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Kalhori RP, Najafi M, Foroughinia A, Mahmoodi F. A study of cardiopulmonary resuscitation literacy among the personnel of universities of medical sciences based in Kermanshah and Khuzestan provinces based on the latest 2015 cardiopulmonary resuscitation guidelines. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2021; 10:29. [PMID: 33688538 PMCID: PMC7933618 DOI: 10.4103/jehp.jehp_645_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 08/18/2020] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Cardiopulmonary resuscitation (CPR) is regarded as the most important skill of the medical staff who is required to be aware of the latest changes to the CPR guidelines so that they can take the most effective actions in the critical conditions of CPR. Therefore, the present study aimed to determine the levels of CPR literacy among the personnel of universities of medical sciences based in Kermanshah and Khuzestan provinces based on the latest 2015 CPR guidelines in 2019. MATERIALS AND METHODS In this descriptive, analytical, cross-sectional study, 525 subjects were selected as the sample population using the two-stage cluster sampling. For data collection, a researcher-made questionnaire was used, whose content validity and reliability were confirmed (r = 0.71). The study screened the data received and analyzed valid data set through the ttest and Spearman's correlation coefficient by incorporating SPSS Statistics software version 23.0. In addition, P < 0.05 was considered statistically significant. RESULTS The 2015 CPR literacy levels of the samples were as follows: excellent (85 subjects or 16.2%), good (404 subjects or 77%), and average (36 subjects or 6.9%). The results of Pearson's correlation coefficient revealed a weak and inverse relationship between the levels of CPR literacy and the age of samples (r = -0.092) and work experience (-0.029), which were statistically significant. In addition, the results of Mann-Whitney U-test demonstrated that the level of CPR literacy among the personnel of Ahwaz University of Medical Sciences exceeded that among the personnel of Kermanshah University of Medical Sciences (P < 0.001). CONCLUSION It is suggested that in retraining the nursing and paramedical personnel, CPR be carried out with more emphasis on the changes introduced in this guideline compared to that in 2010, including esophageal tracheal airway, reasons for the cessation of CPR, intraosseous infusion, and induced hypothermia.
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Affiliation(s)
- Reza Pourmirza Kalhori
- Department of Emergency Medicine, Paramedical School, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | | | - Azadeh Foroughinia
- School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Fatemeh Mahmoodi
- Department of Health Education and Promotion, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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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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Kim HT, Kim JG, Jang YS, Kang GH, Kim W, Choi HY, Jun GS. Comparison of in-hospital use of mechanical chest compression devices for out-of-hospital cardiac arrest patients: AUTOPULSE vs LUCAS. Medicine (Baltimore) 2019; 98:e17881. [PMID: 31702660 PMCID: PMC6855519 DOI: 10.1097/md.0000000000017881] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
This study aimed to investigate the prognostic difference between AUTOPULSE and LUCAS for out-of-hospital cardiac arrest (OHCA) adult patients.A retrospective observational study was performed nationwide. Adult OHCA patients after receiving in-hospital mechanical chest compression from 2012 to 2016 were included. The primary outcomes were sustained return of spontaneous circulation (ROSC) of more than 20 minutes and survival to discharge.Among 142,906 OHCA patients, 820 patients were finally included. In multivariate analysis, female (OR, 0.57; 95% CI, 0.33-0.99), witnessed arrest (OR, 2.10; 95% CI, 1.20-3.69), and arrest cause of non-cardiac origin (OR, 0.25; 95% CI, 0.10-0.62) were significantly associated with the increase in ROSC. LUCAS showed a lower survival than AUTOPULSE (OR, 0.23; 95% CI, 0.06-0.84), although it showed no significant association with ROSC. Percutaneous coronary intervention (OR, 6.30; 95% CI, 1.53-25.95) and target temperature management (TTM; OR, 7.30; 95% CI, 2.27-23.49) were the independent factors for survival. We categorized mechanical CPR recipients by witness to compare prognostic effectiveness of AUTOPULSE and LUCAS. In the witnessed subgroup, female (OR, 0.46; 95% CI, 0.24-0.89) was a prognostic factor for ROSC and shockable rhythm (OR, 5.04; 95% CI, 1.00-25.30), percutaneous coronary intervention (OR, 12.42; 95% CI, 2.04-75.53), and TTM (OR, 9.03; 95% CI, 1.86-43.78) for survival. In the unwitnessed subgroup, no prognostic factors were found for ROSC, and TTM (OR, 99.00; 95% CI, 8.9-1100.62) was found to be an independent factor for survival. LUCAS showed no significant increase in ROSC or survival in comparison with AUTOPULSE in both subgroups.The in-hospital use of LUCAS may have a deleterious effect for survival compared with AUTOPULSE.
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Affiliation(s)
- Hyun Tae Kim
- Department of Emergency Medicine, College of Medicine, Hallym University, Seoul
| | - Jae Guk Kim
- Department of Emergency Medicine, College of Medicine, Hallym University, Seoul
- Department of Emergency Medicine, Graduate School of Medicine, Kangwon National University, Chuncheon, Republic of Korea
| | - Yong Soo Jang
- Department of Emergency Medicine, College of Medicine, Hallym University, Seoul
| | - Gu Hyun Kang
- Department of Emergency Medicine, College of Medicine, Hallym University, Seoul
| | - Wonhee Kim
- Department of Emergency Medicine, College of Medicine, Hallym University, Seoul
| | - Hyun Young Choi
- Department of Emergency Medicine, College of Medicine, Hallym University, Seoul
| | - Gwang Soo Jun
- Department of Emergency Medicine, College of Medicine, Hallym University, Seoul
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Kalhori RP, Jalali A, Naderipour A, Almasi A, Khavasi M, Rezaei M, Abbasi M. Assessment of Iranian Nurses and Emergency Medical Personnel in Terms of Cardiopulmonary Resuscitation Knowledge Based on the 2010 Guideline. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2017; 22:184-189. [PMID: 28706541 PMCID: PMC5494946 DOI: 10.4103/1735-9066.208167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background: The aim of this study was to compare the cardiopulmonary resuscitation (CPR) knowledge of hospital nurses and emergency medical personnel in Kermanshah, Iran. Materials and Methods: This descriptive cross-sectional study was conducted on 330 hospital nurses and 159 emergency medical personnel working in educational hospitals and emergency medical centers in Kermanshah. Data were collected using a validated and reliable (r = 0.74) researcher-made questionnaire consisting of a demographic characteristics questionnaire and the 2010 CPR knowledge questionnaire. Results: Based on the most recent CPR guidelines, the knowledge of 19.5%, 78.6%, and 1.9% of the emergency medical staff was excellent, good, and moderate, respectively. None of the participants had poor knowledge. In addition, the knowledge of 20.2%, 65.4%, 14%, and 0.4% of the nurses in this study was excellent, good, moderate, and poor, respectively. There was no significant difference in CPR knowledge between hospital nurses and emergency medical staff. Moreover, no significant association was found between CPR knowledge and gender, age, work experience, field of study, previous occupation, and advanced resuscitation courses. However, CPR knowledge of individuals with training in basic CPR courses was higher than participants without training in these courses (P < 0.05). Conclusions: Based on the findings of this study, CPR knowledge among Iranian nurses and emergency medical personnel was in an acceptable range. Nevertheless, it is strongly recommended that nurses and emergency staff receive training according to the most recent CPR guidelines.
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Affiliation(s)
- Reza Pourmirza Kalhori
- Department of Emergency Medicine, School of Paramedics, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Amir Jalali
- Department of Psychiatric Nursing, Faculty of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Arsalan Naderipour
- Department of Emergency Medicine, School of Paramedics, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Afshin Almasi
- Department of Epidemiology and Biostatistics, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Khavasi
- Department of Nursing, Faculty of Nursing and Midwifery, Abadan University of Medical Sciences, Abadan, Iran
| | - Masoud Rezaei
- Department of Research Committee, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Abbasi
- Department of Medical-Surgical Nursing, Faculty of Nursing and Midwifery, Qom University of Medical Sciences, Qom, Iran
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Keilholz G, Mutzbauer TS. The laryngeal tube - a helpful tool for cardiopulmonary resuscitation in the dental office? Br Dent J 2016; 218:E15. [PMID: 25952455 DOI: 10.1038/sj.bdj.2015.385] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2015] [Indexed: 11/09/2022]
Abstract
BACKGROUND Supraglottic airway adjuncts such as the laryngeal tube (LT) have been recommended to be used by cardiopulmonary resuscitation (CPR) first responders.Objective This study aims to evaluate the performance characteristics of dental students and dentists using the LT in comparison to a conventional bag valve mask device (BVM) within manikin CPR training. METHOD A group of eight dentists and 12 dental students performed randomised crossover CPR training using LT and BVM. Time intervals needed to perform five CPR cycles were recorded, as well as tidal and total gastric inflation volumes. RESULTS Median tidal volumes 0-1025 ml (median 462.5 ml) were observed using BVM and 100-500 ml (median 237.5 ml) with LT (p = 0.02). Total gastric inflation of 0-2900 ml was measured using BVM, no gastric inflation using LT (p = 0.0005). Time intervals needed to perform five CPR cycles did not differ between BVM (range 87.5-354.5 s, median 112 s) and LT (range 84.7-322.3 s, median 114 s) (p = 0.55). A median delay of 37.6 s (range 0-82.1 s) before starting CPR was observed using LT. CONCLUSIONS Lower tidal volumes but also lower or even no gastric inflation may be observed when dentists use a laryngeal tube during CPR. Respective training must focus on chest compressions. These must be started before inserting the LT or a different supraglottic airway adjunct and be delivered continuously during insertion. It is recommended to use a supraglottic airway such as an LT only after having been trained in its use.
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Affiliation(s)
- G Keilholz
- Mutzbauer &Partner, Maxillofacial Surgery and Dental Anaesthesiology, Tiefenhoefe 11, CH-8001 Zürich, Switzerland
| | - T S Mutzbauer
- 1] Mutzbauer &Partner, Maxillofacial Surgery and Dental Anaesthesiology, Tiefenhoefe 11, CH-8001 Zürich, Switzerland [2] Institute for Anatomy and Cell Biology, University of Heidelberg, Im Neuenheimer Feld 307, D-69120, Heidelberg, Germany
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Schuerner P, Grande B, Piegeler T, Schlaepfer M, Saager L, Hutcherson MT, Spahn DR, Ruetzler K. Hands-Off Time for Endotracheal Intubation during CPR Is Not Altered by the Use of the C-MAC Video-Laryngoscope Compared to Conventional Direct Laryngoscopy. A Randomized Crossover Manikin Study. PLoS One 2016; 11:e0155997. [PMID: 27195693 PMCID: PMC4873178 DOI: 10.1371/journal.pone.0155997] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 05/06/2016] [Indexed: 11/19/2022] Open
Abstract
Introduction Sufficient ventilation and oxygenation through proper airway management is essential in patients undergoing cardio-pulmonary resuscitation (CPR). Although widely discussed, securing the airway using an endotracheal tube is considered the standard of care. Endotracheal intubation may be challenging and causes prolonged interruption of chest compressions. Videolaryngoscopes have been introduced to better visualize the vocal cords and accelerate intubation, which makes endotracheal intubation much safer and may contribute to intubation success. Therefore, we aimed to compare hands-off time and intubation success of direct laryngoscopy with videolaryngoscopy (C-MAC, Karl Storz, Tuttlingen, Germany) in a randomized, cross-over manikin study. Methods Twenty-six anesthesia residents and twelve anesthesia consultants of the University Hospital Zurich were recruited through a voluntary enrolment. All participants performed endotracheal intubation using direct laryngoscopy and C-MAC in a random order during ongoing chest compressions. Participants were strictly advised to stop chest compression only if necessary. Results The median hands-off time was 1.9 seconds in direct laryngoscopy, compared to 3 seconds in the C-MAC group. In direct laryngoscopy 39 intubation attempts were recorded, resulting in an overall first intubation attempt success rate of 97%, compared to 38 intubation attempts and 100% overall first intubation attempt success rate in the C-MAC group. Conclusion As a conclusion, the results of our manikin-study demonstrate that video laryngoscopes might not be beneficial compared to conventional, direct laryngoscopy in easily accessible airways under CPR conditions and in experienced hands. The benefits of video laryngoscopes are of course more distinct in overcoming difficult airways, as it converts a potential “blind intubation” into an intubation under visual control.
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Affiliation(s)
- Philipp Schuerner
- Institute of Anesthesiology, University and University Hospital Zurich, Zurich, Switzerland
| | - Bastian Grande
- Institute of Anesthesiology, University and University Hospital Zurich, Zurich, Switzerland
| | - Tobias Piegeler
- Institute of Anesthesiology, University and University Hospital Zurich, Zurich, Switzerland
| | - Martin Schlaepfer
- Institute of Anesthesiology, University and University Hospital Zurich, Zurich, Switzerland
| | - Leif Saager
- Departments of Outcomes Research and General Anesthesiology, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Matthew T. Hutcherson
- Departments of Outcomes Research and General Anesthesiology, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Donat R. Spahn
- Institute of Anesthesiology, University and University Hospital Zurich, Zurich, Switzerland
| | - Kurt Ruetzler
- Institute of Anesthesiology, University and University Hospital Zurich, Zurich, Switzerland
- Departments of Outcomes Research and General Anesthesiology, Cleveland Clinic, Cleveland, Ohio, United States of America
- * E-mail:
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Abstract
BACKGROUND Approximately 18 million patients are treated in German hospitals annually. On the basis of internationally published data the number of in-hospital cardiac arrests can be estimated as 54,000 per year. A structured treatment of in-hospital resuscitation according to the current scientific evidence is essential. AIM In-hospital resuscitation shows some special characteristics in comparison to resuscitation in emergency services, which are highlighted in this article. MATERIAL AND METHODS This article is based on the international guidelines for cardiopulmonary resuscitation (CPR) first published in 1992 by the European Resuscitation Council (ERC) and the American Heart Association (AHA) as well as the amendments (current version 2010). Some current studies are also presented, which could not be taken into consideration for the guidelines from 2010. RESULTS High quality chest compressions with as few interruptions as possible are of utmost importance. Patients with cardiac rhythms which can be defibrillated should be defibrillated within less than 2 min after the collapse. There is no evidence that equipping hospitals with automated external defibrillators is an advantage for survival after in-hospital cardiac arrest. Endotracheal intubation represents the gold standard of airway management during CPR. During in-hospital resuscitation experienced anesthesiologists are mostly involved; however, the use of supraglottic airway devices may help to minimize interruptions in chest compressions especially before the medical emergency team arrives at the scene. Feedback devices may improve the quality of manual chest compressions; however, most devices overestimate the compression depth if the patient is resuscitated when lying in bed. There is no evidence that mechanical chest compression devices improve the outcome after cardiac arrest. Mild therapeutic hypothermia is still recommended for neuroprotection after successful in-hospital resuscitation. CONCLUSION The prevention of cardiac arrest is of special importance. Uniform and low threshold criteria for alarming the medical emergency team have to be defined to be able to identify and treat critically ill patients in time before cardiac arrest occurs.
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Yeung J, Chilwan M, Field R, Davies R, Gao F, Perkins GD. The impact of airway management on quality of cardiopulmonary resuscitation: An observational study in patients during cardiac arrest. Resuscitation 2014; 85:898-904. [DOI: 10.1016/j.resuscitation.2014.02.018] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Revised: 02/07/2014] [Accepted: 02/24/2014] [Indexed: 11/17/2022]
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Gruber C, Nabecker S, Wohlfarth P, Ruetzler A, Roth D, Kimberger O, Fischer H, Frass M, Ruetzler K. Evaluation of airway management associated hands-off time during cardiopulmonary resuscitation: a randomised manikin follow-up study. Scand J Trauma Resusc Emerg Med 2013; 21:10. [PMID: 23433462 PMCID: PMC3598524 DOI: 10.1186/1757-7241-21-10] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Accepted: 02/19/2013] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Airway management is an important component of cardiopulmonary resuscitation (CPR). Recent guidelines recommend keeping any interruptions of chest compressions as short as possible and not lasting more than 10 seconds. Endotracheal intubation seems to be the ideal method for establishing a secure airway by experienced providers, but emergency medical technicians (EMT) often lack training and practice. For the EMTs supraglottic devices might serve as alternatives. METHODS 40 EMTs were trained in a 1-hour standardised audio-visual lesson to handle six different airway devices including endotracheal intubation, Combitube, EasyTube, I-Gel, Laryngeal Mask Airway and Laryngeal tube. EMTs performances were evaluated immediately after a brief practical demonstration, as well as after 1 and 3 months without any practice in between, in a randomised order. Hands-off time was pair-wise compared between airway devices using a repeated-measures mixed-effects model. RESULTS Overall mean hands-off time was significantly (p<0.01) lower for Laryngeal tube (6.1s; confidence interval 5.2-6.9s), Combitube (7.9s; 95% CI 6.9-9.0s), EasyTube (8.8s; CI 7.3-10.3s), LMA (10.2s; CI 8.6-11.7s), and I-Gel (11.9s; CI 10.2-13.7s) compared to endotracheal intubation (39.4s; CI 34.0-44.9s). Hands-off time was within the recommended limit of 10s for Combitube, EasyTube and Laryngeal tube after 1 month and for all supraglottic devices after 3 months without any training, but far beyond recommended limits in all three evaluations for endotracheal intubation. CONCLUSION Using supraglottic airway devices, EMTs achieved a hands-off time within the recommended time limit of 10s, even after three months without any training or practice. Supraglottic airway devices are recommended tools for EMTs with lack of experience in advanced airway management.
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Affiliation(s)
- Christina Gruber
- Department of General Anaesthesia and Intensive Care, Medical University of Vienna, Vienna, Austria
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Müller JU, Semmel T, Stepan R, Seyfried TF, Popov AF, Graf BM, Wiese CHR. The use of the laryngeal tube disposable by paramedics during out-of-hospital cardiac arrest: a prospectively observational study (2008-2012). Emerg Med J 2013; 30:1012-6. [PMID: 23307754 DOI: 10.1136/emermed-2012-201923] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
SUMMARY In the previous and the current guidelines of the European Resuscitation Council (ERC), endotracheal intubation (ETI), as an instrument for ventilation during resuscitation, was confirmed as less important for paramedics not trained in this method. For those, during resuscitation, the laryngeal tube is recommended by the ERC as a supraglottic airway device. The present study investigated prospectively the use of the laryngeal tube disposable (LT-D) by paramedics in prehospital emergency cases. METHODS During a 42-month period (Sept 2008-Feb 2012), we prospectively registered all prehospital cardiac arrest situations in which the LT-D had been applied by paramedics (from one emergency medical service in Germany). RESULTS During the defined period, 133 attempts, recorded on standardised data sheets, were enrolled into the investigation. Three were excluded from the study because of use during a trauma situation. Therefore, 130 patients were evaluated in this study. For this, the LT-D was used in 98% of all cases during resuscitation, and in about 2% of other emergencies (eg, trauma). With regard to resuscitation, adequate ventilation/oxygenation was described as possible in 83% of all included cases. In 66% of all cases, no problems concerning the insertion of the LT-D were described by the paramedics. No significant problems were reported in 93%. In 7% (n=9 cases), no insertion of the LT-D was possible. Instead of bag-mask-valve ventilation, the LT-D was used as a first-line airway device in about 66%. Between the two defined groups, no statistically significant differences were found (p>0.05). CONCLUSIONS As an alternative airway device during resuscitation, recommended by the ERC in 2005 and 2010, the LT-D may enable ventilation rapidly and, as in most of our described cases, effectively. Additionally, by using the LT-D in a case of cardiac arrest, a reduced 'hands-off time' and, therefore, a high chest compression rate may be possible. Our investigation showed that the LT-D was often used as an alternative to bag-mask-ventilation and to ETI as well. However, we were able to describe more problems in the use of the LT-D than earlier investigations. Therefore, in future, more studies concerning the use of alternative airway devices in comparison with ETI and/or video-laryngoscopy seem to be necessary.
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Affiliation(s)
- Jens-Uwe Müller
- Department of Anaesthesiology, University Medical Centre Regensburg, , Regensburg, Germany
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Jensen JL, Walker M, LeRoux Y, Carter A. Chest Compression Fraction in Simulated Cardiac Arrest Management by Primary Care Paramedics: King Laryngeal Tube Airway Versus Basic Airway Management. PREHOSP EMERG CARE 2013; 17:285-90. [DOI: 10.3109/10903127.2012.744784] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Jan L. Jensen
- From Emergency Health Services, Quality and Learning (JLJ, MW),
Dartmouth, Nova Scotia, Canada; the Division of EMS, QEII Health Sciences Centre, Dalhousie University (JLJ),
Halifax, Nova Scotia, Canada; the Medicine School, Dalhousie University (YL),
Halifax, Nova Scotia, Canada; Emergency Health Services (AC), Dartmouth,
Nova Scotia, Canada; and the Department of Emergency Medicine, Dalhousie University (AC),
Halifax, Nova Scotia, Canada
| | - Mark Walker
- From Emergency Health Services, Quality and Learning (JLJ, MW),
Dartmouth, Nova Scotia, Canada; the Division of EMS, QEII Health Sciences Centre, Dalhousie University (JLJ),
Halifax, Nova Scotia, Canada; the Medicine School, Dalhousie University (YL),
Halifax, Nova Scotia, Canada; Emergency Health Services (AC), Dartmouth,
Nova Scotia, Canada; and the Department of Emergency Medicine, Dalhousie University (AC),
Halifax, Nova Scotia, Canada
| | - Yves LeRoux
- From Emergency Health Services, Quality and Learning (JLJ, MW),
Dartmouth, Nova Scotia, Canada; the Division of EMS, QEII Health Sciences Centre, Dalhousie University (JLJ),
Halifax, Nova Scotia, Canada; the Medicine School, Dalhousie University (YL),
Halifax, Nova Scotia, Canada; Emergency Health Services (AC), Dartmouth,
Nova Scotia, Canada; and the Department of Emergency Medicine, Dalhousie University (AC),
Halifax, Nova Scotia, Canada
| | - Alix Carter
- From Emergency Health Services, Quality and Learning (JLJ, MW),
Dartmouth, Nova Scotia, Canada; the Division of EMS, QEII Health Sciences Centre, Dalhousie University (JLJ),
Halifax, Nova Scotia, Canada; the Medicine School, Dalhousie University (YL),
Halifax, Nova Scotia, Canada; Emergency Health Services (AC), Dartmouth,
Nova Scotia, Canada; and the Department of Emergency Medicine, Dalhousie University (AC),
Halifax, Nova Scotia, Canada
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Research Poster Presentations. J Intensive Care Soc 2012. [DOI: 10.1177/17511437120131s101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Optimisation de la ventilation mécanique dans l’arrêt cardiaque. MEDECINE INTENSIVE REANIMATION 2011. [DOI: 10.1007/s13546-011-0328-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
OBJECTIVE To determine whether prehospital providers can successfully place a pediatric King laryngeal tube (LT-D) and ventilate a Laerdal SimBaby pediatric simulator during a respiratory arrest simulation. METHODS We studied the ability of 45 paramedics and flight nurses to place the pediatric King LT-D in a SimBaby manikin. For the purposes of this study, paramedics and flight nurses were considered equivalent, because in this air medical system they have the same scope of practice in regard to airway skills. Because the participants had previous training and field experience with the adult King LT-D, we limited pediatric King LT-D training to our standard adult training plus selecting the correct size and inflation volumes for the device. Outcomes included rate of successful pediatric King LT-D placement, number of attempts to correctly place the tube, and time to first adequate ventilation. The subjects were evaluated on airway management using an 11-point skill test. A score of 8 or greater (≥ 73%) was considered passing. The subjects indicated their perceptions and preferences for the pediatric King LT-D using a five-point Likert scale. Data were analyzed using descriptive statistics. RESULTS Crew members successfully placed the pediatric King LT-D 95.5% (43/45) of the time. The median number of attempts was one. Four subjects required a second attempt; two of these subjects failed at placement. Mean time to placement was 34 seconds (95% confidence interval [CI]: 26.4-67.3 sec). Ninety percent of the participants (40/45) successfully completed the skill test, with a mean score of 78.2% (95% CI: 73.6-82.7). The subjects strongly agreed that their previous training on the adult King LT-D and using it in the field had adequately prepared them to use the pediatric King LT-D. The subjects agreed that the pediatric King LT-D was easier to place than a pediatric endotracheal tube; they strongly agreed that they would use the pediatric King LT-D as an alternative airway. The participants disagreed that they would prefer the pediatric King LT-D as a primary means of securing pediatric airways. CONCLUSIONS The pediatric King LT-D was quickly and reliably placed. Providers perceived the pediatric King LT-D to be easier to use than pediatric endotracheal intubation in this setting.
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Affiliation(s)
- Seth C Ritter
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213, USA
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Hands-off time during insertion of six airway devices during cardiopulmonary resuscitation: a randomised manikin trial. Resuscitation 2011; 82:1060-3. [PMID: 21514986 DOI: 10.1016/j.resuscitation.2011.03.027] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2011] [Revised: 03/17/2011] [Accepted: 03/24/2011] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Cardiopulmonary resuscitation (CPR) guidelines recommend limiting interruptions of chest compressions because prolonged hands-off (i.e., non-compression) time compromises tissue perfusion. 2010 European Resuscitation Council guidelines suggest that chest compressions should be paused less than 10 s during airway device insertion. METHODS With approval of the local ethics committee of the Medical University of Vienna and written informed consent, we recruited 40 voluntary emergency medical technicians, none of whom had advanced airway management experience. After a standardised audio-visual lecture and practical demonstration, technicians performed airway management with each six airway devices (endotracheal tube, Combitube, EasyTube, laryngeal tube, Laryngeal Mask Airway, and I-Gel) during on-going chest compressions in a randomised sequence on a Resusci Anne Advanced Simulator. Data were analysed using a mixed-effects model accounting for the repeated measurements and pair-wise comparisons among the airway devices. RESULTS The hands-off time associated with airway management using an endotracheal tube (including all intubation attempts) was 48 s (95% confidence interval: 43-53). The hands-off time for airway management using a laryngeal tube was 8.4 (3.4-16.4) s, Combitube 10.0 (4.9-15.1) s, EasyTube 11.4 (6.4-16.4) s, LMA 13.3 (8.2-18.3) s and for I-Gel 15.9 (10.8-20.9) s. Hands-off time was significantly longer with the conventional endotracheal tube than with any of the other airway systems. Only a third of the technicians successfully inserted an endotracheal tube whereas all of them successfully positioned each supraglottic device. CONCLUSION Supraglottic devices appear to be a reasonable emergency airway management strategy, even for inexperienced personnel.
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Deakin CD, Morrison LJ, Morley PT, Callaway CW, Kerber RE, Kronick SL, Lavonas EJ, Link MS, Neumar RW, Otto CW, Parr M, Shuster M, Sunde K, Peberdy MA, Tang W, Hoek TLV, Böttiger BW, Drajer S, Lim SH, Nolan JP. Part 8: Advanced life support: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Resuscitation 2011; 81 Suppl 1:e93-e174. [PMID: 20956032 DOI: 10.1016/j.resuscitation.2010.08.027] [Citation(s) in RCA: 167] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Morrison LJ, Deakin CD, Morley PT, Callaway CW, Kerber RE, Kronick SL, Lavonas EJ, Link MS, Neumar RW, Otto CW, Parr M, Shuster M, Sunde K, Peberdy MA, Tang W, Hoek TLV, Böttiger BW, Drajer S, Lim SH, Nolan JP, Adrie C, Alhelail M, Battu P, Behringer W, Berkow L, Bernstein RA, Bhayani SS, Bigham B, Boyd J, Brenner B, Bruder E, Brugger H, Cash IL, Castrén M, Cocchi M, Comadira G, Crewdson K, Czekajlo MS, Davies SR, Dhindsa H, Diercks D, Dine CJ, Dioszeghy C, Donnino M, Dunning J, El Sanadi N, Farley H, Fenici P, Feeser VR, Foster JA, Friberg H, Fries M, Garcia-Vega FJ, Geocadin RG, Georgiou M, Ghuman J, Givens M, Graham C, Greer DM, Halperin HR, Hanson A, Holzer M, Hunt EA, Ishikawa M, Ioannides M, Jeejeebhoy FM, Jennings PA, Kano H, Kern KB, Kette F, Kudenchuk PJ, Kupas D, La Torre G, Larabee TM, Leary M, Litell J, Little CM, Lobel D, Mader TJ, McCarthy JJ, McCrory MC, Menegazzi JJ, Meurer WJ, Middleton PM, Mottram AR, Navarese EP, Nguyen T, Ong M, Padkin A, Ferreira de Paiva E, Passman RS, Pellis T, Picard JJ, Prout R, Pytte M, Reid RD, Rittenberger J, Ross W, Rubertsson S, Rundgren M, Russo SG, Sakamoto T, Sandroni C, Sanna T, Sato T, Sattur S, Scapigliati A, Schilling R, Seppelt I, Severyn FA, Shepherd G, Shih RD, Skrifvars M, Soar J, Tada K, Tararan S, Torbey M, Weinstock J, Wenzel V, Wiese CH, Wu D, Zelop CM, Zideman D, Zimmerman JL. Part 8: Advanced Life Support. Circulation 2010; 122:S345-421. [DOI: 10.1161/circulationaha.110.971051] [Citation(s) in RCA: 250] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Preusch MR, Bea F, Roggenbach J, Katus HA, Jünger J, Nikendei C. Resuscitation Guidelines 2005: does experienced nursing staff need training and how effective is it? Am J Emerg Med 2010; 28:477-84. [PMID: 20466229 DOI: 10.1016/j.ajem.2009.01.040] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2008] [Revised: 01/28/2009] [Accepted: 01/29/2009] [Indexed: 10/19/2022] Open
Abstract
INTRODUCTION Even among health care professionals, resuscitation performance has been shown to be poor. So far, it remains unclear whether cardiac arrest staff with frequent practice in resuscitation requires training to adapt to the new International Liaison Committee on Resuscitation (ILCOR) guidelines of 2005. This study evaluated the need for basic life support training in nurses with emergency experience. METHODS AND RESULTS Nurses (N = 24) recruited from an intensive care unit self-assessed their resuscitation skills and performed a cardiac arrest scenario using a manikin. After a theoretical instruction and hands-on training followed by feedback, participants once again performed a resuscitation scenario in addition to completing posttraining self-assessments. Participating nurses considered resuscitation skills training--in particular in adapting to the new ILCOR guidelines of 2005--to be important. Pretraining data revealed performance deficits even in this sample of emergency-experienced nursing staff. Training resulted in significant improvement in ventilation volume (P < .001), rate of compressions with correct depth (P < .031) and full release (P < .001), and a reduction in total hands-off time (P < .050). Objective data were mirrored in participants' self-assessed competencies. CONCLUSION Results suggest that basic life support training based on the ILCOR guidelines of 2005 is necessary even in nurses with emergency experience. Training followed by the application of a feedback algorithm seems to improve short-term resuscitation performance and is well accepted by experienced nurses who work on an intensive care unit and who also comprise the inner-hospital cardiac arrest team.
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Affiliation(s)
- Michael R Preusch
- Department of Cardiology, Angiology, Pneumology, University Hospital, University of Heidelberg, 69120 Heidelberg, Germany.
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Frascone RJ, Wewerka SS, Griffith KR, Salzman JG. Use of the King LTS-D During Medication-Assisted Airway Management. PREHOSP EMERG CARE 2009; 13:541-5. [DOI: 10.1080/10903120903144817] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Martin F, Buggy D. New airway equipment: opportunities for enhanced safety. Br J Anaesth 2009; 102:734-8. [DOI: 10.1093/bja/aep104] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Wiese C, Semmel T, Müller J, Bahr J, Ocker H, Graf B. The use of the laryngeal tube disposable (LT-D) by paramedics during out-of-hospital resuscitation—An observational study concerning ERC guidelines 2005. Resuscitation 2009; 80:194-8. [DOI: 10.1016/j.resuscitation.2008.08.023] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2008] [Revised: 08/09/2008] [Accepted: 08/25/2008] [Indexed: 10/21/2022]
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Wiese C, Bahr J, Popov A, Hinz J, Graf B. Influence of airway management strategy on “no-flow-time” in a standardized single rescuer manikin scenario (a comparison between LTS-D™ and I-gel). Resuscitation 2009; 80:100-3. [DOI: 10.1016/j.resuscitation.2008.08.022] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2008] [Revised: 08/01/2008] [Accepted: 08/28/2008] [Indexed: 10/21/2022]
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