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Shinada K, Matsuoka A, Miike T, Koami H, Sakamoto Y. Effects of physician-present prehospital care in patients with out-of-hospital cardiac arrest on return of spontaneous circulation: A retrospective, observational study in Saga, Japan. Health Sci Rep 2024; 7:e1981. [PMID: 38655425 PMCID: PMC11035745 DOI: 10.1002/hsr2.1981] [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: 08/31/2023] [Revised: 01/19/2024] [Accepted: 02/28/2024] [Indexed: 04/26/2024] Open
Abstract
Background and Aims Emergency medical services for out-of-hospital cardiac arrest (OHCA) vary according to region and country, and patient prognosis differs accordingly. In Japan, physicians may provide prehospital care. However, the effect of physician-present prehospital care on achieving return of spontaneous circulation (ROSC) in patients with cardiac arrest is not clear. Here, we aimed to examine the effect of physician-present prehospital care on the prognosis of patients with OHCA at our hospital compared with physician-absent care. Methods In this retrospective, observational study, patients aged ≥18 years with non-traumatic OHCA from a single center in Saga City, Japan, between April 2011 and December 2019, were included. Patients were divided into two groups, based on prehospital physician presence or absence. Logistic regression analysis was used to determine the association between physician-present prehospital care and ROSC. Results Of 820 patients with OHCA, 151 had a physician present and 669 did not. Logistic regression analysis with no adjustment showed that the odds ratio (OR) of physician-present prehospital care for an increased ROSC rate was 1.74 (95% confidence interval [CI]: 1.22-2.48, p = 0.002). Logistic-regression analysis adjusted for ROSC-related factors indicated an OR of 1.05 (95% CI: 0.47-2.34, p = 0.914) for physician-present prehospital care to ROSC. Conclusion Physician-present prehospital care may not necessarily lead to increased ROSC rates. However, insufficient data limited our study findings. Further studies involving larger sample sizes are warranted.
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Affiliation(s)
- Kota Shinada
- Department of Emergency and Critical Care Medicine, Faculty of MedicineSaga UniversitySaga CityJapan
| | - Ayaka Matsuoka
- Department of Emergency and Critical Care Medicine, Faculty of MedicineSaga UniversitySaga CityJapan
| | - Toru Miike
- Department of Emergency and Critical Care Medicine, Faculty of MedicineSaga UniversitySaga CityJapan
| | - Hiroyuki Koami
- Department of Emergency and Critical Care Medicine, Faculty of MedicineSaga UniversitySaga CityJapan
| | - Yuichiro Sakamoto
- Department of Emergency and Critical Care Medicine, Faculty of MedicineSaga UniversitySaga CityJapan
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Hatakeyama T, Kiguchi T, Sera T, Nachi S, Urushibata N, Ochiai K, Kitamura T, Ogura S, Otomo Y, Iwami T. Pre-hospital airway management and neurological status of patients with out-of-hospital cardiac arrest: A retrospective cohort study. Resusc Plus 2023; 15:100422. [PMID: 37457630 PMCID: PMC10339239 DOI: 10.1016/j.resplu.2023.100422] [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: 04/21/2023] [Revised: 06/04/2023] [Accepted: 06/16/2023] [Indexed: 07/18/2023] Open
Abstract
Purpose Little is known about whether pre-hospital advanced airway management (AAM) under the presence of a physician could improve outcome of patients with cardiac arrest, compared with pre-hospital AAM under the absence of a physician. Methods This retrospective multicentre-cohort study enrolled consecutive patients who were transported to participating hospitals after out-of-hospital cardiac arrest in Japan between 1 June 2014 and 31 December 2019. We included patients who underwent pre-hospital AAM and resuscitation after arrival at hospital, and who were ≥18 years of age, with medical aetiologies. The primary outcome was favourable neurological survival (Cerebral Performance Category score of 1 or 2) one month after cardiac arrest. The primary outcome was called one-month favourable neurological survival. The first confirmed cardiac rhythm was defined using 3-lead electrocardiogram monitor or an automated external defibrillator and by determining whether the carotid artery was pulsating. Previous research found that the presence of a pre-hospital physician was associated with improved patients' outcomes, after the type of first confirmed cardiac rhythm was considered. Therefore, the first confirmed cardiac rhythm in current study was subdivided into non-shockable or shockable groups. A multivariable logistic regression analysis was performed on propensity score-matched patients. Results We analysed 16,703 patients. Among the 2,346 patients in the non-shockable group, 1.2% (N = 29) achieved the primary outcome. The adjusted odds ratio of pre-hospital AAM with or without a physician for the primary outcome in the results of the non-shockable group was 4.64 (95% confidence interval: 1.81-14.4). Among the 826 patients in the shockable group, 16.9% (N = 140) achieved the primary outcome and the adjusted odds ratio of pre-hospital AAM with or without a physician for the primary outcome in the results of the shockable group was 1.05 (95% confidence interval: 0.67-1.63). Conclusions This retrospective multicentre-cohort study found that pre-hospital AAM under the presence of a physician was significantly associated with increased neurological outcome in specific patients with cardiac arrest, compared with pre-hospital AAM under the absence of a physician.
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Affiliation(s)
- Toshihiro Hatakeyama
- Department of Emergency and Critical Care Medicine, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minami-koshigaya, Koshigaya, Saitama 343-8555, Japan
| | - Takeyuki Kiguchi
- Department of Preventive Services, School of Public Health, Graduate School of Medicine, Kyoto University, Yoshida-Konoemachi, Sakyo-ku, Kyoto 606-8501, Japan
- Department of Critical Care and Trauma Center, Osaka General Medical Center, 3-1-56 Bandai-Higashi, Sumiyoshi-ku, Osaka 558-8558, Japan
| | - Toshiki Sera
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Advanced Emergency and Critical Care Center, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
- Trauma and Acute Critical Care Medical Center, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan
| | - Sho Nachi
- Department of Emergency and Disaster Medicine, Gifu University Graduate School of Medicine, 1-1 Yanagito, Gifu, Gifu 501-1194, Japan
- Emergency Medical Center, Chuno Kosei Hospital, 5-1, Wakakusa-dori, Seki, Gifu 501-3802, Japan
| | - Nao Urushibata
- Trauma and Acute Critical Care Medical Center, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan
| | - Kanae Ochiai
- Trauma and Acute Critical Care Medical Center, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, 2-2 Yamada-oka, Suita, Osaka 565-0871, Japan
| | - Shinji Ogura
- Department of Emergency and Disaster Medicine, Gifu University Graduate School of Medicine, 1-1 Yanagito, Gifu, Gifu 501-1194, Japan
| | - Yasuhiro Otomo
- National Disaster Medical Center, 3256, Midoricho, Tachikawa, Tokyo 190-0014, Japan
| | - Taku Iwami
- Department of Preventive Services, School of Public Health, Graduate School of Medicine, Kyoto University, Yoshida-Konoemachi, Sakyo-ku, Kyoto 606-8501, Japan
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Edmunds CT, Lachowycz K, McLachlan S, Downes A, Smith A, Major R, Barnard EBG. Nine golden codes: improving the accuracy of Helicopter Emergency Medical Services (HEMS) dispatch-a retrospective, multi-organisational study in the East of England. Scand J Trauma Resusc Emerg Med 2023; 31:27. [PMID: 37308937 DOI: 10.1186/s13049-023-01094-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 06/07/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND Helicopter Emergency Medical Services (HEMS) are a limited and expensive resource, and should be intelligently tasked. HEMS dispatch was identified as a key research priority in 2011, with a call to identify a 'general set of criteria with the highest discriminating potential'. However, there have been no published data analyses in the past decade that specifically address this priority, and this priority has been reaffirmed in 2023. The objective of this study was to define the dispatch criteria available at the time of the initial emergency call with the greatest HEMS utility using a large, regional, multi-organizational dataset in the UK. METHODS This retrospective observational study utilized dispatch data from a regional emergency medical service (EMS) and three HEMS organisations in the East of England, 2016-2019. In a logistic regression model, Advanced Medical Priority Dispatch System (AMPDS) codes with ≥ 50 HEMS dispatches in the study period were compared with the remainder to identify codes with high-levels of HEMS patient contact and HEMS-level intervention/drug/diagnostic (HLIDD). The primary outcome was to identify AMPDS codes with a > 10% HEMS dispatch rate of all EMS taskings that would result in 10-20 high-utility HEMS dispatches per 24-h period in the East of England. Data were analysed in R, and are reported as number (percentage); significance was p < 0.05. RESULTS There were n = 25,491 HEMS dispatches (6400 per year), of which n = 23,030 (90.3%) had an associated AMPDS code. n = 13,778 (59.8%) of HEMS dispatches resulted in patient contact, and n = 8437 (36.6%) had an HLIDD. 43 AMPDS codes had significantly greater rates of patient contact and/or HLIDD compared to the reference group. In an exploratory analysis, a cut-off of ≥ 70% patient contact rate and/or ≥ 70% HLIDD (with a > 10% HEMS dispatch of all EMS taskings) resulted in 17 taskings per 24-h period. This definition derived nine AMPDS codes with high HEMS utility. CONCLUSION We have identified nine 'golden' AMPDS codes, available at the time of initial emergency call, that are associated with high-levels of whole-system and HEMS utility in the East of England. We propose that UK EMS should consider immediate HEMS dispatch to these codes.
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Affiliation(s)
- Christopher T Edmunds
- Department of Research, Audit, Innovation, and Development, East Anglian Air Ambulance, Gambling Close, Norwich Airport, Norwich, NR6 6EG, UK.
- University of East Anglia, Norwich, UK.
| | - Kate Lachowycz
- Department of Research, Audit, Innovation, and Development, East Anglian Air Ambulance, Gambling Close, Norwich Airport, Norwich, NR6 6EG, UK
- University of East Anglia, Norwich, UK
| | - Sarah McLachlan
- Essex & Herts Air Ambulance Trust, Colchester, Essex, UK
- Anglia Ruskin University, Cambridge, UK
| | - Andrew Downes
- Department of Research, Audit, Innovation, and Development, East Anglian Air Ambulance, Gambling Close, Norwich Airport, Norwich, NR6 6EG, UK
| | | | - Rob Major
- Department of Research, Audit, Innovation, and Development, East Anglian Air Ambulance, Gambling Close, Norwich Airport, Norwich, NR6 6EG, UK
- University of East Anglia, Norwich, UK
| | - Edward B G Barnard
- Department of Research, Audit, Innovation, and Development, East Anglian Air Ambulance, Gambling Close, Norwich Airport, Norwich, NR6 6EG, UK
- Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine (Research & Clinical Innovation), Birmingham, UK
- Emergency Department, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Obara T, Yumoto T, Nojima T, Hongo T, Tsukahara K, Matsumoto N, Yorifuji T, Nakao A, Elmer J, Naito H. Association of Prehospital Physician Presence During Pediatric Out-of-Hospital Cardiac Arrest With Neurologic Outcomes. Pediatr Crit Care Med 2023; 24:e244-e252. [PMID: 36749942 DOI: 10.1097/pcc.0000000000003206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
OBJECTIVES To examine the association of prehospital physician presence with neurologic outcomes of pediatric patients with out-of-hospital cardiac arrest (OHCA). DESIGN Retrospective cohort study. SETTING Data from the Japanese Association for Acute Medicine-OHCA Registry. INTERVENTIONS None. PATIENTS Pediatric patients (age 17 yr old or younger) registered in the database between June 2014 and December 2019. MEASUREMENT AND MAIN RESULTS We used logistic regression models with stabilized inverse probability of treatment weighting (IPTW) to estimate the associated treatment effect of a prehospital physician with 1-month neurologically intact survival. Secondary outcomes included in-hospital return of spontaneous circulation (ROSC) and 1-month survival after OHCA. A total of 1,187 patients (276 in the physician presence group and 911 in the physician absence group) were included (median age 3 yr [interquartile range 0-14 yr]; 723 [61%] male). Comparison of the physician presence group, versus the physician absence, showed 1-month favorable neurologic outcomes of 8.3% (23/276) versus 3.6% (33/911). Physician presence was associated with greater odds of 1-month neurologically intact survival after stabilized IPTW adjustment (adjusted odds ratio [aOR] 1.98, 95% CI 1.08-3.66). We also found an association in the secondary outcome between physician presence, opposed to absence, and in-hospital ROSC (aOR 1.48, 95% CI 1.08-2.04). However, we failed to identify an association with 1-month survival (aOR 1.49, 95% CI 0.97-2.88). CONCLUSIONS Among pediatric patients with OHCA, prehospital physician presence, compared with absence, was associated almost two-fold greater odds of 1-month favorable neurologic outcomes.
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Affiliation(s)
- Takafumi Obara
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Tetsuya Yumoto
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Tsuyoshi Nojima
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Takashi Hongo
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Kohei Tsukahara
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Naomi Matsumoto
- Department of Epidemiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Takashi Yorifuji
- Department of Epidemiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Atsunori Nakao
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Jonathan Elmer
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Hiromichi Naito
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
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Descriptive Analysis of Clinical Encounters by Emergency Medical Services Physicians Using the RE-AIM Framework. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2023; 29:E58-E64. [PMID: 36214653 DOI: 10.1097/phh.0000000000001629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
CONTEXT Emergency medical services (EMS) medicine continues to expand and mature as a recognized subspeciality within emergency medicine. In the United States, EMS physicians historically supported training, protocol development, and EMS clinician credentialing. In the past, only limited programs existed in which prehospital physicians were engaged in the direct and routine care of prehospital patients; however, a growing number of EMS programs are recognizing the value and impact of direct EMS physician involvement in prehospital patient care. PROGRAM A large suburban, volunteer-based EMS agency implemented a volunteer prehospital physician program where providers routinely responded to emergency calls for service. IMPLEMENTATION Beginning in November 2019, a cadre of board-certified physicians completed a field preceptorship and local protocol orientation. Once complete, the physicians were released to function and respond independently to high acuity emergency calls or any call at their discretion. Prehospital physicians were authorized to utilize their full scope of practice and expected to provide field mentorship to traditional prehospital clinicians. EVALUATION This study systematically evaluated a prehospital physician program for public health relevance, sustainability, and population health impact using the RE-AIM framework. A retrospective descriptive analysis was performed on the role and responses by a cohort of prehospital physicians using dispatch data and electronic medical records. DISCUSSION Over the 17-month study period, 9 prehospital physicians responded to 482 calls, predominately cardiac arrests, traumatic injuries, and cardiac/chest pain. The physicians performed 99 procedures and administered 113 medications. Ultimately, the program added physician-level care to the prehospital setting in an ongoing and sustainable way. The routine placement of physicians in the prehospital environment can help benefit patients by enhancing access to advanced clinical knowledge and skills, while also benefiting EMS clinicians through opportunities for enhanced patient-side training, education, and medical control.
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Nakajima S, Matsuyama T, Watanabe M, Komukai S, Kandori K, Okada A, Okada Y, Kitamura T, Ohta B. Prehospital Physician Presence for Patients With out-of-Hospital Cardiac Arrest Undergoing Extracorporeal Cardiopulmonary Resuscitation: A Multicenter, Retrospective, Nationwide Observational Study in Japan (The JAAM-OHCA registry). Curr Probl Cardiol 2023; 48:101600. [PMID: 36681207 DOI: 10.1016/j.cpcardiol.2023.101600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 01/12/2023] [Indexed: 01/20/2023]
Abstract
The effectiveness of the presence of a prehospital physician for patients with out-of-hospital cardiac arrest (OHCA) undergoing extracorporeal cardiopulmonary resuscitation (ECPR) remains unknown. In this multicenter, retrospective, observational study, we enrolled patients aged ≥18 years who developed OHCA and received ECPR. The primary outcome was the 1-month favorable neurological outcome. We estimated the impact of the presence of a prehospital physician on outcomes using a propensity score analysis with inverse probability weighting. We enrolled 1269 patients. Favorable neurological outcomes occurred in 25 of 316 (7.9%) patients with prehospital physicians and 94 of 953 (9.9%) patients without prehospital physicians. In the propensity score analysis, favorable neurological outcomes did not differ between 2 groups (odds ratio = 0.72; 95% confidence interval: 0.44-1.17). The 1-month favorable neurological outcome was not associated with the presence of a prehospital physician for patients with OHCA who underwent EPCR.
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Affiliation(s)
- Satoshi Nakajima
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, Japan
| | - Tasuku Matsuyama
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, Japan.
| | - Makoto Watanabe
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, Japan
| | - Sho Komukai
- Division of Biomedical Statistics, Department of Integrated Medicine, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Kenji Kandori
- Department of Emergency and Critical Care Medicine, Japanese Red Cross Kyoto Daini Hospital, Kamigyo-ku, Kyoto, Japan
| | - Asami Okada
- Department of Emergency and Critical Care Medicine, Japanese Red Cross Kyoto Daini Hospital, Kamigyo-ku, Kyoto, Japan
| | - Yohei Okada
- Health Services and Systems Research, Duke-NUS Medical School, National University of Singapore, Singapore, Singapore; Department of Preventive Services, Graduate School of Medicine, Kyoto University, Sakyo-ku, Kyoto, Japan
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Bon Ohta
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, Japan
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Horriar L, Rott N, Böttiger BW. [The new 2021 resuscitation guidelines and the importance of lay resuscitation]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2022; 65:972-978. [PMID: 35723698 PMCID: PMC9207856 DOI: 10.1007/s00103-022-03557-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 05/27/2022] [Indexed: 11/10/2022]
Abstract
Lay resuscitation is one of the most important measures to increase the survival rate of patients after out-of-hospital cardiac arrest. While European countries, and especially Scandinavian countries, achieve lay resuscitation rates of over 80%, the rate in Germany is only around 40%. The 2021 Resuscitation Guidelines updated by the European Resuscitation Council give special weight to Systems Saving Lives and focus on resuscitation by laypersons. The Systems Saving Lives emphasize the interplay between all actors involved in the chain of survival and thereby specify the link between the emergency service and the general population.Based on the BIG FIVE survival strategies after cardiac arrest, five key strategies are outlined that can achieve the greatest improvement in survival. These are (1) increasing lay resuscitation rates through campaigns and KIDS SAVE LIVES school-based resuscitation training, (2) implementing telephone resuscitation in dispatch centers, (3) first responder systems, (4) advanced life support, and (5) specialized cardiac arrest centers.
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Affiliation(s)
- Lina Horriar
- Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - Nadine Rott
- Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
| | - Bernd W Böttiger
- Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland
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Influence of the Type of Physician on Survival from Emergency-Medical-Service-Witnessed Cardiac Arrest: An Observational Study. Healthcare (Basel) 2022; 10:healthcare10101841. [PMID: 36292288 PMCID: PMC9601607 DOI: 10.3390/healthcare10101841] [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: 08/06/2022] [Revised: 09/10/2022] [Accepted: 09/17/2022] [Indexed: 11/19/2022] Open
Abstract
Out-of-hospital cardiac arrest resuscitation by non-emergency dedicated physicians may not be positively associated with survival, as these physicians have less experience and exposure than specialised dedicated personnel. The aim of this study was to compare the survival results of the teams led by emergency dedicated physicians (EDPhy) with those of the teams led by non-emergency dedicated physicians (N-EDPhy) and with a team of basic life support (BLS) emergency technicians (EMTs) used as the control group. A retrospective, multicentre study of emergency-medical-service-witnessed cardiac arrest from medical causes in adults was performed. The records from 2006 to 2016 in a database of a regional emergency system were analysed and updated up to 31 December 2021. Two groups were studied: initial shockable and non-shockable rhythms. In total, 1359 resuscitation attempts were analysed, 281 of which belonged to the shockable group, and 1077 belonged to the non-shockable rhythm group. Any onsite return of spontaneous circulation, patients admitted to the hospital alive, global survival, and survival with a cerebral performance category (CPC) of 1-2 (good and moderate cerebral performance) were studied, with both of the latter categories considered at 30 days, 1 year (primary outcome), and 5 years. The shockable and non-shockable rhythm group (and CPC 1-2) survivals at 1 year were, respectively, as follows: EDPhy, 66.7 % (63.4%) and 14.0% (12.3%); N-EDPhy, 16.0% (16.0%) and 1.96 % (1.47%); and EMTs 32.0% (29.7%) and 1.3% (0.84%). The crude ORs were EDPhy vs. N-EDPhy, 10.50 (5.67) and 8.16 (4.63) (all p < 0.05); EDPhy vs. EMTs, 4.25 (2.65) and 12.86 (7.80) (p < 0.05); and N-EDPhy vs. EMTs, 0.50 (0.76) (p < 0.05) and 1.56 (1.32) (p > 0.05). The presence of an EDPhy was positively related to all the survival and CPC rates.
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9
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Seyahi NS, Ozcan SG. Application of New Acute Kidney Injury Biomarkers. Biomark Med 2022. [DOI: 10.2174/9789815040463122010021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Kidney-related biomarkers can provide structural and functional information
about different parts of the nephron. These biomarkers can be used to evaluate
glomerular, tubular, or interstitial injury, inflammation, or repair, and glomerular or
tubular function. Furthermore, biomarkers can improve the acute kidney injury
diagnosis in various clinical conditions, including acute interstitial nephritis, acute
tubular injury, hepatorenal and cardiorenal syndrome, ischemic and nephrotoxic acute
kidney injury, and drug-induced acute kidney injury. Biomarkers might be used as an
additional precision medicine tool in managing patients with acute kidney injury; they
can help with clinical decision-making and impact patient outcomes. In this chapter, we
reviewed the utility of biomarkers used in acute kidney injury.
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Affiliation(s)
- Nurhan Seyahi Seyahi
- Department of Nephrology, Cerrahpasa Medical Faculty, Istanbul University - Cerrahpasa,
Istanbul, Turkey
| | - Seyda Gul Ozcan
- Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University -
Cerrahpasa, Istanbul, Turkey
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10
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Hsu SH, Sun JT, Huang EPC, Nishiuchi T, Song KJ, Leong B, Rahman NHNAB, Khruekarnchana P, Naroo GY, Hsieh MJ, Chang SH, Chiang WC, Huei-Ming Ma M. The predictive performance of current termination-of-resuscitation rules in patients following out-of-hospital cardiac arrest in Asian countries: A cross-sectional multicentre study. PLoS One 2022; 17:e0270986. [PMID: 35947598 PMCID: PMC9365191 DOI: 10.1371/journal.pone.0270986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 06/21/2022] [Indexed: 11/23/2022] Open
Abstract
Background Termination-of-resuscitation rules (TORRs) in out-of-hospital cardiac arrest (OHCA) patients have been applied in western countries; in Asia, two TORRs were developed and have not been externally validated widely. We aimed to externally validate the TORRs using the registry of Pan-Asian Resuscitation Outcomes Study (PAROS). Methods PAROS enrolled 66,780 OHCA patients in seven Asian countries from 1 January 2009 to 31 December 2012. The American Heart Association-Basic Life Support and AHA-ALS (AHA-BLS), AHA-Advanced Life Support (AHA-ALS), Goto, and Shibahashi TORRs were selected. The diagnostic test characteristics and area under the receiver operating characteristic curve (AUC) were calculated. We further determined the most suitable TORR in Asia and analysed the variable differences between subgroups. Results We included 55,064 patients in the final analysis. The sensitivity, specificity, negative predictive value, positive predictive value, and AUC, respectively, for AHA-BLS, AHA-ALS, Goto, Shibashi TORRs were 79.0%, 80.0%, 19.6%, 98.5%, and 0.80; 48.6%, 88.3%, 9.8%, 98.5%, and 0.60; 53.8%, 91.4%, 11.2%, 99.0%, and 0.73; and 35.0%, 94.2%, 8.4%, 99.0%, and 0.65. In countries using the Goto TORR with PPV<99%, OHCA patients were younger, had more males, a higher rate of shockable rhythm, witnessed collapse, pre-hospital defibrillation, and survival to discharge, compared with countries using the Goto TORR with PPV ≥99%. Conclusions There was no single TORR fit for all Asian countries. The Goto TORR can be considered the most suitable; however, a high predictive performance with PPV ≥99% was not achieved in three countries using it (Korea, Malaysia, and Taiwan).
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Affiliation(s)
- Shu-Hsien Hsu
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Department of Emergency Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu City, Taiwan
| | - Jen-Tang Sun
- Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Edward Pei-Chuan Huang
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Department of Emergency Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu City, Taiwan
| | - Tatsuya Nishiuchi
- Faculty of Medicine, Department of Acute Medicine, Kindai University, Osaka, Japan
| | - Kyoung Jun Song
- Department of Emergency Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - Benjamin Leong
- Emergency Medicine Department, National University Hospital, Singapore, Singapore
| | - Nik Hisamuddin Nik AB Rahman
- Department of Emergency Medicine, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kota Bharu, Malaysia
| | | | - GY Naroo
- Department of Health & Medical Services, ED-Trauma Centre, Rashid Hospital, Dubai, United Arab Emirates
| | - Ming-Ju Hsieh
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Shu-Hui Chang
- Institute of Epidemiology and Preventive Medicine, College of Public Health, Taipei, Taiwan
- * E-mail: (SHC); (WCC); (MHMM)
| | - Wen-Chu Chiang
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Department of Emergency Medicine, National Taiwan University Hospital Yun-Lin Branch, Douliu City, Taiwan
- * E-mail: (SHC); (WCC); (MHMM)
| | - Matthew Huei-Ming Ma
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Department of Emergency Medicine, National Taiwan University Hospital Yun-Lin Branch, Douliu City, Taiwan
- * E-mail: (SHC); (WCC); (MHMM)
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Kim GW, Moon HJ, Lim H, Kim YJ, Lee CA, Park YJ, Lee KM, Woo JH, Cho JS, Jeong WJ, Choi HJ, Kim CS, Choi HJ, Choi IK, Heo NH, Park JS, Lee YH, Park SM, Jeong DK. Effects of Smart Advanced Life Support protocol implementation including CPR coaching during out-of-hospital cardiac arrest. Am J Emerg Med 2022; 56:211-217. [DOI: 10.1016/j.ajem.2022.03.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 03/21/2022] [Accepted: 03/27/2022] [Indexed: 01/23/2023] Open
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Intra-Cardiac Arrest Transport and Survival from Out-of-Hospital Cardiac Arrest: A Nationwide Observational Study. Resuscitation 2022; 175:50-56. [PMID: 35487463 DOI: 10.1016/j.resuscitation.2022.04.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 04/18/2022] [Accepted: 04/19/2022] [Indexed: 11/20/2022]
Abstract
AIM To assess whether intra-cardiac arrest transport as compared to continued on-scene resuscitation was associated with improved clinical outcomes among out-of-hospital cardiac arrest patients in Denmark. METHODS This was an observational study using data from population-based registries in Denmark. Adults (aged ≥18 to ≤65 years) with an out-of-hospital cardiac arrest attended by Emergency Medical Services (EMS) between 2016 and 2018 were included. The primary outcome was survival to 30 days. Time-dependent propensity score matching was used to match patients transported to the hospital within 20 minutes of EMS arrival to patients with assumed on-scene resuscitation (with or without subsequent intra-cardiac arrest transport) at risk of being transported within the same minute. RESULTS The full cohort included 2,873 cardiac arrests. The median age was 56 (quartiles: 48 to 62) years, 1987 (69%) were male, and 104 (4%) were transported within 20 minutes. A total of 87 transported patients were matched to 87 patients at risk of being transported based on the propensity score. Although not reaching statistical significance, in comparison with on-scene resuscitation, intra-cardiac arrest transport was associated with increased survival to 30 days (risk ratio, 1.55; 95%CI, 0.99 to 2.44; P = 0.06). Similar associations were observed for return of spontaneous circulation and survival to one year. CONCLUSIONS Among patients aged 18 to 65 years, intra-cardiac arrest transport was associated with a non-significant increase in survival within 20 minutes of EMS on-scene arrival. However, the results did not eliminate the potential for bias and the results should be interpreted carefully.
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Clinical Validation of Cardiac Arrest Hospital Prognosis (CAHP) Score and MIRACLE2 Score to Predict Neurologic Outcomes after Out-of-Hospital Cardiac Arrest. Healthcare (Basel) 2022; 10:healthcare10030578. [PMID: 35327059 PMCID: PMC8950818 DOI: 10.3390/healthcare10030578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 03/18/2022] [Accepted: 03/18/2022] [Indexed: 11/17/2022] Open
Abstract
Background. Out-of-hospital cardiac arrest (OHCA) remains a challenge for emergency physicians, given the poor prognosis. In 2020, MIRACLE2, a new and easier to apply score, was established to predict the neurological outcome of OHCA. Objective. The aim of this study is to compare the discrimination of MIRACLE2 score with cardiac arrest hospital prognosis (CAHP) score for OHCA neurologic outcomes. Methods. This retrospective cohort study was conducted between January 2015 and December 2019. Adult patients (>17 years) with cardiac arrest who were brought to the hospital by an emergency medical service crew were included. Deaths due to trauma, burn, drowning, resuscitation not initiated due to pre-ordered “do not resuscitate” orders, and patients who did not achieve return of spontaneous circulation were excluded. Receiver operating characteristic curve analysis with Youden Index was performed to calculate optimal cut-off values for both scores. Results. Overall, 200 adult OHCA cases were analyzed. The threshold of the MIRACLE2 score for favorable neurologic outcomes was 5.5, with an area under the curve (AUC) value of 0.70 (0.61−0.80, p < 0.001); the threshold of the CAHP score was 223.4, with an AUC of 0.77 (0.68−0.86, p < 0.001). On setting the MIRACLE2 score cut-off value, we documented 64.7% sensitivity (95% confidence interval [CI], 56.9−71.9%), 66.7.0% specificity (95% CI, 48.2−82.0%), 90.8% positive predictive value (PPV; 95% CI, 85.6−94.2%), and 27.2% negative predictive value (NPV; 95% CI, 21.4−33.9%). On establishing a CAHP cut-off value, we observed 68.2% sensitivity (95% CI, 60.2−75.5%), 80.6% specificity (95% CI, 62.5−92.6%), 94.6% PPV (95% CI, 88.6%−98.0%), and 33.8% NPV (95% CI, 23.2−45.7%) for unfavorable neurologic outcomes. Conclusions. The CAHP score demonstrated better discrimination than the MIRACLE2 score, affording superior sensitivity, specificity, PPV, and NPV; however, the CAHP score remains relatively difficult to apply. Further studies are warranted to establish scores with better discrimination and ease of application.
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Hongo T, Yumoto T, Naito H, Mikane T, Nakao A. Impact of different medical direction policies on prehospital advanced airway management for out-of hospital cardiac arrest patients: A retrospective cohort study. Resusc Plus 2022; 9:100210. [PMID: 35252900 PMCID: PMC8888968 DOI: 10.1016/j.resplu.2022.100210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 12/28/2021] [Accepted: 01/19/2022] [Indexed: 12/26/2022] Open
Abstract
Background Although optimal prehospital airway management after out-of-hospital cardiac arrest (OHCA) remains undetermined, no studies have compared different advanced airway management (AAM) policies adopted by two hospitals in charge of online medical direction by emergency physicians. We examined the impact of two different AAM policies on OHCA patient survival. Methods This observational cohort study included adult OHCA patients treated in Okayama City from 2013 to 2016. Patients were divided into two groups: the O group - those treated on odd days when a hospital with a policy favoring laryngeal tube ventilation (LT) supervised, and the E group - those treated on even days when the other hospital with a policy favoring endotracheal intubation (ETI) supervised. Multiple logistic regression analysis was performed to assess airway device effects. The primary outcome measure was seven-day survival. Results Of 2,406 eligible patients, 50.1% were in the O group and 49.9% were in the E group. O group patients received less ETI (1.0% vs. 12.0%) and more LT (53.3% vs. 43.0%) compared with E group patients. In univariate analysis, no differences were observed in seven-day survival (9.4% vs 10.1%). Multiple regression analysis revealed neither LT nor ETI had a significant independent effect on seven-day survival, considering bag-valve mask ventilation as a reference (OR, 0.78; 95% CI, 0.54 to 1.13, OR, 0.79; 95% CI, 0.36 to 1.72, respectively). Conclusion Despite different advanced airway medical direction policies in a single city, there were no substantial impact on outcomes for OHCA patients.
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Affiliation(s)
- Takashi Hongo
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Japan
| | - Tetsuya Yumoto
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Japan
| | - Hiromichi Naito
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Japan
- Corresponding author at: Okayama University Hospital, Advanced Emergency and Critical Care Medical Center, 2-5-1 Shikata, Okayama 700-8558, Japan.
| | - Takeshi Mikane
- Department of Emergency and Critical Care Medicine, Japanese Red Cross Okayama Hospital, Japan
| | - Atsunori Nakao
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Japan
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Abe T, Kanemaru K, Saito K, Ueda T, Ochiai H. Physician-Staffed Emergency Vehicle Crash: A Case Report. Cureus 2022; 14:e21027. [PMID: 35154997 PMCID: PMC8819582 DOI: 10.7759/cureus.21027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2022] [Indexed: 11/05/2022] Open
Abstract
Physician-staffed vehicles are widely operated in many countries. There is a paucity of literature regarding physician-staffed emergency vehicle accidents. On an evening in January 2016, at the request of the fire department, a physician-staffed vehicle was dispatched with two physicians, a nurse, and a driver from the base hospital to the scene of a patient with cardiopulmonary arrest. The vehicle ran with the alerting siren and warning lights. On its way, the vehicle struck a car and the mission was canceled. The patient was transported to another hospital by the ambulance staff only. No passengers were injured. One physician and a nurse examined the driver of the struck car and transported the driver to the base hospital by additional ambulance units. Because there were no manuals or guidelines, the staff responses were not systematic. After the repair of the crashed vehicle and preparation of operation manuals for two months, the physician-staffed vehicle returned to service, and it has worked without any accident since then. The physician-staffed vehicle is of benefit to critical victims and it rarely crashes. When the vehicle is involved in an accident, it results in multiple victims as well as additional emergency demands. Warning lights and sirens in the dark at a four-point crossroads might increase the risk of crashing. Information influx from the emergency scenes might distract the physicians’ attention and put stress on the driver, leading to dangerous high-speed emergency driving. Educational training and manuals in each hospital and a nationwide framework regarding safety operations and accidents are needed.
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Out-of-hospital cardiac arrest: prehospital physician's role during CPR should be clarified. Eur J Emerg Med 2021; 28:411-413. [PMID: 34714812 DOI: 10.1097/mej.0000000000000881] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hatakeyama T, Kiguchi T, Sera T, Nachi S, Ochiai K, Kitamura T, Ogura S, Otomo Y, Iwami T. Physician's presence in pre-hospital setting improves one-month favorable neurological survival after out-of-hospital cardiac arrest: a propensity score matching analysis of the JAAM-OHCA Registry. Resuscitation 2021; 167:38-46. [PMID: 34390825 DOI: 10.1016/j.resuscitation.2021.08.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 07/23/2021] [Accepted: 08/06/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Using the out-of-hospital cardiac arrest (OHCA) registry in Japan, we evaluated the effectiveness of physicians' presence in pre-hospital settings after adjusting in-hospital treatments. METHODS This was a multicenter cohort study. We registered all consecutive OHCA patients in Japan who, from 1 June 2014 through 31 December 2017, were transported to institutions participating in the Japanese Association for Acute Medicine OHCA registry. We included OHCA patients aged at least 18 years, with medical etiology, and who received resuscitation from emergency medical services (EMS) personnel and medical professionals in hospitals. The primary outcome was one-month favorable neurological survival. We estimated the propensity score by fitting a logistic regression model that was adjusted for several variables before the arrival of EMS personnel and/or pre-hospital physician. A multivariable logistic regression analysis in propensity score-matched patients was used to adjust confounders, including extracorporeal membrane oxygenation, percutaneous coronary intervention, intra-aortic balloon pumping, and targeted temperature management. RESULTS We analyzed 19,247 patients. Among them, 5.4% (N = 1,040) had a neurologically favorable outcome. The adjusted odds ratio (AOR) of the physicians' presence compared with their absence for primary outcome was 1.84 (95% confidence interval (CI): 1.43-2.37). Among first documented non-shockable cardiac rhythm, the AOR was 1.51 (95% CI: 1.04-2.22). Among first documented shockable cardiac rhythm, the AOR of the physicians' presence for primary outcome was 1.15 (95% CI: 0.83-1.59). CONCLUSION The improved one-month favorable neurological survival was significantly associated with the physicians' presence in pre-hospital settings, compared with the physicians' absence.
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Affiliation(s)
- Toshihiro Hatakeyama
- Department of Emergency and Critical Care Medicine, Emergency and Critical Care Center, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minami-Koshigaya, Koshigaya, Saitama 343-8555, Japan; Kyoto University Health Service, Yoshida-Honmachi, Sakyo-ku, Kyoto 606-8501, Japan
| | - Takeyuki Kiguchi
- Kyoto University Health Service, Yoshida-Honmachi, Sakyo-ku, Kyoto 606-8501, Japan; Department of Critical Care and Trauma Center, Osaka General Medical Center, 3-1-56 Bandai-Higashi, Sumiyoshi-ku, Osaka 558-8558, Japan.
| | - Toshiki Sera
- Department of Emergency Medicine, Hiroshima Prefectural Hospital, 1-5-54 Ujinakanda, Minami-ku, Hiroshima 734-8530, Japan; Department of Acute Critical Care and Disaster Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Sho Nachi
- Department of Emergency and Disaster Medicine, Gifu University Graduate School of Medicine, 1-1 Yanagito, Gifu, Gifu 501-1194, Japan
| | - Kanae Ochiai
- Department of Acute Critical Care and Disaster Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, 2-2 Yamada-oka, Suita, Osaka 565-0871, Japan
| | - Shinji Ogura
- Department of Emergency and Disaster Medicine, Gifu University Graduate School of Medicine, 1-1 Yanagito, Gifu, Gifu 501-1194, Japan
| | - Yasuhiro Otomo
- Department of Acute Critical Care and Disaster Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Taku Iwami
- Kyoto University Health Service, Yoshida-Honmachi, Sakyo-ku, Kyoto 606-8501, Japan
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Pietsch U, Knapp J, Mann M, Meuli L, Lischke V, Tissi M, Sollid S, Rauch S, Wenzel V, Becker S, Albrecht R. Incidence and challenges of helicopter emergency medical service (HEMS) rescue missions with helicopter hoist operations: analysis of 11,228 daytime and nighttime missions in Switzerland. Scand J Trauma Resusc Emerg Med 2021; 29:92. [PMID: 34253244 PMCID: PMC8276414 DOI: 10.1186/s13049-021-00898-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 06/09/2021] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE We aimed to investigate the medical characteristics of helicopter hoist operations (HHO) in HEMS missions. METHODS We designed a retrospective study evaluating all HHO and other human external cargo (HEC) missions performed by Swiss Air-Rescue (Rega) between January 1, 2010, and December 31, 2019. RESULTS During the study period, 9,963 (88.7 %) HEMS missions with HHO and HEC were conducted during the day, and 1,265 (11.3 %) at night. Of the victims with time-critical injuries (NACA ≥ 4), 21.1 % (n = 400) reached the hospital within 60 min during the day, and 9.1 % (n = 18) at night. Nighttime missions, a trauma diagnosis, intubation on-site, and NACA Score ≥ 4 were independently and highly significantly associated with longer mission times (p < 0.001). The greatest proportion of patients who needed hoist or HEC operations in the course of the HEMS mission during the daytime sustained moderate injuries (NACA 3, n = 3,731, 37.5 %) while practicing recreational activities (n = 5,492, 55.1 %). In daytime HHO missions, the most common medical interventions performed were insertion of a peripheral intravenous access (n = 3,857, 38.7 %) and administration of analgesia (n = 3,121, 31.3 %). CONCLUSIONS Nearly 20 % of patients who needed to be evacuated by a hoist were severely injured, and complex and lifesaving medical interventions were necessary before the HHO procedure. Therefore, only adequately trained and experienced medical crew members should accompany HHO missions.
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Affiliation(s)
- Urs Pietsch
- Department of Anaesthesiology and Intensive Care Medicine, Cantonal Hospital St. Gallen, Rorschacher Strasse 95, 9007, St. Gallen, Switzerland. .,Air Zermatt, Emergency Medical Service, 3920, Zermatt, Switzerland. .,Department of Emergency Medicine, Inselspital, Bern University, Bern, Switzerland. .,Swiss Air-Ambulance, Rega (Rettungsflugwacht/Guarde Aérienne), Zurich, Switzerland.
| | - Jürgen Knapp
- Air Zermatt, Emergency Medical Service, 3920, Zermatt, Switzerland.,Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
| | - Michael Mann
- Air Zermatt, Emergency Medical Service, 3920, Zermatt, Switzerland
| | - Lorenz Meuli
- Department of Vascular Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Volker Lischke
- Air Zermatt, Emergency Medical Service, 3920, Zermatt, Switzerland
| | - Mario Tissi
- Swiss Air-Ambulance, Rega (Rettungsflugwacht/Guarde Aérienne), Zurich, Switzerland
| | - Stephen Sollid
- Norwegian Air Ambulance Foundation, PB 414 Sentrum, 0103, Oslo, Norway.,University of Stavanger, PB 8600 Forus, 4036, Stavanger, Norway
| | - Simon Rauch
- Institute of Mountain Emergency Medicine, Eurac Research, Bozen, Italy.,Department of Anaesthesiology and Intensive Care Medicine, F. Tappeiner Hospital, Merano, Italy
| | - Volker Wenzel
- Klinik für Anästhesie Klinikum Friedrichshafen GmbH, Röntgenstraße 2, 88048, Friedrichshafen, Germany
| | - Stefan Becker
- Swiss Air-Ambulance, Rega (Rettungsflugwacht/Guarde Aérienne), Zurich, Switzerland
| | - Roland Albrecht
- Department of Anaesthesiology and Intensive Care Medicine, Cantonal Hospital St. Gallen, Rorschacher Strasse 95, 9007, St. Gallen, Switzerland.,Swiss Air-Ambulance, Rega (Rettungsflugwacht/Guarde Aérienne), Zurich, Switzerland
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Abstract
PURPOSE OF REVIEW Out-of-hospital cardiac arrest (OHCA) is the most devastating and time-critical medical emergency. Survival after OHCA requires an integrated system of care, of which transport by emergency medical services is an integral component. The transport system serves to commence and ensure uninterrupted high-quality resuscitation in suitable patients who would benefit, terminate resuscitation in those that do not, provide critical interventions, as well as convey patients to the next appropriate venue of care. We review recent evidence surrounding contemporary issues in the transport of OHCA, relating to who, where, when and how to transport these patients. RECENT FINDINGS We examine the clinical and systems-related evidence behind issues including: contemporary approaches to field termination of resuscitation in patients in whom continued resuscitation and transport to hospital would be medically futile, OHCA patients and organ donation, on-scene versus intra-transport resuscitation, significance of response time, intra-transport interventions (mechanical chest compression, targeted temperature management, ECMO-facilitated cardiopulmonary resuscitation), OHCA in high-rise locations and cardiac arrest centers. We highlight gaps in current knowledge and areas of active research. SUMMARY There remains limited evidence to guide some decisions in transporting the OHCA patient. Evidence is urgently needed to elucidate the roles of cardiac arrest centers and ECPR in OHCA.
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Abstract
In this section of the European Resuscitation Council Guidelines 2021, key information on the epidemiology and outcome of in and out of hospital cardiac arrest are presented. Key contributions from the European Registry of Cardiac Arrest (EuReCa) collaboration are highlighted. Recommendations are presented to enable health systems to develop registries as a platform for quality improvement and to inform health system planning and responses to cardiac arrest.
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Chappuis VN, Deham H, Cottet P, Gartner BA, Sarasin FP, Niquille M, Suppan L, Larribau R. Emergency physician's dispatch by a paramedic-staffed emergency medical communication centre: sensitivity, specificity and search for a reference standard. Scand J Trauma Resusc Emerg Med 2021; 29:31. [PMID: 33563301 PMCID: PMC7871575 DOI: 10.1186/s13049-021-00844-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 01/29/2021] [Indexed: 12/14/2022] Open
Abstract
Background Some emergency medical systems (EMS) use a dispatch centre where nurses or paramedics assess emergency calls and dispatch ambulances. Paramedics may also provide the first tier of care “in the field”, with the second tier being an Emergency Physician (EP). In these systems, the appropriateness of the decision to dispatch an EP to the first line at the same time as the ambulance has not often been measured. The main objective of this study was to compare dispatching an EP as part of the first line emergency service with the severity of the patient’s condition. The secondary objective was to highlight the need for a recognized reference standard to compare performance analyses across EMS. Methods This prospective observational study included all emergency calls received in Geneva’s dispatch centre between January 1st, 2016 and June 30th, 2019. Emergency medical dispatchers (EMD) assigned a level of risk to patients at the time of the initial call. Only the highest level of risk led to the dispatch of an EP. The severity of the patient’s condition observed in the field was measured using the National Advisory Committee for Aeronautics (NACA) scale. Two reference standards were proposed by dichotomizing the NACA scale. The first compared NACA≥4 with other conditions and the second compared NACA≥5 with other conditions. The level of risk identified during the initial call was then compared to the dichotomized NACA scales. Results 97′861 assessments were included. Overall prevalence of sending an EP as first line was 13.11, 95% CI [12.90–13.32], and second line was 2.94, 95% CI [2.84–3.05]. Including NACA≥4, prevalence was 21.41, 95% CI [21.15–21.67], sensitivity was 36.2, 95% CI [35.5–36.9] and specificity 93.2 95% CI [93–93.4]. The Area Under the Receiver-Operating Characteristics curve (AUROC) of 0.7507, 95% CI [0.74734–0.75397] was acceptable. Looking NACA≥5, prevalence was 3.09, 95% CI [2.98–3.20], sensitivity was 64.4, 95% CI [62.7–66.1] and specificity 88.5, 95% CI [88.3–88.7]. We found an excellent AUROC of 0.8229, 95% CI [0.81623–0.82950]. Conclusion The assessment by Geneva’s EMD has good specificity but low sensitivity for sending EPs. The dichotomy between immediate life-threatening and other emergencies could be a valid reference standard for future studies to measure the EP’s dispatching performance. Supplementary Information The online version contains supplementary material available at 10.1186/s13049-021-00844-y.
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Affiliation(s)
- Victor Nathan Chappuis
- Division of Emergency Medicine, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, CH 1211, Geneva, Switzerland
| | - Hélène Deham
- Division of Emergency Medicine, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, CH 1211, Geneva, Switzerland
| | - Philippe Cottet
- Division of Emergency Medicine, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, CH 1211, Geneva, Switzerland
| | - Birgit Andrea Gartner
- Division of Emergency Medicine, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, CH 1211, Geneva, Switzerland
| | - François Pierre Sarasin
- Division of Emergency Medicine, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, CH 1211, Geneva, Switzerland
| | - Marc Niquille
- Division of Emergency Medicine, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, CH 1211, Geneva, Switzerland
| | - Laurent Suppan
- Division of Emergency Medicine, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, CH 1211, Geneva, Switzerland
| | - Robert Larribau
- Division of Emergency Medicine, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, CH 1211, Geneva, Switzerland. .,Division of Emergency Medicine, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospital, Chemin du Petit-Bel-Air 2, CH 1226, Geneva, Thônex, Switzerland.
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Huang JB, Lee KH, Ho YN, Tsai MT, Wu WT, Cheng FJ. Association between prehospital prognostic factors on out-of-hospital cardiac arrest in different age groups. BMC Emerg Med 2021; 21:3. [PMID: 33413131 PMCID: PMC7792209 DOI: 10.1186/s12873-020-00400-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 12/28/2020] [Indexed: 11/13/2022] Open
Abstract
Background The prognosis of out-of-hospital cardiac arrest (OHCA) is very poor. While several prehospital factors are known to be associated with improved survival, the impact of prehospital factors on different age groups is unclear. The objective of the study was to access the impact of prehospital factors and pre-existing comorbidities on OHCA outcomes in different age groups. Methods A retrospective observational analysis was conducted using the emergency medical service (EMS) database from January 2015 to December 2019. We collected information on prehospital factors, underlying diseases, and outcome of OHCAs in different age groups. Kaplan-Meier type survival curves and multivariable logistic regression were used to analyze the association between modifiable pre-hospital factors and outcomes. Results A total of 4188 witnessed adult OHCAs were analyzed. For the age group 1 (age ≦75 years old), after adjustment for confounding factors, EMS response time (odds ratio [OR] = 0.860, 95% confidence interval [CI]: 0.811–0.909, p < 0.001), public location (OR = 1.843, 95% CI: 1.179–1.761, p < 0.001), bystander CPR (OR = 1.329, 95% CI: 1.007–1.750, p = 0.045), attendance by an EMT-Paramedic (OR = 1.666, 95% CI: 1.277–2.168, p < 0.001), and prehospital defibrillation by automated external defibrillator (AED)(OR = 1.666, 95% CI: 1.277–2.168, p < 0.001) were prognostic factors for survival to hospital discharge in OHCA patients. For the age group 2 (age > 75 years old), age (OR = 0.924, CI:0.880–0.966, p = 0.001), EMS response time (OR = 0.833, 95% CI: 0.742–0.928, p = 0.001), public location (OR = 4.290, 95% CI: 2.450–7.343, p < 0.001), and attendance by an EMT-Paramedic (OR = 2.702, 95% CI: 1.704–4.279, p < 0.001) were independent prognostic factors for survival to hospital discharge in OHCA patients. Conclusions There were variations between younger and older OHCA patients. We found that bystander CPR and prehospital defibrillation by AED were independent prognostic factors for younger OHCA patients but not for the older group.
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Affiliation(s)
- Jyun-Bin Huang
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123, Dapi Road, Niaosong Township, Kaohsiung County, 833, Kaohsiung City, Taiwan
| | - Kuo-Hsin Lee
- Department of Emergency Medicine, E-Da Hospital, I-Shou University, No. 1, Yi-Da Road, Jiao-Su Village, Yan-Chao District, Kaohsiung City, 824, Taiwan.,School of Medicine for International Student, I-Shou University, No. 8, Yi-Da Road, Jiao-Su Village, Yan-Chao District, Kaohsiung City, 824, Taiwan
| | - Yu-Ni Ho
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123, Dapi Road, Niaosong Township, Kaohsiung County, 833, Kaohsiung City, Taiwan
| | - Ming-Ta Tsai
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123, Dapi Road, Niaosong Township, Kaohsiung County, 833, Kaohsiung City, Taiwan
| | - Wei-Ting Wu
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123, Dapi Road, Niaosong Township, Kaohsiung County, 833, Kaohsiung City, Taiwan
| | - Fu-Jen Cheng
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123, Dapi Road, Niaosong Township, Kaohsiung County, 833, Kaohsiung City, Taiwan.
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Cassina T, Clivio S, Putzu A, Villa M, Moccetti T, Fortuna D, Casso G. Neurological outcome and modifiable events after out-of-hospital cardiac arrest in patients managed in a tertiary cardiac centre: A ten years register. Med Intensiva 2020; 44:409-419. [DOI: 10.1016/j.medin.2019.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 05/08/2019] [Accepted: 05/18/2019] [Indexed: 01/30/2023]
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27
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Grunau B, Kime N, Leroux B, Rea T, Van Belle G, Menegazzi JJ, Kudenchuk PJ, Vaillancourt C, Morrison LJ, Elmer J, Zive DM, Le NM, Austin M, Richmond NJ, Herren H, Christenson J. Association of Intra-arrest Transport vs Continued On-Scene Resuscitation With Survival to Hospital Discharge Among Patients With Out-of-Hospital Cardiac Arrest. JAMA 2020; 324:1058-1067. [PMID: 32930759 PMCID: PMC7492914 DOI: 10.1001/jama.2020.14185] [Citation(s) in RCA: 130] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 07/15/2020] [Indexed: 12/16/2022]
Abstract
Importance There is wide variability among emergency medical systems (EMS) with respect to transport to hospital during out-of-hospital cardiac arrest (OHCA) resuscitative efforts. The benefit of intra-arrest transport during resuscitation compared with continued on-scene resuscitation is unclear. Objective To determine whether intra-arrest transport compared with continued on-scene resuscitation is associated with survival to hospital discharge among patients experiencing OHCA. Design, Setting, and Participants Cohort study of prospectively collected consecutive nontraumatic adult EMS-treated OHCA data from the Resuscitation Outcomes Consortium (ROC) Cardiac Epidemiologic Registry (enrollment, April 2011-June 2015 from 10 North American sites; follow-up until the date of hospital discharge or death [regardless of when either event occurred]). Patients treated with intra-arrest transport (exposed) were matched with patients in refractory arrest (at risk of intra-arrest transport) at that same time (unexposed), using a time-dependent propensity score. Subgroups categorized by initial cardiac rhythm and EMS-witnessed cardiac arrests were analyzed. Exposures Intra-arrest transport (transport initiated prior to return of spontaneous circulation), compared with continued on-scene resuscitation. Main Outcomes and Measures The primary outcome was survival to hospital discharge, and the secondary outcome was survival with favorable neurological outcome (modified Rankin scale <3) at hospital discharge. Results The full cohort included 43 969 patients with a median age of 67 years (interquartile range, 55-80), 37% were women, 86% of cardiac arrests occurred in a private location, 49% were bystander- or EMS-witnessed, 22% had initial shockable rhythms, 97% were treated by out-of-hospital advanced life support, and 26% underwent intra-arrest transport. Survival to hospital discharge was 3.8% for patients who underwent intra-arrest transport and 12.6% for those who received on-scene resuscitation. In the propensity-matched cohort, which included 27 705 patients, survival to hospital discharge occurred in 4.0% of patients who underwent intra-arrest transport vs 8.5% who received on-scene resuscitation (risk difference, 4.6% [95% CI, 4.0%- 5.1%]). Favorable neurological outcome occurred in 2.9% of patients who underwent intra-arrest transport vs 7.1% who received on-scene resuscitation (risk difference, 4.2% [95% CI, 3.5%-4.9%]). Subgroups of initial shockable and nonshockable rhythms as well as EMS-witnessed and unwitnessed cardiac arrests all had a significant association between intra-arrest transport and lower probability of survival to hospital discharge. Conclusions and Relevance Among patients experiencing out-of-hospital cardiac arrest, intra-arrest transport to hospital compared with continued on-scene resuscitation was associated with lower probability of survival to hospital discharge. Study findings are limited by potential confounding due to observational design.
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Affiliation(s)
- Brian Grunau
- Departments of Emergency Medicine and the Centre for Health Evaluation and Outcome Sciences, St. Paul’s Hospital, Vancouver, Canada
- University of British Columbia, Vancouver, Canada
| | - Noah Kime
- Department of Medicine, University of Washington, Seattle
| | - Brian Leroux
- Department of Medicine, University of Washington, Seattle
| | - Thomas Rea
- Department of Medicine, University of Washington, Seattle
| | | | - James J. Menegazzi
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | | | - Laurie J. Morrison
- Li Ka Shing Knowledge Institute, St Michael’s Hospital, Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, Canada
| | - Jonathan Elmer
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Nancy M. Le
- Oregon Health and Science University, Portland
| | - Michael Austin
- Department of Emergency Medicine, University of Ottawa, Ottawa, Canada
| | - Neal J. Richmond
- Metropolitan Area EMS Authority/Emergency Physicians Advisory Board, Ft Worth, Texas
| | - Heather Herren
- Department of Medicine, University of Washington, Seattle
| | - Jim Christenson
- Departments of Emergency Medicine and the Centre for Health Evaluation and Outcome Sciences, St. Paul’s Hospital, Vancouver, Canada
- University of British Columbia, Vancouver, Canada
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Prause G, Orlob S, Auinger D, Eichinger M, Zoidl P, Rief M, Zajic P. [System and skill utilization in an Austrian emergency physician system: retrospective study]. Anaesthesist 2020; 69:733-741. [PMID: 32696083 PMCID: PMC7544713 DOI: 10.1007/s00101-020-00820-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 05/14/2020] [Accepted: 06/26/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND The continuous rise in calls for emergency physicians and the low proportion of indicated missions has led to a loss of job attractiveness, which in turn renders services in some areas unable to sufficiently staff units. This retrospective analysis evaluated the frequency of emergency and general medical interventions in a ground-based emergency physician response system. METHODS A retrospective analysis of anonymized data from the electronic documentation system of the emergency physician response unit at the Medical University of Graz was carried out. Calls answered by emergency physicians between 2010 and 2018 were extracted, measures carried out were evaluated and categorized into three groups: specific emergency interventions (category I), general medical interventions (category II) and no medical activity (category III). The frequency of occurrence of these categories was compared and incidences of individual measures per 100,000 inhabitants were calculated. RESULTS A total of 15,409 primary responses and 322 secondary transports were extracted and analyzed. The annual rate of system activation rose almost continuously from 1442 calls in 2010 to 2301 calls in 2018. The 3687 (23.4%) cancellations resulted in 12,044 patient contacts. Of these, 2842 (18%) calls were coded as category I, 7372 (47%) as category II and 5518 (35%) as category III. The frequency of specific emergency measures and general medical interventions was estimated at 157/100,000 and 409/100,000 inhabitants, respectively. CONCLUSIONS No specific emergency physician interventions were required in the majority of call-outs. The current model of preclinical care does not appear to be patient-oriented and efficient. Furthermore, the low proportion of critically ill and injured patients already leads to a reduction in attractiveness for emergency physicians and may introduce the threat of quality issues due to insufficient routine experience and lack of training.
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Affiliation(s)
- G Prause
- Klinische Abteilung für Allgemeine Anästhesiologie, Notfall- und Intensivmedizin, Medizinische Universität Graz, Auenbruggerplatz 5, 8036, Graz, Österreich.
| | - S Orlob
- Klinische Abteilung für Allgemeine Anästhesiologie, Notfall- und Intensivmedizin, Medizinische Universität Graz, Auenbruggerplatz 5, 8036, Graz, Österreich
| | - D Auinger
- Klinische Abteilung für Allgemeine Anästhesiologie, Notfall- und Intensivmedizin, Medizinische Universität Graz, Auenbruggerplatz 5, 8036, Graz, Österreich
| | - M Eichinger
- Klinische Abteilung für Allgemeine Anästhesiologie, Notfall- und Intensivmedizin, Medizinische Universität Graz, Auenbruggerplatz 5, 8036, Graz, Österreich
| | - P Zoidl
- Klinische Abteilung für Allgemeine Anästhesiologie, Notfall- und Intensivmedizin, Medizinische Universität Graz, Auenbruggerplatz 5, 8036, Graz, Österreich
| | - M Rief
- Klinische Abteilung für Allgemeine Anästhesiologie, Notfall- und Intensivmedizin, Medizinische Universität Graz, Auenbruggerplatz 5, 8036, Graz, Österreich
| | - P Zajic
- Klinische Abteilung für Allgemeine Anästhesiologie, Notfall- und Intensivmedizin, Medizinische Universität Graz, Auenbruggerplatz 5, 8036, Graz, Österreich
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Ramirez L, Diaz J, Alshami A, Varon DS, Einav S, Surani S, Varon J. Cardiopulmonary resuscitation in television medical dramas: Results of the TVMD2 study. Am J Emerg Med 2020; 43:238-242. [PMID: 32192897 DOI: 10.1016/j.ajem.2020.03.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 03/06/2020] [Accepted: 03/09/2020] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION Television medical dramas (TVMDs) use cardiopulmonary resuscitation (CPR) as a mean of achieving higher viewing rates. TVMDs portrayal of CPR can be used to teach laypersons attempting to perform CPR and to form a shared professional and layperson mental model for CPR decisions. We studied the portrayal of CPR across a wide range of TVMDs to see whether newer series fulfill this promise. MATERIALS AND METHODS Advanced cardiac life support (ACLS) certified healthcare providers underwent training in the use of a unique instrument based on the AHA (American Heart Association) guidelines to assess TVMD CPR scenarios. Components of the assessment included the adequacy of CPR techniques, gender distribution in CPR scenes, performance quality by different healthcare providers, and CPR outcomes. Thirty-one TVMDs created between 2010 and 2018 underwent review. RESULTS Among 836 TVMD episodes reviewed, we identified 216 CPR attempts. CPR techniques were mostly portrayed inaccurately. The recommended compressions depth was shown in only 32.0% of the attempts (n = 62). The recommended rate was shown in only 44.3% of the attempts (n = 86). Survival to hospital discharge was portrayed as twice higher in male patients (67.6%, n = 71) than in female patients (32.4%, n = 29) (p < 0.05). Paramedics were portrayed as having better performance than physicians or nurses; compression rates were shown to be within the recommendations in only 42% (n = 73) of the CPR attempts performed by physicians, 44% (n = 8) of those performed by nurses, and 64% (n = 9) of those performed by paramedics. Complete chest recoil after compression was shown in only 34% (n = 58) of the CPR attempts performed by physicians, 38% (n = 7) of those performed by nurses, and 64% (n = 9) of those performed by paramedics. Outcomes were better on the screen than in real life; among the episodes showing outcome (n = 202), the overall rate of survival from CPR was 61.9% (n = 125). CONCLUSION Portrayal of CPR in TVMDs remains a missed opportunity for improving performance and communication on CPR.
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Affiliation(s)
- Luz Ramirez
- Dorrington Medical Associates, PA, Houston, TX, USA; Benemerita Universidad Autónoma de Puebla, Puebla, Mexico
| | - Jose Diaz
- Dorrington Medical Associates, PA, Houston, TX, USA; Benemerita Universidad Autónoma de Puebla, Puebla, Mexico
| | - Abbas Alshami
- Dorrington Medical Associates, PA, Houston, TX, USA; Department of Medicine, Jersey Shore University Medical Center, Neptune, NJ, USA
| | | | - Sharon Einav
- Shaare Zedek Medical Center, Jerusalem, Hebrew University, Jerusalem, Israel
| | | | - Joseph Varon
- United General Hospital, Department of Acute and Continuing Care, The University of Texas Health Science Center at Houston, USA.
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30
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Martínez-Caballero CM, Sierra Quintana E. In Reply to Dr Soteras et al. Wilderness Environ Med 2020; 31:119-121. [DOI: 10.1016/j.wem.2019.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 10/23/2019] [Accepted: 11/05/2019] [Indexed: 10/25/2022]
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Alhusain F, Alsuwailem H, Aldrees A, Bugis A, Alzuhairi S, Alsulami S, Arabi Y, Aljerian N. Does Being Transported by Emergency Medical Services Improve Compliance with the Surviving Sepsis Bundle and Mortality Rate? A Retrospective Cohort Study. J Epidemiol Glob Health 2019; 10:276-279. [PMID: 32959607 PMCID: PMC7758847 DOI: 10.2991/jegh.k.191215.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 12/11/2019] [Indexed: 11/16/2022] Open
Abstract
Background: This study aimed to investigate the relationship between patients with severe sepsis or septic shock being transported to the Emergency Department (ED) by Emergency Medical Services (EMS) and the compliance with the 3-h sepsis resuscitation bundle [Surviving Sepsis Campaign (SSC)], and to compare the management and laboratory results of patients transported by EMS or non-EMS transport. Methods: A retrospective cohort study was conducted using data from a quality-improvement project at King Abdulaziz Medical City in Riyadh. The data for patients who presented to ED with sepsis (severe sepsis or septic shock) was categorized as being transported with EMS or non-EMS. The two groups were compared in terms of compliance with the SSC bundle and 30-day mortality. Results: In a sample of 436 patients with severe sepsis or septic shock presented at the ED during the study period, EMS transported almost one-third of the patients (134, 31%) and 302 patients (69%) used non-EMS transport. For the EMS group, adherence to intravenous fluid was 91.4% compared with 87% for the non-EMS group (p = 0.19), antibiotics (EMS 50.7% vs non-EMS 52%, p = 0.81), blood cultures before antibiotics (EMS 53% vs non-EMS 47.4%, p = 0.21), and measuring lactate levels (EMS 73.1% vs non-EMS 57%, p = <0.01). The mortality rate was 48.5% for the EMS group and 54% for the non-EMS group, which was not statistically significant. Conclusion: Whether transported with or without EMS did not result in a statistically significant difference in patients presenting with sepsis, in terms of the adherence to the SSC bundle elements or the 30-day hospital mortality rate. The only statistically significant difference was the time to lactate measurement.
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Affiliation(s)
- Faisal Alhusain
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Hanin Alsuwailem
- College of Medicine, Riyadh Elm University, Riyadh, Saudi Arabia
| | - Alanoud Aldrees
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Ahad Bugis
- College of Medicine, Riyadh Elm University, Riyadh, Saudi Arabia
| | - Sarah Alzuhairi
- College of Medicine, Riyadh Elm University, Riyadh, Saudi Arabia
| | - Sami Alsulami
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,Emergency Medicine Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Yaseen Arabi
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,Intensive Care Unit Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Nawfal Aljerian
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,Emergency Medicine Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
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Sato N, Matsuyama T, Akazawa K, Nakazawa K, Hirose Y. Benefits of adding a physician-staffed ambulance to bystander-witnessed out-of-hospital cardiac arrest: a community-based, observational study in Niigata, Japan. BMJ Open 2019; 9:e032967. [PMID: 31772105 PMCID: PMC6887019 DOI: 10.1136/bmjopen-2019-032967] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE This study aimed to assess the benefits of adding a physician-staffed ambulance to bystander-witnessed out-of-hospital cardiac arrest using a community-based registry. DESIGN Population-based, retrospective cohort study. SETTING An urban city with approximately 800 000 residents. PARTICIPANTS Patients aged ≥18 years with bystander-witnessed out-of-hospital cardiac arrests of medical aetiology in Niigata City, Japan, between January 2012 and December 2016, according to the Utstein style. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was 1-month survival with a favourable neurological outcome, defined as a cerebral performance category score of 1 or 2. We used logistic regression analysis to assess the association between favourable neurological outcome and prehospital physician involvement. RESULTS During the study period, a total of 4172 cardiac arrests were registered; of these, 892 patients with out-of-hospital cardiac arrest were eligible for this analysis, among whom 135 (15.1%) had prehospital physician involvement and 757 (84.9%) did not have prehospital physician involvement. The percentage of favourable neurological outcomes was 20.7% (28 of 135) in those with physician involvement and 10.4% (79 of 757) in those without physician involvement (p=0.001). Using multivariable logistic regression, prehospital physician involvement had an OR for a favourable neurological outcome of 3.44 (95% CI 1.64 to 7.23). CONCLUSIONS Among adults with out-of-hospital cardiac arrest, adding a physician-staffed ambulance was associated with significantly greater favourable neurological outcomes than standard emergency medical services.
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Affiliation(s)
- Nobuhiro Sato
- Department of Emergency and Critical Care Medicine, Niigata City General Hospital, Niigata, Japan
| | - Tasuku Matsuyama
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kohei Akazawa
- Department of Medical Informatics and Statistics, Niigata University Graduate School of Medicine, Niigata, Japan
| | - Kyoko Nakazawa
- Department of Medical Informatics and Statistics, Niigata University Graduate School of Medicine, Niigata, Japan
| | - Yasuo Hirose
- Department of Emergency and Critical Care Medicine, Niigata City General Hospital, Niigata, Japan
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Siebert JN, Bloudeau L, Ehrler F, Combescure C, Haddad K, Hugon F, Suppan L, Rodieux F, Lovis C, Gervaix A, Manzano S. A mobile device app to reduce prehospital medication errors and time to drug preparation and delivery by emergency medical services during simulated pediatric cardiopulmonary resuscitation: study protocol of a multicenter, prospective, randomized controlled trial. Trials 2019; 20:634. [PMID: 31747951 PMCID: PMC6868759 DOI: 10.1186/s13063-019-3726-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 09/13/2019] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Emergency drug preparation and administration in children is both complex and time-consuming and places this population at a higher risk than adults for medication errors. Moreover, survival and a favorable neurological outcome from cardiopulmonary resuscitation are inversely correlated to drug preparation time. We developed a mobile device application (the pediatric Accurate Medication IN Emergency Situations (PedAMINES) app) as a step-by-step guide for the preparation to delivery of drugs requiring intravenous injection. In a previous multicenter randomized trial, we reported the ability of this app to significantly reduce in-hospital continuous infusion medication error rates and drug preparation time compared to conventional preparation methods during simulation-based pediatric resuscitations. This trial aims to evaluate the effectiveness of this app during pediatric out-of-hospital cardiopulmonary resuscitation. METHODS/DESIGN We will conduct a multicenter, prospective, randomized controlled trial to compare the PedAMINES app with conventional calculation methods for the preparation of direct intravenously administered emergency medications during standardized, simulation-based, pediatric out-of-hospital cardiac arrest scenarios using a high-fidelity manikin. One hundred and twenty paramedics will be randomized (1:1) in several emergency medical services located in different regions of Switzerland. Each paramedic will be asked to prepare, sequentially, four intravenously administered emergency medications using either the app or conventional methods. The primary endpoint is the medication error rates. Enrollment will start in mid-2019 and data analysis in late 2019. We anticipate that the intervention will be completed in early 2020 and study results will be submitted in late 2020 for publication (expected in early 2021). DISCUSSION This clinical trial will assess the impact of an evidence-based mobile device app to reduce the rate of medication errors, time to drug preparation and time to drug delivery during prehospital pediatric resuscitation. As research in this area is scarce, the results generated from this study will be of great importance and may be sufficient to change and improve prehospital pediatric emergency care practice. TRIAL REGISTRATION ClinicalTrials.gov, ID: NCT03921346. Registered on 18 April 2019.
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Affiliation(s)
- Johan N. Siebert
- Children’s Hospital, Department of Pediatric Emergency Medicine, Geneva University Hospitals, 47 Avenue de la Roseraie, 1211 Geneva 14, Switzerland
| | - Laurie Bloudeau
- A.C.E. Geneva Ambulances SA, 2 Route de Jussy, 1225 Geneva, Switzerland
| | - Frédéric Ehrler
- Division of Medical Information Sciences, Department of Radiology and Medical Informatics, Geneva University Hospitals, 4 Rue Gabrielle Perret-Gentil, 1211 Geneva 14, Switzerland
| | - Christophe Combescure
- Division of Clinical Epidemiology, Department of Health and Community Medicine, University of Geneva and Geneva University Hospitals, 4 Rue Gabrielle Perret-Gentil, 1211 Geneva 14, Switzerland
| | - Kevin Haddad
- Children’s Hospital, Department of Pediatric Emergency Medicine, Geneva University Hospitals, 47 Avenue de la Roseraie, 1211 Geneva 14, Switzerland
| | - Florence Hugon
- Children’s Hospital, Department of Pediatric Emergency Medicine, Geneva University Hospitals, 47 Avenue de la Roseraie, 1211 Geneva 14, Switzerland
| | - Laurent Suppan
- Department of Emergency Medicine, Geneva University Hospitals, 4 Rue Gabrielle Perret-Gentil, 1211 Geneva 14, Switzerland
| | - Frédérique Rodieux
- Service of Clinical Pharmacology and Toxicology, Geneva University Hospitals, 4 Rue Gabrielle Perret-Gentil, 1211 Geneva 14, Switzerland
| | - Christian Lovis
- Division of Medical Information Sciences, Department of Radiology and Medical Informatics, Geneva University Hospitals, 4 Rue Gabrielle Perret-Gentil, 1211 Geneva 14, Switzerland
- Geneva University Faculty of Medicine, 1 Rue Michel Servet, 1205 Geneva, Switzerland
| | - Alain Gervaix
- Children’s Hospital, Department of Pediatric Emergency Medicine, Geneva University Hospitals, 47 Avenue de la Roseraie, 1211 Geneva 14, Switzerland
- Geneva University Faculty of Medicine, 1 Rue Michel Servet, 1205 Geneva, Switzerland
| | - Sergio Manzano
- Children’s Hospital, Department of Pediatric Emergency Medicine, Geneva University Hospitals, 47 Avenue de la Roseraie, 1211 Geneva 14, Switzerland
- Geneva University Faculty of Medicine, 1 Rue Michel Servet, 1205 Geneva, Switzerland
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Abe T, Iwatani K, Aoyama T, Ameda T, Ochiai H. Factors associated with the occurrence of prehospital medical interventions provided by physicians among non-trauma patients: a single-centre retrospective observational study in Japan. BMJ Open 2019; 9:e029186. [PMID: 31434772 PMCID: PMC6707655 DOI: 10.1136/bmjopen-2019-029186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Physician-staffed prehospital units are widely used in many countries. The criteria for predicting fatal injury are well recognised for trauma victims, but there are no criteria for predicting critical condition for non-trauma patients. This study aimed to identify the factors associated with non-trauma cases receiving prehospital interventions by physicians. DESIGN Retrospective observational study. SETTING Physician-staffed prehospital unit (car) at a single-base hospital in a suburban city in Japan. PARTICIPANTS Participants were 1058 non-trauma patients who received prehospital medical examinations from April 2014 to December 2017. OUTCOME MEASURES The outcome was the occurrence of physician-only interventions (POIs) exceeding paramedics' competencies. Univariate analysis and multiple logistic regression analysis were performed. Patient's age and gender, presumed disease category, type of location of the emergency, time of alarm, activation time, activator's occupation, time to arrival, transportation time and the destination facility were included as covariates. RESULTS POIs were provided to 380 (36%) patients. Patient's age, presumed disease category, type of location of the emergency, activator's occupation, time to arrival, transportation time and the destination facility were identified as potential independent factors. Multiple logistic regression analysis found that patient's age, presumed disease category, type of location of the emergency, transportation time and destination facility were the significant independent factors. Transportation times of more than 15 min (adjusted ORs (AORs)=4.17, 95% CI 2.59 to 6.72, p<0.01) or 10 to 14 min (AOR=3.66, 95% CI 2.32 to 5.79, p<0.01) and patient age of 40-59 years (AOR=3.16, 95% CI 1.66 to 6.01, p<0.01) were the strongest independent factors. CONCLUSIONS This study identified the factors associated with non-trauma cases receiving prehospital POIs. Patient's age, presumed disease category, type of location of the emergency and transportation time are independent factors associated with requiring POIs.
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Affiliation(s)
- Tomohiro Abe
- Department of Emergency Medicine, Miyazaki Prefectural Miyazaki Hospital, Miyazaki, Japan
- Department of Trauma and Critical Care Medicine, University of Miyazaki Hospital, Miyazaki, Japan
| | - Kenshi Iwatani
- Department of Emergency Medicine, Miyazaki Prefectural Miyazaki Hospital, Miyazaki, Japan
| | - Takeshi Aoyama
- Department of Emergency Medicine, Miyazaki Prefectural Miyazaki Hospital, Miyazaki, Japan
| | - Tatsunori Ameda
- Department of Emergency Medicine, Miyazaki Prefectural Miyazaki Hospital, Miyazaki, Japan
| | - Hidenobu Ochiai
- Department of Trauma and Critical Care Medicine, University of Miyazaki Hospital, Miyazaki, Japan
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The effect of prehospital critical care on survival following out-of-hospital cardiac arrest: A prospective observational study. Resuscitation 2019; 146:178-187. [PMID: 31412291 DOI: 10.1016/j.resuscitation.2019.08.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 07/04/2019] [Accepted: 08/06/2019] [Indexed: 12/27/2022]
Abstract
AIM To examine the effect of prehospital critical care on survival following OHCA, compared to routine advanced life support (ALS) care. METHODS We undertook a prospective multi-centre cohort study including two ambulance services and six prehospital critical care services in the United Kingdom (UK), between September 2016 and October 2017. Inclusion criteria were adult patients with non-traumatic OHCA treated by either prehospital critical care teams or ALS paramedics. Patients who received prehospital critical care were matched to those receiving ALS using propensity score matching. Primary outcome was survival to hospital discharge; secondary outcome was survival to hospital admission. RESULTS The primary analysis included 658 patients with OHCA receiving prehospital critical care and 1847 patients receiving ALS care. Rates of survival to hospital discharge (primary outcome) were 11.9% in both groups; rates of survival to hospital admission (secondary outcome) were 34.4% and 27.7% in the prehospital critical care and ALS group, respectively. The corresponding odds ratios for survival to hospital discharge and survival to hospital admission with prehospital critical care were 1.06 (95% confidence interval 0.75-1.49) and 1.39 (95% confidence interval 1.10-1.75), respectively. Results were consistent across subgroups and sensitivity analyses. CONCLUSIONS Despite a positive association with the secondary outcome of survival to hospital admission, prehospital critical care was not associated with increased rates of survival to hospital discharge following OHCA.
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Busch HJ, Schmid B, Kron J, Fink K, Busche C, Danner T, Veits O, Gottlieb D, Benk C, Trummer G, Meyer-Först S, Kopp S, Schwab W, Wengenmayer T, Biever P. [Freiburg Cardiac Arrest Receiving Team (CART) : Interdisciplinary solution for the acute management of non-traumatic out-of-hospital cardiac arrest]. Med Klin Intensivmed Notfmed 2019; 115:292-299. [PMID: 31363800 DOI: 10.1007/s00063-019-0598-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 04/18/2019] [Accepted: 05/13/2019] [Indexed: 10/26/2022]
Abstract
Standard procedures and guidelines provide specific instructions for basic and advanced cardiac life support. Recommendations for the admission of patients from preclinical into clinical structures after successful cardiopulmonary resuscitation (CPR) are available, but only a few are detailed. In the presence of ST-elevation myocardial infarction after return of spontaneous circulation (ROSC), coronary angiography must be performed as soon as possible. However, acute management and consecutive diagnostic procedures after hospital admission are up to the doctor on duty, who can rely on standard internal hospital procedures at best. Despite the enormous progress and new findings in intensive care and emergency medicine, intra-hospital mortality, as well as long-term survival, after CPR remains low and depends on a wide variety of influencing factors. To optimize in-hospital acute care of successfully resuscitated patients, an interdisciplinary admission team, a so-called cardiac arrest receiving team (CART), has been implemented at the University Hospital of Freiburg, Germany. The aim of the CART is to provide primary care to resuscitated patients as quickly and in as standardized a manner as possible with predefined diagnostic and therapeutic pathways by a team with special expertise in the field of CPR and post-resuscitation management. Accordingly, clear criteria for procedures and the location of primary care (e.g. emergency room vs. cardiac catheter laboratory), the composition of the CART and concrete treatment measures were defined.
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Affiliation(s)
- H-J Busch
- Universitäts-Notfallzentrum (UNZ), Universitätsklinikum Freiburg, Sir-Hans-A.-Krebs-Str., 79106, Freiburg im Breisgau, Deutschland.
| | - B Schmid
- Universitäts-Notfallzentrum (UNZ), Universitätsklinikum Freiburg, Sir-Hans-A.-Krebs-Str., 79106, Freiburg im Breisgau, Deutschland
| | - J Kron
- Universitäts-Notfallzentrum (UNZ), Universitätsklinikum Freiburg, Sir-Hans-A.-Krebs-Str., 79106, Freiburg im Breisgau, Deutschland
| | - K Fink
- Universitäts-Notfallzentrum (UNZ), Universitätsklinikum Freiburg, Sir-Hans-A.-Krebs-Str., 79106, Freiburg im Breisgau, Deutschland
| | - C Busche
- Universitäts-Notfallzentrum (UNZ), Universitätsklinikum Freiburg, Sir-Hans-A.-Krebs-Str., 79106, Freiburg im Breisgau, Deutschland
| | - T Danner
- Universitäts-Notfallzentrum (UNZ), Universitätsklinikum Freiburg, Sir-Hans-A.-Krebs-Str., 79106, Freiburg im Breisgau, Deutschland
| | - O Veits
- Universitäts-Notfallzentrum (UNZ), Universitätsklinikum Freiburg, Sir-Hans-A.-Krebs-Str., 79106, Freiburg im Breisgau, Deutschland
| | - D Gottlieb
- Universitäts-Notfallzentrum (UNZ), Universitätsklinikum Freiburg, Sir-Hans-A.-Krebs-Str., 79106, Freiburg im Breisgau, Deutschland
| | - C Benk
- Universitäts-Herzzentrum Freiburg Bad Krozingen GmbH, Bad Krozingen, Deutschland
| | - G Trummer
- Universitäts-Herzzentrum Freiburg Bad Krozingen GmbH, Bad Krozingen, Deutschland
| | - S Meyer-Först
- Universitäts-Herzzentrum Freiburg Bad Krozingen GmbH, Bad Krozingen, Deutschland
| | - S Kopp
- Universitäts-Herzzentrum Freiburg Bad Krozingen GmbH, Bad Krozingen, Deutschland
| | - W Schwab
- Universitäts-Herzzentrum Freiburg Bad Krozingen GmbH, Bad Krozingen, Deutschland
| | - T Wengenmayer
- Universitäts-Herzzentrum Freiburg Bad Krozingen GmbH, Bad Krozingen, Deutschland
| | - P Biever
- Universitäts-Herzzentrum Freiburg Bad Krozingen GmbH, Bad Krozingen, Deutschland
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Borowicz A, Nadolny K, Bujak K, Cieśla D, Gąsior M, Hudzik B. Paramedic versus physician-staffed ambulances and prehospital delays in the management of patients with ST-segment elevation myocardial infarction. Cardiol J 2019; 28:110-117. [PMID: 31313273 DOI: 10.5603/cj.a2019.0072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 06/03/2019] [Accepted: 06/23/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Time delays to reperfusion therapy in ST-segment elevation myocardial infarction (STEMI) still remain a considerable drawback in many healthcare systems. Emergency medical service (EMS) has a critical role in the early management of STEMI. Under investigation herein, was whether the use of physician-staffed ambulances leads to shorter pre-hospital delays in STEMI patients. METHODS This was an observational and retrospective study, using data from the registry of the Silesian regional EMS system in Katowice, Poland and the Polish Registry on Acute Coronary Syndromes (PL-ACS) for a study period of January 1, 2013 to December 31, 2016. The study population (n = 717) was divided into two groups: group 1 (n = 546 patients) - physician-staffed ambulances and group 2 (n = 171 patients) - paramedic-staffed ambulances. RESULTS Responses during the day and night shifts were similar. Paramedic-led ambulances more often transmitted 12-lead electrocardiogram (ECG) to the percutaneous coronary intervention centers. All EMS time intervals were similar in both groups. The type of EMS dispatched to patients (physicianstaffed vs. paramedic/nurse-only staffed ambulance) was adjusted for ECG transmission, sex had no impact on in-hospital mortality (odds ratio [OR] 1.41; 95% confidence interval [CI] 0.79-1.95; p = 0.4). However, service time exceeding 42 min was an independent predictor of in-hospital mortality (OR 4.19; 95% CI 1.27-13.89; p = 0.019). In-hospital mortality rate was higher in the two upper quartiles of service time in the entire study population. CONCLUSIONS These findings suggest that both physician-led and paramedic-led ambulances meet the criteria set out by the Polish and European authorities. All EMS time intervals are similar regardless of the type of EMS unit dispatched. A physician being present on board did not have a prognostic impact on outcomes.
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Affiliation(s)
- Artur Borowicz
- Voivodeship Rescue Service in Katowice, Katowice, Poland
| | - Klaudiusz Nadolny
- Voivodeship Rescue Service in Katowice, Katowice, Poland.,Department of Emergency Medicine, Medical University of Bialystok, Bialystok.,University of Strategic Planning in Dabrowa Gornicza, Poland
| | - Kamil Bujak
- 3rd Department of Cardiology, Silesian Center for Heart Disease, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Sil
| | - Daniel Cieśla
- Department of Science, Biostatistics and New Technologies, Silesian Center for Heart Disease, Zabrze, Poland
| | - Mariusz Gąsior
- 3rd Department of Cardiology, Silesian Center for Heart Disease, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Sil
| | - Bartosz Hudzik
- 3rd Department of Cardiology, Silesian Center for Heart Disease, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Sil. .,Department of Cardiovascular Disease Prevention, School of Public Health in Bytom, Medical University of Silesia.
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A multidisciplinary approach for improving the outcome of out-of-hospital cardiac arrest in South Korea. Eur J Emerg Med 2019; 27:46-53. [PMID: 31166220 PMCID: PMC6946101 DOI: 10.1097/mej.0000000000000612] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM Direct medical control using video conferencing capabilities of smartphones has never been conducted in out-of-hospital cardiac arrest patients. This study was conducted to investigate the feasibility and treatment effectiveness of real-time smartphone video conferencing calls for the management of out-of-hospital cardiac arrest. METHODS This study was a pre-post-intervention prospective cohort study conducted from January 2013 to July 2015. The intervention was pre-hospital advanced life support under a physician's direction using a smartphone video call. RESULTS In total, 942 cardiac arrests occurred over the 2-year period; 308 patients were excluded, and 314 (49.5%) and 320 (50.5%) cardiac arrest patients were enrolled during the pre- and post-intervention study periods, respectively. There were 248/320 (77.5%) cases of smartphone video-assisted advanced life support during the post-intervention period. For patients in the pre- and post-intervention groups, the pre-hospital return of spontaneous circulation was 6.7 and 20%, respectively (adjusted odds ratio 3.3, 95% confidence interval 1.6-6.8, P < 0.01), and favourable neurological outcomes were ascertained in 1.9 and 6.9%, respectively (adjusted odds ratio 23.6, 95% confidence interval 3.4-164.0, P < 0.01). The smartphone voice and video quality were rated 8.5 and 8.2 out of 10, respectively, in physician evaluation, while the overall utility was rated 9.1. CONCLUSION We concluded that a multidisciplinary approach including the re-education of basic life support, simulation training for advanced life support, real-time medical direction via video call, and dispatching two teams rather than one team improved the outcome of out-of-hospital cardiac arrest.
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What is the impact of physicians in prehospital treatment for patients in need of acute critical care? - An overview of reviews. Int J Technol Assess Health Care 2019; 35:27-35. [PMID: 30722802 DOI: 10.1017/s0266462318003616] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVES The aim of this overview was to systematically identify and synthesize existing evidence from systematic reviews on the impact of prehospital physician involvement. METHODS The Medline, Embase, and Cochrane library were searched from 1 January 2000 to 17 November 2017. We included systematic reviews comparing physician-based with non-physician-based prehospital treatment in patients with one of five critical conditions requiring a rapid response. RESULTS Ten reviews published from 2009 to 2017 were included. Physician treatment was associated with increased survival in patients with out-of-hospital cardiac arrest and patients with severe trauma; in the latter group, the result was based on more limited evidence. The success rate of prehospital endotracheal intubation (ETI) has improved over the years, but ETI by physicians is still associated with higher success rates than intubation by paramedics. In patients with severe traumatic brain injury, intubation by paramedics who were not well skilled to do so markedly increased mortality. CONCLUSIONS Current evidence is hinting at a benefit of physicians in selected aspects of prehospital emergency services, including treatment of patients with out-of-hospital cardiac arrest and critically ill or injured patients in need of prehospital intubation. Evidence is, however, limited by confounding and bias, and comparison is hampered by differences in case mix and the organization of emergency medical services. Future research should strive to design studies that enable appropriate control of baseline confounding and obtain follow-up data for the proportion of patients who die in the prehospital setting.
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Gries A, Bernhard M, Helm M, Brokmann J, Gräsner JT. [Future of emergency medicine in Germany 2.0]. Anaesthesist 2018; 66:307-317. [PMID: 28424835 DOI: 10.1007/s00101-017-0308-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
In 2003 an article on the future of prehospital emergency medicine in Germany was published in the journal Der Anaesthesist. Emergency medicine in Germany, which at that time was almost exclusively defined as prehospital emergency rescue, has evolved and now in-hospital domains have increasingly moved into the focus. At that time, the primary goal was to connect prehospital management with a smooth transition to hospital admission and further care in the hospital and to further optimize the rescue chain from the actual emergency through to causative treatment. Now after 15 years, the authors have critically assessed the development postulated in 2003 and reevaluated it. Which aspects could be developed further and become firmly established, what is still open and which questions in preclinical and clinical emergency treatment of the population will occupy us in the coming 15 years? With a critical eye to the past, the present contribution aims to capture the essential and new topics and open questions and provide a fresh perspective for the future of emergency medicine. Regulation at the state level or even lower levels of government often stand in contrast to more sweeping and economically effective approaches at the federal level. Prehospital emergency medicine in Germany is on the whole well-positioned with respect to facilities and personnel; however, as far as the economic situation and the utilization of available systems are concerned, there is still substantial room for improvement.
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Affiliation(s)
- A Gries
- Zentrale Notaufnahme, Universitätsklinikum Leipzig, Leipzig, Deutschland.
| | - M Bernhard
- Zentrale Notaufnahme, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - M Helm
- Abt X, Anästhesie und Intensivmedizin, Bundeswehrkrankenhaus Ulm, Ulm, Deutschland
| | - J Brokmann
- Zentrale Notaufnahme, Uniklinik RWTH Aachen, Aachen, Deutschland
| | - J-T Gräsner
- Institut für Rettungs- und Notfallmedizin, Universitätsklinikum Schleswig-Holstein, Kiel, Deutschland
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Nolan JP, Berg RA, Callaway CW, Morrison LJ, Nadkarni V, Perkins GD, Sandroni C, Skrifvars MB, Soar J, Sunde K, Cariou A. The present and future of cardiac arrest care: international experts reach out to caregivers and healthcare authorities. Intensive Care Med 2018; 44:823-832. [DOI: 10.1007/s00134-018-5230-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Accepted: 05/12/2018] [Indexed: 12/24/2022]
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Biomarkers of Sepsis-Induced Acute Kidney Injury. BIOMED RESEARCH INTERNATIONAL 2018; 2018:6937947. [PMID: 29854781 PMCID: PMC5941779 DOI: 10.1155/2018/6937947] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 03/19/2018] [Indexed: 12/29/2022]
Abstract
Sepsis, an infection-induced systemic disease, leads to pathological, physiological, and biochemical abnormalities in the body. Organ dysfunction is caused by a dysregulated host response to infection during sepsis which is a major contributing factor to acute kidney injury (AKI) and the mortality rate for sepsis doubles due to coincidence of AKI. Sepsis-induced AKI is strongly associated with increased mortality and other adverse outcomes. More timely diagnosis would allow for earlier intervention and could improve patient outcomes. Sepsis-induced AKI is characterized by a distinct pathophysiology compared with other diseases and may also have unique patterns of plasma and urinary biomarkers. This concise review summarizes properties and perspectives of the biomarkers for their individual clinical utilization.
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Mathiesen WT, Bjørshol CA, Kvaløy JT, Søreide E. Effects of modifiable prehospital factors on survival after out-of-hospital cardiac arrest in rural versus urban areas. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2018; 22:99. [PMID: 29669574 PMCID: PMC5907488 DOI: 10.1186/s13054-018-2017-x] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 03/21/2018] [Indexed: 11/20/2022]
Abstract
Background The modifiable prehospital system factors, bystander cardiopulmonary resuscitation (CPR), emergency medical services (EMS), response time, and EMS physician attendance, may affect short- and long-term survival for both rural and urban out-of-hospital cardiac arrest (OHCA) patients. We studied how such factors influenced OHCA survival in a mixed urban/rural region with a high survival rate after OHCA. Methods We analyzed the association between modifiable prehospital factors and survival to different stages of care in 1138 medical OHCA patients from an Utstein template-based cardiac arrest registry, using Kaplan-Meier type survival curves, univariable and multivariable logistic regression and mortality hazard plots. Results We found a significantly higher probability for survival to hospital admission (OR: 1.84, 95% CI 1.43–2.36, p < 0.001), to hospital discharge (OR: 1.51, 95% CI 1.08–2.11, p = 0.017), and at 1 year (OR: 1.58, 95% CI 1.11–2.26, p = 0.012) in the urban group versus the rural group. In patients receiving bystander CPR before EMS arrival, the odds of survival to hospital discharge increased more than threefold (OR: 3.05, 95% CI 2.00–4.65, p < 0.001). However, bystander CPR was associated with increased patient survival to discharge only in urban areas (survival probability 0.26 with CPR vs. 0.08 without CPR, p < 0.001). EMS response time ≥ 10 min was associated with decreased survival (OR: 0.61, 95% CI 0.45–0.83, p = 0.002), however, only in urban areas (survival probability 0.15 ≥ 10 min vs. 0.25 < 10 min, p < 0.001). In patients with prehospital EMS physician attendance, no significant differences were found in survival to hospital discharge (OR: 1.37, 95% CI 0.87–2.16, p = 0.17). In rural areas, patients with EMS physician attendance had an overall better survival to hospital discharge (survival probability 0.17 with EMS physician vs. 0.05 without EMS physician, p = 0.019). Adjusted for modifiable factors, the survival differences remained. Conclusions Overall, OHCA survival was higher in urban compared to rural areas, and the effect of bystander CPR, EMS response time and EMS physician attendance on survival differ between urban and rural areas. The effect of modifiable factors on survival was highest in the prehospital stage of care. In patients surviving to hospital admission, there was no significant difference in in-hospital mortality or in 1 year mortality between OHCA in rural versus urban areas.
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Affiliation(s)
- Wenche Torunn Mathiesen
- Critical Care and Anesthesiology Research Group, Stavanger University Hospital, Stavanger, Norway. .,Norwegian Air Ambulance Foundation, Department of Research and Development, Drøbak, Norway. .,Stavanger University Hospital, Forskningens Hus, Armauer Hansensgate 2, P.O. box: 8100, 4068, Stavanger, Norway.
| | - Conrad Arnfinn Bjørshol
- Department of Anesthesiology and Intensive Care, Stavanger University Hospital, Stavanger, Norway
| | - Jan Terje Kvaløy
- Research Department, Stavanger University Hospital, Stavanger, Norway.,Department of Mathematics and Physics, University of Stavanger, Stavanger, Norway
| | - Eldar Søreide
- Critical Care and Anesthesiology Research Group, Stavanger University Hospital, Stavanger, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
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Bernhard M, Gries A. Präklinische Notfallmedizin – ein Blick über den Tellerrand lohnt sich! Anaesthesist 2018; 67:81-82. [DOI: 10.1007/s00101-018-0405-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Cournoyer A, Notebaert É, Iseppon M, Cossette S, Londei-Leduc L, Lamarche Y, Morris J, Piette É, Daoust R, Chauny JM, Sokoloff C, Cavayas YA, Paquet J, Denault A. Prehospital Advanced Cardiac Life Support for Out-of-hospital Cardiac Arrest: A Cohort Study. Acad Emerg Med 2017. [PMID: 28646584 DOI: 10.1111/acem.13246] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Out-of-hospital advanced cardiac life support (ACLS) has not consistently shown a positive impact on survival. Extracorporeal cardiopulmonary resuscitation (E-CPR) could render prolonged on-site resuscitation (ACLS or basic cardiac life support [BCLS]) undesirable in selected cases. The objectives of this study were to evaluate, in patients suffering from out-of-hospital cardiac arrest (OHCA) and in a subgroup of potential E-CPR candidates, the association between the addition of prehospital ACLS to BCLS and survival to hospital discharge, prehospital return of spontaneous circulation (ROSC), and delay from call to hospital arrival. METHODS This cohort study targets adult patients treated for OHCA between April 2010 and December 2015 in the city of Montreal, Canada. We defined potential E-CPR candidates using clinical criteria previously described in the literature (65 years of age or younger, initial shockable rhythm, absence of ROSC after 15 minutes of prehospital resuscitation, and emergency medical services-witnessed collapse or witnessed collapse with bystander cardiopulmonary resuscitation). Associations were evaluated using multivariate regression models. RESULTS A total of 7,134 patients with OHCA were included, 761 (10.7%) of whom survived to discharge. No independent association between survival to hospital discharge and the addition of prehospital ACLS to BCLS was found in either the entire cohort (adjusted odds ratio [AOR] = 1.05 [95% confidence interval {CI} = 0.84-1.32], p = 0.68) or among the 246 potential E-CPR candidates (AOR = 0.82 [95% CI = 0.36-1.84], p = 0.63). The addition of prehospital ACLS to BCLS was associated with a significant increase in the rate of prehospital ROSC in all patients experiencing OHCA (AOR = 3.92 [95% CI = 3.38-4.55], p < 0.001) and in potential E-CPR candidates (AOR = 3.48 [95% CI = 1. 76-6.88], p < 0.001) compared to isolated prehospital BCLS. Delay from call to hospital arrival was longer in the ACLS group than in the BCLS group (difference = 16 minutes [95% CI = 15-16 minutes], p < 0.001). CONCLUSIONS In a tiered-response urban emergency medical service setting, prehospital ACLS is not associated with an improvement in survival to hospital discharge in patients suffering from OHCA and in potential E-CPR candidates, but with an improvement in prehospital ROSC and with longer delay to hospital arrival.
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Affiliation(s)
- Alexis Cournoyer
- Université de Montréal; Montréal Québec Canada
- Hôpital du Sacré-Cœur de Montréal; Montréal Québec Canada
- Institut de Cardiologie de Montréal; Montréal Québec Canada
| | - Éric Notebaert
- Université de Montréal; Montréal Québec Canada
- Hôpital du Sacré-Cœur de Montréal; Montréal Québec Canada
| | - Massimiliano Iseppon
- Université de Montréal; Montréal Québec Canada
- Hôpital du Sacré-Cœur de Montréal; Montréal Québec Canada
| | | | - Luc Londei-Leduc
- Université de Montréal; Montréal Québec Canada
- Corporation d'Urgences-santé; Montréal Québec Canada
- Centre Hospitalier de l'Université de Montréal; Montréal Québec Canada
| | - Yoan Lamarche
- Université de Montréal; Montréal Québec Canada
- Hôpital du Sacré-Cœur de Montréal; Montréal Québec Canada
- Institut de Cardiologie de Montréal; Montréal Québec Canada
| | - Judy Morris
- Université de Montréal; Montréal Québec Canada
- Hôpital du Sacré-Cœur de Montréal; Montréal Québec Canada
| | - Éric Piette
- Université de Montréal; Montréal Québec Canada
- Hôpital du Sacré-Cœur de Montréal; Montréal Québec Canada
| | - Raoul Daoust
- Université de Montréal; Montréal Québec Canada
- Hôpital du Sacré-Cœur de Montréal; Montréal Québec Canada
| | - Jean-Marc Chauny
- Université de Montréal; Montréal Québec Canada
- Hôpital du Sacré-Cœur de Montréal; Montréal Québec Canada
| | - Catalina Sokoloff
- Université de Montréal; Montréal Québec Canada
- Centre Hospitalier de l'Université de Montréal; Montréal Québec Canada
| | | | - Jean Paquet
- Hôpital du Sacré-Cœur de Montréal; Montréal Québec Canada
| | - André Denault
- Université de Montréal; Montréal Québec Canada
- Institut de Cardiologie de Montréal; Montréal Québec Canada
- Centre Hospitalier de l'Université de Montréal; Montréal Québec Canada
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Koppenberg J, Button D, Albrecht R. [Not Available]. PRAXIS 2017; 106:825-828. [PMID: 28745113 DOI: 10.1024/1661-8157/a002742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Zusammenfassung. Zusammenfassung: Schwere Unfälle zählen weiterhin zu den häufigsten Todesursachen bei jungen Erwachsenen. Die Notfallmedizin hat im Bereich der Traumaversorgung in den vergangenen Jahren grosse Fortschritte erzielen können. In diesem Artikel werden die strukturelle Entwicklung der Notfallmedizin in der Schweiz und die medizinischen Behandlungsstrategien bei Schwerstverletzten dargestellt.
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Affiliation(s)
- Joachim Koppenberg
- 1 Abteilung für Anästhesiologie, Schmerztherapie und Rettungsmedizin, Ospidal - Gesundheitszentrum Unterengadin, Scuol
- 3 Schweizerische Rettungsflugwacht (Rega), Zürich-Flughafen
| | - Daniel Button
- 2 Institut für Anästhesiologie, Kantonsspital Winterthur
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