Impact of Specific Emergency Measures on Survival in Out-of-Hospital Traumatic Cardiac Arrest

2021 ◽  
pp. 1-6
Author(s):  
Dominique Savary ◽  
François Morin ◽  
Delphine Douillet ◽  
Adrien Drouet ◽  
François Xavier Ageron ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Life Support ◽  
Cerebral Performance Category ◽  
Tension Pneumothorax ◽  
Advanced Life Support ◽  
Neurological Status ◽  
Performance Category ◽  
Traumatic Cardiac Arrest ◽  
Pelvic Stabilization ◽  
The Impact

Abstract Introduction: The management of out-of-hospital traumatic cardiac arrest (TCA) for professional rescuers entails Advanced Life Support (ALS) with specific actions to treat the potential reversible causes of the arrest: hypovolemia, hypoxemia, tension pneumothorax (TPx), and tamponade. The aim of this study was to assess the impact of specific rescue measures on short-term outcomes in the context of resuscitating patients with a TCA. Methods: This retrospective study concerns all TCA patients treated in two emergency medical units, which are part of the Northern French Alps Emergency Network (RENAU), from January 2004 through December 2017. Utstein variables and specific rescue measures in TCA were compiled: fluid expansion, pelvic stabilization, tourniquet application, bilateral thoracostomy, and thoracotomy procedures. The primary endpoint was survival rate at Day 30 with good neurological status (Cerebral Performance Category [CPC] score CPC 1 and CPC 2). Results: In total, 287 resuscitation attempts in TCA were included and 279 specific interventions were identified: 262 fluid expansions, 41 pelvic stabilizations, five tourniquets, and 175 bilateral thoracostomies (including 44 with TPx). Conclusion: Among the standard resuscitation measures to treat the reversible causes of cardiac arrest, this study found that bilateral thoracostomy and tourniquet application on a limb hemorrhage improve survival in TCA. A larger sample for pelvic stabilization is needed.

scholarly journals Impact of specific emergency measures on survival of out of hospital traumatic cardiac arrest: data from the northern french alps cardiac arrest registry.

2020 ◽  
Author(s):  
Dominique Savary ◽  
François Morin ◽  
Delphine Douillet ◽  
Thierry Roupioz ◽  
François Xavier Ageron ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Life Support ◽  
Cerebral Performance Category ◽  
Tension Pneumothorax ◽  
Advanced Life Support ◽  
Traumatic Cardiac Arrest ◽  
Advanced Airway ◽  
Good Neurologic Outcome ◽  
Pelvic Stabilization ◽  
The Impact

Abstract The management of Out of hospital Traumatic Cardiac Arrest (TCA) for professional rescuers combines advanced life support with specifics actions to treat potential reversible causes of the arrest: hypovolemia, hypoxemia, Tension Pneumothorax (TPx) and tamponade. The aim of this study was to assess the impact of specific rescue gestures on short-term outcomes in the context of resuscitation of patients with a pre-hospital TCA.Methods: We conducted a retrospective study of all TCA treated in two emergency medical units (EM unit), which are part of the Northern Alps emergency network, from January 2004 to December 2017. Utstein variables and specific rescue actions in TCA were compiled: advanced airway management, fluid administration, pelvic stabilization or tourniquet application, bilateral thoracostomy, and thoracotomy procedures. The primary end point was the survival rate at day 30 with good neurologic outcome (cerebral performance category [CPC] score 1 & 2).Results: 287 resuscitations attempt in TCA were included and 279 specific interventions were Identified: 262 Fluid expansion, 41 External Pelvic stabilizations, 5 tourniquets, 175 bilateral thoracostomies, (including 44 with TPx).Conclusion: Among standard resuscitation measures to treat reversible causes of cardiac arrest, we were able to show that bilateral thoracostomy and tourniquet application on a limb hemorrhage improves survival of TCA. A larger sample for pelvic stabilization is necessary.

scholarly journals (A152) Comparison of Load Distributing Band and Standard Cardiopulmonary Resuscitation in Patients Presenting with Cardiac Arrest to Emergency Department

2011 ◽  
Vol 26 (S1) ◽  
pp. s43-s43
Author(s):  
M.E. Ong ◽  
P. Sultana ◽  
S. Fook-Chong ◽  
A. Annitha ◽  
S.H. Ang ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Hospital Admission ◽  
Hospital Discharge ◽  
Cerebral Performance Category ◽  
Spontaneous Circulation ◽  
Secondary Outcome ◽  
Number Needed To Treat ◽  
Performance Category ◽  
Traumatic Cardiac Arrest

ObjectiveTo compare resuscitation outcomes before and after switching from manual cardiopulmonary resuscitation (CPR) to load-distributing band (LDB) CPR in a multi-center Emergency Departments (ED) trial.MethodsThis is a phased, prospective cohort evaluation with intention-to-treat analysis of adults with non-traumatic cardiac arrest. The intervention is change in the system from manual CPR to LDB-CPR at two Urban EDs. The main outcome measure is survival to hospital discharge, with secondary outcome measures of return of spontaneous circulation (ROSC), survival to hospital admission and neurological outcome at discharge.ResultsA total of 1,011 patients were included in the study, with 459 in the manual CPR phase (January 01, 2004, to August 24, 2007) and 552 patients in the LDB-CPR phase (August 16, 2007, to December 31, 2009). In the LDB phase, the LDB device was applied in 454 patients (82.3%). Patients in the manual CPR and LDB-CPR phases were comparable for mean age, gender and ethnicity. Rates for ROSC were comparable with LDB-CPR (manual 22.4% vs. LDB 35.3%; adjusted odds ratio [OR], 1.07; 95% confidence interval [CI], 0.63-1.83). Survival to hospital admission was increased, Manual 14.2% vs. LDB 19.7%; adjusted OR, 2.50; 95% CI, 1.05-6.00. Survival to hospital discharge was increased Manual 1.3% vs. LDB 3.3%; adjusted OR, 3.99; 95% CI, 1.06-15.02. The number of survivors with Cerebral Performance Category 1 (good) (Manual 1 vs. LDB 12, p < 0.01) and Overall Performance Category 1 (good) (Manual 1 vs. LDB 10, p < 0.01) was also increased. The Number Needed to Treat (NNT) for 1 survivor was 52 (95% CI, 26-1000).ConclusionA resuscitation strategy using LDB-CPR in an ED environment was associated with improved survival to admission and discharge in adults with non-traumatic cardiac arrest.

scholarly journals INFLUENCE OF EMERGENCY MEDICAL STUDENTS TRAINING ON PREPAREDNESS TO PERFORM PAEDIATRIC LIFE SUPPORT

2021 ◽  
Vol 8 (4) ◽  
pp. 244-252
Author(s):  
Jerzy Kiszka ◽  
Dawid Filip ◽  
Piotr Wasylik
Keyword(s):  
Cardiac Arrest ◽  
Medical Students ◽  
Life Support ◽  
Advanced Life Support ◽  
Development Project ◽  
Competence Development ◽  
Emergency Medical ◽  
Before And After ◽  
Post Test ◽  
The Impact

Aim: Assessment of the increase in knowledge in specific categories among students of the last-year emergency medical students after 45-hour training in advanced paediatric life support. Comparison of the impact of participation in the project and the ILS course on the increase of knowledge in the field of advanced life support in children. Material and methods: 138 third-year emergency medical students of the University of Rzeszów were studied. A proprietary questionnaire on paediatric life support was conducted before and after completing a 45-hour training on emergency medical services in children (pretest/posttest). Results: The mean percentage of subjects’ correct answers in the post-test was slightly over 60 which was statistically significantly higher compared to the pre-test, t(276)=6.54; p<0.001. The highest percentage of correct answers concerned paediatric basic life support and AED (M=77.78; SD=12.47), while the lowest – cardiac arrest in children in special situations (M=60.54; SD=21.06). No statistically significant relationship was found between the percentage of correct answers in the pre-test/post-test and the respondents’ age, gender and participation in a competence development project (p>0.05). Conclusions: The knowledge of paediatric life support among the third year emergency medical students is good. The students of subsequent years and individuals reading the literature and participating in the competence development project are better prepared to perform life support procedures in newborns and infants. From year to year, students gain less knowledge from medical literature and have the least knowledge on cardiac arrest in children in special circumstances.

Sudden cardiac arrest pharmacotherapy with prefilled syringes improves adherence to Advanced Life Support protocol in understaffed resuscitation pre-hospital care teams

2020 ◽  
Keyword(s):  
Cardiac Arrest ◽  
Simulation Study ◽  
Life Support ◽  
Sudden Cardiac Arrest ◽  
Advanced Life Support ◽  
Control Group ◽  
Performance Quality ◽  
Prefilled Syringes ◽  
The Impact

Every procedural facilitation or a change in available equipment in treatment of out-of-hospital arrest (OHCA) by two-person teams may significantly enhance their performance quality. The aim of this study was to assess the impact of adrenaline in prefilled syringes on improving the adherence to Advanced Life Support protocol by understaffed teams. The research was based on a randomized cross-over high-fidelity simulation study. Two-person teams took part in two 10-minute simulation scenarios featuring sudden cardiac arrest in ventricular fibrillation (VF). The control group (group C) had at its disposal standard ampoules, whereas the experimental group (group E) prefilled syringes. The execution times of CPR start, defibrillation shocks, intravenous (IV) access, epinephrine and amiodarone doses were measured. Additionally, the chest compression fraction (CCF) was calculated. The designed two-minute loops were considerably prolonged in group C. Nineteen teams (31.1%) in group C but 49 (80.3%) in group E carried out the fifth defibrillation (P < 0.001). After two minutes of CPR nobody in group C switched to perform chest compressions. IV access was obtained significantly earlier in group E (114.7 ± 52.2 sec) than in group C (150.2 ± 68.6 sec)(P = 0.002). Two doses of adrenaline were administered in group E, whereas its second dose only by 12 teams in group C. The simulation study has proved that for understaffed teams a use of prefilled syringes not only did enhance the flow of ALS procedure, but it also improved the quality of cardiopulmonary resuscitation.

scholarly journals Impacts of Emergency Medical Technician Configurations on Outcomes of Patients with Out-Of-Hospital Cardiac Arrest

2020 ◽  
Vol 17 (6) ◽  
pp. 1930
Author(s):  
Pin-Hui Fang ◽  
Yu-Yuan Lin ◽  
Chien-Hsin Lu ◽  
Ching-Chi Lee ◽  
Chih-Hao Lin
Keyword(s):  
Cardiac Arrest ◽  
Life Support ◽  
Advanced Life Support ◽  
Spontaneous Circulation ◽  
Emergency Medical Technician ◽  
Population Database ◽  
Emergency Medical ◽  
The Impact ◽  
Hospital Cardiac Arrest ◽  
Medical Technician

Paramedics can provide advanced life support (ALS) for patients with out-of-hospital cardiac arrest (OHCA). However, the impact of emergency medical technician (EMT) configuration on their outcomes remains debated. A three-year cohort study consisted of non-traumatic OHCA adults transported by ALS teams was retrospectively conducted in Tainan City using an Utstein-style population database. The EMT-paramedic (EMT-P) ratio was defined as the EMT-P proportion out of all on-scene EMTs. Among the 1357 eligible cases, the median (interquartile range) number of on-scene EMTs and the EMT-P ratio were 2 (2–2) persons and 50% (50–100%), respectively. The multivariate analysis identified five independent predictors of sustained return of spontaneous circulation (ROSC): younger adults, witnessed cardiac arrest, prehospital ROSC, prehospital defibrillation, and comorbid diabetes mellitus. After adjustment, every 10% increase in the EMT-P ratio was on average associated with an 8% increased chance (adjusted odds ratio [aOR], 1.08; p < 0.01) of sustained ROSC and a 12% increase change (aOR, 1.12; p = 0.048) of favorable neurologic status at discharge. However, increased number of on-scene EMTs was not linked to better outcomes. For nontraumatic OHCA adults, an increase in the on-scene EMT-P ratio resulted in a higher proportion of improved patient outcomes.

Cardiac arrest

2019 ◽  
pp. 185-192
Author(s):  
Gajen Sunthar Kanaganayagam ◽  
Andrew Constantine ◽  
Susanna Price
Keyword(s):  
Cardiac Arrest ◽  
Coronary Artery ◽  
Cardiopulmonary Resuscitation ◽  
Pulmonary Embolus ◽  
Cardiac Rhythm ◽  
Life Support ◽  
Tension Pneumothorax ◽  
Advanced Life Support ◽  
Cardiac Ultrasound ◽  
Coronary Artery Thrombosis

This chapter will present how advanced life support-compliant focused cardiac ultrasound can help confirm the cardiac rhythm, diagnose reversible causes, and predict favourable outcomes during cardiopulmonary resuscitation. It will describe how to recognize severe hypovolaemia, cardiac tamponade, coronary artery thrombosis, massive pulmonary embolus, and tension pneumothorax, and when to intervene. It will conclude by introducing how echo can assist clinical management during post-resuscitation care.

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