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Groulx M, Graham J, Zelt N, Ali B, Wang JJ. Are three criteria enough to determine who benefits from extracorporeal cardiopulmonary resuscitation? Resuscitation 2022; 179:221-222. [PMID: 36182237 DOI: 10.1016/j.resuscitation.2022.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 07/05/2022] [Indexed: 10/14/2022]
Affiliation(s)
- Mathieu Groulx
- McGill University Emergency Medicine Residency Program, Montréal, Québec, Canada.
| | - Johann Graham
- McGill University Emergency Medicine Residency Program, Montréal, Québec, Canada
| | - Nicholas Zelt
- McGill University Emergency Medicine Residency Program, Montréal, Québec, Canada
| | - Bader Ali
- McGill University Emergency Medicine Residency Program, Montréal, Québec, Canada
| | - Josh J Wang
- McGill University, Montréal, Québec, Canada; Centre Anti-poison du Québec, Québec, Québec, Canada
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Dufour-Neyron H, Tanguay K, Nadeau A, Emond M, Harrisson J, Robert S, Capolla-Daneau N, Groulx M, Carmichael PH, Mercier E. Prehospital Use of the Esophageal Tracheal Combitube Supraglottic Airway Device: A Retrospective Cohort Study. J Emerg Med 2022; 62:324-331. [PMID: 35067394 DOI: 10.1016/j.jemermed.2021.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 10/26/2021] [Accepted: 11/27/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND In the province of Quebec (Canada), paramedics use the esophageal tracheal Combitube (ETC) for prehospital airway management. OBJECTIVES Our main objective was to determine the proportion of patients with successful ventilation achieved after ETC use. Our secondary aim was to determine the number of ETC insertion attempts required to ventilate the patient. METHOD This is a retrospective cohort study. All patients who had ≥1 attempt to insert an ETC during prehospital care between January 1, 2017 and December 31, 2018 were included. Prehospital and in-hospital data were extracted. Successful ventilation was defined as thorax elevation, lung sounds on chest auscultation, or positive end-tidal capnography after ETC insertion. RESULTS A total of 580 emergency medical services interventions (99.3% cardiac arrests) were included. Most patients were men (62.5%) with a mean age 67.0 years (SD 17.6 years), and 35 (13.1%) of the 298 patients transported to emergency department survived to hospital discharge. Sufficient information to determine whether ventilation was successful or not was available for 515 interventions. Ventilation was achieved during 427 (82.7%) of these interventions. The number of ETC insertion attempts was available for 349 of the 427 successful ETC use. Overall, the first insertion resulted in successful ventilation during 294 interventions for an overall proportion of first-pass success ranging between 57.1% and 72.1%. CONCLUSION Proportions of successful ventilation and ETC first-pass success are lower than those reported in the literature with supraglottic airway devices. The reasons explaining these lower rates and their impact on patient-centered outcomes need to be studied.
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Affiliation(s)
| | | | | | - Marcel Emond
- Centre de recherche du CHU de Québec, Université Laval; VITAM - Centre de recherche en santé durable de l'Université Laval; Département de médecine d'urgence, Institut de Cardiologie et de Pneumologie de l'Université Laval; Direction des services préhospitaliers d'urgence, Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale
| | - Jessica Harrisson
- Direction des services préhospitaliers d'urgence, Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale
| | - Sébastien Robert
- Département de médecine d'urgence, Institut de Cardiologie et de Pneumologie de l'Université Laval
| | - Nicolas Capolla-Daneau
- Direction des services préhospitaliers d'urgence, Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale
| | | | | | - Eric Mercier
- Centre de recherche du CHU de Québec, Université Laval; VITAM - Centre de recherche en santé durable de l'Université Laval; Département de médecine d'urgence, Institut de Cardiologie et de Pneumologie de l'Université Laval; Direction des services préhospitaliers d'urgence, Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale
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Groulx M, Nadeau A, Émond M, Harrisson J, Blanchard PG, Eramian D, Mercier E. Continuous flow insufflation of oxygen compared with manual ventilation during out-of-hospital cardiac arrest: A survey of the paramedics. SAGE Open Med 2021; 9:20503121211018105. [PMID: 34262761 PMCID: PMC8252405 DOI: 10.1177/20503121211018105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 04/26/2021] [Indexed: 11/21/2022] Open
Abstract
Introduction: In 2018, a continuous flow insufflation of oxygen (CFIO) device (b-card™, Vygon (USA)) placed on a supraglottic airway (SGA) became the standard of care to ventilate patients during adult out-of-hospital cardiac arrest (OHCA) care in Quebec–Capitale-Nationale region, Canada. This study aims to assess the paramedics’ perception as well as the disadvantages and the benefits relative to the use of CFIO during OHCA management. Methods: An invitation to complete an online survey (Survey Monkey™) was sent to all 560 paramedics who are working in our region. The survey included 22 questions of which 9 aimed to compare the traditional manual ventilation with a bag to the CFIO using a 5-point Likert-type scale. Results: A total of 244 paramedics completed the survey, of which 189 (77.5%) had used the CFIO device during an OHCA at least once. Most respondents felt that the intervention was faster (70.2%) and easier (86.5%) with the CFIO device compared with manual ventilation. CFIO was also associated with perceived increased patient safety (64.4%) as well as paramedic safety during the evacuation (88.9%) and the ambulance transport (88.9%). Paramedics reported that physical (48.1%) and cognitive (52.9%) fatigue were also improved with CFIO. The main reported barriers were the bending of the external SGA tube and the loss of capnography values. Conclusion: The use of CFIO during adult OHCA care allows a simplified approach and was perceived as safer for the patient and the paramedics compared with manual ventilation. Its impact on patient-centred outcomes needs to be assessed.
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Affiliation(s)
- Mathieu Groulx
- Centre de recherche du CHU de Québec, Université Laval, Québec, QC, Canada.,Faculté de médecine, Université Laval, Québec, QC, Canada
| | - Alexandra Nadeau
- Centre de recherche du CHU de Québec, Université Laval, Québec, QC, Canada.,Centre de recherche sur les soins et les services de première ligne de l'Université Laval (CERSSPL-UL), Québec, QC, Canada
| | - Marcel Émond
- Centre de recherche du CHU de Québec, Université Laval, Québec, QC, Canada.,Faculté de médecine, Université Laval, Québec, QC, Canada.,Centre de recherche sur les soins et les services de première ligne de l'Université Laval (CERSSPL-UL), Québec, QC, Canada.,Département de médecine d'urgence, CHU de Québec, Québec, QC, Canada
| | - Jessica Harrisson
- Direction des services préhospitaliers d'urgence, Centre Intégré Universitaire de Santé et de Services Sociaux (CIUSSS) de la Capitale-Nationale, Québec, QC, Canada
| | - Pierre-Gilles Blanchard
- Centre de recherche du CHU de Québec, Université Laval, Québec, QC, Canada.,Faculté de médecine, Université Laval, Québec, QC, Canada
| | - Douglas Eramian
- Département de médecine d'urgence, CHU de Québec, Québec, QC, Canada.,Direction des services préhospitaliers d'urgence, Centre Intégré Universitaire de Santé et de Services Sociaux (CIUSSS) de la Capitale-Nationale, Québec, QC, Canada
| | - Eric Mercier
- Centre de recherche du CHU de Québec, Université Laval, Québec, QC, Canada.,Faculté de médecine, Université Laval, Québec, QC, Canada.,Centre de recherche sur les soins et les services de première ligne de l'Université Laval (CERSSPL-UL), Québec, QC, Canada.,Département de médecine d'urgence, CHU de Québec, Québec, QC, Canada.,Direction des services préhospitaliers d'urgence, Centre Intégré Universitaire de Santé et de Services Sociaux (CIUSSS) de la Capitale-Nationale, Québec, QC, Canada
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Groulx M, Emond M, Boudreau-Drouin F, Cournoyer A, Nadeau A, Blanchard PG, Mercier E. Continuous flow insufflation of oxygen for cardiac arrest: Systematic review of human and animal model studies. Resuscitation 2021; 162:292-303. [PMID: 33766663 DOI: 10.1016/j.resuscitation.2021.03.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 02/26/2021] [Accepted: 03/10/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To synthetize the evidence regarding the effect of constant flow insufflation of oxygen (CFIO) on the rate of return of spontaneous circulation (ROSC) and other clinical outcomes during cardiac arrest (CA). METHODS A systematic review was performed using four databases (PROSPERO: CRD42020071960). Studies reporting on adult CA patients or on animal models simulating CA and assessing the effect of CFIO on ROSC or other clinical outcomes were considered. RESULTS A total of 3540 citations were identified, of which 16 studies were included. Four studies (two randomized controlled trials (RCT), two cohort studies), reported on humans while 12 studies used animal models. No meta-analysis was performed due to clinical heterogeneity. There were no differences in the ROSC (18.9% vs 20.8%, p = 0.99; 27.1% vs 21.3%, p = 0.51) and sustained ROSC rates (16.1% vs 17.3%, p = 0.81; 12.5% vs 14.9%, p = 0.73) with CFIO compared to intermitant positive pressure ventilation (IPPV) in the two human RCTs. Survival to ICU discharge was similar between CFIO (2.3%) and IPPV (2.3%) in the largest RCT (p = 0.96). Human studies were at serious or high risk of bias. In animal models' studies, ROSC rates were presented in seven RCTs. CFIO was superior to IPPV in one trial, but was associated with similar ROSC rates using different ventilation strategies in the remaining six studies. CONCLUSIONS No definitive association between CFIO and ROSC, sustained ROSC or survival compared to other ventilation strategies could be demonstrated. Future studies should assess CFIO effect on post-survival neurological functions and patient-important CA outcomes.
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Affiliation(s)
- Mathieu Groulx
- Faculté de Médecine, Université Laval, Québec, Canada; Centre de recherche du CHU de Québec-Université Laval, Québec, Canada
| | - Marcel Emond
- Faculté de Médecine, Université Laval, Québec, Canada; Centre de recherche du CHU de Québec-Université Laval, Québec, Canada; VITAM - Centre de recherche en santé durable de l'Université Laval, Québec, Canada
| | - Felix Boudreau-Drouin
- Faculté de Médecine, Université Laval, Québec, Canada; VITAM - Centre de recherche en santé durable de l'Université Laval, Québec, Canada
| | - Alexis Cournoyer
- Faculté de médecine, Université de Montréal, Québec, Canada; Département de médecine d'urgence, Hôpital du Sacré-Cœur, Montréal, Québec, Canada; Département de médecine d'urgence, Hôpital Maisonneuve-Rosemont, Montréal, Canada
| | - Alexandra Nadeau
- VITAM - Centre de recherche en santé durable de l'Université Laval, Québec, Canada
| | - Pierre-Gilles Blanchard
- Faculté de Médecine, Université Laval, Québec, Canada; VITAM - Centre de recherche en santé durable de l'Université Laval, Québec, Canada
| | - Eric Mercier
- Faculté de Médecine, Université Laval, Québec, Canada; Centre de recherche du CHU de Québec-Université Laval, Québec, Canada; VITAM - Centre de recherche en santé durable de l'Université Laval, Québec, Canada.
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