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Keselica M, Peřan D, Renza M, Duška F, Omáčka D, Schnaubelt S, Lulic I, Sýkora R. Efficiency of two-member crews in delivering prehospital advanced life support cardiopulmonary resuscitation: A scoping review. Resusc Plus 2024; 18:100661. [PMID: 38784406 PMCID: PMC11111834 DOI: 10.1016/j.resplu.2024.100661] [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: 03/04/2024] [Revised: 04/29/2024] [Accepted: 05/06/2024] [Indexed: 05/25/2024] Open
Abstract
Background Advanced Life Support (ALS) during cardiopulmonary resuscitation (CPR) for out-of-hospital cardiac arrest (OHCA) is frequently administered by two-member crews. However, ALS CPR is mostly designed for larger crews, and the feasibility and efficacy of implementing ALS guidelines for only two rescuers remain unclear. Objective This scoping review aims to examine the existing evidence and identify knowledge gaps in the efficiency of pre-hospital ALS CPR performed by two-member teams. Design A comprehensive search was undertaken across the following databases: PubMed, Web of Science, SCOPUS, Cochrane Library Trials, and ClinicalTrials.gov. The search covered publications in English or German from January 1, 2005, to November 30, 2023. The review included studies that focused on ALS CPR procedures carried out by two-member teams in adult patients in either simulated or clinical settings. Results A total of 22 articles were included in the qualitative synthesis. Seven topics in two-person prehospital ALS/CPR delivery were identified: 1) effect of team configuration on clinical outcome and CPR quality, 2) early airway management and ventilation techniques, 3) mechanical chest compressions, 4) prefilled syringes, 5) additional equipment, 6) adaptation of recommended ALS/CPR protocols, and 7) human factors. Conclusion There is a lack of comprehensive data regarding the adaptation of the recommended ALS algorithm in CPR for two-member crews. Although simulation studies indicate potential benefits arising from the employment of mechanical chest compression devices, prefilled syringes, and automation-assisted protocols, the current evidence is too limited to support specific modifications to existing guidelines.
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Affiliation(s)
- Miroslav Keselica
- Department of Anesthesia and Intensive Care, Third Faculty of Medicine, Charles University and FNKV University Hospital, Šrobárova 1150/50, Prague 100 34, Czech Republic
| | - David Peřan
- Department of Anesthesia and Intensive Care, Third Faculty of Medicine, Charles University and FNKV University Hospital, Šrobárova 1150/50, Prague 100 34, Czech Republic
- Emergency Medical Services of the Karlovy Vary Region, Závodní 390/98C, 360 06 Karlovy Vary, Czech Republic
| | - Metoděj Renza
- Department of Anesthesia and Intensive Care, Third Faculty of Medicine, Charles University and FNKV University Hospital, Šrobárova 1150/50, Prague 100 34, Czech Republic
| | - František Duška
- Department of Anesthesia and Intensive Care, Third Faculty of Medicine, Charles University and FNKV University Hospital, Šrobárova 1150/50, Prague 100 34, Czech Republic
| | - David Omáčka
- Department of Anesthesia and Intensive Care, Third Faculty of Medicine, Charles University and FNKV University Hospital, Šrobárova 1150/50, Prague 100 34, Czech Republic
| | - Sebastian Schnaubelt
- Department of Emergency Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
- PULS - Austrian Cardiac Arrest Awareness Association, Vienna, Austria
| | - Ileana Lulic
- Department of Anesthesiology, Intensive Care and Pain Medicine, Clinical Hospital Merkur, Zajceva 19, 10000 Zagreb, Croatia
| | - Roman Sýkora
- Department of Anesthesia and Intensive Care, Third Faculty of Medicine, Charles University and FNKV University Hospital, Šrobárova 1150/50, Prague 100 34, Czech Republic
- Emergency Medical Services of the Karlovy Vary Region, Závodní 390/98C, 360 06 Karlovy Vary, Czech Republic
- Air Rescue Service and Emergency Medicine Department Pilsen-Line, Military Medical Agency, U Letiště, 330 21 Líně, Czech Republic
- Medical College, Duškova 7, 150 00 Prague, Czech Republic
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Suppan L, Fehlmann CA, Stuby L, Suppan M. The Importance of Acknowledging an Intermediate Category of Airway Management Devices in the Prehospital Setting. Healthcare (Basel) 2022; 10:healthcare10050961. [PMID: 35628096 PMCID: PMC9141081 DOI: 10.3390/healthcare10050961] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 05/17/2022] [Accepted: 05/20/2022] [Indexed: 02/04/2023] Open
Abstract
Prehospital airway devices are often classified as either basic or advanced, with this latter category including both supraglottic airway (SGA) devices and instruments designed to perform endotracheal intubation (ETI). Therefore, many authors analyze the impact of SGA and ETI devices jointly. There are however fundamental differences between these instruments. Indeed, adequate airway protection can only be achieved through ETI, and SGA devices all have relatively low leak pressures which might compromise both oxygenation and ventilation when lung compliance is decreased. In addition, there is increasing evidence that SGA devices reduce carotid blood flow in case of cardiac arrest. Nevertheless, SGA devices might be particularly useful in the prehospital setting where many providers are not experienced enough to safely perform ETI. Compared to basic airway management (bag-valve-mask) devices, SGA devices enable better oxygenation, decrease the odds of aspiration, and allow for more reliable capnometric measurement by virtue of their enhanced airtightness. For all these reasons, we strongly believe that SGA devices should be categorized as "intermediate airway management devices" and be systematically analyzed separately from devices designed to perform ETI.
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Affiliation(s)
- Laurent Suppan
- Division of Emergency Medicine, Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Faculty of Medicine, Geneva University Hospitals, 1211 Geneva, Switzerland;
- Correspondence:
| | - Christophe Alain Fehlmann
- Division of Emergency Medicine, Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Faculty of Medicine, Geneva University Hospitals, 1211 Geneva, Switzerland;
| | - Loric Stuby
- Genève TEAM Ambulances, Emergency Medical Services, 1201 Geneva, Switzerland;
| | - Mélanie Suppan
- Division of Anesthesiology, Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Faculty of Medicine, Geneva University Hospitals, 1211 Geneva, Switzerland;
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Stuby L, Suppan L, Jampen L, Thurre D. Impact of the Over-the-Head Position with a Supraglottic Airway Device on Chest Compression Depth and Rate: A Post Hoc Analysis of a Randomized Controlled Trial. Healthcare (Basel) 2022; 10:healthcare10040718. [PMID: 35455895 PMCID: PMC9025543 DOI: 10.3390/healthcare10040718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 03/26/2022] [Accepted: 04/11/2022] [Indexed: 11/30/2022] Open
Abstract
There is considerable controversy regarding the optimal airway management strategy in the case of out-of-hospital cardiac arrest. Registry-based studies yield contradicting results and the actual impact of using supraglottic devices on survival and neurological outcomes remains unknown. In a recent simulation study, the use of an i-gel® device was associated with significantly shallower chest compressions. It was hypothesized that these shallower compressions could be linked to the provision of chest compressions in an over-the-head position, to the cumbersome airway management apparatus, and to a shallower i-gel® insertion depth in the manikin. To test this hypothesis, we carried out a post hoc analysis, which is described in this report. Briefly, no association was found between the over-the-head position and compression depth.
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Affiliation(s)
- Loric Stuby
- Genève TEAM Ambulances, Emergency Medical Services, CH-1201 Geneva, Switzerland;
- Correspondence:
| | - Laurent Suppan
- Division of Emergency Medicine, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Faculty of Medicine, University of Geneva, CH-1211 Geneva, Switzerland;
| | - Laurent Jampen
- ESAMB—École Supérieure de Soins Ambulanciers, College of Higher Education in Ambulance Care, CH-1231 Conches, Switzerland;
| | - David Thurre
- Genève TEAM Ambulances, Emergency Medical Services, CH-1201 Geneva, Switzerland;
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Impact of Face-to-Face Teaching in Addition to Electronic Learning on Personal Protective Equipment Doffing Proficiency in Student Paramedics: Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19053077. [PMID: 35270768 PMCID: PMC8910255 DOI: 10.3390/ijerph19053077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 03/02/2022] [Accepted: 03/03/2022] [Indexed: 01/04/2023]
Abstract
Personal protective equipment doffing is a complex procedure that needs to be adequately performed to prevent health care worker contamination. During the COVID-19 pandemic, junior health care workers and students of different health care professions who had not been trained to carry out such procedures were often called upon to take care of infected patients. To limit direct contact, distance teaching interventions were used, but different trials found that their impact was rather limited. We therefore designed and carried out a randomized controlled trial assessing the impact of adding a face-to-face intervention using Peyton's four-step approach to a gamified e-learning module. Sixty-five student paramedics participated in this study. The proportion of doffing sequences correctly performed was higher in the blended learning group (33.3% (95%CI 18.0 to 51.8) versus 9.7% (95%CI 2.0 to 25.8), p = 0.03). Moreover, knowledge and skill retention four to eight weeks after the teaching intervention were also higher in this group. Even though this study supports the use of a blended learning approach to teach doffing sequences, the low number of student paramedics able to adequately perform this procedure supports the need for iterative training sessions. Further studies should determine how often such sessions should be carried out.
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