1
|
Pinto-Villalba RS, Leon-Rojas JE. Reported adverse events during out-of-hospital mechanical ventilation and ventilatory support in emergency medical services and critical care transport crews: a systematic review. Front Med (Lausanne) 2023; 10:1229053. [PMID: 37877027 PMCID: PMC10590890 DOI: 10.3389/fmed.2023.1229053] [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: 05/25/2023] [Accepted: 09/20/2023] [Indexed: 10/26/2023] Open
Abstract
Background Emergency medical services (EMS) and critical care transport crews constantly face critically-ill patients who need ventilatory support in scenarios where correct interventions can be the difference between life and death; furthermore, challenges like limited staff working on the patient and restricted spaces are often present. Due to these, mechanical ventilation (MV) can be a support by liberating staff from managing the airway and allowing them to focus on other areas; however, these patients face many complications that personnel must be aware of. Aims To establish the main complications related to out-of-hospital MV and ventilatory support through a systematic review. Methodology PubMed, BVS and Scopus were searched from inception to July 2021, following the PRISMA guidelines; search strategy and protocol were registered in PROSPERO. Two authors carried out an independent analysis of the articles; any disagreement was solved by mutual consensus, and data was extracted on a pre-determined spreadsheet. Only original articles were included, and risk of bias was assessed with quality assessment tools from the National Institutes of Health. Results The literature search yielded a total of 2,260 articles, of which 26 were included in the systematic review, with a total of 9,418 patients with out-of-hospital MV; 56.1% were male, and the age ranged from 18 to 82 years. In general terms of aetiology, 12.2% of ventilatory problems were traumatic in origin, and 64.8% were non-traumatic, with slight changes between out-of-hospital settings. Mechanical ventilation was performed 49.2% of the time in prehospital settings and 50.8% of the time in interfacility transport settings (IFTS). Invasive mechanical ventilation was used 98.8% of the time in IFTS while non-invasive ventilation was used 96.7% of the time in prehospital settings. Reporting of adverse events occurred in 9.1% of cases, of which 94.4% were critical events, mainly pneumothorax in 33.1% of cases and hypotension in 27.6% of cases, with important considerations between type of out-of-hospital setting and ventilatory mode; total mortality was 8.4%. Conclusion Reported adverse events of out-of-hospital mechanical ventilation vary between settings and ventilatory modes; this knowledge could aid EMS providers in promptly recognizing and resolving such clinical situations, depending on the type of scenario being faced.
Collapse
Affiliation(s)
- Ricardo Sabastian Pinto-Villalba
- Carrera de Atención Prehospitalaria y en Emergencias, Universidad Central del Ecuador, Quito, Ecuador
- Facultad de Medicina, Carrera de Atención Prehospitalaria y en Emergencias, Universidad UTE, Quito, Ecuador
- Medignosis, Medical Research Department, Quito, Ecuador
| | | |
Collapse
|
2
|
Shekhar AC, Blumen IJ, Ruskin KJ. Increasing use of prehospital mechanical ventilation by emergency medical services (EMS). Am J Emerg Med 2023:S0735-6757(23)00282-6. [PMID: 37270363 DOI: 10.1016/j.ajem.2023.05.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 05/18/2023] [Indexed: 06/05/2023] Open
Affiliation(s)
- Aditya C Shekhar
- Icahn School of Medicine at Mount Sinai, New York City, NY, United States of America.
| | - Ira J Blumen
- Section of Emergency Medicine, The University of Chicago Medicine, Chicago, IL, United States of America; University of Chicago Aeromedical Network (UCAN), Chicago, IL, United States of America
| | - Keith J Ruskin
- Department of Anesthesia and Critical Care, The University of Chicago Medicine, Chicago, IL, United States of America
| |
Collapse
|
3
|
Merrell JG, Scott AC, Stambro R, Boukai A, Cooper DD. Improved simulated ventilation with a novel tidal volume and peak inspiratory pressure controlling bag valve mask: A pilot study. Resusc Plus 2023; 13:100350. [PMID: 36654722 PMCID: PMC9841173 DOI: 10.1016/j.resplu.2022.100350] [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: 10/13/2022] [Revised: 12/05/2022] [Accepted: 12/19/2022] [Indexed: 01/07/2023] Open
Abstract
Introduction The dangers of hyperventilation during resuscitation are well known. Traditional bag valve mask (BVM) devices rely on end users to control tidal volume (Vt), rate, and peak inspiratory pressures (PIP) of ventilation. The Butterfly BVM (BBVM) is a novel device intending to give greater control over these parameters. The objective of this pilot study was to compare the BBVM against a traditional device in simulated resuscitations. Methods Senior emergency medicine residents and fellows participated in a three-phase simulation study. First, participants used the Ambu Spur II BVM in adult and pediatric resuscitations. Vt, PIP, and rate were recorded. Second, participants repeated the resuscitations after a brief introduction to the BBVM. Third, participants were given a longer introduction to the BBVM and were tested on their ability to adjust its various settings. Results Nineteen participants were included in the adult arm of the study, and 16 in the pediatric arm. The BBVM restricted Vt delivered to a range of 4-8 ml/kg vs 9 ml/kg and 13 ml/kg (Ambu adult and Ambu pediatric respectively). The BBVM never exceeded target minute ventilations while the Ambu BVMs exceeded target minute ventilation in 2 of 4 tests. The BBVM failed to reliably reach higher PIP targets in one test, while the pediatric Ambu device had 76 failures of excessive PIP compared to 2 failures by the BBVM. Conclusion The BBVM exceeded the Ambu Spur II in delivering appropriate Vts and in keeping PIPs below target maximums to simulated adult and pediatric patients in this pilot study.
Collapse
Affiliation(s)
- Jonathan G. Merrell
- Department of Pediatrics, Indiana University School of Medicine, 340 West 10th Street, Suite 6200, Indianapolis, IN, USA
- Compact Medical Inc, 7711 Ashtree Dr., Indianapolis, IN, USA
| | - Adam C. Scott
- Compact Medical Inc, 7711 Ashtree Dr., Indianapolis, IN, USA
| | - Ryan Stambro
- The Simulation Center at Fairbanks Hall, Indiana University Health, 340 W Tenth Street, Suite 4100, Indianapolis, IN, USA
| | - Amit Boukai
- Department of Emergency Medicine, Aventura Hospital and Medical Center, 20900 Biscayne Blvd, Aventura, FL, USA
| | - Dylan D. Cooper
- The Simulation Center at Fairbanks Hall, Indiana University Health, 340 W Tenth Street, Suite 4100, Indianapolis, IN, USA
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
- Corresponding author at: 340 W Tenth Street, Suite 4100, Indianapolis, IN 46202, USA.
| |
Collapse
|
4
|
Hardjo S, Haworth M, Croton C, Purcell S, Goodwin W. Pre-hospital emergency cricothyrotomy in dogs part 2: Airway sealing and ventilation using cricothyrotomy tubes. Front Vet Sci 2023; 10:1129462. [PMID: 36876002 PMCID: PMC9981793 DOI: 10.3389/fvets.2023.1129462] [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: 12/22/2022] [Accepted: 01/31/2023] [Indexed: 02/19/2023] Open
Abstract
Cricothyrotomy (CTT) has been recommended for use in the pre-hospital setting for military working dogs and Operational K9s during airway emergencies. Although the CTT can establish a patent airway for spontaneous ventilation, the ability to seal the airway and provide positive pressure ventilation (PPV) using tubes designed for humans has not been determined. Using various CTT tubes placed in cadaver dog airways, this study aimed to determine: (1) Whether the tube cuff could create a functional airway seal with safe intra-cuff pressures; (2) The magnitude of delivered tidal volume (TV) loss during a standard breath to assess the possibility of delivering an adequate tidal volume with a bag-valve device (BVM); (3) The best performing tubes for either test; (4) The reasons behind the findings using observations from upper airway endoscopy, dissection, and measurements. Cadaver dogs of similar weights to MWD and Operational K9 breeds had various CTT tubes placed including three from commercial kits, a standard endotracheal tube, and a tracheostomy tube. The minimum occlusive volume technique was used to inflate the tube cuff and a pressure ≤ 48 cm H2O with an adequate seal was considered successful. Individual TVs were calculated for each dog and added to the volume lost during delivery of a standard breath from an ICU ventilator. Endoscopy and airway dissection were performed to assess the relationship between tubes cuffs and the airway. The tubes from the CTT kits performed poorly with regards to producing an airway seal with the H&H tube failing to seal the airway all tests. Tracheal dimensions were significantly associated with successful airway sealing (P = 0.0004). Tidal volume loss could be compensated using a BVM in 34/35 tests with the H&H tube in cadaver 8 the only to fail. Tracheal airway sealing is influenced by airway anatomy when tube cuffs are inflated to a target pressure and larger tubes do not always provide a better seal. The CTT tubes tested have the potential to facilitate ventilation with a BVM under the conditions set in this study. The 8.0 mm endotracheal tube performed the best and the H&H the worst in both tests.
Collapse
Affiliation(s)
- Sureiyan Hardjo
- Faculty of Science, School of Veterinary Science, The University of Queensland, Gatton, QLD, Australia
| | - Mark Haworth
- Faculty of Science, School of Veterinary Science, The University of Queensland, Gatton, QLD, Australia
| | - Catriona Croton
- Faculty of Science, School of Veterinary Science, The University of Queensland, Gatton, QLD, Australia
| | - Sarah Purcell
- Faculty of Science, School of Veterinary Science, The University of Queensland, Gatton, QLD, Australia
| | - Wendy Goodwin
- Faculty of Science, School of Veterinary Science, The University of Queensland, Gatton, QLD, Australia
| |
Collapse
|
5
|
Maxey BS, White LA, Solitro GF, Conrad SA, Alexander JS. Experimental validation of a portable tidal volume indicator for bag valve mask ventilation. BMC Biomed Eng 2022; 4:9. [PMCID: PMC9668705 DOI: 10.1186/s42490-022-00066-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: 05/31/2022] [Accepted: 10/20/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction Short-term emergency ventilation is most typically accomplished through bag valve mask (BVM) techniques. BVMs like the AMBU® bag are cost-effective and highly portable but are also highly prone to user error, especially in high-stress emergent situations. Inaccurate and inappropriate ventilation has the potential to inflict great injury to patients through hyper- and hypoventilation. Here, we present the BVM Emergency Narration-Guided Instrument (BENGI) – a tidal volume feedback monitoring device that provides instantaneous visual and audio feedback on delivered tidal volumes, respiratory rates, and inspiratory/expiratory times. Providing feedback on the depth and regularity of respirations enables providers to deliver more consistent and accurate tidal volumes and rates. We describe the design, assembly, and validation of the BENGI as a practical tool to reduce manual ventilation-induced lung injury. Methods The prototype BENGI was assembled with custom 3D-printed housing and commercially available electronic components. A mass flow sensor in the central channel of the device measures air flow, which is used to calculate tidal volume. Tidal volumes are displayed via an LED ring affixed to the top of the BENGI. Additional feedback is provided through a speaker in the device. Central processing is accomplished through an Arduino microcontroller. Validation of the BENGI was accomplished using benchtop simulation with a clinical ventilator, BVM, and manikin test lung. Known respiratory quantities were delivered by the ventilator which were then compared to measurements from the BENGI to validate the accuracy of flow measurements, tidal volume calculations, and audio cue triggers. Results BENGI tidal volume measurements were found to lie within 4% of true delivered tidal volume values (95% CI of 0.53 to 3.7%) when breaths were delivered with 1-s inspiratory times, with similar performance for breaths delivered with 0.5-s inspiratory times (95% CI of 1.1 to 6.7%) and 2-s inspiratory times (95% CI of –1.1 to 2.3%). Audio cues “Bag faster” (1.84 to 2.03 s), “Bag slower” (0.35 to 0.41 s), and “Leak detected” (43 to 50%) were triggered close to target trigger values (2.00 s, 0.50 s, and 50%, respectively) across varying tidal volumes. Conclusions The BENGI achieved its proposed goals of accurately measuring and reporting tidal volumes delivered through BVM systems, providing immediate feedback on the quality of respiratory performance through audio and visual cues. The BENGI has the potential to reduce manual ventilation-induced lung injury and improve patient outcomes by providing accurate feedback on ventilatory parameters. Supplementary Information The online version contains supplementary material available at 10.1186/s42490-022-00066-y.
Collapse
Affiliation(s)
- Benjamin S. Maxey
- grid.411417.60000 0004 0443 6864Department of Molecular & Cellular Physiology, LSU Health Shreveport, 1501 Kings Highway, Shreveport, LA 71103-3932 USA
| | - Luke A. White
- grid.411417.60000 0004 0443 6864Department of Molecular & Cellular Physiology, LSU Health Shreveport, 1501 Kings Highway, Shreveport, LA 71103-3932 USA
| | - Giovanni F. Solitro
- grid.411417.60000 0004 0443 6864Department of Orthopaedic Surgery, LSU Health Shreveport, Shreveport, LA USA
| | - Steven A. Conrad
- grid.411417.60000 0004 0443 6864Department of Medicine, LSU Health Shreveport, Shreveport, LA USA ,grid.411417.60000 0004 0443 6864Department of Emergency Medicine, LSU Health Shreveport, Shreveport, LA USA ,grid.411417.60000 0004 0443 6864Department of Pediatrics, LSU Health Shreveport, Shreveport, LA USA
| | - J. Steven Alexander
- grid.411417.60000 0004 0443 6864Department of Molecular & Cellular Physiology, LSU Health Shreveport, 1501 Kings Highway, Shreveport, LA 71103-3932 USA ,grid.411417.60000 0004 0443 6864Department of Medicine, LSU Health Shreveport, Shreveport, LA USA ,grid.411417.60000 0004 0443 6864Department of Neurology, LSU Health Shreveport, Shreveport, LA USA
| |
Collapse
|
6
|
Sun G, Wojcik S, Noce J, Cochran-Caggiano N, DeSantis T, Friedman S, Cooney DR, Knutsen C. Are Pediatric Manual Resuscitators Only Fit For Pediatric Use? A Comparison of Ventilation Volumes in a Moving Ambulance. PREHOSP EMERG CARE 2022; 27:501-505. [PMID: 35420928 DOI: 10.1080/10903127.2022.2066235] [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
BACKGROUND The manual resuscitator device is the most common method of ventilating patients with respiratory failure, either with a facemask, or with an advanced airway such as an ETT. Barotrauma and gastric inflation from excessive ventilation volumes or pressure are concerning complications. Ventilating adult patients with pediatric manual resuscitator may provide more lung-protective tidal volumes based on stationary patient simulations. However, use of a pediatric manual resuscitator in mobile simulations contradictorily generates inadequate tidal volumes. METHODS Sixty-two EMS clinicians in a moving ambulance ventilated a manikin using pediatric and adult manual resuscitators in conjunction with oral-pharyngeal airway, i-gel, King LTS-D, or an endotracheal tube. RESULTS Oral-pharyngeal airway data were discarded due to EMS clinician inability to produce measurable tidal volumes. Mean ventilation volumes using the pediatric manual resuscitator were inadequate compared to those with the adult manual resuscitator on all other airway devices. In addition, i-gel, King LTS-D, and endotracheal tube volumes were statistically comparable. Paramedics ventilated larger volumes than emergency medical technicians. CONCLUSIONS Using a pediatric manual resuscitator on adult patients is not supported by our findings.
Collapse
Affiliation(s)
- Gregory Sun
- Department of Emergency Medicine, Morristown Medical Center, Morristown, NJ, USA.,Department of Emergency Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Susan Wojcik
- Department of Emergency Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
| | | | | | - Tracie DeSantis
- Department of Emergency Medicine, SUNY Upstate Medical University, Syracuse, NY, USA.,American Medical Response of Central New York, Syracuse, NY
| | - Steven Friedman
- Department of Emergency Medicine, SUNY Upstate Medical University, Syracuse, NY, USA.,American Medical Response of Central New York, Syracuse, NY
| | - Derek R Cooney
- Department of Emergency Medicine, SUNY Upstate Medical University, Syracuse, NY, USA.,American Medical Response of Central New York, Syracuse, NY
| | - Chrisitan Knutsen
- Department of Emergency Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
| |
Collapse
|
7
|
Sojar SH, Neronha ZJ, Vuong B, Puzone JR, Decerbo PC, Baird J, Wing R. Use of a novel pedal-operated compressor is non-inferior to the use of a standard hand-compressed bag-valve mask. J Am Coll Emerg Physicians Open 2022; 3:e12668. [PMID: 35156091 PMCID: PMC8828681 DOI: 10.1002/emp2.12668] [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: 11/16/2021] [Revised: 12/25/2021] [Accepted: 01/05/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND The standard bag-valve mask (BVM) used universally requires that a single healthcare practitioner affix the mask to the face with 1 hand while compressing a self-inflating bag with the second hand. Studies have demonstrated that creating a 2-handed seal (with 2 healthcare practitioners) is superior. Our study aims to assess the efficacy of a novel single-practitioner BVM device that uses a foot pedal as the bag compressor, allowing both hands to be available for the seal to facilitate delivery of appropriate tidal volumes during single-practitioner resuscitation. METHODS This was a prospective, randomized, cross-over study. Participants with various BVM ventilation experience performed 2 minutes of metronome-guided BVM ventilation using a standard BVM and the pedal-operated compressor on a high-fidelity simulation mannequin. Analysis examining differences in mean tidal volume delivered was conducted using a regression model that adjusted for covariates. A secondary analysis using a series of Wilcoxon tests was conducted to compare differences in the additional out-of-range sensed breaths metrics to compare differences by prior BVM ventilation experience. RESULTS A total of 58 subjects participated. The pedal-operated compressor unadjusted mean tidal volume delivered was 446.5 mL (95% confidence interval [CI], 425.9-467.1) compared with 340.6 mL (95% CI, 312.2-369.0) by standard BVM (mean change, 105.9 mL [95% CI, 71.2-140.6]; P < .001). When modeling a generalized estimation equation regression model, standard BVM ventilation provided a mean difference of 105.9 mL less than pedal-operated compressor ventilation after adjusting for covariates (P = 0.01). For the secondary outcome, the pedal-operated compressor did have a significantly lower median number of out-of-range breaths (median, 3; interquartile range [IQR], 1-11.5) compared with the standard device (median, 13.5; IQR, 6-19; P < 0.001). CONCLUSIONS Use of a novel pedal-operated compressor may allow a single healthcare practitioner, regardless of prior experience, to deliver consistent, appropriate tidal volumes with more ease compared with the standard BVM during manual respiratory resuscitation.
Collapse
Affiliation(s)
- Sakina H. Sojar
- Department of Emergency MedicineUniversity of Florida College of MedicineGainesvilleFloridaUSA
| | - Zachary J. Neronha
- Washington University in St Louis School of MedicineSt. LouisMissouriUSA
| | - Brian Vuong
- Department of Mechanical EngineeringStanford UniversityStanfordCaliforniaUSA
| | | | - Paul C. Decerbo
- Lifespan Simulation CenterRhode Island HospitalProvidenceRhode IslandUSA
| | - Janette Baird
- Department of Emergency MedicineAlpert Medical School of Brown UniversityProvidenceRhode IslandUSA
| | - Robyn Wing
- Department of Emergency MedicineAlpert Medical School of Brown UniversityProvidenceRhode IslandUSA
- Department of PediatricsAlpert Medical School of Brown UniversityProvidenceRhode IslandUSA
| |
Collapse
|
8
|
Baez AA, Qasim Z, Wilcox S, Weir WB, Loeffler P, Golden BM, Schwartz D, Levy M. Prehospital Mechanical Ventilation: An NAEMSP Position Statement and Resource Document. PREHOSP EMERG CARE 2022; 26:88-95. [PMID: 35001824 DOI: 10.1080/10903127.2021.1994676] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Airway emergencies and respiratory failure frequently occur in the prehospital setting. Patients undergoing advanced airway management customarily receive manual ventilations. However, manual ventilation is associated with hypo- and hyperventilation, variable tidal volumes, and barotrauma, among other potential complications. Portable mechanical ventilators offer an important strategy for optimizing ventilation and mitigating ventilatory complications.EMS clinicians, including those performing emergency response as well as interfacility transports, should consider using mechanical ventilation after advanced airway insertion.Prehospital mechanical ventilation techniques, strategies, and parameters should be disease-specific and should mirror in-hospital best practices.EMS clinicians must receive training in the general principles of mechanical ventilation as well as detailed training in the operation of the specific system(s) used by the EMS agency.Patients undergoing mechanical ventilation must receive appropriate sedation and analgesia.
Collapse
|
9
|
W Lyng J, Guyette FX, Levy M, Bosson N. Prehospital Manual Ventilation: An NAEMSP Position Statement and Resource Document. PREHOSP EMERG CARE 2022; 26:23-31. [PMID: 35001826 DOI: 10.1080/10903127.2021.1981506] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Manual ventilation using a self-inflating bag device paired with a facemask (bag-valve-mask, or BVM ventilation) or invasive airway (bag-valve-device, or BVD ventilation) is a fundamental airway management skill for all Emergency Medical Services (EMS) clinicians. Delivery of manual ventilations is challenging. Several strategies and adjunct technologies can increase the effectiveness of manual ventilation. NAEMSP recommends:All EMS clinicians must be proficient in bag-valve-mask ventilation.BVM ventilation should be performed using a two-person technique whenever feasible.EMS clinicians should use available techniques and adjuncts to achieve optimal mask seal, improve airway patency, optimize delivery of the correct rate, tidal volume, and pressure during manual ventilation, and allow continual assessment of manual ventilation effectiveness.
Collapse
|
10
|
Carlson JN, Colella MR, Daya MR, J De Maio V, Nawrocki P, Nikolla DA, Bosson N. Prehospital Cardiac Arrest Airway Management: An NAEMSP Position Statement and Resource Document. PREHOSP EMERG CARE 2022; 26:54-63. [PMID: 35001831 DOI: 10.1080/10903127.2021.1971349] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Airway management is a critical component of out-of-hospital cardiac arrest (OHCA) resuscitation. Multiple cardiac arrest airway management techniques are available to EMS clinicians including bag-valve-mask (BVM) ventilation, supraglottic airways (SGAs), and endotracheal intubation (ETI). Important goals include achieving optimal oxygenation and ventilation while minimizing negative effects on physiology and interference with other resuscitation interventions. NAEMSP recommends:Based on the skill of the clinician and available resources, BVM, SGA, or ETI may be considered as airway management strategies in OHCA.Airway management should not interfere with other key resuscitation interventions such as high-quality chest compressions, rapid defibrillation, and treatment of reversible causes of the cardiac arrest.EMS clinicians should take measures to avoid hyperventilation during cardiac arrest resuscitation.Where available for clinician use, capnography should be used to guide ventilation and chest compressions, confirm and monitor advanced airway placement, identify return of spontaneous circulation (ROSC), and assist in the decision to terminate resuscitation.
Collapse
|
11
|
Van de Voorde P, Turner NM, Djakow J, de Lucas N, Martinez-Mejias A, Biarent D, Bingham R, Brissaud O, Hoffmann F, Johannesdottir GB, Lauritsen T, Maconochie I. [Paediatric Life Support]. Notf Rett Med 2021; 24:650-719. [PMID: 34093080 PMCID: PMC8170638 DOI: 10.1007/s10049-021-00887-9] [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] [Accepted: 04/19/2021] [Indexed: 12/11/2022]
Abstract
The European Resuscitation Council (ERC) Paediatric Life Support (PLS) guidelines are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations of the International Liaison Committee on Resuscitation (ILCOR). This section provides guidelines on the management of critically ill or injured infants, children and adolescents before, during and after respiratory/cardiac arrest.
Collapse
Affiliation(s)
- Patrick Van de Voorde
- Department of Emergency Medicine, Faculty of Medicine UG, Ghent University Hospital, Gent, Belgien
- Federal Department of Health, EMS Dispatch Center, East & West Flanders, Brüssel, Belgien
| | - Nigel M. Turner
- Paediatric Cardiac Anesthesiology, Wilhelmina Children’s Hospital, University Medical Center, Utrecht, Niederlande
| | - Jana Djakow
- Paediatric Intensive Care Unit, NH Hospital, Hořovice, Tschechien
- Paediatric Anaesthesiology and Intensive Care Medicine, University Hospital Brno, Medical Faculty of Masaryk University, Brno, Tschechien
| | | | - Abel Martinez-Mejias
- Department of Paediatrics and Emergency Medicine, Hospital de Terassa, Consorci Sanitari de Terrassa, Barcelona, Spanien
| | - Dominique Biarent
- Paediatric Intensive Care & Emergency Department, Hôpital Universitaire des Enfants, Université Libre de Bruxelles, Brüssel, Belgien
| | - Robert Bingham
- Hon. Consultant Paediatric Anaesthetist, Great Ormond Street Hospital for Children, London, Großbritannien
| | - Olivier Brissaud
- Réanimation et Surveillance Continue Pédiatriques et Néonatales, CHU Pellegrin – Hôpital des Enfants de Bordeaux, Université de Bordeaux, Bordeaux, Frankreich
| | - Florian Hoffmann
- Pädiatrische Intensiv- und Notfallmedizin, Kinderklinik und Kinderpoliklinik im Dr. von Haunerschen Kinderspital, Ludwig-Maximilians-Universität, München, Deutschland
| | | | - Torsten Lauritsen
- Paediatric Anaesthesia, The Juliane Marie Centre, University Hospital of Copenhagen, Kopenhagen, Dänemark
| | - Ian Maconochie
- Paediatric Emergency Medicine, Faculty of Medicine Imperial College, Imperial College Healthcare Trust NHS, London, Großbritannien
| |
Collapse
|
12
|
Lyng J, Adelgais K, Alter R, Beal J, Chung B, Gross T, Minkler M, Moore B, Stebbins T, Vance S, Williams K, Yee A. Recommended Essential Equipment for Basic Life Support and Advanced Life Support Ground Ambulances 2020: A Joint Position Statement. Pediatrics 2021; 147:peds.2021-051508. [PMID: 34011633 DOI: 10.1542/peds.2021-051508] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- John Lyng
- National Association of EMS Physicians, Overland Park, Kansas;
| | - Kathleen Adelgais
- Emergency Medical Services for Children Innovation and Improvement Center, Austin, Texas
| | - Rachael Alter
- Emergency Medical Services for Children Innovation and Improvement Center, Austin, Texas
| | - Justin Beal
- Emergency Nurses Association, Des Plaines, Illinois
| | - Bruce Chung
- American College of Surgeons Committee on Trauma, Chicago, Illinois
| | - Toni Gross
- National Association of EMS Physicians, Overland Park, Kansas
| | - Marc Minkler
- National Association of State Emergency Medical Services Officials, Falls Church, Virginia; and
| | - Brian Moore
- American Academy of Pediatrics, Itasca, Illinois
| | - Tim Stebbins
- National Association of EMS Physicians, Overland Park, Kansas
| | - Sam Vance
- Emergency Medical Services for Children Innovation and Improvement Center, Austin, Texas
| | - Ken Williams
- National Association of State Emergency Medical Services Officials, Falls Church, Virginia; and
| | - Allen Yee
- National Association of EMS Physicians, Overland Park, Kansas
| |
Collapse
|
13
|
Van de Voorde P, Turner NM, Djakow J, de Lucas N, Martinez-Mejias A, Biarent D, Bingham R, Brissaud O, Hoffmann F, Johannesdottir GB, Lauritsen T, Maconochie I. European Resuscitation Council Guidelines 2021: Paediatric Life Support. Resuscitation 2021; 161:327-387. [PMID: 33773830 DOI: 10.1016/j.resuscitation.2021.02.015] [Citation(s) in RCA: 151] [Impact Index Per Article: 50.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
These European Resuscitation Council Paediatric Life Support (PLS) guidelines, are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. This section provides guidelines on the management of critically ill infants and children, before, during and after cardiac arrest.
Collapse
Affiliation(s)
- Patrick Van de Voorde
- Department of Emergency Medicine Ghent University Hospital, Faculty of Medicine UG, Ghent, Belgium; EMS Dispatch Center, East & West Flanders, Federal Department of Health, Belgium.
| | - Nigel M Turner
- Paediatric Cardiac Anesthesiology, Wilhelmina Children's Hospital, University Medical Center, Utrecht, Netherlands
| | - Jana Djakow
- Paediatric Intensive Care Unit, NH Hospital, Hořovice, Czech Republic; Paediatric Anaesthesiology and Intensive Care Medicine, University Hospital Brno, Medical Faculty of Masaryk University, Brno, Czech Republic
| | | | - Abel Martinez-Mejias
- Department of Paediatrics and Emergency Medicine, Hospital de Terassa, Consorci Sanitari de Terrassa, Barcelona, Spain
| | - Dominique Biarent
- Paediatric Intensive Care & Emergency Department, Hôpital Universitaire des Enfants, Université Libre de Bruxelles, Brussels, Belgium
| | - Robert Bingham
- Hon. Consultant Paediatric Anaesthetist, Great Ormond Street Hospital for Children, London, UK
| | - Olivier Brissaud
- Réanimation et Surveillance Continue Pédiatriques et Néonatales, CHU Pellegrin - Hôpital des Enfants de Bordeaux, Université de Bordeaux, Bordeaux, France
| | - Florian Hoffmann
- Paediatric Intensive Care and Emergency Medicine, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany
| | | | - Torsten Lauritsen
- Paediatric Anaesthesia, The Juliane Marie Centre, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Ian Maconochie
- Paediatric Emergency Medicine, Imperial College Healthcare Trust NHS, Faculty of Medicine Imperial College, London, UK
| |
Collapse
|
14
|
Blackburn MB, Hudson IL, Rodriguez C, Wienandt N, Ryan KL. Acute overventilation does not cause lung damage in moderately hemorrhaged swine. J Appl Physiol (1985) 2021; 130:1337-1344. [PMID: 33734830 DOI: 10.1152/japplphysiol.01048.2020] [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: 11/22/2022] Open
Abstract
Airway management is important in trauma and critically ill patients. Prolonged mechanical ventilation results in overventilation-induced lung barotrauma, but few studies have examined the consequence of acute (1 h or less) overventilation. We hypothesized that acute hyperventilation, as might inadvertently be performed in prehospital settings, would elevate systemic inflammation and cause lung damage. Female Yorkshire pigs (40-50 kg, n = 10/group) were anesthetized, instrumented for hemodynamic measurements and blood sampling, and underwent a 25% controlled hemorrhage followed by 1 h of 1) spontaneous breathing, 2) "normal" bag ventilation (4.8 L·min volume, ∼400 mL tidal volume, 12 breaths/minute), 3) bag hyperventilation (9 L·min volume, ∼750 mL tidal volume, 12 breaths/minute), 4) maximum hyperventilation (15 L·min volume, ∼750 mL tidal volume, 20 breaths/minute), or 5) mechanical ventilation. Pigs then regained consciousness and recovered for 24 h, followed by euthanasia and collection of blood and tissue samples. No level of manual ventilation had any significant impact on hemodynamic variables. Blood markers of tissue damage and plasma cytokines were not statistically different between groups with the exception of a transient increase in IL-1β; all values returned to baseline by 24 h. On pathological review, severity and distribution of lung edema or other gross pathologies were not significantly different between groups. These data indicate hyperventilation causes no adverse effects, to include inflammation and tissue damage, and that acute overventilation, as could be seen in the prehospital phase of trauma care, does not produce evidence of adverse effects on the lungs following moderate hemorrhage.NEW & NOTEWORTHY Appropriate airway management is essential in trauma and critically ill patients. Prolonged mechanical ventilation can result in overventilation-induced lung barotrauma, but few studies have examined the consequence of acute overventilation. We investigated the outcome of hemorrhage followed by 1 h of overventilation in swine. We found that acute overventilation, as could be seen in the prehospital phase of trauma care, does not produce evidence of adverse effects on otherwise healthy lungs following moderate hemorrhage.
Collapse
Affiliation(s)
- Megan B Blackburn
- Tactical and Enroute Care Research Department, United States Army Institute of Surgical Research, Joint Base San Antonio-Fort Sam Houston, San Antonio, Texas
| | - Ian L Hudson
- Tactical and Enroute Care Research Department, United States Army Institute of Surgical Research, Joint Base San Antonio-Fort Sam Houston, San Antonio, Texas
| | - Cassandra Rodriguez
- Tactical and Enroute Care Research Department, United States Army Institute of Surgical Research, Joint Base San Antonio-Fort Sam Houston, San Antonio, Texas
| | - Nathan Wienandt
- Comparative Pathology Department, United States Army Institute of Surgical Research, Joint Base San Antonio-Fort Sam Houston, San Antonio, Texas
| | - Kathy L Ryan
- Tactical and Enroute Care Research Department, United States Army Institute of Surgical Research, Joint Base San Antonio-Fort Sam Houston, San Antonio, Texas
| |
Collapse
|
15
|
Lyng J, Adelgais K, Alter R, Beal J, Chung B, Gross T, Minkler M, Moore B, Stebbins T, Vance S, Williams K, Yee A. Recommended Essential Equipment for Basic Life Support and Advanced Life Support Ground Ambulances 2020: A Joint Position Statement. PREHOSP EMERG CARE 2021; 25:451-459. [PMID: 33557659 DOI: 10.1080/10903127.2021.1886382] [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] [Indexed: 10/22/2022]
Abstract
In continued support of establishing and maintaining a foundation for standards of care, our organizations remain committed to periodic review and revision of this position statement. This latest revision was created based on a structured review of the National Model EMS Clinical Guidelines Version 2.2 in order to identify the equipment items necessary to deliver the care defined by those guidelines. In addition, in order to ensure congruity with national definitions of provider scope of practice, the list is differentiated into BLS and ALS levels of service utilizing the National Scope of Practice-defined levels of Emergency Medical Responder (EMR) and Emergency Medical Technician (EMT) as BLS, and Advanced EMT (AEMT) and Paramedic as ALS. Equipment items listed within each category were cross-checked against recommended scopes of practice for each level in order to ensure they were appropriately dichotomized to BLS or ALS levels of care. Some items may be considered optional at the local level as determined by agency-defined scope of practice and applicable clinical guidelines. In addition to the items included in this position statement our organizations agree that all EMS service programs should carry equipment and supplies in quantities as determined by the medical director and appropriate to the agency's level of care and available certified EMS personnel and as established in the agency's approved protocols.
Collapse
|
16
|
Heo S, Yoon SY, Kim J, Kim HS, Kim K, Yoon H, Hwang SY, Cha WC, Kim T. Effectiveness of a Real-Time Ventilation Feedback Device for Guiding Adequate Minute Ventilation: A Manikin Simulation Study. ACTA ACUST UNITED AC 2020; 56:medicina56060278. [PMID: 32516894 PMCID: PMC7353869 DOI: 10.3390/medicina56060278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/29/2020] [Accepted: 06/01/2020] [Indexed: 11/24/2022]
Abstract
Background and objectives: It is often challenging even for skilled rescuers to provide adequate positive pressure ventilation consistently. This study aimed to investigate the effectiveness of a newly developed real-time ventilation feedback device (RTVFD) that estimates tidal volume (TV) and ventilation interval (VI) in real time. Materials and methods: We conducted a randomised, crossover, manikin simulation study. A total of 26 medical providers were randomly assigned to the RTVFD-assisted ventilation (RAV) first group (n = 13) and the non-assisted ventilation (NV) first group (n = 13). Participants provided ventilation using adult and paediatric bag valves (BVs) for 2 min each. After a washout period, the simulation was repeated by exchanging the participants’ groups. Results: The primary outcome was optimal TV in the RAV and NV groups using adult and paediatric BVs. A secondary outcome was optimal VI in the RAV and NV groups using adult and paediatric BVs. The proportions of optimal TV values were higher for the RAVs when using both adult and paediatric BVs (adult BV: 47.29% vs. 18.46%, p < 0.001; paediatric BV: 89.51% vs. 72.66%, p < 0.001) than for the NVs. The proportions of optimal VI were significantly higher in RAVs when using both adult and paediatric BVs than that in NVs (adult BV: 95.64% vs. 50.20%, p < 0.001; paediatric BV: 95.83% vs. 57.14%, p < 0.001). Additionally, we found that with paediatric BVs, the simulation had a higher OR for both optimal TV (13.26; 95% CI, 9.96–17.65; p < 0.001) and VI (1.32; 1.08–1.62, p = 0.007), regardless of RTVFD use. Conclusion: Real-time feedback using RTVFD significantly improves the TV and VI in both adult and paediatric BVs in a manikin simulation study.
Collapse
Affiliation(s)
- Sejin Heo
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (S.H.); (S.Y.Y.); (H.Y.); (S.Y.H.); (W.C.C.)
| | - Sun Young Yoon
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (S.H.); (S.Y.Y.); (H.Y.); (S.Y.H.); (W.C.C.)
| | - Jongchul Kim
- Department of Biomedical Engineering, Samsung Medical Center, Seoul 06351, Korea;
| | - Hye Seung Kim
- Biostatistics and Clinical Epidemiology Center, Samsung Medical Center, Seoul 06351, Korea; (H.S.K.); (K.K.)
| | - Kyunga Kim
- Biostatistics and Clinical Epidemiology Center, Samsung Medical Center, Seoul 06351, Korea; (H.S.K.); (K.K.)
- Department of Digital Health, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul 06355, Korea
| | - Hee Yoon
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (S.H.); (S.Y.Y.); (H.Y.); (S.Y.H.); (W.C.C.)
| | - Sung Yeon Hwang
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (S.H.); (S.Y.Y.); (H.Y.); (S.Y.H.); (W.C.C.)
| | - Won Chul Cha
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (S.H.); (S.Y.Y.); (H.Y.); (S.Y.H.); (W.C.C.)
- Department of Digital Health, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul 06355, Korea
| | - Taerim Kim
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (S.H.); (S.Y.Y.); (H.Y.); (S.Y.H.); (W.C.C.)
- Correspondence: ; Tel.: +82-2-3410-2053; Fax: +82-2-3410-0049
| |
Collapse
|
17
|
Dafilou B, Schwester D, Ruhl N, Marques-Baptista A. It's In The Bag: Tidal Volumes in Adult and Pediatric Bag Valve Masks. West J Emerg Med 2020; 21:722-726. [PMID: 32421525 PMCID: PMC7234703 DOI: 10.5811/westjem.2020.3.45788] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 03/11/2020] [Indexed: 01/09/2023] Open
Abstract
Introduction A bag valve mask (BVM) is a life saving device used by all levels of health care professionals during resuscitative care. We focus most of our time optimizing the patient’s position, firmly securing the mask, and frequency of ventilations. However, despite our best efforts to control these factors, we may still be precipitating harm to the patient. Multiple studies have shown the tidal volumes typically delivered by the adult BVM are often higher than recommended for lung-protective ventilation protocols. In this study we measure and compare the ventilation parameters delivered by the adult and pediatric BVM ventilators. Methods A RespiTrainer Advance® adult mannequin was used to simulate a patient. Healthcare providers were directed to manually ventilate an intubated mannequin for two minutes using adult and pediatric sized BVMs. Tidal volume, minute ventilation, peak pressure, and respiration rate was recorded. Results The adult BVM provided a mean tidal volume of 807.7mL versus the pediatric BVM providing 630.7mL, both of which exceeded the upper threshold of 560mL of tidal volume necessary for lung protective ventilation of an adult male with an ideal body weight of 70kg. The adult BVM exceeded this threshold by 44.2% versus the pediatric BVM’s 12.6% with 93% of participants exceeding the maximum threshold with the adult BVM and 82.3% exceeding it with the pediatric BVM. Conclusion The pediatric BVM in our study provided far more consistent and appropriate ventilation parameters for adult patients compared to an adult BVM, but still exceeded the upper limits of lung protective ventilation parameters. The results of this study highlight the potential dangers in using an adult BVM due to increased risk of pulmonary barotrauma. These higher tidal volumes can contribute to lung injury. This study confirms that smaller BVMs may provide safer ventilatory parameters. Future studies should focus on patient-centered outcomes with BVM.
Collapse
Affiliation(s)
- Benjamin Dafilou
- Capital Health Hospital System, Department of Emergency Medical Services, Trenton, New Jersey
| | - Daniel Schwester
- Capital Health Hospital System, Department of Emergency Medical Services, Trenton, New Jersey
| | - Nathan Ruhl
- Rowan University, Department of Biological Sciences, Glassboro, New Jersey
| | | |
Collapse
|
18
|
McLachlan B, Bilbrey C, Mausner K, Lenz TJ. Effectiveness of Manual Ventilation in Intubated Helicopter Emergency Services-Transported Trauma Patients. Air Med J 2019; 38:273-275. [PMID: 31248536 DOI: 10.1016/j.amj.2019.03.013] [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: 11/24/2018] [Revised: 03/01/2019] [Accepted: 03/27/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Helicopter Emergency Medical Services agencies frequently transport intubated patients to definitive care. No evidence exists to determine the type of ventilation in this population. Practice varies amongst programs from bag-valve-mask to mechanical ventilation. STUDY OBJECTIVE Evaluate the effectiveness of bag-valve ventilation in intubated trauma patients. We hypothesized manual ventilation provides adequate support to maintain physiologic ETCO2. METHODS From June to December 2015, twenty patients were enrolled in this prospective, observational study. Included were endotracheally intubated trauma patients transported by this HEMS program. Excluded were interfacility transports, non-scene calls, and patients with supraglottic devices. ETCO2 was recorded every 30 seconds during the flight. As a descriptive pilot study, power was not considered. RESULTS 20 patients provided over 500 cumulative minutes of manual ventilation data. The percentage of cumulative time spent with adequate oxygen saturations was 83.6%. The percentage of cumulative time spent with adequate ETCO2 was 48.7%, with 34.6% of time spent under and 16.7% above this range. CONCLUSION Manual ventilation maintained a physiologic ETCO2 only 16.7% of the time. Significant variability existed, resulting in intermittent hypoxia and hyperventilation. Prior research linked such events to increased morbidity and mortality. Further studies are warranted to compare manual against mechanically ventilated patients.
Collapse
Affiliation(s)
- Brett McLachlan
- Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Craig Bilbrey
- Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Keith Mausner
- Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Timothy J Lenz
- Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI.
| |
Collapse
|
19
|
Kroll M, Das J, Siegler J. Can Altering Grip Technique and Bag Size Optimize Volume Delivered with Bag-Valve-Mask by Emergency Medical Service Providers? PREHOSP EMERG CARE 2018; 23:210-214. [PMID: 30130437 DOI: 10.1080/10903127.2018.1489020] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Emergency Medical Services (EMS) professionals rely on the bag-valve-mask (BVM) to provide life-saving positive-pressure ventilation in the prehospital setting. Multiple emergency medicine and critical care studies have shown that lung-protective ventilation protocols reduce morbidity and mortality. A recent study has shown that the volumes typically delivered by EMS professionals with the adult BVM are often higher than recommended by lung-protective ventilation protocols. Our primary objective was to determine if a group of EMS professionals could reduce the volume delivered by adjusting the way the BVM was held. Secondary objectives included 1) if the adjusted grip allowed for volumes more consistent with lung-protection ventilation strategies and 2) comparing volumes to similar grip strategies used with a smaller BVM. METHODS A patient simulator of a head and thorax was used to record respiratory rate, tidal volume, peak pressure, and minute volume delivered by participants for 1 minute each across 6 different scenarios: 3 different grips (using the thumb and either 3 fingers, 2 fingers, or one finger) with 2 different sized BVMs (adult and pediatric). Trials were randomized by blindly selecting a paper with the scenario listed. A convenience sample of EMS providers was used based on EMS provider and research staff availability. RESULTS We enrolled 50 providers from a large, busy, urban hospital-based EMS agency a mean 8.60 (SD = 9.76) years of experience. Median volumes for each scenario were 836.0 mL, 834.5 mL, and 794 mL for the adult BMV (p = 0.003); and 576.0 mL, 571.5 mL, and 547.0 mL for the pediatric BVM (p < 0.001). Across all 3 grips, the pediatric BVM provided more breaths within the recommended volume range for a 70 kg patient (46.4% vs. 0.4%; p < 0.001) with only a 1.1% of breaths below the recommended tidal volume. CONCLUSION The study suggests that it is possible to alter the volume provided by the BVM by altering the grip on the BVM. The tidal volumes recorded with the pediatric BVM were above recommended range in 2 of the 3 grips. The volumes of the pediatric BVM were overall more consistent with lung-protective ventilation volumes when compared to all 3 finger-grips of the adult BVM.
Collapse
|
20
|
Cicero MX, Whitfill T, Walsh B, Diaz MC, Arteaga G, Scherzer DJ, Goldberg S, Madhok M, Bowen A, Paesano G, Redlener M, Munjal K, Kessler D, Auerbach M. 60 Seconds to Survival: A Multisite Study of a Screen-based Simulation to Improve Prehospital Providers Disaster Triage Skills. AEM EDUCATION AND TRAINING 2018; 2:100-106. [PMID: 30051076 PMCID: PMC5996818 DOI: 10.1002/aet2.10080] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 11/24/2017] [Accepted: 12/12/2017] [Indexed: 06/01/2023]
Abstract
OBJECTIVES Paramedics and emergency medical technicians (EMTs) perform triage at disaster sites. There is a need for disaster triage training. Live simulation training is costly and difficult to deliver. Screen-based simulations may overcome these training barriers. We hypothesized that a screen-based simulation, 60 Seconds to Survival (60S), would be associated with in-game improvements in triage accuracy. METHODS This was a prospective cohort study of a screen-based simulation intervention, 60S. Participants included emergency medical services (EMS) personnel from 21 EMS agencies across 12 states. Participants performed assessments (e.g., check for pulse) and actions (e.g., reposition the airway) for 12 patients in each scenario and assigned color-coded triage levels (red, yellow, green, or black) to each patient. Participants received on-screen feedback about triage performance immediately after each scenario. A scoring system was designed to encourage accurate and timely triage decisions. Participants who played 60S included practicing EMTs, paramedics, and nurses as well as students studying to assume these roles. Participants played the game at least three times over 13 weeks. RESULTS In total, 2,234 participants began game play and 739 completed the study and were included in the analysis. Overall, the median number of plays of the game was just above the threshold inclusion criteria (three or more plays) with a median of four plays during the study period (interquartile range [IQR] = 3-7). There was a significant difference in triage accuracy from the first play of the game to the last play of the game. Median baseline triage accuracy in the game was 89.7% (IQR = 82.1%-94.9%), which then increased to a median of 100% at the last game play (IQR = 87.5%-100.0%; p < 0.001). There was some variability in median triage accuracy on fourth through 11th game plays, ranging from 95% to 100%, and on the 12th to 16th plays, the median accuracy was sustained at 100%. There was a significant decrease in the rate of undertriage: from 10.3% (IQR = 5.1%-18.0%) to 0 (IQR = 0%-12.5%; p < 0.001). CONCLUSION 60 Seconds to Survival is associated with improved in-game triage accuracy. Further study of the correlation between in-game triage accuracy and improvements in live simulation or real-world triage decisions is warranted.
Collapse
Affiliation(s)
- Mark X. Cicero
- Department of PediatricsYale University School of MedicineNew HavenCT
| | - Travis Whitfill
- Department of PediatricsYale University School of MedicineNew HavenCT
| | - Barbara Walsh
- Department of PediatricsDivision of Pediatric Emergency MedicineBoston Medical CenterBoston University School of MedicineNew Hyde ParkNY
| | | | - Grace Arteaga
- Department of Pediatric and Adolescent MedicineMayo ClinicRochesterMN
| | - Daniel J. Scherzer
- Department of Emergency MedicineNationwide Children's HospitalColumbusOH
| | | | - Manu Madhok
- Division of Emergency MedicineChildren's Hospitals and Clinics of MinnesotaMinneapolisMN
| | - Angela Bowen
- Radiation Emergency Assistance Center/Training Site (REAC/TS)Oak RidgeTN
| | | | | | | | - David Kessler
- Department of PediatricsNew York–Presbyterian HospitalNew YorkNY
| | - Marc Auerbach
- Department of PediatricsYale University School of MedicineNew HavenCT
- Department of Emergency MedicineYale University School of MedicineNew HavenCT
| |
Collapse
|
21
|
Kinsman JM, Robinson K. National Systematic Legal Review of State Policies on Emergency Medical Services Licensure Levels' Authority to Administer Opioid Antagonists. PREHOSP EMERG CARE 2018; 22:650-654. [PMID: 29485328 DOI: 10.1080/10903127.2018.1439129] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Previous research conducted in November 2013 found there were a limited number of states and territories in the United States (US) that authorize emergency medical technicians (EMTs) and emergency medical responders (EMRs) to administer opioid antagonists. Given the continued increase in the number of opioid-related overdoses and deaths, many states have changed their policies to authorize EMTs and EMRs to administer opioid antagonists. The goal of this study is to provide an updated description of policy on EMS licensure levels' authority to administer opioid antagonists for all 50 US states, the District of Columbia (DC), and the Commonwealth of Puerto Rico (PR). METHODS State law and scopes of practice were systematically reviewed using a multi-tiered approach to determine each state's legally-defined EMS licensure levels and their authority to administer an opioid antagonist. State law, state EMS websites, and state EMS scope of practice documents were identified and searched using Google Advanced Search with Boolean Search Strings. Initial results of the review were sent to each state office of EMS for review and comment. RESULTS As of September 1, 2017, 49 states and DC authorize EMTs to administer an opioid antagonist. Among the 40 US jurisdictions (39 states and DC) that define the EMR or a comparable first responder licensure level in state law, 37 states and DC authorize their EMRs to administer an opioid antagonist. Paramedics are authorized to administer opioid antagonists in all 50 states, DC, and PR. All 49 of the US jurisdictions (48 states and DC) that define the advanced emergency medical technician (AEMT) or a comparable intermediate EMS licensure level in state law authorize their AEMTs to administer an opioid antagonist. CONCLUSIONS 49 out of 52 US jurisdictions (50 states, DC, and PR) authorize all existing levels of EMS licensure levels to administer an opioid antagonist. Expanding access to this medication can save lives, especially in communities that have limited advanced life support coverage.
Collapse
|