Improvements in the quality of advanced life support and patient outcome after implementation of a standardized real-life post-resuscitation feedback system

AbstractIntroduction:Behavioral and social science research suggests that job satisfaction and job performance are positively correlated. It is important that Emergency Medical Services managers identify predictors of job satisfaction in order to maximize job performance among prehospital personnel.Purpose:Identify job stressors that predict the level of job satisfaction among prehospital personnel.Methods:The study was conducted with in a large, urban Emergency Medical Services (Emergency Medical Services) service performing approximately 60,000 Advanced Life Support (Advanced Life Support) responses annually. Using focus groups and informal interviews, potential predictors of global job satisfaction were identified. These factors included: interactions with hospital nurses and physicians; on-line communications; dispatching; training provided by the ambulance service; relationship with supervisors and; standing orders as presently employed by the ambulance service. These factors were incorporated into a 21 item questionnaire including one item measuring global job satisfaction, 14 items measuring potential predictors of satisfaction, and seven questions exploring demographic information such as age, gender, race, years of experience, and years with the company. The survey was administered to all paramedics and Emergency Medical Technicians (Emergency Medical Technicians s) Results of the survey were analyzed using univariate and multivariate techniques to identify predictors of global job satisfaction.Results:Ninety paramedics and Emergency Medical Technicians participated in the study, a response rate of 57.3%. Job satisfaction was cited as extremely satisfying by 11%, very satisfying by 29%, satisfying by 45%, and not satisfying by 15% of respondents. On univariate analysis, only the quality of training, quality of physician interaction, and career choice were associated with global job satisfaction. On multivariate analysis, only career choice (p = 0.005) and quality of physician interaction (p = 0.05) were predictive of global job satisfactionConclusion:Quality of career choice and interactions with physicians are predictive of global job satisfaction within this urban emergency medical service (Emergency Medical Technicians). Future studies should examine specific characteristics of the physician-paramedic interface that influence job satisfaction and attempt to generalize these results to other settings.

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MP20: Evaluation of the disruptors during advanced life support in emergency departments

CJEM ◽

10.1017/cem.2020.168 ◽

2020 ◽

Vol 22 (S1) ◽

pp. S49-S49

Author(s):

J. Truchot ◽

D. Michelet ◽

D. Drummond ◽

P. Plaisance

Keyword(s):

Emergency Departments ◽

Exploratory Study ◽

Online Survey ◽

Life Support ◽

Medical Curriculum ◽

Real Life ◽

Advanced Life Support ◽

Cross Sectional ◽

Phone Calls ◽

Ed Overcrowding

Introduction: Simulation is used as a teaching technique in the medical curriculum, and especially for advanced life support (ALS). However, simulated ALS can differ greatly from real life ALS. The aim of this exploratory study was to identify the different disruptors associated with real life ALS. Methods: We conducted a cross-sectional, anonymous, online survey that included 32 items. It was distributed by email to emergency physicians from five emergency departments in Paris. The aim of this online survey was to identify the elements perceived as disruptors during ALS. Other aspects of the survey explored the perceived differences between simulated ALS and real life ALS. Descriptive statistics of percentage, mean and standard deviation were used to analyse the data. Results: Among 100 surveyed physicians, 43 (43%) answers were analysed. 53% were women with a mean age of 32 ± 3 years old. The identified disruptors from real life ALS were task interruptions mainly from non-medical staff (n = 16; 37%), patient's siblings (n = 5; 12%), other specialists (n = 5; 12%) and the phone calls (n = 2; 5%). The situation of ED overcrowding (n = 12; 28%) was also mentioned as a potential disruptor. Overall, physicians reported that some technical and non-technical tasks were harder to perform in real life compared to simulated sessions. Conclusion: This exploratory study allowed the identification of disruptors encountered in real life cases of ALS, and may be used for future simulation-based teaching to enhance realism during sessions

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Сardiopulmonary and cerebral resuscitation: new European Resuscitation Council Guidelines for resuscitation 2021

EMERGENCY MEDICINE ◽

10.22141/2224-0586.17.8.2021.245567 ◽

2021 ◽

Vol 17 (8) ◽

pp. 6-19

Author(s):

L.V. Usenko ◽

А.V. Tsarev ◽

Yu.Yu. Kobelatsky

Keyword(s):

Cardiac Arrest ◽

Healthcare Workers ◽

Basic Life Support ◽

Life Support ◽

Extracorporeal Life Support ◽

Advanced Life Support ◽

European Resuscitation Council ◽

Improved Outcomes ◽

Electrical Defibrillation

The article presents the current changes in the algorithm of cardiopulmonary and cerebral resuscitation (CPCR), adopted by the European Council for Resuscitation in 2021. The article presents the principles of basic life support and advanced life support, inclu-ding taking into account the European recommendations published in 2020, dedicated to the specifics of CPCR in the context of the COVID-19 pandemic. The main focus of CPCR in the COVID-19 pandemic is that the safety of healthcare workers should never be compromised, based on the premise that the time it takes to ensure that care is delivered safely to rescuers is acceptable part of the CPCR process. The principles of electrical defibrillation, including in patients with coronavirus disease who are in the prone position, pharmacological support of CPCR, modern monitoring capabilities for assessing the quality of resuscitation measures and identifying potentially reversible causes of cardiac arrest, the use of extracorporeal life support techno-logies during CPR are highlighted. The modern principles of intensive care of the post-resuscitation syndrome are presented, which makes it possible to provide improved outcomes in patients after cardiac arrest.

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Automatic compression improves adherence to advanced life support protocol in two-paramedic team. A randomized simulation study

10.22514/sv.2020.16.0110 ◽

2020 ◽

Keyword(s):

Human Error ◽

Life Support ◽

Advanced Life Support ◽

Supraglottic Airway ◽

Control Group ◽

Delivery Time ◽

Chest Compressions ◽

Adherence To Guidelines ◽

Experimental Group

Introduction: The use of protocols reduces the risk of human error and increases healthcare professionals’ adherence to guidelines. In a team of only two providers, following Advanced Life Support (ALS) protocol might be challenging. Automated Chest Compressions Devices (ACCD) may increase the quality of chest compressions. The aim of this study was to evaluate if the use of ACCD in resuscitation by a two-paramedic crew improves adherence to the ALS protocol. Materials and Methods: This study was designed as a prospective randomized high-fidelity cross-over simulation trial. Fifty-two doubleperson teams were enrolled. Each team performed two full resuscitation scenarios: one with ACCD (the experimental group-ACC) and one with manual compressions (the control group-MAN). Results: ACC achieved shorter mean durations of resuscitation loops, being less prolonged in relation to recommended durations than MAN (13 vs. 23 sec over recommended respectively, P = 0.0003). ACC also achieved mean times for supraglottic airway completion significantly faster than MAN: 224 ± 66 s vs 122 ± 35 s (P < 0.0001). In ACC, the intravenous line was obtained earlier then in MAN (162 ± 35 s vs 183 ± 45 s, P = 0.0111). Moreover, the first and second doses of adrenaline (epinephrine) were administered earlier 272± 58 s vs 232 ± 57 s (P = 0.0014) for the first and 486 ± 96 s vs 424 ± 69 s (P = 0.0007) for the second doses, respectively. Mean chest compression fraction (CCF) in MAN group was significantly lower (74 ± 4%) than in ACC group (83 ± 2%) (P < 0.0001). Conclusions: In a simulated setting, ACCD used by two-person paramedic teams yielded earlier achievement of resuscitation endpoints and improved delivery time of compressions. which may have implications for effective clinical resuscitation.

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Abstract 146: Evaluation of Out-of-hospital Ventricular Fibrillation Cardiac Arrest Management, With a Simulation Method

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.10.suppl_3.146 ◽

2017 ◽

Vol 10 (suppl_3) ◽

Author(s):

Cécile Ursat ◽

Guillaume Douge ◽

Charles Groizard ◽

Anna Ozguler ◽

Michel Baer ◽

...

Keyword(s):

Cardiac Arrest ◽

Life Support ◽

Advanced Life Support ◽

Simulation Method ◽

Quality Parameters ◽

Real Patient ◽

Decision Algorithm ◽

St Segment Elevation ◽

Monitoring Devices

Introduction: Feed-back on quality of CPR is an important aspect to consider on cardiac arrest management. This has been pointed out during trainings organized for emergency medicine residents. In parallel, RéAC registry (registry on cardiac arrests in France) showed some difficulties in following guidelines of VF.The aim of this study was to evaluate the performance of Emergency Medical Service (EMS) in the management of patients in cardiac arrest through the use of external chest compression (CC) data from the Resusci Anne Simulator manikin from Laerdal (SimMan®), equipped with SimPad SkillReporter. Methodology: During 2nd to 6th of March 2015, 18 EMS teams (1 physician, 1 paramedic and 1 nurse) were asked to manage a VF on a Resusci Anne Simulator manikin. This allowed the direct measurement of CC quality parameters and the evaluation of decision algorithm, through the use of a same scenario. The scenario was introduced to each team at the beginning of each session. At first, the “patient” was still conscious, on a stretcher and had a ST-segment elevation myocardial infarction. While the patient was installed in the ambulance, he suddenly had a FV cardiac arrest that could be detected on monitoring devices (time 0 of simulation). VF lasted for 10 minutes, followed by 5 minutes of asystole. The manikin software displayed the different parameters as the scenario progressed. The simulation was performed on a stretcher in an EMS premise, with the same equipment and monitoring devices as in an advanced life support ambulance (ALS). Results: CC were performed 71% of CPR time. CC depth was considered as non-compliant to guidelines in 28% of cases, with a mean depth of 4.4 cm, compressions with complete release in 37% of cases. Mean compression rate was 122/minute and was correct in 49% of cases. One third used Amiodarone after the third shock. 13/18 teams resumed chest compressions immediately after defibrillation attempts. Conclusion: This study shows the difficulty to strictly follow guidelines. According to participants, the massage was considered as more difficult with a manikin rather than on a real patient. Although cardiac arrest occurring during transportation is quite rare, quality of CPR at pre-hospital level should be improved.

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Recommended Guidelines for Uniform Reporting of Pediatric Advanced Life Support: The Pediatric Utstein Style

PEDIATRICS ◽

10.1542/peds.96.4.765 ◽

1995 ◽

Vol 96 (4) ◽

pp. 765-779 ◽

Cited By ~ 1

Author(s):

Arno Zaritsky ◽

Vinay Nadkarni ◽

Mary Fran Hazinski ◽

George Foltin ◽

Linda Quan ◽

...

Keyword(s):

Life Support ◽

Task Force ◽

Age Groups ◽

Advanced Life Support ◽

Data Set ◽

Consensus Document ◽

Eastern Virginia Medical School ◽

Pediatric Resuscitation ◽

Recommended Guidelines

This consensus document is an attempt to provide an organized method of reporting pediatric ALS data in out-of-hospital, emergency department, and in-hospital settings. For this methodology to gain wide acceptance, the task force encourages development of a common data set for both adult and pediatric ALS interventions. In addition, every effort should be made to ensure that consistent definitions are used in all age groups. As health care changes, we will all be challenged to document the effectiveness of what we currently do and show how new interventions or methods of treatment improve outcome and/or reduce cost. Only through collaborative research will we obtain the necessary data. For these reasons, and to improve the quality of care and patient outcomes, it is the hope of the task force that clinical researchers will follow the recommendations in this document. It is recognized that further refinements of this statement will be needed; these recommendations will improve only when researchers, clinicians, and EMS personnel use them, work with them, and modify them. Suggestions, emendations, and other comments aimed at improving the reporting of pediatric resuscitation should be sent to Arno Zaritsky, MD, Eastern virginia Medical School, Children's Hospital of The King's Daughter, Division of Critical Care Medicine, 601 Children's Lane, Norfolk, VA 23507.

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Socio-emotional stress does not affect the quality of cardiopulmonary resuscitation in simulated advanced life support

Resuscitation ◽

10.1016/j.resuscitation.2010.09.053 ◽

2010 ◽

Vol 81 (2) ◽

pp. S10

Author(s):

Bjørshol C.A. ◽

Myklebust H. ◽

Nilsen K. ◽

Hoff T. ◽

Bjørkli C. ◽

...

Keyword(s):

Cardiopulmonary Resuscitation ◽

Emotional Stress ◽

Life Support ◽

Advanced Life Support

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PP17 Verbalisation of plans during out-of-hospital cardiac arrest resuscitation

Emergency Medicine Journal ◽

10.1136/emermed-2019-999.17 ◽

2019 ◽

Vol 36 (1) ◽

pp. e7.2-e7

Author(s):

Ernisa Marzuki ◽

Anna Crawford ◽

Chris Cummins ◽

Hannah Rohde ◽

Holly Branigan ◽

...

Keyword(s):

Cardiac Arrest ◽

Mental Models ◽

Life Support ◽

Real Life ◽

Advanced Life Support ◽

Team Members ◽

Life Planning ◽

Context Specific ◽

Task Goals ◽

Hospital Cardiac Arrest

BackgroundPlanning and communication are pivotal in achieving team goals. Studies have shown that teams with effective planning and sharing of mental models display better performance in resuscitation. The Advanced Life Support (ALS) algorithm serves as an overall script regarding specific stages during resuscitation, but it does not explicitly specify how tasks should be delegated or synchronised. Team members therefore need to rely on ongoing, context-specific shared plans for effective team coordination.MethodsIn our research, we explore paramedic resuscitation teams’ verbal communication from a discourse-analytic perspective. We analysed out-of-hospital cardiac arrest (OHCA) resuscitation videos, recorded using body cameras in the field, for plan verbalisation patterns and possible association with successful or unsuccessful outcomes. For the current study, the first five minutes of 10 OHCA resuscitations were transcribed and annotated using a bespoke coding scheme. We focused on how paramedics use language to coordinate their goals and manage the transitions between stages of the OHCA treatment process, and whether this is associated with the deployment of the mechanical compression device, AutoPulse.ResultsAll 10 videos showed similar patterns of plan verbalisation in the first five minutes. The amount of verbalised plans took up nearly half the spoken utterances of all teams, suggesting that paramedics actively shared plans with their team members. Early in the resuscitation, paramedics tended to concentrate on immediate, single-task goals (e.g. moving patient to ideal position) rather than long-term, multi-task goals (e.g. accessing airway). We found little communication of the team leader’s overall mental model or script. Instead, plans were shared moment by moment. Based on the 10 videos, the timing of AutoPulse deployment seemed unaffected by the way plans were shared.ConclusionThis study enriches our understanding of real-life planning and sharing of mental models during resuscitation. Through these, we can contribute to the betterment of professional interaction in this critical domain.

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New insights for adult cardiopulmonary resuscitation. Up-coming resuscitation guidelines 2010

Medicina ◽

10.3390/medicina46090082 ◽

2010 ◽

Vol 46 (9) ◽

pp. 571 ◽

Cited By ~ 2

Author(s):

Andrius Pranskūnas ◽

Paulius Dobožinskas ◽

Vidas Pilvinis ◽

Živilė Petkevičiūtė ◽

Nedas Jasinskas ◽

...

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Life Support ◽

Survival Rates ◽

Advanced Life Support ◽

Current Trends ◽

Resuscitation Guidelines ◽

Chain Of Survival ◽

Meta Analyses

Despite advances in cardiac arrest care, the overall survival to hospital discharge remains poor. The objective of this paper was to review the innovations in cardiopulmonary resuscitation that could influence survival or change our understanding about cardiopulmonary resuscitation. We have performed a search in the MEDLINE and the Cochrane databases for randomized controlled trials, meta-analyses, expert reviews from December 2005 to March 2010 using the terms cardiac arrest, basic life support, and advanced life support. The lack of randomized trials during the last 5 years remains the main problem for crucial decisions in cardiopulmonary resuscitation. Current trends in cardiopulmonary resuscitation are toward minimizing the interruptions of chest compressions and improving the quality of cardiopulmonary resuscitation. In addition, attention should be paid to all the parts of chain of survival, which remains essential in improving survival rates.

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