez-Hurtado
- Department of Anesthesiology, Hospital Universitario Infanta Leonor, Madrid, Spain
| | | | - L Reviriego-Agudo
- Department of Anesthesiology, Hospital Clínico Universitario, Valencia, Spain
| | - U Gutierrez-Couto
- Biblioteca, Complejo Hospitalario Universitario de Ferrol (CHUF), Ferrol, A Coruña, Spain
| | - J García-Fernández
- Department of Anesthesiology, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, Spain; President of the Spanish Society of Anesthesiology, Resuscitation and Pain Therapy (SEDAR), Spain
| | | | | | | | | | - J M Fandiño Orgeira
- Emergency Department, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - M J Vázquez Lima
- Emergency Department, Hospital do Salnes, Vilagarcía de Arousa, Pontevedra, Spain; President of the Spanish Emergency Medicine Society (SEMES), Spain
| | - M Mayo-Yáñez
- Department of Otorhinolaryngology/Head Neck Surgery, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - P Parente-Arias
- Department of Otorhinolaryngology/Head Neck Surgery, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - J A Sistiaga-Suárez
- Department of Otorhinolaryngology, Hospital Universitario Donostia, Donostia, Gipuzkoa, Spain
| | - M Bernal-Sprekelsen
- Department of Otorhinolaryngology, Hospital Clínic Barcelona, University of Barcelona, Barcelona, Spain; President of the Spanish Society for Otorhinolaryngology Head & Neck Surgery (SEORL-CCC), Spain
| | - P Charco-Mora
- Department of Anesthesiology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
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Forestell B, Ramsden S, Sharif S, Centofanti J, Al Lawati K, Fernando SM, Welsford M, Nichol G, Nolan JP, Rochwerg B. Supraglottic Airway Versus Tracheal Intubation for Airway Management in Out-of-Hospital Cardiac Arrest: A Systematic Review, Meta-Analysis, and Trial Sequential Analysis of Randomized Controlled Trials. Crit Care Med 2024; 52:e89-e99. [PMID: 37962112 DOI: 10.1097/ccm.0000000000006112] [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] [Indexed: 11/15/2023]
Abstract
OBJECTIVES Given the uncertainty regarding the optimal approach for airway management for adult patients with out-of-hospital cardiac arrest (OHCA), we conducted a systematic review and meta-analysis to compare the use of supraglottic airways (SGAs) with tracheal intubation for initial airway management in OHCA. DATA SOURCES We searched MEDLINE, PubMed, Embase, Cochrane Library, as well as unpublished sources, from inception to February 7, 2023. STUDY SELECTION We included randomized controlled trials (RCTs) of adult OHCA patients randomized to SGA compared with tracheal intubation for initial prehospital airway management. DATA EXTRACTION Reviewers screened abstracts, full texts, and extracted data independently and in duplicate. We pooled data using a random-effects model. We used the modified Cochrane risk of bias 2 tool and assessed certainty of evidence using the Grading Recommendations Assessment, Development, and Evaluation approach. We preregistered the protocol on PROSPERO (CRD42022342935). DATA SYNTHESIS We included four RCTs ( n = 13,412 patients). Compared with tracheal intubation , SGA use probably increases return of spontaneous circulation (ROSC) (relative risk [RR] 1.09; 95% CI, 1.02-1.15; moderate certainty) and leads to a faster time to airway placement (mean difference 2.5 min less; 95% CI, 1.6-3.4 min less; high certainty). SGA use may have no effect on survival at longest follow-up (RR 1.06; 95% CI, 0.84-1.34; low certainty), has an uncertain effect on survival with good functional outcome (RR 1.11; 95% CI, 0.82-1.50; very low certainty), and may have no effect on risk of aspiration (RR 1.04; 95% CI, 0.94 to 1.16; low certainty). CONCLUSIONS In adult patients with OHCA, compared with tracheal intubation, the use of SGA for initial airway management probably leads to more ROSC, and faster time to airway placement, but may have no effect on longer-term survival outcomes or aspiration events.
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Affiliation(s)
- Ben Forestell
- Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Sophie Ramsden
- Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Sameer Sharif
- Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, ON, Canada
- Division of Critical Care Medicine, Department of Medicine, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada
- Department of Critical Care, Lakeridge Health Corporation, Oshawa, ON, Canada
- Departments of Emergency Medicine and Medicine, Harborview Center for Prehospital Emergency Care, University of Washington, Seattle, WA
- Warwick Clinical Trials Unit, University of Warwick, Coventry, United Kingdom
- Department of Anesthesia and Intensive Care Medicine, Royal United Hospital, Bath, United Kingdom
| | - John Centofanti
- Division of Critical Care Medicine, Department of Medicine, McMaster University, Hamilton, ON, Canada
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada
| | - Kumait Al Lawati
- Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, ON, Canada
- Division of Critical Care Medicine, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Shannon M Fernando
- Department of Critical Care, Lakeridge Health Corporation, Oshawa, ON, Canada
| | - Michelle Welsford
- Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Graham Nichol
- Departments of Emergency Medicine and Medicine, Harborview Center for Prehospital Emergency Care, University of Washington, Seattle, WA
| | - Jerry P Nolan
- Warwick Clinical Trials Unit, University of Warwick, Coventry, United Kingdom
- Department of Anesthesia and Intensive Care Medicine, Royal United Hospital, Bath, United Kingdom
| | - Bram Rochwerg
- Division of Critical Care Medicine, Department of Medicine, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
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5
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Katabami K, Kimura T, Hirata T, Tamakoshi A. Association Between Advanced Airway Management With Adrenaline Injection and Prognosis in Adult Patients With Asystole Asphyxia Out-of-hospital Cardiac Arrest. J Epidemiol 2024; 34:31-37. [PMID: 36709978 PMCID: PMC10701249 DOI: 10.2188/jea.je20220240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 12/26/2022] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND The neurological prognosis of asphyxia is poor and the effect of advanced airway management (AAM) in the prehospital setting remains unclear. This study aimed to evaluate the association between AAM with adrenaline injection and prognosis in adult patients with asystole asphyxia out-of-hospital cardiac arrest (OHCA). METHODS This study assessed all-Japan Utstein cohort registry data between January 1, 2013 and December 31, 2019. We used propensity score matching analyses before logistic regression analysis to evaluate the effect of AAM on favorable neurological outcome. RESULTS There were 879,057 OHCA cases, including 70,299 cases of asphyxia OHCAs. We extracted the data of 13,642 cases provided with adrenaline injection by emergency medical service. We divided 7,945 asphyxia OHCA cases in asystole into 5,592 and 2,353 with and without AAM, respectively. After 1:1 propensity score matching, 2,338 asphyxia OHCA cases with AAM were matched with 2,338 cases without AAM. Favorable neurological outcome was not significantly different between the AAM and no AAM groups (adjusted odds ratio [OR] 1.1; 95% confidence interval [CI], 0.5-2.5). However, the return of spontaneous circulation (ROSC) (adjusted OR 1.7; 95% CI, 1.5-1.9) and 1-month survival (adjusted OR 1.5; 95% CI, 1.1-1.9) were improved in the AAM group. CONCLUSION AAM with adrenaline injection for patients with asphyxia OHCA in asystole was associated with improved ROSC and 1-month survival rate but showed no differences in neurologically favorable outcome. Further prospective studies may comprehensively evaluate the effect of AAM for patients with asphyxia.
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Affiliation(s)
- Kenichi Katabami
- Department of Public Health, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Takashi Kimura
- Department of Public Health, Hokkaido University Faculty of Medicine, Sapporo, Japan
| | - Takumi Hirata
- Department of Public Health, Hokkaido University Faculty of Medicine, Sapporo, Japan
- Institute for Clinical and Translational Science, Nara Medical University Hospital, Nara, Japan
| | - Akiko Tamakoshi
- Department of Public Health, Hokkaido University Faculty of Medicine, Sapporo, Japan
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6
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Wang HE. Prehospital Airway Management - the Continued Search for Evidence. PREHOSP EMERG CARE 2023; 28:558-560. [PMID: 38133521 DOI: 10.1080/10903127.2023.2281361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 11/06/2023] [Indexed: 12/23/2023]
Affiliation(s)
- Henry E Wang
- Department Emergency Medicine, The Ohio State University, Columbus, Ohio
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7
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Fuller RG, Rossetto MA, Paulson MW, April MD, Ginde AA, Bebarta VS, Flarity KM, Keenan S, Schauer SG. Market Analysis of Video Laryngoscopy Equipment for the Role 1 Setting. Mil Med 2023; 188:e3482-e3487. [PMID: 37338293 DOI: 10.1093/milmed/usad189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 04/17/2023] [Accepted: 05/10/2023] [Indexed: 06/21/2023] Open
Abstract
INTRODUCTION Airway compromise is the second leading cause of potentially preventable prehospital combat death. Endotracheal intubation (ETI) remains the most common role 1 airway intervention. Video laryngoscopy (VL) is superior to direct laryngoscopy (DL) for first-attempt intubation, especially in less-experienced providers and for trauma patients. The cost has been a major challenge in pushing VL technology far-forward; however, the cost of equipment continues to become more affordable. We conducted a market analysis of VL devices under $10,000 for possible options for role 1. MATERIALS AND METHODS We searched Google, PubMed, and the Food and Drug Administration database from August 2022 to January 2023 with a combination of several keywords to identify current VL market options under $10,000. After identifying relevant manufacturers, we then reviewed individual manufacturer or distributor websites for pricing data and system specifications. We noted several characteristics regarding VL device design for comparison. These include monitor features, size, modularity, system durability, battery life, and reusability. When necessary, we requested formal price quotes from respective companies. RESULTS We identified 17 VL options under $10,000 available for purchase, 14 of which were priced below $5,000 for individual units. Infium (n = 3) and Vimed Medical (n = 4) provided the largest number of unique models. VL options under $10,000 exist in both reusable and disposable modalities. These modalities included separate monitors as well as monitors attached to the VL handle. Disposable options, on a per-unit basis, cost less than reusable options. CONCLUSIONS Several VL options exist within our goal price point in both reusable and disposable options. Clinical studies assessing the technology performance of ETI and deliberate downselection are needed to identify the most cost-effective solution for role 1 dispersion.
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Affiliation(s)
- Robert G Fuller
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO 80045, USA
- Center for COMBAT Research, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Marika A Rossetto
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO 80045, USA
- Center for COMBAT Research, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Matthew W Paulson
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO 80045, USA
- Center for COMBAT Research, University of Colorado School of Medicine, Aurora, CO 80045, USA
- Colorado National Guard Medical Detachment, Buckley Space Force Base, CO 80112, USA
- Department of Emergency Medicine, Denver Health Medical Center, Denver, CO,USA
| | - Michael D April
- 40th Forward Resuscitative Surgical Detachment, Fort Carson, CO 80902, USA
| | - Adit A Ginde
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO 80045, USA
- Center for COMBAT Research, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Vikhyat S Bebarta
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO 80045, USA
- Center for COMBAT Research, University of Colorado School of Medicine, Aurora, CO 80045, USA
- 59th Medical Wing, JBSA Lackland, TX 78236, USA
| | - Kathleen M Flarity
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO 80045, USA
- Center for COMBAT Research, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Sean Keenan
- Center for COMBAT Research, University of Colorado School of Medicine, Aurora, CO 80045, USA
- Joint Trauma System, Defense Health Agency, JBSA Fort Sam Houston, TX, USA
- Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Steven G Schauer
- Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
- Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, TX 78234, USA
- United States Army Institute of Surgical Research, JBSA Fort Sam Houston, TX 78234, USA
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Thierry S, Jaulin F, Starck C, Ariès P, Schmitz J, Kerkhoff S, Bernard CI, Komorowski M, Warnecke T, Hinkelbein J. Evaluation of free-floating tracheal intubation in weightlessness via ice-pick position with a direct laryngoscopy and classic approach with indirect videolaryngoscopy. NPJ Microgravity 2023; 9:73. [PMID: 37684267 PMCID: PMC10491756 DOI: 10.1038/s41526-023-00314-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 08/02/2023] [Indexed: 09/10/2023] Open
Abstract
Long duration spaceflights to the Moon or Mars are at risk for emergency medical events. Managing a hypoxemic distress and performing an advanced airway procedure such as oro-tracheal intubation may be complicated under weightlessness due to ergonomic constraints. An emergency free-floating intubation would be dangerous because of high failure rates due to stabilization issues that prohibits its implementation in a space environment. Nevertheless, we hypothesized that two configurations could lead to a high first-pass success score for intubation performed by a free-floating operator. In a non-randomized, controlled, cross-over simulation study during a parabolic flight campaign, we evaluated and compared the intubation performance of free-floating trained operators, using either a conventional direct laryngoscope in an ice-pick position or an indirect laryngoscopy with a video-laryngoscope in a classic position at the head of a high-fidelity simulation manikin, in weightlessness and in normogravity. Neither of the two tested conditions reached the minimal terrestrial ILCOR recommendations (95% first-pass success) and therefore could not be recommended for general implementation under weightlessness conditions. Free-floating video laryngoscopy at the head of the manikin had a significant better success score than conventional direct laryngoscopy in an ice-pick position. Our results, combined with the preexisting literature, emphasis the difficulties of performing oro-tracheal intubation, even for experts using modern airway devices, under postural instability in weightlessness. ClinicalTrials registration number NCT05303948.
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Affiliation(s)
- Séamus Thierry
- Anaesthesiology Department, South Brittany General Hospital, 56100, Lorient, France.
- Space Medicine Group, European Society of Aerospace Medicine (ESAM), Cologne, Germany.
- Medical Simulation Centre B3S, 56100, Lorient, France.
- Laboratoire Psychologie, Cognition, Communication, Comportement, Université Bretagne Sud, 56000, Vannes, France.
| | - François Jaulin
- Sorbonne Medical University, Assistance Publique des Hôpitaux de Paris, Paris, France
- Human Factor in Healthcare Association, Group FHS, Paris, France
| | - Clément Starck
- Space Medicine Group, European Society of Aerospace Medicine (ESAM), Cologne, Germany
- Anaesthesiology and Intensive Care Department, University Hospital of Brest, 29200, Brest, France
| | - Philippe Ariès
- Anaesthesiology and Intensive Care Department, University Hospital of Brest, 29200, Brest, France
| | - Jan Schmitz
- Space Medicine Group, European Society of Aerospace Medicine (ESAM), Cologne, Germany
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital and Medical Faculty, Cologne, Germany
- German Society of Aerospace Medicine (DGLRM), Munich, Germany
| | - Steffen Kerkhoff
- Space Medicine Group, European Society of Aerospace Medicine (ESAM), Cologne, Germany
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital and Medical Faculty, Cologne, Germany
- German Society of Aerospace Medicine (DGLRM), Munich, Germany
| | - Cécile Isabelle Bernard
- Laboratoire Psychologie, Cognition, Communication, Comportement, Université Bretagne Sud, 56000, Vannes, France
| | - Matthieu Komorowski
- Space Medicine Group, European Society of Aerospace Medicine (ESAM), Cologne, Germany
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Tobias Warnecke
- Space Medicine Group, European Society of Aerospace Medicine (ESAM), Cologne, Germany
- Department of Anaesthesiology, Critical Care, Emergency Medicine and Pain Therapy, Hospital of Oldenburg, Medical Campus University of Oldenburg, Oldenburg, Germany
| | - Jochen Hinkelbein
- Space Medicine Group, European Society of Aerospace Medicine (ESAM), Cologne, Germany
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital and Medical Faculty, Cologne, Germany
- German Society of Aerospace Medicine (DGLRM), Munich, Germany
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9
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Kluj P, Fedorczak M, Gaszyński T, Ratajczyk P. A pilot, prospective trial of IntuBrite® versus Macintosh direct laryngoscopy for paramedic endotracheal intubation in out of hospital cardiac arrest. BMC Emerg Med 2023; 23:70. [PMID: 37349703 PMCID: PMC10288703 DOI: 10.1186/s12873-023-00845-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 06/15/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND Intubation in the case of out-of-hospital cardiac arrest (OHCA) is one of the most difficult procedures for Emergency Medical Services (EMS). The use of a laryngoscope with a dual light source is an interesting alternative to classic laryngoscopes. However, there are as yet no prospective data concerning the use of double light direct laryngoscopy (DL) by paramedics in traditional ground ambulance agencies in OHCA. METHODS We performed a non-blinded trial in a single EMS in Poland within ambulances crews, comparing time and first pass success (FPS) for endotracheal intubation (ETI) in DL using the IntuBrite® (INT) and Macintosh laryngoscope (MCL) during cardiopulmonary resuscitation (CPR). We collected both patient and provider demographic information along with intubation details. The time and success rates were compared using an intention-to-treat analysis. RESULTS Over a period of 40 months, a total of 86 intubations were performed using 42 INT and 44 MCL based on an intention-to-treat analysis. The FPS time of the ETI attempt (13.49 vs. 15.55 s) using an INT which was shorter than MCL was used (p < 0.05). First attempt success (34/42, 80.9% vs. 29/44, 64.4%) was comparable for INT and MCL with no statistical significance. CONCLUSIONS We found a statistically significant difference in intubation attempt time when the INT laryngoscope was used. Intubation first attempt success rates with INT and MCL were comparable with no statistical significance during CPR performed by paramedics. TRIAL REGISTRATION Trial was registered in Clinical Trials: NCT05607836 (10/28/2022).
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Affiliation(s)
- Przemysław Kluj
- Department of Anesthesiology and Intensive Therapy, Medical University of Lodz, Lodz, Poland
| | - Michał Fedorczak
- Department of Anesthesiology and Intensive Therapy, Medical University of Lodz, Lodz, Poland
| | - Tomasz Gaszyński
- Department of Anesthesiology and Intensive Therapy, Medical University of Lodz, Lodz, Poland
| | - Paweł Ratajczyk
- Department of Anesthesiology and Intensive Therapy, Medical University of Lodz, Lodz, Poland
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Kluj P, Fedorczak A, Fedorczak M, Gaszyński T, Kułak C, Wasilewski M, Znyk M, Bartczak M, Ratajczyk P. Comparison of Three Video Laryngoscopes and Direct Laryngoscopy for Emergency Endotracheal Intubation While Wearing PPE-AGP: A Randomized, Crossover, Simulation Trial. Healthcare (Basel) 2023; 11:healthcare11060884. [PMID: 36981541 PMCID: PMC10048466 DOI: 10.3390/healthcare11060884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/10/2023] [Accepted: 03/16/2023] [Indexed: 03/22/2023] Open
Abstract
Background: The COVID-19 pandemic has necessitated changes in the safety protocols of endotracheal intubation at every level of care. This study aimed to compare the first-pass success rates (FPS) and intubation times (IT) of three video laryngoscopes (VL) and direct laryngoscopy (DL) for simulated COVID-19 patient emergency intubation (EI). Methods: The study was a prospective, randomized, crossover trial. Fifty-three active paramedics performed endotracheal intubation with the I-viewTM VL, UESCOPE® VL, ProVu® VL and Macintosh direct laryngoscope (MAC) wearing personal protective equipment for aerosol-generating procedures (PPE-AGP) on a manikin with normal airway conditions. Results: The longest IT was noted when the UESCOPE® (29.4 s) and ProVu® (27.7 s) VL were used. The median IT for I-view was 17.4 s and for MAC DL 17.9 s. The FPS rates were 88.6%, 81.1%, 83.0% and 84.9%, respectively, for I-view, ProVu®, UESCOPE® and MAC DL. The difficulty of EI attempts showed a statistically significant difference between UESCOPE® and ProVu®. Conclusions: The intubation times performed by paramedics in PPE-AGP using UESCOPE® and ProVu® were significantly longer than those with the I-view and Macintosh laryngoscopes. The use of VL by prehospital providers in PPE did not result in more effective EI than the use of a Macintosh laryngoscope.
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Affiliation(s)
- Przemysław Kluj
- Department of Anesthesiology and Intensive Care, Medical University of Lodz, 90-549 Lodz, Poland
- Correspondence:
| | - Anna Fedorczak
- Department of Pediatrics, Nephrology and Immunology, Medical University of Lodz, 93-338 Lodz, Poland
- Department of Endocrinology and Metabolic Diseases, Polish Mother’s Memorial Hospital-Research Institute, 93-338 Lodz, Poland
| | - Michał Fedorczak
- Department of Anesthesiology and Intensive Care, Medical University of Lodz, 90-549 Lodz, Poland
| | - Tomasz Gaszyński
- Department of Anesthesiology and Intensive Care, Medical University of Lodz, 90-549 Lodz, Poland
| | - Cezary Kułak
- Medical Simulation Center, Medical University of Lodz, 92-213 Lodz, Poland (M.Z.)
| | - Mikołaj Wasilewski
- Clinic of Anesthesiology and Intensive Therapy, Medical University of Lodz, 92-213 Lodz, Poland
| | - Mateusz Znyk
- Medical Simulation Center, Medical University of Lodz, 92-213 Lodz, Poland (M.Z.)
| | - Maria Bartczak
- Medical Simulation Center, Medical University of Lodz, 92-213 Lodz, Poland (M.Z.)
| | - Paweł Ratajczyk
- Department of Anesthesiology and Intensive Care, Medical University of Lodz, 90-549 Lodz, Poland
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11
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Bartos JA, Clare Agdamag A, Kalra R, Nutting L, Frascone RJ, Burnett A, Vuljaj N, Lick C, Tanghe P, Quinn R, Simpson N, Peterson B, Haley K, Sipprell K, Yannopoulos D. Supraglottic Airway Devices are Associated with Asphyxial Physiology After Prolonged CPR in Patients with Refractory Out-of-Hospital Cardiac Arrest Presenting for Extracorporeal Cardiopulmonary Resuscitation. Resuscitation 2023; 186:109769. [PMID: 36933882 DOI: 10.1016/j.resuscitation.2023.109769] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 03/08/2023] [Accepted: 03/09/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Multiple randomized clinical trials have compared specific airway management strategies during ACLS with conflicting results. However, patients with refractory cardiac arrest died in almost all cases without the availability of extracorporeal cardiopulmonary resuscitation (ECPR). Our aim was to determine if endotracheal intubation (ETI) was associated with improved outcomes compared to supraglottic airways (SGA) in patients with refractory cardiac arrest presenting for ECPR. METHODS We retrospectively studied 420 consecutive adult patients with refractory out-of-hospital cardiac arrest due to shockable presenting rhythms presenting to the University of Minnesota ECPR program. We compared outcomes between patients receiving ETI (n=179) and SGA (n=204). The primary outcome was the pre-cannulation arterial PaO2 upon arrival to the ECMO cannulation center. Secondary outcomes included neurologically favorable survival to hospital discharge and eligibility for VA-ECMO based upon resuscitation continuation criteria applied upon arrival to the ECMO cannulation center. RESULTS Patients receiving ETI had significantly higher median PaO2 (71 vs. 58 mmHg, p=0.001), lower median PaCO2 (55 vs. 75 mmHg, p<0.001), and higher median pH (7.03 vs. 6.93, p<0.001) compared to those receiving SGA. Patients receiving ETI were also significantly more likely to meet VA-ECMO eligibility criteria (85% vs. 74%, p=0.008). Of patients eligible for VA-ECMO, patients receiving ETI had significantly higher neurologically favorable survival compared to SGA (42% vs. 29%, p=0.02). CONCLUSIONS ETI was associated with improved oxygenation and ventilation after prolonged CPR. This resulted in increased rate of candidacy for ECPR and increased neurologically favorable survival to discharge with ETI compared to SGA. Short Title: Airway Effects in Refractory Cardiac Arrest.
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Affiliation(s)
- Jason A Bartos
- Division of Cardiology, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN, USA; Center for Resuscitation Medicine, University of Minnesota School of Medicine, Minneapolis, MN, USA.
| | - Arianne Clare Agdamag
- Division of Cardiology, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN, USA
| | - Rajat Kalra
- Division of Cardiology, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN, USA
| | - Lindsay Nutting
- Division of Cardiology, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN, USA
| | - R J Frascone
- Department of Emergency Medicine, Regions Hospital, St. Paul, MN, USA
| | - Aaron Burnett
- Woodbury and Cottage Grove, Emergency Medical Services, MN, USA
| | - Nik Vuljaj
- M Health Fairview Emergency Medical Services, Minneapolis, MN, USA
| | - Charles Lick
- Allina Health Emergency Medical Services, Minneapolis, MN, USA
| | - Peter Tanghe
- Department of Emergency Medicine, North Memorial Health Ambulance Service, North Memorial Health Medical Center, Robbinsdale, MN, USA
| | | | | | - Bjorn Peterson
- Department of Emergency Medicine, Regions Hospital, St. Paul, MN, USA
| | - Kari Haley
- Department of Emergency Medicine, Regions Hospital, St. Paul, MN, USA
| | - Kevin Sipprell
- Department of Emergency Medicine, Ridgeview Medical Center, Waconia, MN, USA
| | - Demetris Yannopoulos
- Division of Cardiology, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN, USA; Center for Resuscitation Medicine, University of Minnesota School of Medicine, Minneapolis, MN, USA
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12
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Clare D, Funk Z. Airway: To pause or not to pause? Resuscitation 2023; 186:109759. [PMID: 36894127 DOI: 10.1016/j.resuscitation.2023.109759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 02/27/2023] [Indexed: 03/09/2023]
Affiliation(s)
- Drew Clare
- University of Florida College of Medicine - Jacksonville, United States
| | - Zack Funk
- University of Florida College of Medicine - Jacksonville, United States
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13
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Lou J, Tian S, Kang X, Lian H, Liu H, Zhang W, Peran D, Zhang J. Airway management in out-of-hospital cardiac arrest: A systematic review and network meta-analysis. Am J Emerg Med 2023; 65:130-138. [PMID: 36630861 DOI: 10.1016/j.ajem.2022.12.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 12/07/2022] [Accepted: 12/18/2022] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES Airway management during cardiopulmonary resuscitation is particularly important for patients with out-of-hospital cardiac arrest (OHCA). This study was performed to compare the efficacy of the most commonly used out-of-hospital airway management methods in increasing the survival to discharge in patients with OHCA. METHODS We screened all relevant literature from database inception to 21st January 2019 in PubMed, Web of Science, Embase, and the Cochrane Library. We included all randomized controlled trials (RCTs) of airway management for OHCA in adults (≥16 years of age) with no limitations on publication status, publication date, or language. The primary outcome was survival to discharge. The secondary outcomes were the overall airway technique success rate, return of spontaneous circulation, and survival to hospital admission. RESULTS Overall, from 1986 to 2018, 9 RCTs involving 13,949 patients were included in the network meta-analysis, and the efficacy of six airway management methods for patients with OHCA were compared. However, none of the results were statistically significant. CONCLUSIONS As the gold standard of airway management for patients with out-of-hospital cardiac arrest in most countries, endotracheal intubation (ETI) has been widely used for many years. However, our systematic review and network meta-analysis showed that ETI is no better than other methods in increasing the survival to discharge. This is not directly proportional to the various preparations required before ETI. Additional randomized controlled trials are needed to identify more effective methods and improve patients' outcome.
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Affiliation(s)
- Jing Lou
- Beijing Emergency Medical Center, Beijing, China; Beijing Emergency Medicine Research Institute, Beijing, China
| | - Sijia Tian
- Beijing Emergency Medical Center, Beijing, China; Beijing Emergency Medicine Research Institute, Beijing, China
| | - Xuqin Kang
- Beijing Emergency Medical Center, Beijing, China; Beijing Emergency Medicine Research Institute, Beijing, China
| | - Huixin Lian
- Beijing Emergency Medical Center, Beijing, China
| | - Hongmei Liu
- Beijing Emergency Medical Center, Beijing, China
| | | | - David Peran
- Prague Emergency Medical Services, Prague, Czech Republic
| | - Jinjun Zhang
- Beijing Emergency Medical Center, Beijing, China; Beijing Emergency Medicine Research Institute, Beijing, China.
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14
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Steffen R, Hischier S, Roten FM, Huber M, Knapp J. Airway management during ongoing chest compressions-direct vs. video laryngoscopy. A randomised manikin study. PLoS One 2023; 18:e0281186. [PMID: 36757942 PMCID: PMC9910718 DOI: 10.1371/journal.pone.0281186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 01/18/2023] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND Tracheal intubation is used for advanced airway management during cardiac arrest, particularly when basic airway techniques cannot ensure adequate ventilation. However, minimizing interruptions of chest compressions is of high priority. Video laryngoscopy has been shown to improve the first-pass success rate for tracheal intubation in emergency airway management. We aimed to compare first-pass success rate and time to successful intubation during uninterrupted chest compression using video laryngoscopy and direct laryngoscopy. METHODS A total of 28 anaesthetists and 28 anaesthesia nurses with varied clinical and anaesthesiological experience were recruited for the study. All participants performed a tracheal intubation on a manikin simulator during ongoing chest compressions by a mechanical resuscitation device. Stratified randomisation (physicians/nurses) was performed, with one group using direct laryngoscopy and the other using video laryngoscopy. RESULTS First-pass success rate was 100% (95% CI: 87.9% - 100.0%) in the video laryngoscopy group and 67.8% (95% CI: 49.3% - 82.1%) in the direct laryngoscopy group [difference: 32.2% (95% CI: 17.8% - 50.8%), p<0.001]. The median time for intubation was 27.5 seconds (IQR: 21.8-31.0 seconds) in the video laryngoscopy group and 30.0 seconds (IQR: 26.5-36.5 seconds) in the direct laryngoscopy group (p = 0.019). CONCLUSION This manikin study on tracheal intubation during ongoing chest compressions demonstrates that video laryngoscopy had a higher first-pass success rate and shorter time to successful intubation compared to direct laryngoscopy. Experience in airway management and professional group were not significant predictors. A clinical randomized controlled trial appears worthwhile.
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Affiliation(s)
- Richard Steffen
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Simon Hischier
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Fredy-Michel Roten
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Markus Huber
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jürgen Knapp
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Anaesthesiology, Intensive Care Medicine and Pain Medicine, Hospital of Schwyz, Schwyz, Switzerland
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- * E-mail:
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15
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Santou N, Ueta H, Nakagawa K, Hata K, Kusunoki S, Sadamori T, Takyu H, Tanaka H. A comparative study of Video laryngoscope vs Macintosh laryngoscope for prehospital tracheal intubation in Hiroshima, Japan. Resusc Plus 2022; 13:100340. [PMID: 36582475 PMCID: PMC9792877 DOI: 10.1016/j.resplu.2022.100340] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/16/2022] [Accepted: 11/28/2022] [Indexed: 12/23/2022] Open
Abstract
Background In Japan, there are no studies comparing endotracheal intubation performed by emergency medical technicians (EMTs) during out-of-hospital cardiac arrest (OHCA) using a Macintosh laryngoscope and a video laryngoscope. Objective The purpose of this study was to compare the success rate, complication rate, return of spontaneous circulation (ROSC), neurological prognosis (CPC1-2) and regional differences between Video laryngoscope (VL) and Macintosh laryngoscope (ML) for OHCA patients. Method This study is a retrospective cohort study using 10,067 OHCA data extracted from the national Utstein Form and emergency medical transport data. The primary endpoint was the success rate of tracheal intubation and the complication rate and the secondary endpoints were the incidence of ROSC and CPC1-2. Results A total of 885 tracheal Intubated OHCA patients were enrolled in this study. The success rate was 94.1% (490/521) in the VL group and 89.3% (325/364) in the ML group (RR, 1.05; 95%CI, 1.01-1.10, P = 0.01), the VL group shows significantly higher success rate than that of the ML group. In the complication rates, oesophageal intubation occurred in 0.2% (1/521) of in the VL group and in 6.0% (22/364) in the ML group, Indicating significantly higher complication rates in the ML group compared with the VL group (RR, 1.06; 95% CI, 1.03-1.09, P < 0.001). The ROSC rate and CPC1-2 rate are similar among the groups. Conclusion Our data suggest that using VL had a little advantage with a higher success rate and lower complication rate. Further discussion is necessary for the future development of Emergency Medical Services (EMS) intubation devices.
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Affiliation(s)
- N. Santou
- Research Institute of Disaster Management and EMS, Kokushikan University,Tokyo, Japan,Corresponding author at: Research Institute of Disaster Management and EMS, Kokushikan University, 7-3-1, Nagayama, Tama city, Tokyo 205-8515, Japan.
| | - H. Ueta
- Research Institute of Disaster Management and EMS, Kokushikan University,Tokyo, Japan
| | - K. Nakagawa
- Department of Emergency Medical System, Graduate School, Kokushikan University , Tokyo, Japan
| | - K. Hata
- Department of Emergency Medical System, Graduate School, Kokushikan University , Tokyo, Japan,Research Center for Mathematical Medicine, Tokyo, Japan
| | - S. Kusunoki
- Hiroshima Prefectural Hospital Emergency and Critical Care Medicine
| | - T. Sadamori
- Emergency and Intensive Care Medicine, Hiroshima University
| | - H. Takyu
- Department of Emergency Medical System, Graduate School, Kokushikan University , Tokyo, Japan
| | - H. Tanaka
- Research Institute of Disaster Management and EMS, Kokushikan University,Tokyo, Japan,Department of Emergency Medical System, Graduate School, Kokushikan University , Tokyo, Japan
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16
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Airway management in cardiac arrest and outcomes. Author's reply. Intensive Care Med 2022; 48:1829-1832. [PMID: 36173414 PMCID: PMC9520998 DOI: 10.1007/s00134-022-06888-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 09/05/2022] [Indexed: 12/02/2022]
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17
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Knapp J, Huber M, Gräsner JT, Bernhard M, Fischer M. Outcome differences between PARAMEDIC2 and the German Resuscitation Registry: a secondary analysis of a randomized controlled trial compared with registry data. Eur J Emerg Med 2022; 29:421-430. [PMID: 35791269 PMCID: PMC9605191 DOI: 10.1097/mej.0000000000000958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 05/28/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND IMPORTANCE There has been much discussion of the results of the PARAMEDIC2 trial, as resuscitation outcome rates are considerably lower in this trial than in country-level registries on out-of-hospital cardiac arrest (OHCA). Here, we developed a statistical framework to investigate this gap and to examine possible sources for observed discrepancies in outcome rates. DESIGN Summary data from the PARAMEDIC2 trial were used as available in the publication of this study. We developed a modelling framework based on logistic regression to compare data from this randomized controlled trial and registry data from the German Resuscitation Registry (GRR), where we considered 26 019 patients treated with epinephrine for OHCA in the GRR. To account and adjust for differences in patient characteristics and baseline variables predictive for outcomes after OHCA between the GRR cohort and the PARAMEDIC2 study sample, we included all available variables determined at the arrival of EMS personnel in the modelling framework: age, sex, initial cardiac rhythm, cause of cardiac arrest, witness of cardiac arrest, CPR performed by a bystander, and the interval between emergency call and arrival of the ambulance at the scene (baseline model). In order to find possible explanations for the discrepancies in outcome between PARAMEDIC2 and GRR, in a second (baseline plus treatment) model, we additionally included all available variables related to the interventions of the EMS personnel (type of airway management, type of vascular access, and time to administration of epinephrine). MAIN RESULTS A patient cohort with baseline variables as in the PARAMEDIC2 trial would have survived to hospital discharge in 7.7% and survived with favourable neurological outcome in 5.0% in an EMS and health care system as in Germany, compared with 3.2 and 2.2%, respectively, in the Epinephrine group of the trial. Adding treatment-related variables to our logistic regression model, the rate of survival to discharge would decrease from 7.7 (for baseline variables only) to 5.6% and the rate of survival with favourable neurological outcome from 5.0 to 3.4%. CONCLUSION Our framework helps in the medical interpretation of the PARAMEDIC2 trial and the transferability of the trial's results for other EMS systems. Significantly higher rates of survival and favourable neurological outcome than reported in this trial could be possible in other EMS and health care systems.
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Affiliation(s)
- Jürgen Knapp
- Department of Anaesthesiology and Pain Medicine, Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute for Emergency Medicine, University Hospital Schleswig-Holstein, Kiel
| | - Markus Huber
- Department of Anaesthesiology and Pain Medicine, Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Michael Bernhard
- Emergency Department, University Hospital of Duesseldorf, Heinrich Heine University, Duesseldorf
| | - Matthias Fischer
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, ALB FILS Kliniken, Goeppingen, Germany
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Montag S, Herdtle S, John S, Lehmann T, Behringer W, Hohenstein C. Association between prehospital FPS and ROSC in adults with OHCA : A retrospective multicenter study using the German Resuscitation Registry and Intubation Registry (FiPS-CPR). DIE ANAESTHESIOLOGIE 2022; 71:198-203. [PMID: 36036834 PMCID: PMC9763137 DOI: 10.1007/s00101-022-01193-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 06/02/2022] [Accepted: 07/19/2022] [Indexed: 05/30/2023]
Abstract
BACKGROUND Advanced airway management (AAM) is part of the standard treatment during advanced cardiac life support (ACLS). Current studies underline the importance of a first-pass intubation success (FPS) during in-hospital ACLS. It was shown that a failed initial intubation attempt in out-of-hospital cardiac arrest (OHCA) patients in the emergency department is an independent risk factor for the decreased effectiveness of ACLS measured by the return of spontaneous circulation (ROSC). OBJECTIVE This study first examines the association between prehospital FPS and ROSC in adults with OHCA and second identifies factors associated with FPS and ROSC. The initial hypothesis was that FPS would increase the probability of ROSC as well as decrease the time to ROSC. MATERIAL AND METHODS A retrospective multicenter analysis of 180 adult non-traumatic OHCA patients on whom advanced airway management (AAM) was performed between July 2017 and December 2018 in five different German physician-staffed ambulance stations. For information on FPS the Intubation Registry, and for information on ROSC the German Resuscitation Registry were used. In addition to yes/no questions, multiple answers and free text answers are possible in those questionnaires. The main outcome variables were 'FPS', 'ROSC' and 'time to ROSC'. Mann-Whitney tests, χ2-tests, Fisher's exact tests and multivariate binary logistic regressions were used for the statistical evaluation. Demographic factors, characteristics of the performer, selected equipment, laryngoscopy type, intubation method, medications, verification of tube position, respiratory evaluation, complications and time to ROSC were examined with respect to the influence on FPS. Concerning ROSC, the following factors were examined: demographic factors, initial heart rhythm, initial breathing, medications, defibrillation and AAM. RESULTS An FPS was recorded in 150 patients (83.3%), and ROSC was achieved in 82 patients (45.5%) after an average time of 22.16 min. There was a positive association between FPS and ROSC (p = 0.027). In patients with FPS, a trend for shorter time to ROSC was observed (p = 0.059; FPS 18 min; no FPS 28 min). The use of capnography (odds ratio, OR = 7.384, 95% confidence interval, CI 1.886-28.917) and complications during AAM (OR = 0.033, 95% CI: 0.007-0.153) were independently associated with FPS. The independent factor associated with ROSC was FPS (OR = 5.281, 95% CI: 1.800-15.494). CONCLUSION In prehospitally resuscitated adult OHCA patients with AAM, FPS is associated with a higher chance of ROSC.
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Affiliation(s)
- Sarah Montag
- Klinik für Anaesthesiologie, LMU Klinikum der Universität München, Marchioninistr. 15, 81377, Munich, Germany.
| | - Steffen Herdtle
- Akut- und Notfallmedizin, Krankenhaus Agatharied, Norbert-Kerkel-Platz, 83734, Hausham, Germany
| | - Samuel John
- Klinik für Anästhesie und Intensivmedizin, ISAR Klinikum, Sonnenstr. 24-26, 80331, Munich, Germany
| | - Thomas Lehmann
- Institut für Medizinische Statistik, Informatik und Datenwissenschaften, Universitätsklinikum Jena, Bachstr. 18, 07743, Jena, Germany
| | - Wilhelm Behringer
- Universitätsklinik für Notfallmedizin, MedUni Wien, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Christian Hohenstein
- Interdisziplinäres Notfallzentrum, Zentralklinik Bad Berka GmbH, Robert-Koch-Allee 9, 99437, Bad Berka, Germany
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Price P, Laurie A, Plant E, Chandra K, Pishe T, Brunt K. Comparing the First-Pass Success Rate of the King LTS-D and the i-gel Airway Devices in Out-of-Hospital Cardiac Arrest. Cureus 2022; 14:e30987. [PMID: 36475129 PMCID: PMC9715278 DOI: 10.7759/cureus.30987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 10/31/2022] [Indexed: 06/17/2023] Open
Abstract
OBJECTIVES Significant heterogeneity exists internationally in the airway devices used in the pre-hospital setting during cardiac arrest. This study evaluated the first-pass success (FPS) rate of two supraglottic airways (SGAs) used by paramedics during out-of-hospital cardiac arrest: the King LTS-D and the i-gel. METHODS By examining 2,680 patient care records compiled by Ambulance New Brunswick between 2015 and 2020, we evaluated the FPS rate of the two SGAs using a 2x2 Pearson chi-square test for association, and a Mann-Whitney U test, to determine whether there were significant differences in FPS rates. RESULTS Our study demonstrated a statistically significant association between airway devices and FPS favoring the i-gel with an FPS of 90.6% compared to a 76.6% FPS with the King LTS-D; X 2(1) = 96.01, p < 0.001. The odds of successfully inserting the airway on the first attempt were 2.94 times higher if paramedics used the i-gel than if they used the King LTS-D with a 95% CI [2.32, 3.60]. Mann-Whitney's U test for SGA differences favored the i-gel in fewer attempts for successful insertion (z = -4.357, p < 0.001, d = 0.15). CONCLUSIONS Among patients in New Brunswick with out-of-hospital cardiac arrest, paramedics had a higher FPS rate with the i-gel compared to the King LTS-D. Our study also found a statistically significant difference between the King LTS-D and i-gel, favoring the i-gel in fewer attempts. Our findings suggest that the i-gel provides a more consistent FPS rate compared to the King LTS-D within our study populations; however, further research is necessary to determine the clinical implications of this. While multiple attempts at tracheal intubation are associated with negative clinical outcomes, no such evidence exists for SGAs.
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Affiliation(s)
- Patrick Price
- Medicine, Dalhousie Medicine New Brunswick, Saint John, CAN
| | - Anne Laurie
- Education, Concordia University, Montreal, CAN
| | - Eric Plant
- Medicine, Dalhousie Medicine New Brunswick, Saint John, CAN
| | | | - Tushar Pishe
- Emergency Medicine, Saint John Regional Hospital/Horizon Health Network, Saint John, CAN
| | - Keith Brunt
- Medicine, Dalhousie Medicine New Brunswick, Saint John, CAN
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20
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Strategies of Advanced Airway Management in Out-of-Hospital Cardiac Arrest during Intra-Arrest Hypothermia: Insights from the PRINCESS Trial. J Clin Med 2022; 11:jcm11216370. [DOI: 10.3390/jcm11216370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/21/2022] [Accepted: 10/22/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Trans-nasal evaporative cooling is an effective method to induce intra-arrest therapeutic hypothermia in out-of-hospital cardiac arrest (OHCA). The use of supraglottic airway devices (SGA) instead of endotracheal intubation may enable shorter time intervals to induce cooling. We aimed to study the outcomes in OHCA patients receiving endotracheal intubation (ETI) or a SGA during intra-arrest trans-nasal evaporative cooling. Methods: This is a pre-specified sub-study of the PRINCESS trial (NCT01400373) that included witnessed OHCA patients randomized during resuscitation to trans-nasal intra-arrest cooling vs. standard care followed by temperature control at 33 °C for 24 h. For this study, patients randomized to intra-arrest cooling were stratified according to the use of ETI vs. SGA prior to the induction of cooling. SGA was placed by paramedics in the first-tier ambulance or by physicians or anesthetic nurses in the second tier while ETI was performed only after the arrival of the second tier. Propensity score matching was used to adjust for differences at the baseline between the two groups. The primary outcome was survival with good neurological outcome, defined as cerebral performance category (CPC) 1–2 at 90 days. Secondary outcomes included time to place airway, overall survival at 90 days, survival with complete neurologic recovery (CPC 1) at 90 days and sustained return of spontaneous circulation (ROSC). Results: Of the 343 patients randomized to the intervention arm (median age 64 years, 24% were women), 328 received intra-arrest cooling and had data on the airway method (n = 259 with ETI vs. n = 69 with SGA). Median time from the arrival of the first-tier ambulance to successful airway management was 8 min for ETI performed by second tier and 4 min for SGA performed by the first or second tier (p = 0.001). No significant differences in the probability of good neurological outcome (OR 1.43, 95% CI 0.64–3.01), overall survival (OR 1.26, 95% CI 0.57–2.55), full neurological recovery (OR 1.17, 95% CI 0.52–2.73) or sustained ROSC (OR 0.88, 95% CI 0.50–1.52) were observed between ETI and SGA. Conclusions: Among the OHCA patients treated with trans-nasal evaporative intra-arrest cooling, the use of SGA was associated with a significantly shorter time to airway management and with similar outcomes compared to ETI.
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McCans K, Varma S, Ramgopal S, Martin-Gill C, Owusu-Ansah S. Variation in Prehospital Protocols for Pediatric Respiratory Distress Management in the United States. Pediatr Emerg Care 2022; 38:e1355-e1361. [PMID: 35267248 DOI: 10.1097/pec.0000000000002620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study aimed to compare statewide emergency medical services protocols for the management of pediatric respiratory distress. METHODS We performed a descriptive study of emergency medical services protocols for the management of pediatric respiratory distress in the United States, excluding those without model or mandatory protocols. We compared medication recommendations for specific disease processes, including asthma, croup, epiglottitis, anaphylaxis, generalized respiratory distress, intubation, and drug assisted intubation. RESULTS Thirty-four state protocols were included. All had protocols to address the management of pediatric respiratory distress. There was high agreement in albuterol use for bronchospasm and epinephrine use in anaphylaxis. Epinephrine was recommended in all anaphylaxis protocols, 27 croup protocols (79%), and 3 epiglottitis protocols (9%). Six states (18%) called for albuterol in patients with generalized respiratory distress. Steroid recommendations and indications had variance among states; 26 states (76%) allowed steroid use in patients with asthma, 19 states (56%) recommended steroid use in anaphylaxis, and 11 (32%) recommended steroid use in croup protocols. The route for steroid administration also varied among protocols. Five states (15%) allowed continuous positive airway pressure application in pediatric patients, whereas endotracheal intubation and rapid sequence intubations had varying requirements as well as recommendations for use. Twelve (35%) listed impending or current respiratory failure as an indication, whereas other states had specific markers, such as Glasgow Coma Scale or oxygen saturation, as indications. CONCLUSIONS All included states had specific recommendations for the management of pediatric respiratory distress. There was consistency in recommendations for albuterol use for wheezing and epinephrine use for anaphylaxis. However, there was wide variability in other uses for epinephrine, steroid administration, continuous positive airway pressure use, and specific treatments for croup and epiglottitis. The findings of this study provide a base for important future evidence-based protocol developments and changes in prehospital pediatric respiratory distress treatment.
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Affiliation(s)
- Kerry McCans
- From the University of Pittsburgh, Pittsburgh, PA
| | - Selina Varma
- Division of Emergency Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Sriram Ramgopal
- Division of Emergency Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | - Sylvia Owusu-Ansah
- Division of Pediatric Emergency Medicine, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
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22
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Kuo IM, Chen YF, Chien CY, Hong YW, Kang SC, Fu CY, Hsu CP, Liao CH, Hsieh CH. A novel scoring system using easily assessible predictors of return of spontaneous circulation and mortality in traumatic out-of-hospital cardiac arrest patients: A retrospective cohort study. Int J Surg 2022; 104:106731. [PMID: 35772592 DOI: 10.1016/j.ijsu.2022.106731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 06/11/2022] [Accepted: 06/13/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND An accident event may necessitate triage of multiple cases of traumatic out-of-hospital cardiac arrest (TOHCA). However, factors for prioritizing treatment among multiple TOHCA patients have not been established. This study aims to use easily assessible predictors of TOHCA outcomes to develop a triage scoring system. METHODS Patients with TOHCA brought to our hospital by emergency medical services (EMS) were included for analysis to identify independent risk factors for poor outcomes. A scoring system was developed and validated internally and externally. RESULTS Of the 401 included patients, 86 (21.4%) had return of spontaneous circulation (ROSC) after cardiopulmonary resuscitation (CPR) for 30 min (81 patients, 94.2%) or 45 min (86 patients, 100%). The emergency department (ED) mortality rate was 89.3% and overall in-hospital mortality rate was 99%. Univariate and multivariate analyses identified body temperature <33 °C (OR, 4.65; 95% CI, 1.37-15.86), obvious chest injury (OR, 2.11; 95% CI, 1.03-4.34), and presumable etiology of out-of-hospital cardiac arrest (OR, 1.73; 95% CI, 1.01-2.98) as significant independent risk factors for non-ROSC. The TOHCA score, calculated as 1 point per risk factor, correlated significantly with the rate of non-ROSC and ED mortality (TOHCA score 0, 1, 2, 3: non-ROSC rate, 63.0%, 80.4%, 90.8%, 100%, respectively; ED mortality rate, 79.5%, 91.5%, 96.1%, and 100% respectively). The results of internal and external validations show a similar trend in both non-ROSC and mortality in the ED with increasing score. CONCLUSIONS Termination of CPR for TOHCA after 45 min is reasonable; a 30-minute resuscitation is acceptable in case of insufficient medical staff or resources. The TOHCA score may be able to be used with caution for triage.
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Affiliation(s)
- I-Ming Kuo
- Department of Surgery, Division of General Surgery, New Taipei Municipal TuCheng Hospital, Taiwan.
| | - Yi-Fu Chen
- Department of Surgery, Division of General Surgery, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Taiwan
| | - Chih-Ying Chien
- Department of Surgery, Division of General Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan; Institute of Emergency and Critical Care Medicine, National Yang Ming University, Taiwan
| | - Yi-Wen Hong
- Department of Surgery, Division of General Surgery, New Taipei Municipal TuCheng Hospital, Taiwan
| | - Shih-Ching Kang
- Department of Surgery, Division of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Taiwan
| | - Chih-Yuan Fu
- Department of Surgery, Division of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Taiwan
| | - Chih-Po Hsu
- Department of Surgery, Division of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Taiwan
| | - Chien-Hung Liao
- Department of Surgery, Division of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Taiwan
| | - Chi-Hsun Hsieh
- Department of Surgery, Division of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Taiwan
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Shekhar AC, Effiong A, Mann NC, Blumen IJ. Success of prehospital tracheal intubation during cardiac arrest varies based on race/ethnicity and sex. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2022. [DOI: 10.1016/j.tacc.2022.05.006] [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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24
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Segond N, Bellier A, Duhem H, Sanchez C, Busi O, Deutsch S, Aguilera L, Truan D, Koch FX, Viglino D, Debaty G. Supraglottic airway device to improve ventilation success and reduce pulmonary aspiration during cardio-pulmonary resuscitation by basic life support rescuers: a randomised cross-over human cadaver study. PREHOSP EMERG CARE 2022:1-9. [PMID: 35543652 DOI: 10.1080/10903127.2022.2075994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Objectives: Early airway management during cardiopulmonary resuscitation (CPR) prevents aspiration of gastric contents. Endotracheal intubation is the gold standard to protect airways, but supraglottic airway devices (SGA) may provide some protection with less training. Bag-mask ventilation (BMV) is the most common method used by rescuers. We hypothesized that SGA use by first rescuers during CPR could increase ventilation success rate and also decrease intragastric pressure and pulmonary aspiration.Methods: We performed a randomized cross-over experimental trial on human cadavers. Protocol A: we assessed the rate of successful ventilation (chest rise), intragastric pressure, and CPR key time metrics. Protocol B: cadaver stomachs were randomized to be filled with 300 mL of either blue or green serum saline solution through a Foley catheter. Each rescuer was randomly assigned to use SGA or BMV during a 5-minute standard CPR period. Then, in a crossover design, the stomach was filled with the second colour solution and another 5-minute CPR period was performed using the other airway method. Pulmonary aspiration, defined as the presence of coloured solution below the vocal cords, was assessed by a blinded operator using bronchoscopy. A generalized linear mixed model was used for statistical analysis.Results: Protocol A: Forty-eight rescuers performed CPR on 11 cadavers. Median ventilation success was higher with SGA than BMV: 75.0% (IQR: 59.8-87.3) vs. 34.7% (IQR: 25.0-50.0), (p = 0.003). Gastric pressure and differential (maximum minus minimum) gastric pressure were lower in the SGA group: 2.21 mmHg (IQR: 1.66; 2.68) vs. 3.02 mmHg (IQR: 2.02; 4.22) (p = 0.02) and 5.70 mmHg (IQR: 4.10; 7.60) vs. 8.05 mmHg (IQR: 5.40; 11.60) (p = 0.05). CPR key times were not different between groups. Protocol B: Ten cadavers were included with 20 CPR periods. Aspiration occurred in 2 (20%) SGA procedures and 5 (50%) BMV procedures (p = 0.44).Conclusion: Use of SGA by rescuers improved the ventilation success rate, decreased intragastric pressure, and did not affect key CPR metrics. SGA use by basic life support rescuers appears feasible and efficient.
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Affiliation(s)
- N Segond
- Emergency Department and Mobile Intensive Care Unit, University Hospital of Grenoble Alpes, Grenoble, France.,CNRS TIMC Laboratory, UMR 5525, Univ. Grenoble Alpes, Grenoble, France
| | - A Bellier
- CNRS TIMC Laboratory, UMR 5525, Univ. Grenoble Alpes, Grenoble, France.,LADAF-Laboratoire d'Anatomie Des Alpes Françaises, Univ. Grenoble Alpes, Grenoble, France
| | - H Duhem
- Emergency Department and Mobile Intensive Care Unit, University Hospital of Grenoble Alpes, Grenoble, France.,CNRS TIMC Laboratory, UMR 5525, Univ. Grenoble Alpes, Grenoble, France
| | - C Sanchez
- Emergency Department and Mobile Intensive Care Unit, University Hospital of Grenoble Alpes, Grenoble, France
| | - O Busi
- Emergency Department and Mobile Intensive Care Unit, University Hospital of Grenoble Alpes, Grenoble, France
| | - S Deutsch
- Emergency Department and Mobile Intensive Care Unit, University Hospital of Grenoble Alpes, Grenoble, France
| | - L Aguilera
- Emergency Department and Mobile Intensive Care Unit, University Hospital of Grenoble Alpes, Grenoble, France
| | - D Truan
- Emergency Department and Mobile Intensive Care Unit, University Hospital of Grenoble Alpes, Grenoble, France
| | - F X Koch
- Emergency Department and Mobile Intensive Care Unit, University Hospital of Grenoble Alpes, Grenoble, France
| | - D Viglino
- Emergency Department and Mobile Intensive Care Unit, University Hospital of Grenoble Alpes, Grenoble, France.,INSERM U1300, HP2 Laboratory, Univ. Grenoble Alpes, Grenoble, France
| | - G Debaty
- Emergency Department and Mobile Intensive Care Unit, University Hospital of Grenoble Alpes, Grenoble, France.,CNRS TIMC Laboratory, UMR 5525, Univ. Grenoble Alpes, Grenoble, France
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25
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Impact of Operator Medical Specialty on Endotracheal Intubation Rates in Prehospital Emergency Medicine—A Retrospective Cohort Study. J Clin Med 2022; 11:jcm11071992. [PMID: 35407600 PMCID: PMC8999662 DOI: 10.3390/jcm11071992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 03/10/2022] [Accepted: 03/28/2022] [Indexed: 02/01/2023] Open
Abstract
Prehospital endotracheal intubation (ETI) can be challenging, and the risk of complications is higher than in the operating room. The goal of this study was to compare prehospital ETI rates between anaesthesiologists and non-anaesthesiologists. This retrospective cohort study compared prehospital interventions performed by either physicians from the anaesthesiology department (ADP) or physicians from another department (NADP, for non-anaesthesiology department physicians). The primary outcome was the prehospital ETI rate. Overall, 42,190 interventions were included in the analysis, of whom 68.5% were performed by NADP. Intubation was attempted on 2797 (6.6%) patients, without any difference between NADPs and ADPs (6.5 versus 6.7%, p = 0.555). However, ADPs were more likely to proceed to an intubation when patients were not in cardiac arrest (3.4 versus 3.0%, p = 0.026), whereas no difference was found regarding cardiac arrest patients (65.2 versus 67.7%, p = 0.243) (p for homogeneity = 0.005). In a prehospital physician-staffed emergency medical service, overall ETI rates did not depend on the frontline operator’s medical specialty background. ADPs were, however, more likely to proceed with ETI than NADPs when patients were not in cardiac arrest. Further studies should help to understand the reasons for this difference.
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26
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Tang Y, Sun M, Zhu A. Outcome of cardiopulmonary resuscitation with different ventilation modes in adults: A meta-analysis. Am J Emerg Med 2022; 57:60-69. [DOI: 10.1016/j.ajem.2022.04.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 04/17/2022] [Accepted: 04/20/2022] [Indexed: 10/18/2022] Open
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27
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Reinert L, Herdtle S, Hohenstein C, Behringer W, Arrich J. Predictors for Prehospital First-Pass Intubation Success in Germany. J Clin Med 2022; 11:jcm11030887. [PMID: 35160336 PMCID: PMC8836538 DOI: 10.3390/jcm11030887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 02/01/2022] [Accepted: 02/05/2022] [Indexed: 12/04/2022] Open
Abstract
(1) Background: Endotracheal intubation in the prehospital setting is an important skill for emergency physicians, paramedics, and other members of the EMS providing airway management. Its success determines complications and patient mortality. The aim of this study was to find predictors for first-pass intubation success in the prehospital emergency setting. (2) The study was based on a retrospective analysis of a population-based registry of prehospital advanced airway management in Germany. Cases of endotracheal intubation by the emergency medical services in the cities of Tübingen and Jena between 2016 and 2019 were included. The outcome of interest was first-pass intubation success. Univariate and multivariable regression analysis were used to analyse the influence of predefined predictors, including the characteristics of patients, the intubating staff, and the clinical situation. (3) Results: A total of 308 patients were analysed. After adjustment for multiple confounders, the direct vocal cord view, a less favourable Cormack–Lehane classification, the general practitioner as medical specialty, and location and type of EMS were independent predictors for first-pass intubation success. (4) Conclusions: In physician-led emergency medical services, the laryngoscopic view, medical specialty, type of EMS, and career level are associated with FPS. The latter points towards the importance of experience and regular training in endotracheal intubation.
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Affiliation(s)
- Lukas Reinert
- Department of Emergency Medicine, Faculty of Medicine, Friedrich Schiller University Jena, 07747 Jena, Germany;
| | - Steffen Herdtle
- Department of Emergency Medicine, Hospital of Agatharied, 83734 Hausham, Germany;
| | - Christian Hohenstein
- Department of Emergency Medicine, Zentralklinik Bad Berka, 99438 Bad Berka, Germany;
| | - Wilhelm Behringer
- Department of Emergency Medicine, Medical University of Vienna, 1090 Wien, Austria;
| | - Jasmin Arrich
- Department of Emergency Medicine, Medical University of Vienna, 1090 Wien, Austria;
- Correspondence:
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28
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Yau SY, Chang YC, Wu MY, Liao SC. Does seniority always correlate with simulated intubation performance? Comparing endotracheal intubation performance across medical students, residents, and physicians using a high-fidelity simulator. PLoS One 2021; 16:e0257969. [PMID: 34559834 PMCID: PMC8462689 DOI: 10.1371/journal.pone.0257969] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 09/14/2021] [Indexed: 02/01/2023] Open
Abstract
Background Endotracheal intubation is crucial in emergency medical care and anaesthesia. Our study employed a high-fidelity simulator to explore differences in intubation success rate and other skills between junior and senior physicians. Methods We examined the performance of 50 subjects, including undergraduate students (UGY), postgraduate trainees (PGY), residents (R), and attending physicians (VS). Each participant performed 12 intubations (i.e. 3 devices x 4 scenarios) on a high-fidelity simulator. Main outcome measures included success rate, time for intubation, force applied on incisor and tongue, and Cormack Lehane grades. Results There was no primary effect of seniority on any outcome measure except success rate and Cormack Lehane grades. However, VS demonstrated shorter duration than medical students using Glidescope and direct laryngoscopy, whereas VS and R applied significantly more force on the incisor in the normal airway and rigid neck scenario respectively. Discussion Seniority does not always correlate with skill perfection in detailed processes. Our study suggests that the use of video laryngoscopy enhances the intubation success rate and speed, but the benefit only accrues to senior learners, whereby they applied more force on the incisor at a single peak under difficult scenarios. These findings are discussed in terms of psychological and cognitive perspectives. Conclusion Speed and safety are essential for high quality critical medical procedures. A tool should be designed and implemented to educate junior physicians with an emphasis on practice and efficiency, which should also contribute to updating senior physicians’ knowledge and competence by providing instant feedback on their performance. This type of fine-grained feedback could serve as a complement to traditional training and provide a sustainable learning model for medical education.
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Affiliation(s)
- Sze-Yuen Yau
- Chang Gung Medical Education Research Center (CGMERC), Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Yu-Che Chang
- Chang Gung Medical Education Research Center (CGMERC), Chang Gung Memorial Hospital, Linkou, Taiwan
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
- Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Meng-Yu Wu
- Chang Gung Medical Education Research Center (CGMERC), Chang Gung Memorial Hospital, Linkou, Taiwan
- Chang Gung University College of Medicine, Taoyuan, Taiwan
- Department of Cardiac Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Shu-Chen Liao
- Chang Gung Medical Education Research Center (CGMERC), Chang Gung Memorial Hospital, Linkou, Taiwan
- Chang Gung University College of Medicine, Taoyuan, Taiwan
- Department of Emergency Medicine, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
- * E-mail:
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29
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Otomune K, Hifumi T, Jinno K, Nakamura K, Okazaki T, Inoue A, Kawakita K, Kuroda Y. Neurological outcomes associated with prehospital advanced airway management in patients with out-of-hospital cardiac arrest due to foreign body airway obstruction. Resusc Plus 2021; 7:100140. [PMID: 34223396 PMCID: PMC8244501 DOI: 10.1016/j.resplu.2021.100140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 05/15/2021] [Accepted: 05/15/2021] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Several studies have examined the association between advanced airway management (AAM) and survival for arrest that is non-shockable, noncardiac in origin, or due to suffocation; however, the efficacy of prehospital AAM compared with no AAM following foreign body removal by emergency medical services (EMS) has not been examined. We aimed to compare neurological outcomes in patients after out-of-hospital cardiac arrest (OHCA) due to foreign body airway obstruction (FBAO) managed with and without AAM after foreign body removal. METHODS This retrospective observational cohort study used all emergency transportation data of Japan and the All-Japan Utstein Registry. We included patients with OHCA aged ≥18 years undergoing resuscitation and removal of airway foreign bodies by EMS from January 2015 to December 2017. The exposure of interest was prehospital AAM by EMS after foreign body removal, and the primary outcome was a favorable neurological outcome at hospital discharge (i.e., a cerebral performance category of 1-2). RESULTS Overall, 329,098 adults had OHCAs and 23,060 had foreign bodies removed from their airways; 3681 adult patients met our eligibility criteria and were divided as: AAM (2045) and non-AAM (1636) groups. Propensity score matching resulted in 1210 matched pairs with balanced baseline characteristics between the groups. The rate of favorable neurological outcome was significantly lower in the AAM group than in the non-AAM group (OR 0.34, 95% CI 0.19-0.62). However, survival was not significantly different between the two groups (OR 1.08, 95% CI 0.84-1.37). CONCLUSIONS We have not demonstrated the benefit of AAM for patients with OHCA due to FBAO. Further study will be required to confirm the efficacy of AAM for those patients.
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Affiliation(s)
- Kanako Otomune
- Emergency Medical Center, Kagawa University Hospital, Kagawa, Japan
| | - Toru Hifumi
- Department of Emergency and Critical Care Medicine, St. Luke’s International Hospital, Tokyo, Japan
| | - Keisuke Jinno
- Emergency Medical Center, Kagawa University Hospital, Kagawa, Japan
| | - Kentaro Nakamura
- Emergency Medical Center, Kagawa University Hospital, Kagawa, Japan
| | - Tomoya Okazaki
- Emergency Medical Center, Kagawa University Hospital, Kagawa, Japan
| | - Akihiko Inoue
- Emergency Medical Center, Kagawa University Hospital, Kagawa, Japan
| | - Kenya Kawakita
- Emergency Medical Center, Kagawa University Hospital, Kagawa, Japan
| | - Yasuhiro Kuroda
- Emergency Medical Center, Kagawa University Hospital, Kagawa, Japan
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30
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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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First pass success of tracheal intubation using the C-MAC PM videolaryngoscope as first-line device in prehospital cardiac arrest compared with other emergencies: An observational study. Eur J Anaesthesiol 2021; 38:806-812. [PMID: 32833853 DOI: 10.1097/eja.0000000000001286] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Successful airway management is a priority in the resuscitation of critically ill or traumatised patients. Several studies have demonstrated the importance of achieving maximum first pass success, particularly in prehospital advanced airway management. OBJECTIVE To compare success rates of emergency intubations between patients requiring cardiopulmonary resuscitation (CPR) for cardiac arrest (CPR group) and other emergencies (non-CPR group) using the C-MAC PM videolaryngoscope. DESIGN Ongoing analysis of prospective collected prehospital advanced airway management core variables. SETTING Single helicopter emergency medical service (HEMS) 'Christoph 22', Ulm Military Hospital, Germany, May 2009 to July 2018. PATIENTS We included all 1006 HEMS patients on whom prehospital advanced airway management was performed by board-certified anaesthesiologists on call at HEMS 'Christoph 22'. INTERVENTIONS The C-MAC PM was used as the first-line device. The initial direct laryngoscopy was carried out using the C-MAC PM without the monitor in sight. After scoring the direct laryngoscopic view according to the Cormack and Lehane grade, the monitor was folded within the sight of the physician and tracheal intubation was performed using the videolaryngoscopic view without removing the blade. MAIN OUTCOME MEASURES The primary outcome was successful airway management. Secondary outcomes were the patient's position during airway management, necessity for suction, direct and videolaryngoscopic view according to Cormack and Lehane grading, as well as number of attempts needed for successful intubation. RESULTS A patent airway was achieved in all patients including rescue techniques. There was a lower first pass success rate in the CPR group compared with the non-CPR group (84.4 vs. 91.4%, P = 0.01). In the CPR group, direct laryngoscopy resulted more often in a clinically unfavourable (Cormack and Lehane grade 3 or 4) glottic view (CPR vs. non-CPR-group 37.2 vs. 26.7%, P = 0.0071). Using videolaryngoscopy reduced the clinically unfavourable grading to Cormack and Lehane 1 or 2 (P < 0.0001). The odds of achieving first pass success were approximately 12-fold higher with a favourable glottic view than with an unfavourable glottic view (OR 12.6, CI, 6.70 to 23.65). CONCLUSION Airway management in an anaesthesiologist-staffed HEMS is associated with a high first pass success rate but even with skilled providers using the C-MAC PM videolaryngoscope routinely, patients who require CPR offer more difficulties for successful prehospital advanced airway management at the first attempt. TRIAL REGISTRATION German Clinical trials register (drks.de) DRKS00020484.
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Lai PH, Lancet EA, Weiden MD, Webber MP, Zeig-Owens R, Hall CB, Prezant DJ. Characteristics Associated With Out-of-Hospital Cardiac Arrests and Resuscitations During the Novel Coronavirus Disease 2019 Pandemic in New York City. JAMA Cardiol 2021; 5:1154-1163. [PMID: 32558876 PMCID: PMC7305567 DOI: 10.1001/jamacardio.2020.2488] [Citation(s) in RCA: 208] [Impact Index Per Article: 69.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Question What characteristics are associated with out-of-hospital cardiac arrests and death during the COVID-19 pandemic in New York City? Findings In this population-based cross-sectional study of 5325 patients with out-of-hospital cardiac arrests, the number undergoing resuscitation was 3-fold higher during the 2020 COVID-19 period compared with during the comparison period in 2019. Patients with out-of-hospital cardiac arrest during 2020 were older, less likely to be white, and more likely to have specific comorbidities and substantial reductions in return and sustained return of spontaneous circulation. Meaning Identifying patients at risk for out-of-hospital cardiac arrest and death during the COVID-19 pandemic should lead to interventions in the outpatient setting to help reduce out-of-hospital deaths. Importance Risk factors for out-of-hospital death due to novel coronavirus disease 2019 (COVID-19) are poorly defined. From March 1 to April 25, 2020, New York City, New York (NYC), reported 17 118 COVID-19–related deaths. On April 6, 2020, out-of-hospital cardiac arrests peaked at 305 cases, nearly a 10-fold increase from the prior year. Objective To describe the characteristics (race/ethnicity, comorbidities, and emergency medical services [EMS] response) associated with outpatient cardiac arrests and death during the COVID-19 pandemic in NYC. Design, Setting, and Participants This population-based, cross-sectional study compared patients with out-of-hospital cardiac arrest receiving resuscitation by the NYC 911 EMS system from March 1 to April 25, 2020, compared with March 1 to April 25, 2019. The NYC 911 EMS system serves more than 8.4 million people. Exposures The COVID-19 pandemic. Main Outcomes and Measures Characteristics associated with out-of-hospital arrests and the outcomes of out-of-hospital cardiac arrests. Results A total of 5325 patients were included in the main analysis (2935 men [56.2%]; mean [SD] age, 71 [18] years), 3989 in the COVID-19 period and 1336 in the comparison period. The incidence of nontraumatic out-of-hospital cardiac arrests in those who underwent EMS resuscitation in 2020 was 3 times the incidence in 2019 (47.5/100 000 vs 15.9/100 000). Patients with out-of-hospital cardiac arrest during 2020 were older (mean [SD] age, 72 [18] vs 68 [19] years), less likely to be white (611 of 2992 [20.4%] vs 382 of 1161 [32.9%]), and more likely to have hypertension (2134 of 3989 [53.5%] vs 611 of 1336 [45.7%]), diabetes (1424 of 3989 [35.7%] vs 348 of 1336 [26.0%]), and physical limitations (2259 of 3989 [56.6%] vs 634 of 1336 [47.5%]). Compared with 2019, the odds of asystole increased in the COVID-19 period (odds ratio [OR], 3.50; 95% CI, 2.53-4.84; P < .001), as did the odds of pulseless electrical activity (OR, 1.99; 95% CI, 1.31-3.02; P = .001). Compared with 2019, the COVID-19 period had substantial reductions in return of spontaneous circulation (ROSC) (727 of 3989 patients [18.2%] vs 463 of 1336 patients [34.7%], P < .001) and sustained ROSC (423 of 3989 patients [10.6%] vs 337 of 1336 patients [25.2%], P < .001), with fatality rates exceeding 90%. These associations remained statistically significant after adjustment for potential confounders (OR for ROSC, 0.59 [95% CI, 0.50-0.70; P < .001]; OR for sustained ROSC, 0.53 [95% CI, 0.43-0.64; P < .001]). Conclusions and Relevance In this population-based, cross-sectional study, out-of-hospital cardiac arrests and deaths during the COVID-19 pandemic significantly increased compared with the same period the previous year and were associated with older age, nonwhite race/ethnicity, hypertension, diabetes, physical limitations, and nonshockable presenting rhythms. Identifying patients with the greatest risk for out-of-hospital cardiac arrest and death during the COVID-19 pandemic should allow for early, targeted interventions in the outpatient setting that could lead to reductions in out-of-hospital deaths.
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Affiliation(s)
- Pamela H Lai
- Office of Medical Affairs, Fire Department of the City of New York, Brooklyn, New York
| | - Elizabeth A Lancet
- Office of Medical Affairs, Fire Department of the City of New York, Brooklyn, New York
| | - Michael D Weiden
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York.,Pulmonary, Critical Care and Sleep Medicine Division, Department of Medicine and Department of Environmental Medicine, New York University School of Medicine, New York
| | - Mayris P Webber
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York.,Division of Epidemiology, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Rachel Zeig-Owens
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York.,Division of Epidemiology, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York.,Pulmonary Medicine Division, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York
| | - Charles B Hall
- Division of Biostatistics, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - David J Prezant
- Office of Medical Affairs, Fire Department of the City of New York, Brooklyn, New York.,Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York.,Pulmonary Medicine Division, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York
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Nakagawa K, Sagisaka R, Tanaka S, Takyu H, Tanaka H. Early endotracheal intubation improves neurological outcome following witnessed out-of-hospital cardiac arrest in Japan: a population-based observational study. Acute Med Surg 2021; 8:e650. [PMID: 33968414 PMCID: PMC8088393 DOI: 10.1002/ams2.650] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 03/30/2021] [Indexed: 11/10/2022] Open
Abstract
Aim It is unclear whether endotracheal intubation in the prehospital setting improves outcomes following out-of-hospital cardiac arrest. The purpose of this study was to evaluate the association between endotracheal intubation time (time from patient contact to endotracheal intubation) and favorable neurological outcomes on out-of-hospital cardiac arrest. Methods We extracted patients who underwent endotracheal intubation on the scene from a nationwide out-of-hospital cardiac arrest database registered between 2014 and 2017 in Japan. We included 14,969 witnessed and intubated adult out-of-hospital cardiac arrest cases. Patients were divided into Shockable (n = 1,102) and Non-shockable (n = 13,867) cohorts. We first drew the logistic curve due to predicting the association between endotracheal intubation time and favorable neurological outcome defined as Cerebral Performance Category (CPC) 1 or 2. Secondary, multivariable logistic regressions were used to estimate the association between the endotracheal intubation time (1-min unit increase), CPC 1 or 2. Results The logistic curve for CPC 1 or 2 showed similar shapes and indicated a decreasing outcome over time. From the results of multivariable logistic regression, in the Shockable cohort, endotracheal intubation time delay was correlated with decreasing favorable outcomes: CPC 1 or 2 (adjusted odds ratio, 0.89; 95% confidence interval, 0.82-0.87). Results were the same for the Non-shockable cohort: CPC 1 or 2 (adjusted odds ratio, 0.94; 95% confidence interval, 0.89-0.99). Conclusion Early endotracheal intubation was correlated with favorable neurological outcome. Training for intubation skills and improving protocols are needed for carrying out early endotracheal intubation.
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Affiliation(s)
- Koshi Nakagawa
- Department of Emergency Medical System Graduate School Kokushikan University Tokyo Japan
| | - Ryo Sagisaka
- Department of Integrated Science and Engineering for Sustainable Society Chuo University Tokyo Japan.,Research and Development Initiative Chuo University Tokyo Japan.,Research Institute of Disaster Management and EMS Kokushikan University Tokyo Japan
| | - Shota Tanaka
- Research Institute of Disaster Management and EMS Kokushikan University Tokyo Japan.,Tokai University School of Medicine Kanagawa Japan
| | - Hiroshi Takyu
- Department of Emergency Medical System Graduate School Kokushikan University Tokyo Japan
| | - Hideharu Tanaka
- Department of Emergency Medical System Graduate School Kokushikan University Tokyo Japan.,Research Institute of Disaster Management and EMS Kokushikan University Tokyo Japan
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Lønvik MP, Elden OE, Lunde MJ, Nordseth T, Bakkelund KE, Uleberg O. A prospective observational study comparing two supraglottic airway devices in out-of-hospital cardiac arrest. BMC Emerg Med 2021; 21:51. [PMID: 33879067 PMCID: PMC8056505 DOI: 10.1186/s12873-021-00444-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 04/06/2021] [Indexed: 11/30/2022] Open
Abstract
Background Airway management in patients with out of hospital cardiac arrest (OHCA) is important and several methods are used. The establishment of a supraglottic airway device (SAD) is a common technique used during OHCA. Two types of SAD are routinely used in Norway; the Kings LTS-D™ and the I-gel®. The aim of this study was to compare the clinical performance of these two devices in terms of difficulty, number of attempts before successful insertion and overall success rate of insertion. Methods All adult patients with OHCA, in whom ambulance personnel used a SAD over a one-year period in the ambulance services of Central Norway, were included. After the event, a questionnaire was completed and the personnel responsible for the airway management were interviewed. Primary outcomes were number of attempts until successful insertion, by either same or different ambulance personnel, and the difficulty of insertion graded by easy, medium or hard. Secondary outcomes were reported complications with inserting the SAD’s. Results Two hundred and fifty patients were included, of whom 191 received I-gel and 59 received LTS-D. Overall success rate was significantly higher in I-gel (86%) compared to LTS-D (75%, p = 0.043). The rates of successful placements were higher when using I-gel compared to LTS-D, and there was a significant increased risk that the insertion of the LTS-D was unsuccessful compared to the I-gel (risk ratio 1.8, p = 0.04). I-gel was assessed to be easy to insert in 80% of the patients, as opposed to LTS-D which was easy to insert in 51% of the patients. Conclusions Overall success rate was significantly higher and the difficulty in insertion was significantly lower in the I-gel group compared to the LTS-D in patients with OHCA. Supplementary Information The online version contains supplementary material available at 10.1186/s12873-021-00444-0.
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Affiliation(s)
- Maja Pålsdatter Lønvik
- Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, NO-7491, Trondheim, Norway.,Department of Internal Medicine, Nord-Trøndelag Hospital Trust, NO-7601, Levanger, Norway
| | - Odd Eirik Elden
- Department of Emergency Medicine and Pre-Hospital Services, St. Olav's University Hospital, NO-7030, Trondheim, Norway.,Department of Pre-Hospital Services, Nord-Trøndelag Hospital Trust, N-7600, Levanger, Norway.,Department of Surgery, Levanger Hospital, Nord-Trøndelag Hospital Trust, N-7600, Levanger, Norway
| | - Mats Joakimsen Lunde
- Department of Surgery, Levanger Hospital, Nord-Trøndelag Hospital Trust, N-7600, Levanger, Norway
| | - Trond Nordseth
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, NO-7491, Trondheim, Norway.,Department of Anesthesia and Intensive Care Medicine, St.Olav's University Hospital, NO-7030, Trondheim, Norway
| | - Karin Elvenes Bakkelund
- Department of Emergency Medicine and Pre-Hospital Services, St. Olav's University Hospital, NO-7030, Trondheim, Norway
| | - Oddvar Uleberg
- Department of Emergency Medicine and Pre-Hospital Services, St. Olav's University Hospital, NO-7030, Trondheim, Norway. .,Department of Research and Development, Norwegian Air Ambulance Foundation, NO-0103, Oslo, Norway.
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Ryan KM, Bui MD, Dugas JN, Zvonar I, Tobin JM. Impact of prehospital airway interventions on outcome in cardiac arrest following drowning: A study from the CARES Surveillance Group. Resuscitation 2021; 163:130-135. [PMID: 33482267 DOI: 10.1016/j.resuscitation.2020.12.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 12/12/2020] [Accepted: 12/23/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Drowning results in more than 360,000 deaths annually, making it the 3rd leading cause of unintentional injury death worldwide. Prior studies have examined airway interventions affecting patient outcomes in cardiac arrest, but less is known about drowning patients in arrest. This study evaluated the outcomes of drowning patients in the Cardiac Arrest Registry to Enhance Survival (CARES) who received advanced airway management. METHODS A retrospective analysis of the CARES database identified cases of drowning etiology between 2013 and 2018. Patients were stratified by airway intervention performed by EMS personnel. Demographics, sustained return of spontaneous circulation [ROSC], survival to hospital admission, survival to hospital discharge, and neurological outcomes were compared between airway groups using chi-squared tests and logistic regression. RESULTS Among 2388 drowning patients, 70.4% were male, 41.8% white, and 13.1% survived to hospital discharge. Patients that received supraglottic airways [SGA] had statistically significantly lower odds of survival to hospital admission compared to endotracheal tube [ETT] use (adjusted odds ratio [aOR] = 0.56, 95% confidence interval [CI] 0.42-0.76) as well as lower odds of survival to discharge compared to bag valve mask [BVM] use (aOR = 0.40, 95% CI 0.19-0.86) when accounting for relative ROSC timing. CONCLUSION In this national cohort of drowning patients in cardiac arrest, SGA use was associated with significantly lower odds of survival to hospital admission and discharge. However, survival to discharge with favorable neurological outcome did not differ significantly between airway management techniques. Further studies will need to examine if airway intervention order or time to intervention affects outcomes.
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Affiliation(s)
- Kevin M Ryan
- Boston University School of Medicine, 785 Albany Street, 5th Floor, Boston, MA 02118, United States.
| | - Matthew D Bui
- Boston University School of Medicine, 72 E Concord Street, Boston, MA 02118, United States
| | - Julianne N Dugas
- Department of Emergency Medicine, Boston Medical Center, BCD Building, 800 Harrison Avenue, Boston, MA 02118, United States
| | - Ivan Zvonar
- Department of Emergency Medicine, Boston Medical Center, BCD Building, 800 Harrison Avenue, Boston, MA 02118, United States
| | - Joshua M Tobin
- American Red Cross Scientific Advisory Council, 431 18th Street, NW, Washington, DC 20006, United States
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Benoit JL, Stolz U, McMullan JT, Wang HE. Duration of exposure to a prehospital advanced airway and neurological outcome for out-of-hospital cardiac arrest: A retrospective cohort study. Resuscitation 2021; 160:59-65. [PMID: 33482266 DOI: 10.1016/j.resuscitation.2021.01.009] [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] [Received: 08/28/2020] [Revised: 12/23/2020] [Accepted: 01/07/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND Out-of-hospital cardiac arrest (OHCA) studies have focused on the benefits and harms of placing an intra-arrest advanced airway, but few studies have evaluated the benefits and harms after successful placement. We hypothesize that increased time in the tumultuous prehospital environment after intra-arrest advanced airway placement results in reduced patient survival. METHODS This was a secondary analysis of adult, non-traumatic, OHCA patients with an advanced airway placed in the PRIMED trial. The exposure variable was the time interval between successful advanced airway placement and Emergency Department (ED) arrival. The outcome was cerebral performance category (CPC) 1 or 2 at hospital discharge. Multivariable logistic regression, adjusted for Utstein variables and resuscitation-associated time intervals, was used to estimate adjusted odds ratios (aOR). RESULTS The cohort of complete cases included 4779 patients. The median time exposed to a prehospital advanced airway was 27 min (IQR 20-35). The total prehospital time was 39.4 min (IQR 32.3-48.1). An advanced airway was placed intra-arrest in 3830 cases (80.1%) and post-return of spontaneous circulation (post-ROSC) in 949 cases (19.9%). Overall, 486 (10.2%) of the cohort achieved the CPC outcome, but this was higher in the post-ROSC (21.7%) versus intra-arrest (7.5%) cohort. CPC was not associated with the time interval from advanced airway placement to ED arrival in the intra-arrest airway cohort (aOR 0.98, 95%CI 0.94-1.01). CONCLUSIONS In OHCA patients who receive an intra-arrest advanced airway, longer time intervals exposed to a prehospital advanced airway are not associated with reduced patient survival.
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Affiliation(s)
- Justin L Benoit
- Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Uwe Stolz
- Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Jason T McMullan
- Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Henry E Wang
- Department of Emergency Medicine, University of Texas Health Science Center at Houston, Houston, TX, USA
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Norii T, Makino Y, Unuma K, Hatch GM, Adolphi NL, Dallo S, Albright D, Sklar DP, Braude D. Extraglottic Airway Device Misplacement: A Novel Classification System and Findings in Postmortem Computed Tomography. Ann Emerg Med 2021; 77:285-295. [PMID: 33455839 DOI: 10.1016/j.annemergmed.2020.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 09/30/2020] [Accepted: 10/05/2020] [Indexed: 12/20/2022]
Abstract
STUDY OBJECTIVE Extraglottic airway devices are frequently used during cardiac arrest resuscitations and for failed intubation attempts. Recent literature suggests that many extraglottic airway devices are misplaced. The aim of this study is to create a classification system for extraglottic airway device misplacement and describe its frequency in a cohort of decedents who died with an extraglottic airway device in situ. METHODS We assembled a cohort of all decedents who died with an extraglottic airway device in situ and underwent postmortem computed tomographic (CT) imaging at the state medical examiner's office during a 6-year period, using retrospective data. An expert panel developed a novel extraglottic airway device misplacement classification system. We then applied the schema in reviewing postmortem CT for extraglottic airway device position and potential complications. RESULTS We identified 341 eligible decedents. The median age was 47.0 years (interquartile range 32 to 59 years). Out-of-hospital personnel placed extraglottic airway devices in 265 patients (77.7%) who subsequently died out of hospital; the remainder died inhospital. The classification system consisted of 6 components: depth, size, rotation, device kinking, mechanical blockage of ventilation opening, and injury. Under the system, extraglottic airway devices were found to be misplaced in 49 cases (14.4%), including 5 (1.5%) that resulted in severe injuries. CONCLUSION We created a novel extraglottic airway device misplacement classification system. Misplacement occurred in greater than 14% of cases. Severe traumatic complications occurred rarely. Quality improvement activities should include review of extraglottic airway device placement when CT images are available and use the classification system to describe misplacements.
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Affiliation(s)
- Tatsuya Norii
- Department of Emergency Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM.
| | - Yohsuke Makino
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kana Unuma
- Department of Forensic Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Gary M Hatch
- Department of Radiology, University of New Mexico Health Sciences Center, Albuquerque, NM
| | - Natalie L Adolphi
- Department of Radiology, University of New Mexico Health Sciences Center, Albuquerque, NM; Center for Forensic Imaging, University of New Mexico Health Sciences Center, Albuquerque, NM
| | - Sarah Dallo
- Department of Biochemistry and Molecular Biology, University of New Mexico, Albuquerque, NM
| | - Danielle Albright
- Department of Emergency Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM
| | - David P Sklar
- College of Health Solutions, Arizona State University, Phoenix, AZ
| | - Darren Braude
- Department of Emergency Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM; Department of Anesthesiology, University of New Mexico Health Sciences Center, Albuquerque, NM
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Cheng FJ, Wu WT, Hung SC, Ho YN, Tsai MT, Chiu IM, Wu KH. Pre-hospital Prognostic Factors of Out-of-Hospital Cardiac Arrest: The Difference Between Pediatric and Adult. Front Pediatr 2021; 9:723327. [PMID: 34746054 PMCID: PMC8567010 DOI: 10.3389/fped.2021.723327] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 09/13/2021] [Indexed: 01/07/2023] Open
Abstract
The prognosis of out-of-hospital cardiac arrest (OHCA) is very poor. Although several pre-hospital factors are associated with survival, the different association of pre-hospital factors with OHCA outcomes in pediatric and adult groups remain unclear. To assess the association of pre-hospital factors with OHCA outcomes among pediatric and adult groups, a retrospective observational study was conducted using the emergency medical service (EMS) database in Kaohsiung from January 2015 to December 2019. Pre-hospital factors, underlying diseases, and OHCA outcomes were collected for the pediatric (Age ≤ 20) and adult groups. Kaplan-Meier type plots and multivariable logistic regression were used to analyze the association between pre-hospital factors and outcomes. In total, 7,461 OHCAs were analyzed. After adjusting for EMS response time, bystander CPR, attended by EMT-P, witness, and pre-hospital defibrillation, we found that age [odds ratio (OR) = 0.877, 95% confidence interval (CI): 0.764-0.990, p = 0.033], public location (OR = 7.681, 95% CI: 1.975-33.428, p = 0.003), and advanced airway management (AAM) (OR = 8.952; 95% CI, 1.414-66.081; p = 0.02) were significantly associated with survival till hospital discharge in pediatric OHCAs. The results of Kaplan-Meier type plots with log-rank test showed a significant difference between the pediatric and adult groups in survival for 2 h (p < 0.001), 24 h (p < 0.001), hospital discharge (p < 0.001), and favorable neurologic outcome (p < 0.001). AAM was associated with improved survival for 2 h (p = 0.015), 24 h (p = 0.023), and neurologic outcome (p = 0.018) only in the pediatric group. There were variations in prognostic factors between pediatric and adult patients with OHCA. The prognosis of the pediatric group was better than that of the adult group. Furthermore, AAM was independently associated with outcomes in pediatric patients, but not in adult patients. Age and public location of OHCA were independently associated with survival till hospital discharge in both pediatric and adult patients.
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Affiliation(s)
- Fu-Jen Cheng
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung City, Taiwan
| | - Wei-Ting Wu
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung City, Taiwan
| | - Shih-Chiang Hung
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung City, Taiwan
| | - Yu-Ni Ho
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung City, Taiwan
| | - Ming-Ta Tsai
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung City, Taiwan
| | - I-Min Chiu
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung City, Taiwan
| | - Kuan-Han Wu
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung City, Taiwan
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Cardiopulmonary Resuscitation during the COVID-19 pandemic. Do supraglottic airways protect against aerosol-generation? Resuscitation 2020; 157:123-125. [PMID: 33172828 PMCID: PMC7584877 DOI: 10.1016/j.resuscitation.2020.10.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 10/02/2020] [Indexed: 01/15/2023]
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Hansen ML, Wagner A, Schnapp A, Lin A, Le N, Deverman S, Pedigo E, Johnson A, Cusick J, Gries H, Kato M. Cluster cross-over randomised trial of paediatric airway management devices in the simulation lab and operating room among paramedic students. Emerg Med J 2020; 38:27-32. [PMID: 33046528 DOI: 10.1136/emermed-2020-209929] [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] [Received: 05/01/2020] [Revised: 08/18/2020] [Accepted: 08/24/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVES The objective of this study was to compare paediatric emergency airway management strategies in the simulation lab and operating room environments. METHODS This was a two-part cluster cross-over randomised trial including simulation lab and operating room environments conducted between January 2017 and June 2018 in Portland, Oregon, USA. In simulated infant cardiac arrests, paramedic students placed an endotracheal tube, an i-gel or a laryngeal mask airway in random order. In the operating room, paramedic students placed a laryngeal mask airway or i-gel device in random order in sequential patients. The primary outcome for both portions of the study was time to ventilation. In the operating room portion, we also evaluated leak pressures and average initial tidal volumes. RESULTS There were 58 paramedic students who participated in the simulation lab and 22 who participated in the operating room study. The mean time to airway placement in the simulation lab was 48.5 s for the i-gel, 68.9 s for the laryngeal mask and 129.5 s for the endotracheal tube. In the operating room, mean time to i-gel placement was 34.3 s with 45.2 s for the laryngeal mask. In multivariable analysis of the simulation study, the laryngeal mask and i-gel were significantly faster than the endotracheal tube, and the i-gel was faster than the laryngeal mask. In the operating room, there was no significant difference in time to placement, leak pressure and average volume of the first five breaths between the i-gel and laryngeal mask. CONCLUSIONS We found that paramedic students were able to place supraglottic devices rapidly with high success rates in simulation lab and operating room environments. Supraglottic devices, particularly the i-gel, were rated as easy to use. The i-gel may be easiest to use since it lacks an inflable cuff and requires fewer steps to place.
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Affiliation(s)
- Matthew Lee Hansen
- Emergency Medicine, Oregon Health & Science University School of Medicine, Portland, Oregon, USA
| | - Adam Wagner
- Oregon Institute of Technology, Wilsonville, Oregon, US
| | - Ashley Schnapp
- Emergency Medicine, Oregon Health & Science University School of Medicine, Portland, Oregon, USA
| | - Amber Lin
- Emergency Medicine, Oregon Health & Science University School of Medicine, Portland, Oregon, USA
| | - Nancy Le
- Emergency Medicine, Oregon Health & Science University School of Medicine, Portland, Oregon, USA
| | - Sarah Deverman
- Anesthesiology and Peri-operative Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Elizabeth Pedigo
- Anesthesiology and Peri-operative Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Andrea Johnson
- Anesthesiology and Peri-operative Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Jordan Cusick
- Anesthesiology and Peri-operative Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Heike Gries
- Anesthesiology and Peri-operative Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Meredith Kato
- Anesthesiology and Peri-operative Medicine, Oregon Health & Science University, Portland, Oregon, USA
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Abstract
Airway management during cardiac arrest has undergone several advancements. Endotracheal intubation (ETI) often is considered the gold standard for airway management in cardiac arrest; however, other options exist. Recent prospective randomized trials have compared outcomes in bag-valve mask ventilation and supraglottic airways to ETI in out-of-hospital cardiac arrest. ETI, if performed early in resuscitation, is associated with worse patient outcomes and has been de-emphasized so as not to interfere with other aspects of the resuscitation. Hyperventilation has multiple theoretic harms during cardiac arrest, and methods, such as compression-adjusted ventilation, may be utilized to help reduce the incidence of hyperventilation.
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Affiliation(s)
- Jestin N Carlson
- Department of Emergency Medicine, Saint Vincent Hospital, Allegheny Health Network, 232 West 25th Street, Erie, PA 16544, USA.
| | - Henry E Wang
- Department of Emergency Medicine, The University of Texas Health Science Center at Houston, 64312 Fannin Street, JJL 434, Houston, TX 77030, USA
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Chan JJ, Goh ZX, Koh ZX, Soo JJE, Fergus J, Ng YY, Allen JC, Ong MEH. Clinical evaluation of the use of laryngeal tube verses laryngeal mask airway for out-of-hospital cardiac arrest by paramedics in Singapore. Singapore Med J 2020; 63:157-161. [PMID: 32798357 DOI: 10.11622/smedj.2020119] [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: 11/18/2022]
Abstract
INTRODUCTION It is unclear which advanced airway device has better placement success and fewer adverse events in out-of-hospital cardiac arrests (OHCAs). This study aimed to evaluate the efficacy of the VBM laryngeal tube (LT) against the laryngeal mask airway (LMA) in OHCAs managed by emergency ambulances in Singapore. METHODS This was a real-world, prospective, cluster-randomised crossover study. All OHCA patients above 13 years old who were suitable for resuscitation were randomised to receive either LT or LMA. The primary outcome was placement success. Per-protocol analysis was performed and association between outcomes and airway device group was compared using multivariate binomial logistic regression analysis. RESULTS Of 965 patients with OHCAs from March 2016 to January 2018, 905 met the inclusion criteria, of which 502 (55.5%) were randomised to receive LT while 403 (44.5%) were randomised to receive LMA. Only 174 patients in the LT group actually received the device due to noncompliance. Placement success for LT was lower than for LMA (adjusted odds ratio [OR] 0.52, 95% confidence interval [CI] 0.31-0.90). Complications were more likely when using LT (OR 2.82,0 95% CI 1.64-4.86). Adjusted OR for prehospital return of spontaneous circulation (ROSC) was similar in both groups. A modified intention-to-treat analysis showed similar outcomes to the per-protocol analysis between the groups. CONCLUSION LT was associated with poorer placement success and higher complication rates than LMA. The likelihood of prehospital ROSC was similar between the two groups. Familiarity bias and a low compliance rate to the LT were the main limitations of this study.
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Affiliation(s)
- Jing Jing Chan
- Department of Emergency Medicine, Singapore General Hospital, Singapore
| | - Zi Xin Goh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Zhi Xiong Koh
- Department of Emergency Medicine, Singapore General Hospital, Singapore
| | | | - Jes Fergus
- Medical Department, Singapore Civil Defence Force, Singapore
| | - Yih Yng Ng
- Home Team, Ministry of Home Affairs, Singapore
| | - John Carson Allen
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore
| | - Marcus Eng Hock Ong
- Department of Emergency Medicine, Singapore General Hospital, Singapore.,Health Services and Systems Research, Duke-NUS Medical School, Singapore
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Ninokawa S, Friedman J, Tatum D, Smith A, Taghavi S, McGrew P, Duchesne J. Patient Contact Time and Prehospital Interventions in Hypotensive Trauma Patients: Should We Reconsider the "ABC" Algorithm When Time Is of the Essence? Am Surg 2020; 86:937-943. [PMID: 32762468 DOI: 10.1177/0003134820940244] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION There is disagreement in the trauma community concerning the extent to which emergency medical services (EMS) should perform on-scene interventions. Additionally, in recent years the "ABC" algorithm has been questioned in hypotensive patients. The objective of this study was to quantify the delay introduced by different on-scene interventions. METHODS A retrospective analysis of hypotensive trauma patients brought to an urban level 1 trauma center by EMS from 2007 to 2018 was performed, and patients were stratified by mechanism of injury and new injury severity score (NISS). Independent samples median tests were used to compare median on-scene times. RESULTS Among 982 trauma patients, median on-scene time was 5 minutes (interquartile range 3-8). In penetrating trauma patients (n = 488) with NISS of 16-25, intubation significantly increased scene time from 4 to 6 minutes (P < .05). In penetrating trauma patients with NISS of 10-15, wound care significantly increased scene time from 3 to 6 minutes (P < .05). Tourniquet use, interosseous (IO) access, intravenous (IV) access, and needle decompression did not significantly increase scene time. CONCLUSION Understanding that intubation increases scene time in penetrating trauma, while IV and IO access do not, alterations to the traditional "ABC" algorithm may be warranted. Further investigation of prehospital interventions is needed to determine which are appropriate on-scene.
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Affiliation(s)
- Scott Ninokawa
- 5783 Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Jessica Friedman
- 5783 Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Danielle Tatum
- Our Lady of the Lake Regional Medical Center, Baton Rouge, LA, USA
| | - Alison Smith
- 5783 Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Sharven Taghavi
- 5783 Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Patrick McGrew
- 5783 Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Juan Duchesne
- 5783 Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
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Effect of airway management strategies during resuscitation from out-of-hospital cardiac arrest on clinical outcome: A registry-based analysis. Resuscitation 2020; 152:157-164. [DOI: 10.1016/j.resuscitation.2020.04.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 04/04/2020] [Accepted: 04/13/2020] [Indexed: 11/20/2022]
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Effects of Bag Mask Ventilation and Advanced Airway Management on Adherence to Ventilation Recommendations and Chest Compression Fraction: A Prospective Randomized Simulator-Based Trial. J Clin Med 2020; 9:jcm9072045. [PMID: 32610672 PMCID: PMC7408746 DOI: 10.3390/jcm9072045] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 06/16/2020] [Accepted: 06/23/2020] [Indexed: 01/16/2023] Open
Abstract
The role of advanced airway management (AAM) in cardiopulmonary resuscitation (CPR) is currently debated as observational studies reported better outcomes after bag-mask ventilation (BMV), and the only prospective randomized trial was inconclusive. Adherence to CPR guidelines ventilation recommendations is unknown and difficult to assess in clinical trials. This study compared AAM and BMV with regard to adherence to ventilation recommendations and chest compression fractions in simulated cardiac arrests. A total of 154 teams of 3–4 physicians were randomized to perform CPR with resuscitation equipment restricting airway management to BMV only or equipment allowing for all forms of AAM. BMV teams ventilated 6 ± 6/min and AAM teams 19 ± 8/min (range 3–42/min; p < 0.0001 vs. BMV). 68/78 BMV teams and 23/71 AAM teams adhered to the ventilation recommendations (p < 0.0001). BMV teams had lower compression fractions than AAM teams (78 ± 7% vs. 86 ± 6%, p < 0.0001) resulting entirely from higher no-flow times for ventilation (9 ± 4% vs. 3 ± 3 %; p < 0.0001). Compared to BMV, AAM leads to significant hyperventilation and lower adherence to ventilation recommendations but favourable compression fractions. The cumulative effect of deviations from ventilation recommendations has the potential to blur findings in clinical trials.
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Ozbek AE, Halhalli HC, Yilmaz S, Celik E, Ozerol H, Şancı E. Effects of Using an Endotracheal Tube Introducer for Intubation During Mechanical Chest Compressions of a Manikin: Randomized, Prospective, Crossover Study. J Emerg Med 2020; 59:56-60. [PMID: 32532581 DOI: 10.1016/j.jemermed.2020.04.056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 04/28/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Airway management methods during out-of-hospital cardiac arrest remain controversial. OBJECTIVES This study aimed to compare the impact of using an endotracheal tube introducer with a Macintosh laryngoscope on the first-pass success rates of final-year medical students on a manikin during continuous chest compressions with a mechanical compression device. METHODS Fifty-two final-year students of the faculty of medicine performed endotracheal intubations on a manikin using the Macintosh laryngoscope with and without the endotracheal tube introducer during chest compressions. First-pass success rates, the times of endotracheal intubations, the second endotracheal intubation attempt success rates, and the difficulty level of each method according to the participants' perceptions were measured. RESULTS First-pass success rates did not differ using an endotracheal tube introducer as an adjunct to a Macintosh laryngoscope. Second endotracheal intubation attempt success rates also did not differ by endotracheal tube introducer use. The usage of an endotracheal tube introducer required significantly longer endotracheal intubation time than using only a Macintosh laryngoscope. The perception of difficulty was significantly lower with endotracheal tube introducer use. CONCLUSION The use of an endotracheal tube introducer as an adjunct to a Macintosh laryngoscope is not associated with higher first-pass success rates during mechanical chest compressions in adult simulations performed by final-year medical students. © 2020 Elsevier Inc.
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Affiliation(s)
- Asim Enes Ozbek
- Department of Emergency Medicine, University of Health Sciences Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey
| | - Huseyin Cahit Halhalli
- Department of Emergency Medicine, University of Health Sciences Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey
| | - Serkan Yilmaz
- Department of Emergency Medicine, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Emrah Celik
- Department of Emergency Medicine, University of Health Sciences Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey
| | - Hakan Ozerol
- Department of Emergency Medicine, University of Health Sciences Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey
| | - Emre Şancı
- Department of Emergency Medicine, University of Health Sciences Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey
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Tran A, Fernando SM, Rochwerg B, Vaillancourt C, Inaba K, Kyeremanteng K, Nolan JP, McCredie VA, Petrosoniak A, Hicks C, Haut ER, Perry JJ. Pre-arrest and intra-arrest prognostic factors associated with survival following traumatic out-of-hospital cardiac arrest - A systematic review and meta-analysis. Resuscitation 2020; 153:119-135. [PMID: 32531405 DOI: 10.1016/j.resuscitation.2020.05.052] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 05/04/2020] [Accepted: 05/31/2020] [Indexed: 01/16/2023]
Abstract
AIM To summarize the prognostic associations of pre- and intra-arrest factors with return of spontaneous circulation (ROSC) and survival (in-hospital or 30 days) after traumatic out-of-hospital cardiac arrest. METHODS We conducted this review in accordance with the PRISMA and CHARMS guidelines. We searched Medline, Pubmed, Embase, Scopus, Web of Science and the Cochrane Database of Systematic Reviews from inception through December 1st, 2019. We included English language studies evaluating pre- and intra-arrest prognostic factors following penetrating or blunt traumatic OHCA. Risk of bias was assessed using the QUIPS tool. We pooled unadjusted odds ratios using random-effects models and presented adjusted odds ratios with 95% confidence intervals. We used the GRADE method to describe certainty. RESULTS We included 53 studies involving 37,528 patients. The most important predictors of survival were presence of cardiac motion on ultrasound (odds ratio 33.91, 1.87-613.42, low certainty) or a shockable initial cardiac rhythm (odds ratio 7.29, 5.09-10.44, moderate certainty), based on pooled unadjusted analyses. Importantly, mechanism of injury was not associated with either ROSC (odds ratio 0.97, 0.51-1.85, very low certainty) or survival (odds ratio 1.40, 0.79-2.48, very low certainty). CONCLUSION This review provides very low to moderate certainty evidence that pre- and intra-arrest prognostic factors following penetrating or blunt traumatic OHCA predict ROSC and survival. This evidence is primarily based on unadjusted data. Further well-designed studies with larger cohorts are warranted to test the adjusted prognostic ability of pre- and intra-arrest factors and guide therapeutic decision-making.
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Affiliation(s)
- Alexandre Tran
- Department of Surgery, University of Ottawa, Ottawa, ON, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada; Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
| | - Shannon M Fernando
- Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada; Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Bram Rochwerg
- Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Christian Vaillancourt
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada; Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada; Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada
| | - Kenji Inaba
- Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Kwadwo Kyeremanteng
- Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada; Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada; Institute du Savoir, Montfort, Ottawa, ON, Canada
| | - Jerry P Nolan
- Anesthesia and Intensive Care Medicine, Royal United Hospital, Bath, United Kingdom; Warwick Clinical Trials Unit, University of Warwick, United Kingdom
| | - Victoria A McCredie
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada; Department of Critical Care Medicine, Toronto Western Hospital, University Health Network, Toronto, ON, Canada; Krembil Research Institute, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Andrew Petrosoniak
- Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Christopher Hicks
- Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Elliott R Haut
- Division of Acute Care Surgery, Department of Surgery, Department of Anesthesiology and Critical Care, Department of Emergency Medicine, The Johns Hopkins University School of Medicine, Baltimore MD, USA; Department of Health Policy and Management, The Johns Hopkins Bloomberg School of Public Health, Baltimore MD, USA
| | - Jeffrey J Perry
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada; Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada; Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada
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Neth MR, Idris A, McMullan J, Benoit JL, Daya MR. A review of ventilation in adult out-of-hospital cardiac arrest. J Am Coll Emerg Physicians Open 2020; 1:190-201. [PMID: 33000034 PMCID: PMC7493547 DOI: 10.1002/emp2.12065] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 03/20/2020] [Accepted: 03/23/2020] [Indexed: 12/17/2022] Open
Abstract
Out-of-hospital cardiac arrest continues to be a devastating condition despite advances in resuscitation care. Ensuring effective gas exchange must be weighed against the negative impact hyperventilation can have on cardiac physiology and survival. The goals of this narrative review are to evaluate the available evidence regarding the role of ventilation in out-of-hospital cardiac arrest resuscitation and to provide recommendations for future directions. Ensuring successful airway patency is fundamental for effective ventilation. The airway management approach should be based on professional skill level and the situation faced by rescuers. Evidence has explored the influence of different ventilation rates, tidal volumes, and strategies during out-of-hospital cardiac arrest; however, other modifiable factors affecting out-of-hospital cardiac arrest ventilation have limited supporting data. Researchers have begun to explore the impact of ventilation in adult out-of-hospital cardiac arrest outcomes, further stressing its importance in cardiac arrest resuscitation management. Capnography and thoracic impedance signals are used to measure ventilation rate, although these strategies have limitations. Existing technology fails to reliably measure real-time clinical ventilation data, thereby limiting the ability to investigate optimal ventilation management. An essential step in advancing cardiac arrest care will be to develop techniques to accurately and reliably measure ventilation parameters. These devices should allow for immediate feedback for out-of-hospital practitioners, in a similar way to chest compression feedback. Once developed, new strategies can be established to guide out-of-hospital personnel on optimal ventilation practices.
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Affiliation(s)
- Matthew R. Neth
- Department of Emergency MedicineOregon Health and Science UniversityPortlandOregon
| | - Ahamed Idris
- Department of Emergency MedicineUT SouthwesternDallasTexas
| | - Jason McMullan
- Department of Emergency MedicineUniversity of Cincinnati College of MedicineCincinnatiOhio
| | - Justin L. Benoit
- Department of Emergency MedicineUniversity of Cincinnati College of MedicineCincinnatiOhio
| | - Mohamud R. Daya
- Department of Emergency MedicineOregon Health and Science UniversityPortlandOregon
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Sharma A, Sonny A, Panaich S, Walia A, Ramakrishna H. Analysis of the 2019 American Heart Association (AHA) Focused Update on Advanced Cardiovascular Life Support. J Cardiothorac Vasc Anesth 2020; 35:1516-1523. [PMID: 32576411 DOI: 10.1053/j.jvca.2020.05.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 05/18/2020] [Indexed: 12/21/2022]
Affiliation(s)
- Archit Sharma
- Department of Anesthesia, University of Iowa, Iowa City, IA
| | - Abraham Sonny
- Department of Anesthesiology, Massachusetts General Hospital, Boston, MA
| | - Sidakpal Panaich
- Division of Cardiovascular Diseases, Department of Internal Medicine, University of Iowa, Iowa City, IA
| | - Anureet Walia
- Department of Anesthesia, University of Iowa, Iowa City, IA
| | - Harish Ramakrishna
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN.
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Ott T, Tschöpe K, Toenges G, Buggenhagen H, Engelhard K, Kriege M. Does the revised intubating laryngeal tube (ILTS-D2) perform better than the intubating laryngeal mask (Fastrach)? - a randomised simulation research study. BMC Anesthesiol 2020; 20:111. [PMID: 32393169 PMCID: PMC7212614 DOI: 10.1186/s12871-020-01029-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 04/29/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The intubating laryngeal tube (ILTS-D™) and the intubating laryngeal mask (Fastrach™) are devices that facilitate both extraglottic application and blind tracheal intubation. A revised model of the iLTS-D (for scientific reasons called ILTS-D2) has been designed but not yet evaluated. Therefore, we compared the ILTS-D2 with the established Fastrach under controlled conditions in a prospective randomised controlled simulation research study. METHODS After ethical approval, we randomised 126 medical students into two groups. Each participant received either Fastrach or ILTS-D2 to perform five consecutive ventilation attempts in a manikin. The primary endpoint was the time to ventilation in the last attempt of using the devices as extraglottic devices. Secondary endpoints were the time to tracheal intubation and the success rates. RESULTS There was no relevant difference between the two devices in the time to ventilation in the last of five attempts (Fastrach: median 14 s [IQR: 12-15]; ILTS-D2: median 13 s [IQR: 12-15], p = 0.592). Secondary endpoints showed a 2 s faster blind tracheal intubation using the Fastrach than using the ILTS-D2 (Fastrach: median 14 s [IQR: 13-17]; ILTS-D2: median 16 s [IQR: 15-20] p < 0.001). For both devices, the success rates were 100% in the last attempt. CONCLUSIONS Concerning extraglottic airway management, we could not detect a relevant difference between the revised ILTS-D2 and the Fastrach under laboratory conditions. We advocate for an evaluation of the ILTS-D2 in randomised controlled clinical trials. TRIAL REGISTRATION Identifier at clinicaltrials.gov: NCT03542747. May 31, 2018.
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Affiliation(s)
- Thomas Ott
- Department of Anaesthesiology, Medical Centre of the Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany.
| | - Katharina Tschöpe
- Department of Anaesthesiology, Medical Centre of the Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Gerrit Toenges
- Institute of Medical Biostatistics, Epidemiology, and Informatics, Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | - Holger Buggenhagen
- Rudolf-Frey Lernklinik Central Education Platform, Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | - Kristin Engelhard
- Department of Anaesthesiology, Medical Centre of the Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Marc Kriege
- Department of Anaesthesiology, Medical Centre of the Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany
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