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Beierle S, Beierle A, Rossaint R, Beckers SK, Schröder H, Felzen M. Prehospital emergency anesthesia: A single-center retrospective analysis of guideline adherence and unexpected incidents. PLoS One 2024; 19:e0310146. [PMID: 39241031 PMCID: PMC11379260 DOI: 10.1371/journal.pone.0310146] [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: 12/11/2023] [Accepted: 08/25/2024] [Indexed: 09/08/2024] Open
Abstract
Although prehospital emergency anesthesia (PHEA), with a specific focus on intubation attempts, is frequently studied in prehospital emergency care, there is a gap in the knowledge on aspects related to adherence to PHEA guidelines. This study investigates adherence to the "Guidelines for Prehospital Emergency Anesthesia in Adults" with regard to the induction of PHEA, including the decision making, rapid sequence induction, preoxygenation, standard monitoring, intubation attempts, adverse events, and administration of appropriate medications and their side effects. This retrospective study examined PHEA interventions from 01/01/2020 to 12/31/2021 in the city of Aachen, Germany. The inclusion criteria were adult patients who met the indication criteria for the PHEA. Data were obtained from emergency medical protocols. A total of 127 patients were included in this study. All the patients met the PHEA indication criteria. Despite having a valid indication, 29 patients did not receive the PHEA. 98 patients were endotracheally intubated. For these patients, monitoring had conformed to the guidelines. The medications were used according to the guidelines. A significant increase in oxygen saturation was reported after anesthesia induction (p < 0.001). The patients were successfully intubated endotracheally on the third attempt. Guideline adherence was maintained in terms of execution of PHEA, rapid sequence induction, preoxygenation, monitoring, selection, and administration of relevant medications. Emergency physicians demonstrated the capacity to effectively respond to cardiorespiratory events. Further investigations are needed on the group of patients who did not receive PHEA despite meeting the criteria. The underlying causes of decision making in these cases need to be evaluated in the future.
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Affiliation(s)
- Syrina Beierle
- Medical Faculty RWTH Aachen University, Department of Anesthesiology, University Hospital RWTH Aachen, Aachen, Germany
- Aachen Institute for Rescue Management & Public Safety, City of Aachen and University Hospital RWTH Aachen, Aachen, Germany
| | - Alexander Beierle
- Medical Faculty RWTH Aachen University, Department of Anesthesiology, University Hospital RWTH Aachen, Aachen, Germany
- Aachen Institute for Rescue Management & Public Safety, City of Aachen and University Hospital RWTH Aachen, Aachen, Germany
- Department of Anesthesiology, Asklepios Klinik Lich GmbH, Lich, Germany
| | - Rolf Rossaint
- Medical Faculty RWTH Aachen University, Department of Anesthesiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Stefan K Beckers
- Medical Faculty RWTH Aachen University, Department of Anesthesiology, University Hospital RWTH Aachen, Aachen, Germany
- Aachen Institute for Rescue Management & Public Safety, City of Aachen and University Hospital RWTH Aachen, Aachen, Germany
- Medical Direction of Aachen Fire Department, Aachen, Germany
| | - Hanna Schröder
- Medical Faculty RWTH Aachen University, Department of Anesthesiology, University Hospital RWTH Aachen, Aachen, Germany
- Aachen Institute for Rescue Management & Public Safety, City of Aachen and University Hospital RWTH Aachen, Aachen, Germany
| | - Marc Felzen
- Medical Faculty RWTH Aachen University, Department of Anesthesiology, University Hospital RWTH Aachen, Aachen, Germany
- Aachen Institute for Rescue Management & Public Safety, City of Aachen and University Hospital RWTH Aachen, Aachen, Germany
- Medical Direction of Aachen Fire Department, Aachen, Germany
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Hayashi K, Kikuchi J, Hishinuma H, Noguchi T, Zaitsu M, Wake K. Impact of the Coronavirus Pandemic on Patients Requiring Tracheal Intubation by Helicopter Emergency Medical Services: A Retrospective, Single-Center, Observational Study. J Clin Med 2024; 13:3694. [PMID: 38999261 PMCID: PMC11242781 DOI: 10.3390/jcm13133694] [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: 05/11/2024] [Revised: 06/16/2024] [Accepted: 06/21/2024] [Indexed: 07/14/2024] Open
Abstract
Background/Objectives: The impacts of the coronavirus disease 2019 (COVID-19) pandemic on patients using helicopter emergency medical services (HEMS) regarding tracheal intubation and patient management remain unclear. Thus, we aimed to investigate this matter in Japan. Methods: In this retrospective, observational study, we analyzed 2277 patients who utilized HEMS in Tochigi Prefecture during 2018-2022. We included only patients who required tracheal intubation. We categorized patients from February 2020 to January 2022 in the pandemic group and those from February 2018 to January 2020 in the control group. We compared the interval from arrival at the scene to leaving the scene (on-scene time) and secondary variables between the two groups. Results: A total of 278 eligible patients were divided into the pandemic group (n = 127) and the control group (n = 151). The on-scene time was lower during the pandemic than that before (25.64 ± 9.19 vs. 27.83 ± 8.74 min, p = 0.043). The percentage of patients using midazolam was lower (11.8% vs. 22.5%, p = 0.02) and that of patients using rocuronium bromide was higher (29.1% vs. 6.0%, p < 0.001) during the pandemic. In contrast, the type of intervention other than tracheal intubation and the type of transportation to the hospital did not differ between the groups. Conclusions: The COVID-19 pandemic was associated with changes in the mission time of and the frequency of certain drugs administered by the HEMS. However, the type of intervention and the type of transportation did not differ. Further research is needed on changes in patient prognosis and condition due to the effects of the COVID-19 pandemic.
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Affiliation(s)
- Kentaro Hayashi
- Department of Emergency and Critical Care Medicine, Dokkyo Medical University, Tochigi 321-0293, Japan
- Data Science Center, Jichi Medical University, Tochigi 329-0498, Japan
| | - Jin Kikuchi
- Department of Emergency and Critical Care Medicine, Dokkyo Medical University, Tochigi 321-0293, Japan
| | - Hidekazu Hishinuma
- Department of Public Health, School of Medicine, Dokkyo Medical University, Tochigi 321-0293, Japan
| | - Takafumi Noguchi
- Department of Adult Nursing, School of Nursing, Dokkyo Medical University, Tochigi 321-0293, Japan
| | - Masayoshi Zaitsu
- Center for Research of the Aging Workforce, University of Occupational and Environmental Health, Fukuoka 807-8555, Japan
| | - Koji Wake
- Department of Emergency and Critical Care Medicine, Dokkyo Medical University, Tochigi 321-0293, Japan
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Hayes-Bradley C, McCreery M, Delorenzo A, Bendall J, Lewis A, Bowles KA. Predictive and protective factors for failing first pass intubation in prehospital rapid sequence intubation: an aetiology and risk systematic review with meta-analysis. Br J Anaesth 2024; 132:918-935. [PMID: 38508943 DOI: 10.1016/j.bja.2024.02.004] [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: 08/21/2023] [Revised: 01/15/2024] [Accepted: 02/01/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Prehospital rapid sequence intubation first pass success rates vary between 59% and 98%. Patient morbidity is associated with repeat intubation attempts. Understanding what influences first pass success can guide improvements in practice. We performed an aetiology and risk systematic review to answer the research question 'what factors are associated with success or failure at first attempt laryngoscopy in prehospital rapid sequence intubation?'. METHODS MEDLINE, EMBASE, CINAHL, and Cochrane Library were searched on March 3, 2023 for studies examining first pass success rates for rapid sequence intubation of prehospital live patients. Screening was performed via Covidence, and data synthesised by meta-analysis. The review was registered with PROSPERO and performed and reported as per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS Reasonable evidence was discovered for predictive and protective factors for failure of first pass intubation. Predictive factors included age younger than 1 yr, the presence of blood or fluid in the airway, restricted jaw or neck movement, trauma patients, nighttime procedures, chronic or acute distortions of normal face/upper airway anatomy, and equipment issues. Protective factors included an experienced intubator, adequate training, use of certain videolaryngoscopes, elevating the patient on a stretcher in an inclined position, use of a bougie, and laryngeal manoeuvres. CONCLUSIONS Managing bloody airways, positioning well, using videolaryngoscopes with bougies, and appropriate training should be further explored as opportunities for prehospital services to increase first pass success. Heterogeneity of studies limits stronger conclusions. SYSTEMATIC REVIEW PROTOCOL PROSPERO (CRD42022353609).
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Affiliation(s)
- Clare Hayes-Bradley
- Department of Paramedicine, Monash University, Frankston, VIC, Australia; NSW Ambulance Aeromedical Operations, Sydney, NSW, Australia.
| | | | - Ashleigh Delorenzo
- Department of Paramedicine, Monash University, Frankston, VIC, Australia
| | | | | | - Kelly-Ann Bowles
- Department of Paramedicine, Monash University, Frankston, VIC, Australia
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Eun S, Yoon H, Kang SY, Jo IJ, Heo S, Chang H, Lee G, Park JE, Kim T, Lee SU, Hwang SY, Baek SY. Real-Time Tracheal Ultrasound vs. Capnography for Intubation Confirmation during CPR Wearing a Powered Air-Purifying Respirator in COVID-19 Era. Diagnostics (Basel) 2024; 14:225. [PMID: 38275472 PMCID: PMC10813934 DOI: 10.3390/diagnostics14020225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/11/2024] [Accepted: 01/19/2024] [Indexed: 01/27/2024] Open
Abstract
This study aimed to compare the accuracy of real-time trans-tracheal ultrasound (TTUS) with capnography to confirm intubation in cardiopulmonary resuscitation (CPR) while wearing a powered air-purifying respirator (PAPR). This setting reflects increased caution due to contagious diseases. This single-center, prospective, comparative study enrolled patients requiring CPR while wearing a PAPR who visited the emergency department of a tertiary medical center from December 2020 to August 2022. A physician performed the TTUS in real time and recorded the tube placement assessment. Another healthcare provider attached waveform capnography to the tube and recorded end-tidal carbon dioxide (EtCO2) after five ventilations. The accuracy and agreement of both methods compared with direct laryngoscopic visualization of tube placement, and the time taken by both methods was evaluated. Thirty-three patients with cardiac arrest were analyzed. TTUS confirmed tube placement with 100% accuracy, sensitivity, and specificity, whereas capnography demonstrated 97% accuracy, 96.8% sensitivity, and 100% specificity. The Kappa values for TTUS and capnography compared to direct visualization were 1.0 and 0.7843, respectively. EtCO2 was measured in 45 (37-59) seconds (median (interquartile range)), whereas TTUS required only 12 (8-23) seconds, indicating that TTUS was significantly faster (p < 0.001). No significant correlation was found between the physician's TTUS proficiency and image acquisition time. This study demonstrated that TTUS is more accurate and faster than EtCO2 measurement for confirming endotracheal tube placement during CPR, particularly in the context of PAPR usage in pandemic conditions.
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Affiliation(s)
- Seungwan Eun
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06355, Republic of Korea (I.J.J.); (S.H.); (H.C.); (G.L.); (J.E.P.); (T.K.)
| | - Hee Yoon
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06355, Republic of Korea (I.J.J.); (S.H.); (H.C.); (G.L.); (J.E.P.); (T.K.)
| | - Soo Yeon Kang
- Department of Emergency Medicine, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong-si 14353, Republic of Korea;
| | - Ik Joon Jo
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06355, Republic of Korea (I.J.J.); (S.H.); (H.C.); (G.L.); (J.E.P.); (T.K.)
| | - Sejin Heo
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06355, Republic of Korea (I.J.J.); (S.H.); (H.C.); (G.L.); (J.E.P.); (T.K.)
| | - Hansol Chang
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06355, Republic of Korea (I.J.J.); (S.H.); (H.C.); (G.L.); (J.E.P.); (T.K.)
| | - Guntak Lee
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06355, Republic of Korea (I.J.J.); (S.H.); (H.C.); (G.L.); (J.E.P.); (T.K.)
| | - Jong Eun Park
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06355, Republic of Korea (I.J.J.); (S.H.); (H.C.); (G.L.); (J.E.P.); (T.K.)
| | - Taerim Kim
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06355, Republic of Korea (I.J.J.); (S.H.); (H.C.); (G.L.); (J.E.P.); (T.K.)
| | - Se Uk Lee
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06355, Republic of Korea (I.J.J.); (S.H.); (H.C.); (G.L.); (J.E.P.); (T.K.)
| | - Sung Yeon Hwang
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06355, Republic of Korea (I.J.J.); (S.H.); (H.C.); (G.L.); (J.E.P.); (T.K.)
| | - Sun-Young Baek
- Biomedical Statistics Center, Data Science Research Institute, Research Institute for Future Medicine, Samsung Medical Center, Seoul 06351, Republic of Korea;
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Canakci ME, Cetin M. PPEs and First-Pass Success in COVID-19. Prehosp Disaster Med 2023; 38:278. [PMID: 36799175 DOI: 10.1017/s1049023x23000195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Affiliation(s)
| | - Murat Cetin
- Emergency Department, Dr. Behcet Uz Pediatric Diseases and Surgery Training Research Hospital, Izmir, Turkey
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Heni A, Situmorang DDB. Prehospital as Responsibility for Life: The Duties that Humans Who Survive from the Danger of COVID-19 as a Humanitarian Disaster. Prehosp Disaster Med 2022; 38:1-2. [PMID: 36537795 DOI: 10.1017/s1049023x22002321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Anastasia Heni
- Master of Health Psychology, Faculty of Psychology, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
| | - Dominikus David Biondi Situmorang
- Department of Guidance and Counseling, Faculty of Education and Language, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
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