Success rates and procedure times of oesophageal temperature probe insertion for therapeutic hypothermia treatment of cardiac arrest according to insertion methods in the emergency department

2012 ◽  
Vol 30 (11) ◽  
pp. 896-900 ◽  
Author(s):  
Uh-Hyun Paik ◽  
Tae Rim Lee ◽  
Mun Ju Kang ◽  
Tae Gun Shin ◽  
Min Seob Sim ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cardiac Arrest ◽  
Therapeutic Hypothermia ◽  
Success Rates ◽  
Oesophageal Temperature ◽  
Hypothermia Treatment ◽  
Temperature Probe ◽  
Probe Insertion

A Study of Orotracheal Intubation in Emergency Departments of Five District Hospitals in Hong Kong

2003 ◽  
Vol 10 (3) ◽  
pp. 138-145 ◽  
Author(s):  
YF Choi ◽  
TW Wong ◽  
CC Lau ◽  
AYC Siu ◽  
CB Lo ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cardiac Arrest ◽  
Hong Kong ◽  
Complication Rate ◽  
Orotracheal Intubation ◽  
Junior Doctors ◽  
Common Complication ◽  
Success Rates ◽  
Laryngeal View ◽  
District Hospitals

Objective To study the success rates and complications of orotracheal intubation in emergency departments of five district hospitals in Hong Kong in order to identify ways for improvement. Method This was a prospective observational study. The emergency department doctors performing the intubation were asked to complete an intubation study form immediately after the procedure over a period of four months. Data collected included vital signs, experiences of intubators, method of intubation and complications. Results A total of 347 cases were collected and 93% of them were non-trauma cases. Fifty-two percent (52%) of the cases were in cardiac arrest before intubation. Rapid sequence intubation (RSI) was applied in 36% of the cases. Junior doctors first intubated about 72% of the patients. Successful intubation was achieved in 1 and 2 attempts in 70% and 89% of the cases respectively. In 10 cases (3%), secondary methods such as laryngeal mask airway, Combitube, Trachlight or cricothyroidotomy were needed. The overall complication rate was 7.8% and the complication rate in the RSI group was 15.3%. The complication rate was even higher (20%) if intubation without medication was used in non-cardiac arrest patients. Significant drop in blood pressure was the most common complication and it could be attributed to the use of midazolam as induction medication. The success rate was found to correlate with the experience of the first intubator (p<0.05) and the laryngeal view (p<0.001). The complication rate increased with repeated attempts (p<0.001) and was higher among junior doctors (p<0.05). Early use of elastic gum bougie was associated with lower complication and higher success rates. Conclusion Orotracheal intubation in the emergency department was associated with high complication rate. Many complications came from junior intubators. Hypotension was the most common complication. Potentially avoidable complications may be a result of failure to use RSI in non-cardiac arrest patients and failure to use bougie in cases of poor laryngeal view.

scholarly journals Temperature post out-of-hospital cardiac arrest: the TOPCAT study

2010 ◽  
Vol 27 (Suppl 1) ◽  
pp. A6.1-A6
Author(s):  
Richard Lyon
Keyword(s):  
Emergency Department ◽  
Cardiac Arrest ◽  
Hospital Discharge ◽  
Prospective Observational Study ◽  
Spontaneous Circulation ◽  
Single Centre ◽  
Oesophageal Temperature ◽  
Arterial Blood ◽  
The Relationship ◽  
Hospital Cardiac Arrest

IntroductionOut-of-hospital cardiac arrest (OHCA) is a significant cause of death and severe neurological disability. The only postreturn of spontaneous circulation (ROSC) therapy shown to increase survival is mild therapeutic hypothermia (MTH). The relationship between body temperature post OHCA and outcome is still poorly defined.MethodsProspective observational study of all OHCA patients admitted to a single centre for a 14-month period. Oesophageal temperature was measured in the Emergency Department and Intensive Care Unit (ICU). Select patients had prehospital temperature monitoring.Results164 OHCA patients were included in the study. 105 (64.0%) were pronounced dead in the Emergency Department. 59 (36.0%) were admitted to ICU for cooling; 40 (24.4%) died in ICU and 19 (11.6%) survived to hospital discharge. Patients who achieved ROSC and had oesophageal temperature measured prehospital (n=29) had a mean prehospital temperature of 33.9°C (95% CI 33.2 to 34.5). All patients arriving in the ED post OHCA had a relatively low oesophageal temperature (34.3°C, 95% CI 34.1 to 34.6). Patients surviving to hospital discharge were warmer on admission to ICU than patients who died in hospital (35.7°C vs 34.3°C, p<0.05). Patients surviving to hospital discharge also took longer to reach target MTH temperature than non-survivors (2 h 48 min vs 1 h 32 min, p<0.05). There was no difference in mean arterial blood pressure on arrival in the ED between survivors and non-survivors.ConclusionsFollowing OHCA all patients have oesophageal temperatures below normal in the prehospital phase and on arrival in the Emergency Department. This questions the need for prehospital cooling post-OHCA patients. Patients who achieve ROSC following OHCA and survive to hospital discharge are warmer on arrival in ICU and take longer to reach target MTH temperatures compared to patients who die in hospital. The mechanisms of action underlying oesophageal temperature and survival from OHCA remain unclear and further research is warranted to clarify this relationship.

Sign in / Sign up

Export Citation Format

Share Document