9: Emergency Department Capnographic Confirmation of Endotracheal Tube Position in Out-of-Hospital Cardiac Arrest Patients

Background To determine the sensitivity and specificity of the self-inflating bulb (SIB) to verify tracheal intubation in out-of-hospital cardiac arrest patients. Methods Sixty-five consecutive adult patients with out-of-hospital cardiac arrest were enrolled. Patients were provided chest compression and ventilation by either ba-valve-mask or the esophageal tracheal double-lumen airway by ambulance crews when they arrived at the authors' department. Immediately after intubation in the emergency department, the endotracheal tube position was tested by the SIB and end-tidal carbon dioxide (ETCO2) monitor using an infrared carbon dioxide analyzer. We observed the SIB reinflating for 10 s, and full reinflation within 4 s was defined as a positive result (tracheal intubation). Results Five esophageal intubations occurred, and the SIB correctly identified all esophageal intubations. Of the 65 tracheal intubations, the SIB correctly identified 47 tubes placed in the trachea (72.3%). Delayed but full reinflation occurred in one tracheal intubation during the 10-s observation period. Fifteen tracheal intubations had incomplete reinflation during the observation period, and two tracheal intubations did not achieve any reinflation. Thirty-nine tracheal intubations were identified by ETCO2 (60%). When the SIB test is combined with the ETCO2 detection, 59 tracheal intubations were identified with a 90.8% sensitivity. Conclusions The authors found a high incidence of false-negative results of the SIB in out-of-hospital cardiac arrest patients. Because no single test for verifying endotracheal tube position is reliable, all available modalities should be tested and used in conjunction with proper clinical judgment to verify tracheal intubation in cases of out-of-hospital cardiac arrest.

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Effectiveness of mechanical chest compression for out-of-hospital cardiac arrest patients in an emergency department

Journal of the Chinese Medical Association ◽

10.1016/j.jcma.2015.01.005 ◽

2015 ◽

Vol 78 (6) ◽

pp. 360-363 ◽

Cited By ~ 2

Author(s):

Ching-Kuo Lin ◽

Mei-Chin Huang ◽

Yu-Tung Feng ◽

Wei-Hsuan Jeng ◽

Te-Cheng Chung ◽

...

Keyword(s):

Emergency Department ◽

Cardiac Arrest ◽

Chest Compression ◽

Mechanical Chest Compression ◽

Hospital Cardiac Arrest

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Continuation of CPR on admission to emergency department after out-of-hospital cardiac arrest. Occurrence, characteristics and outcome

Resuscitation ◽

10.1016/s0300-9572(96)01014-3 ◽

1997 ◽

Vol 33 (3) ◽

pp. 223-231 ◽

Cited By ~ 37

Author(s):

J. Herlitz ◽

L. Ekström ◽

Å. Axelsson ◽

A. Bång ◽

B. Wennerblom ◽

...

Keyword(s):

Emergency Department ◽

Cardiac Arrest ◽

Occurrence Characteristics ◽

Hospital Cardiac Arrest

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Out-of-hospital cardiac arrest: two and a half years experience of an accident and emergency department in Hong Kong.

Emergency Medicine Journal ◽

10.1136/emj.12.1.34 ◽

1995 ◽

Vol 12 (1) ◽

pp. 34-39 ◽

Cited By ~ 8

Author(s):

T W Wong ◽

K C Yeung

Keyword(s):

Emergency Department ◽

Cardiac Arrest ◽

Hong Kong ◽

Accident And Emergency ◽

Accident And Emergency Department ◽

Hospital Cardiac Arrest

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The association of emergency department administration of sodium bicarbonate after out of hospital cardiac arrest with outcomes

The American Journal of Emergency Medicine ◽

10.1016/j.ajem.2018.03.010 ◽

2018 ◽

Vol 36 (11) ◽

pp. 1998-2004 ◽

Cited By ~ 2

Author(s):

Yi-Chuan Chen ◽

Ming-Szu Hung ◽

Chia-Yen Liu ◽

Cheng-Ting Hsiao ◽

Yao-Hsu Yang

Keyword(s):

Emergency Department ◽

Cardiac Arrest ◽

Sodium Bicarbonate ◽

Hospital Cardiac Arrest

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Qualitative and quantitative analysis of emergency department cardiac arrest publications

10.22514/10.22514/sv.2021.209 ◽

2021 ◽

Keyword(s):

Emergency Department ◽

Cardiac Arrest ◽

Prediction Models ◽

Patient Characteristics ◽

Research Direction ◽

Medical Emergency ◽

Aggregated Data ◽

Academic Publications ◽

Relationship Of ◽

Hospital Cardiac Arrest

Cardiac arrest is a medical emergency with a poor prognosis. Patient characteristics and outcomes are associated with location and are traditionally categorized into out-of-hospital cardiac arrest (OHCA) or in-hospital cardiac arrest (IHCA). Increasing evidence has revealed that cardiac arrest occurring in the emergency department is distinct from OHCA or IHCA in other locations in hospitals, but most academic publications combine these populations and apply the knowledge arising from OHCA or IHCA to patients with emergency department cardiac arrest (EDCA). The aim of this study was to identify the research direction of EDCA in the past 20 years and to analyze the characteristics and content of academic publications. We searched the MEDLINE and EMBASE databases for eligible articles until May 30, 2021. Two independent reviewers extracted data by using a customized form to record crucial information, and any conflicts between the two reviewers were resolved through discussion with another independent reviewer. The aggregated data underwent a scoping review and analyzed qualitatively and quantitatively. In total, 52 original articles investigating EDCA were included; only 15 articles simply focused on EDCA, while other articles involved OHCA or IHCA simultaneously. There were 3 articles discussing the relationship of overcrowdedness and EDCA, 12 articles for prediction and risk factors associated with EDCA, 15 articles for epidemiology and prognosis, and 22 articles for specific diagnostic or resuscitation skills with regard to EDCA. Studies focusing on EDCA are increasing but still scarce. Applying the knowledge arising from OHCA or IHCA to EDCA is questionable, and research focused on EDCA is necessary. ED overcrowdedness-associated EDCA and prediction models for EDCA are essential topics that need further investigation.

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Abstract 309: Prediction Chart for Neurological Outcomes of Elderly Patients with Out-of-hospital Cardiac Arrest and the Corresponding Time to Termination of Resuscitation: Evidence from a Japanese Nationwide Population-based Cohort Study

Circulation ◽

10.1161/circ.142.suppl_4.309 ◽

2020 ◽

Vol 142 (Suppl_4) ◽

Author(s):

Akira Funada ◽

Yoshikazu Goto ◽

Masayuki Takamura

Keyword(s):

Emergency Department ◽

Cardiac Arrest ◽

Elderly Patients ◽

Service Providers ◽

Patient Characteristics ◽

Case Scenario ◽

Worst Case ◽

Neurological Outcomes ◽

Shockable Rhythm ◽

Hospital Cardiac Arrest

Introduction: Neurological outcomes and the appropriate duration from call receipt to termination of resuscitation (TOR) in patients with out-of-hospital cardiac arrest (OHCA) could differ according to patient characteristics. Hypothesis: We hypothesized that a prediction chart comprising prehospital variables, including age, could be useful for predicting neurological outcomes and determining the time to TOR in the field or at the emergency department. Methods: We evaluated 19,829 elderly patients with OHCA (age ≥65 years) of cardiac origin who achieved prehospital return of spontaneous circulation (ROSC). Data were obtained from the prospectively recorded All-Japan Utstein Registry between 2011 and 2016. Patients with OHCA witnessed by emergency medical service providers were excluded. The primary outcome was 1-month neurologically intact survival, defined as a cerebral performance category (CPC) score of 1-2. Patients with OHCA were divided into 12 groups according to shockable rhythm (YES/NO), witness status (YES/NO), and age (65-74, 75-89, or ≥90 years). The time from call receipt to ROSC was calculated and categorized by 5-min intervals. The time from call receipt to ROSC at which the probability of 1-month CPC 1-2 decreased to <1% was defined as the call to TOR duration. Results: The overall 1-month CPC 1-2 rate was 18.9% (n = 3,756). When stratified by patient characteristics, the 1-month CPC 1-2 rates ranged from 52.3% in patients aged 65-74 years with shockable rhythm and witnessed OHCA (best-case scenario) to 1.6% in patients aged ≥90 years with non-shockable rhythm and un-witnessed OHCA (worst-case scenario). The corresponding call to TOR duration ranged from 35 to 10 min (Table). Conclusions: Neurological outcomes and the appropriate call to TOR duration differed according to patient characteristics, including age. Our prediction chart for elderly patients with OHCA could be useful for determining TOR in the field or at the emergency department.

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