Abstract 277: Supraglottic Airway Use Is Associated with Higher Chest Compression Fraction than Endotracheal Intubation During Out-of-Hospital Cardiopulmonary Arrest

Objective: Chest compression interruptions - such as those from endotracheal intubation (ETI) - are associated with poorer out-of hospital cardiac arrest (OHCA) survival. Select Emergency Medical Services (EMS) practitioners substitute ETI with supraglottic airway (SGA) insertion to minimize these interruptions, but the resulting effects upon chest compression fraction (CCF) are unknown. We sought to determine the differences in CCF between adult OHCA receiving ETI and those receiving SGA. Methods: We studied adult, non-traumatic OHCA patients enrolled in the Resuscitation Outcomes Consortium (ROC) PRIMED trial. Chest compressions were measured using compression or thoracic impedance sensors. We limited the analysis to those receiving ETI or SGA and >2 minutes of chest compression data before and after airway insertion. We compared CCF between ETI and SGA before and after airway insertion, adjusting for age, sex, witnessed arrest, bystander CPR, shockable initial rhythm, public location, PRIMED trial arm, and regional ROC center. We also compared the change in CCF for each airway technique and stratified these analyses by initial rhythm. We analyzed the data using t-tests and multivariable linear regression. Results: Of 14,955 patients enrolled in the ROC PRIMED trial, we analyzed 2,767 cases, including 2051 ETI, 671 SGA, and 45 both. Unadjusted pre- and post- airway CCF was higher for SGA than ETI (pre- 0.732 vs 0.706, difference -0.026 95% CI -0.044, -0.008; post- 0.767 vs 0.724, difference -0.043 95% CI -0.060, -0.026). Adjusted post-airway CCF improved with both techniques, but the changes were not statistically significant (0.012 difference, 95% CI 0.036, -0.012, p-value 0.32). CCF differences were similar when stratified by initial rhythm. Conclusion: In this series SGA insertion was associated with a higher CCF than ETI and that difference persisted post-airway insertion. Advanced airway management strategy may minimally impact CCF.

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Abstract 222: Effects of the COVID-19 Pandemic on Care of Out-of-Hospital Cardiac Arrests in Detroit

Circulation ◽

10.1161/circ.142.suppl_4.222 ◽

2020 ◽

Vol 142 (Suppl_4) ◽

Author(s):

Shobi Mathew ◽

Adam D Chalek ◽

Brian J Oneil ◽

Robert B Dunne

Keyword(s):

Disease Transmission ◽

Supraglottic Airway ◽

Global Changes ◽

Public Places ◽

Absolute Increase ◽

Patient Demographics ◽

Shockable Rhythm ◽

Initial Rhythm ◽

Bystander Cpr ◽

Major Factors

Introduction: March 10 th , 2020 marked the first positive case of SARS-CoV-2 in Detroit. EMS protocol changes were implemented by March 25 th , 2020 in response to the virus. These modifications restricted intubation and allowed medical control to terminate resuscitation in cases of suspected COVID-19 after 10 minutes of CPR without ROSC. Due to global changes in pre-hospital cardiac arrest care caused by COVID-19, we conducted an analysis to determine OHCA characteristics of patients and fatality rates in the COVID-19 era. Methods: CARES data was analyzed between March 10 th , 2019 - April 30 th , 2019 and March 10 th , 2020 - April 30 th, 2020 for comparison before and during the pandemic. Patient demographics, location of arrest, initial rhythms, bystander CPR, EMS interventions and field termination were compared between the two time points. No major factors occurred in 2019 that would potentially skew that data. Descriptive statistics were utilized. Results: A total of 475 CARES patients were included during the study period. Total arrests surged in the COVID-19 era from 180 to 295. OHCA for individuals greater than 50 increased from 130 to 243. An initial rhythm of PEA tripled (10 to 30) during COVID-19, possibly due to hypoxia. The percentage of patients with a shockable rhythm declined (7.8 to 5.1). Bystander CPR decreased from 28.9% (52) to 18.3% (54), secondary to an increase of arrests being in non-public places and concern about disease transmission. Nursing home cardiac arrests increased during COVID from 19 to 73, from the previous year. Placement of an endotracheal tube or supraglottic airway by a basic or advanced unit decreased from 68.3% (123) in pre-COVID-19 era to 37.0% (109) in the current state of the pandemic. Termination of resuscitation in the field occurred over 3-fold from the previous year, an absolute increase from 64 to 204. Conclusion: There was a 61% increase in cardiac arrests during COVID-19 in Detroit. The pandemic and subsequent protocol changes greatly altered practice. COVID-19 has likely directly and indirectly, due to fear of going to the hospital, affected the number of out-of-hospital cardiac arrests. Additional review is being conducted to further delineate arrest etiologies.

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Fiberoptic, Video Laryngoscope, and Nasal Airway Procedures

Pediatric Anesthesia Procedures ◽

10.1093/med/9780190685188.003.0003 ◽

2021 ◽

pp. 37-60

Author(s):

Heather Ballard ◽

Michelle Tsao ◽

Narasimhan Jagannathan

Keyword(s):

Endotracheal Intubation ◽

Nasotracheal Intubation ◽

Video Laryngoscopy ◽

Supraglottic Airway ◽

Seldinger Technique ◽

Advantages And Disadvantages ◽

Advanced Airway ◽

Difficult Airways ◽

Spine Movement ◽

Pierre Robin

In patients with known or suspected difficult airways, advanced airway procedures such as fiberoptic laryngoscopy (under general anesthesia—with and without supraglottic airways—and sometimes in awake patients) as well as video laryngoscopy are invaluable. All may be particularly advantageous for use with patients who have limited or reduced cervical spine movement. Other advantages and disadvantages are addressed in this chapter. Techniques for nasotracheal intubation are also described. Flexible fiberoptic laryngoscopy is a means of indirectly visualizing airway structures by threading a fiberoptic scope with a camera at the end of the scope into the airway. The goal of fiberoptic laryngoscopy is endotracheal intubation using a Seldinger technique, whereby an endotracheal tube is guided into the trachea over the fiberoptic bronchoscope. Fiberoptic endotracheal intubation may be performed through the mouth or nose, or through a supraglottic airway (SGA). The use of the fiberoptic scope through an SGA is an especially useful technique in infants who suffer from airway obstruction at rest (e.g., infants with Pierre Robin syndrome). Video laryngoscopy employs a laryngoscope with a camera at the end of the blade to enable the user to indirectly visualize airway structures.

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Abstract 164: Comparison of Tracheal Intubation vs. Supraglottic Airway Following Pediatric Out of Hospital Cardiac Arrest

Circulation ◽

10.1161/circ.138.suppl_2.164 ◽

2018 ◽

Vol 138 (Suppl_2) ◽

Author(s):

Maryam Y Naim ◽

Heather Griffis ◽

Robert A Berg ◽

Richard N Bradley ◽

Matthew L Hansen ◽

...

Keyword(s):

Cardiac Arrest ◽

Tracheal Intubation ◽

Hospital Discharge ◽

Multivariable Analysis ◽

Cerebral Performance Category ◽

Supraglottic Airway ◽

Secondary Outcome ◽

Initial Rhythm ◽

Bystander Cpr ◽

Hospital Cardiac Arrest

Introduction: There are few data comparing Tracheal Intubation (TI) and SupraGlottic Airway (SGA) following pediatric out of hospital cardiac arrest (OHCA). Hypothesis: TI is associated with improved outcomes compared to SGA following pediatric OHCA. Methods: Analysis of the Cardiac Arrest Registry to Enhance Survival database. Inclusion criteria were age ≤ 18 years, non-traumatic OHCA from 2013 through 2017, resuscitated by Emergency Medical Services (EMS). To adjust for covariate imbalance, propensity score matching and entropy balancing were utilized; variables included age category, sex, bystander CPR, and initial rhythm. Primary outcome was neurologically favorable survival defined as a cerebral performance category scale of 1 or 2. Secondary outcome was survival to hospital discharge. Results: Of 2653 cardiac arrests evaluated, 2178 (82.1%) had TI and 475 (17.9%) had SGA placed during OHCA. 835 (31.2%) arrests were resuscitated by agencies used bag valve mask (BVM) and TI and 1818 (68.0%) arrests had agencies that used all 3 airway types (BVM/TI/SGA). Overall, unadjusted favorable neurological survival was 5.7% for TI and 5.3% for SGA, p=0.67 and survival to hospital discharge was 7.9% for TI and 7.5% for SGA, p=0.73. In multivariable analysis (adjusting for age, sex, race/ethnicity, bystander witness, bystander CPR, initial rhythm, AED use, year of arrest, and agency category), SGA was associated with lower neurologically favorable survival compared to TI (adjusted proportion 3.7% vs. 6.3%, OR 0.49, p=0.01), and lower survival to hospital discharge (5.5% vs. 8.5%, OR 0.57, 95% CI 0.36, 0.89). These results were robust on tests for unmeasured confounding and covariate balance; propensity analysis neurologically favorable survival 4.4% vs.7.6% (OR 0.54, 95% CI 0.30, 0.96), survival to hospital discharge 6.6% vs.10.5% (OR 0.58, 95% CI 0.35, 0.95); and entropy balance neurologically favorable survival 5.0 % vs. 9.7% for ETI (OR 0.44, 95% CI 0.27, 0.72), survival to hospital discharge 7.3% vs.12.5% (OR 0.51, 95% CI 0.34, 0.78). Conclusion: In pediatric OHCA, TI, compared with SGA advanced airway management is associated with improved neurologically favorable survival and survival to hospital discharge.

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Abstract 118: The Epidemiology of Airway Management Following Pediatric Out-of-Hospital Cardiac Arrest in the United States

Circulation ◽

10.1161/circ.138.suppl_2.118 ◽

2018 ◽

Vol 138 (Suppl_2) ◽

Author(s):

Maryam Y Naim ◽

Heather Griffis ◽

Robert A Berg ◽

Richard N Bradley ◽

Matthew L Hansen ◽

...

Keyword(s):

Cardiac Arrest ◽

Airway Management ◽

Multivariable Analysis ◽

Cerebral Performance Category ◽

The United States ◽

Supraglottic Airway ◽

Shockable Rhythm ◽

Advanced Airway ◽

Bystander Cpr ◽

Hospital Cardiac Arrest

Introduction: Bag mask ventilation (BMV) has been associated with improved survival following out of hospital cardiac arrest (OHCA), however advanced airway placement remains part of pre-hospital protocols for many emergency medical services (EMS) agencies. Hypothesis: To characterize airway management for pediatric OHCA and assess whether BMV alone vs. BMV plus advanced airway (supraglottic airway or tracheal intubation) is associated with neurologically favorable survival. Methods: Analysis of the Cardiac Arrest Registry to Enhance Survival database. Inclusion criteria were age ≤ 18 years, non-traumatic OHCA from 2013 through 2017, resuscitated by EMS. To adjust for covariate imbalance, propensity score matching and entropy balancing were utilized; variables included age category, sex, bystander CPR, and shockable rhythm. The primary outcome was favorable neurologically favorable survival defined as a cerebral performance category scale of 1 or 2. Results: Of 5241 cardiac arrests, 2588 (49.3%) had BVM and 2653 (50.6%) had advanced airway placement. The majority 5118 (97.7%) were resuscitated by agencies using both BMV and advanced airways. Advanced airway placement was more common in older children compared to infants, arrests with bystander CPR, in white and Hispanic children, witnessed arrests, arrests with a shockable rhythm, and AED use (Table). Neurologically favorable survival was significantly higher with BMV compared to advanced airways in bivariate analysis (11.4% vs. 5.7%, p<0.001). In multivariable analysis, advanced airway placement was associated with lower neurologically favorable survival (adjusted proportion 4.9% vs. 13.5% BVM, OR 0.21, 95% CI 0.17, 0.28). These results were robust on propensity analysis 3.0% advanced airway vs.11.9% BMV (OR 0.18, 95% CI 0.14, 0.25), and entropy balance 5.9% advanced airway, 15.0% for BMV (OR 0.28, 95% CI 0.22). Conclusion: In pediatric OHCA, advanced airways are placed in half of cardiac arrests where resuscitation is attempted. Advanced airway, compared to BMV alone management, is associated with lower neurologically favorable survival.

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Comparison of the Skill of Emergency Medical Technicians in Terms of Advanced Airway Management Using Endotracheal Tube vs Laryngeal Mask Airway in an OSCE Using a Mannequin

Archives of Anesthesia and Critical Care ◽

10.18502/aacc.v6i4.4632 ◽

2020 ◽

Author(s):

Peyman Saberian ◽

Ehsan Karimialavijeh ◽

Mostafa Sadeghi ◽

Mojgan Rahimi ◽

Parisa Hasani-Sharamin ◽

...

Keyword(s):

Laryngeal Mask Airway ◽

Airway Management ◽

Endotracheal Tube ◽

Endotracheal Intubation ◽

Laryngeal Mask ◽

Supraglottic Airway ◽

Emergency Medical ◽

Advanced Airway ◽

Significant Difference ◽

The Mean

Background: Supraglottic airway management tools such as the laryngeal mask airway (LMA) have recently emerged as the first choice in pre-hospital and hospital airway management guidelines as well as an alternative strategy after endotracheal tube (ETT) placement failure. However, the pros and cons of the LMA compared to endotracheal intubation are still debated. Given that no study has been conducted to date on the skills of emergency medical technician (EMT) in airway management using LMA compared to endotracheal intubation, we decided to do a study in this regard. Methods: In this objective structured clinical examination (OSCE), EMTs who had a degree of associate or bachelor were participated. The examiner asked the examinees the required information and entered it in the pre-prepared checklists. The participants took part in a two-stage exam. In the first stage, the airway management of the simulated trauma patient was performed by endotracheal intubation, and in the second stage, the same scenario was performed with LMA. At each stage, the examiner evaluated the examinee's performance in 4 fields of Preparation, Pre-oxygenation, Position and Placement, and Post-intubation management using a standard checklist. In addition, the duration of the procedure from the beginning to the time of fixing the ETT or LMA was recorded and compared. Results: Totally, 105 EMTs participated in this study, of whom, 102 were male (97.1%). The mean age of the subjects was 36.4± 7.3 years old. Of the total participants, 72 passed both practical exams successfully, and they generally insert the LMA faster; so that the duration of intubation and LMA insertion in 1.4% and 30.6% were <1 min, respectively (p< 0.001). However, no significant difference was observed in terms of the mean time (p= 0.427). Conclusion: In the present study, the skills of the technicians participating in the study in performing advanced airway procedures were moderate, and also, it was found that their skills in LMA insertion were less than endotracheal tube insertion.

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PELATIHAN COMPRESSION ONLY-CPR EFEKTIF MENINGKATKAN KETEPATAN KOMPRESI DADA PADA ORANG AWAM

Media Ilmu Kesehatan ◽

10.30989/mik.v8i1.335 ◽

2019 ◽

Vol 8 (1) ◽

pp. 9-14

Author(s):

Muhamat Nofiyanto ◽

Miftafu Darussalam ◽

Arif Adi Setiawan

Keyword(s):

Cardiac Arrest ◽

Chest Compression ◽

Emergency Preparedness ◽

Sampling Technique ◽

Simple Random Sampling ◽

P Value ◽

Lay People ◽

Before And After ◽

Post Test ◽

Cpr Training

Background: Many studies show a low rate of immediate chest compression in OHCA cases. One of the factors that inhibits is the lack of knowledge of lay people who witness cases of cardiac arrest. Objective: To determine the effect of providing compression-only CPR training on chest compression skills in lay people Methods: This research used pre-experiment with one group pre-post test design, with a total of 28 respondents, using simple random sampling technique. Respondents measured chest compression skills before training, then provided training for 120 minutes.Wilcoxon test was used to analyze data sets. Results: There were almost the same number between male and female respondents, and most have never received CPR training. Only 5 respondents had received previous training, with details of 3 years, 6 years, 8 years, 9 years and 11 years ago. There was a difference in the accumulation of the accuracy of chest compression before and after training with a p-value of 0,000. Conclusion: Compression only-CPR training can improve chest compression skills, especially aspects of accuracy of compression. Broader training and intensification of training programs are needed to realize emergency preparedness in the campus community. Keywords: Cardiac arrest, CPR, training

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PELATIHAN COMPRESSION ONLY-CPR EFEKTIF MENINGKATKAN KETEPATAN KOMPRESI DADA PADA ORANG AWAM

Media Ilmu Kesehatan ◽

10.30989/mik.v8i1.250 ◽

2019 ◽

Vol 8 (1) ◽

pp. 9-14

Author(s):

Muhamat Nofiyanto ◽

Miftafu Darussalam ◽

Arif Adi Setiawan

Keyword(s):

Cardiac Arrest ◽

Chest Compression ◽

Emergency Preparedness ◽

Sampling Technique ◽

Simple Random Sampling ◽

P Value ◽

Lay People ◽

Before And After ◽

Post Test ◽

Cpr Training

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Abstract 13249: Temporal Trends in Out-of-Hospital Cardiac Arrest Bystander CPR and Defibrillation Following Implementation of Citizen Responder Programs

Circulation ◽

10.1161/circ.144.suppl_2.13249 ◽

2021 ◽

Vol 144 (Suppl_2) ◽

Author(s):

Louise Kollander Jakobsen ◽

Sidsel Gamborg Moeller ◽

Kristian Bundgaard Ringgren ◽

Amalie Lykkemark Moeller ◽

Linn Andelius ◽

...

Keyword(s):

Cardiac Arrest ◽

Observational Study ◽

Temporal Trends ◽

P Value ◽

Residential Areas ◽

The Past ◽

Residential Locations ◽

Before And After ◽

Bystander Cpr ◽

Hospital Cardiac Arrest

Introduction: In Denmark, survival after out-of-hospital cardiac arrest (OHCA) has increased markedly in the past years, from 3.9% in 2001 to 15.8% in 2019. Still, bystander defibrillation remains low, especially for OHCAs in residential areas. To improve bystander defibrillation, smartphone activated Citizen Responder (CR) Programs have expanded to nationwide coverage in Denmark during September 2017 to May 2020. Hypothesis: Implementation of CR programs in Denmark was associated with increased bystander CPR and defibrillation. Methods: We conducted an observational study of 15,308 OHCAs from the Danish Cardiac Arrest Registry from 2016-2019. App-based CR programs were implemented in four out of five Danish regions during the study period. All OHCAs were divided into two groups according to the date of CR implementation (“before” and “after CR” implementation). The groups were compared focusing on bystander defibrillation, bystander CPR and 30-day survival. Results: “Before CR” included 8,819 OHCAs and the “after CR” 6,489 OHCAs. The proportion of bystander CPR was 77.9% and 78.0% (p-value 0.91) for the before -and after CR implementation groups, respectively. The corresponding numbers for bystander defibrillation were 7.4% and 9.5% (p-value < 0.001), respectively. In residential OHCA, bystander defibrillation went from 4.0% to 6.3% (p-value<0.001) in the before -and after group respectively. In public, bystander defibrillation was 19.3% and 22.2% (p-value 0.05) in the groups respectively. 30-day survival was 12.7% before and 13.1% after CR implementation (p-value 0.49). Conclusion: We found no changes in bystander CPR or 30-day survival following implementation of CR programs in Denmark, but a significant increase in bystander defibrillation for all OHCAs. Importantly bystander defibrillation also increased significantly in residential locations, where the majority of OHCAs occur and where bystander defibrillation has remained low for decades.

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Association of advanced airway device with chest compression fraction during out-of-hospital cardiopulmonary arrest

Resuscitation ◽

10.1016/j.resuscitation.2015.10.011 ◽

2016 ◽

Vol 98 ◽

pp. 35-40 ◽

Cited By ~ 20

Author(s):

Michael Christopher Kurz ◽

David K. Prince ◽

James Christenson ◽

Jestin Carlson ◽

Dion Stub ◽

...

Keyword(s):

Chest Compression ◽

Cardiopulmonary Arrest ◽

Airway Device ◽

Advanced Airway

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Pengaruh Perawatan Metode Kanguru (PMK) terhadap Pencegahan Hipotermi pada Bayi Baru Lahir

Jurnal Bidan Cerdas (JBC) ◽

10.33860/jbc.v2i2.56 ◽

2020 ◽

Vol 2 (2) ◽

pp. 66-71

Author(s):

Parti ◽

Sumiati Malik ◽

Nurhayati

Keyword(s):

Birth Weight ◽

Infant Mortality ◽

Low Birth Weight ◽

Health Workers ◽

Kangaroo Mother Care ◽

Infant Mortality Rate ◽

P Value ◽

Low Birth Weight Infants ◽

Low Birth Weight Babies ◽

Before And After

Most causes of infant death are problems that occur in newborn/neonatal (0-28 days old), Low Birth Weight Babies (LBW) is one of the factors which has a contribution to infant mortality, especially in the neonatal period. Infant Mortality Rate (IMR) is a benchmark in determining the degree of public health, both at the National and Provincial levels. This study aimed to determine the effect of the Kangaroo Mother Care Method (KMC) on the prevention of hypothermia in low birth weight infants at Morowali District Hospital in 2019. The type of research used was a quasi-experiment. The population is all low birth weight babies born from May to July 2019. The sample in this study was all newborns with low birth weight born from May to July 2019, totaling 30 babies. There is a difference (influence) on the baby's body temperature before and after KMC with a p-value=0,000. The kangaroo mother care can continue to be affiliated considering its benefits for both infants and mothers, as well as increasing the ability of health workers in conducting KMC so that they can provide in-house training for mothers to be carried out at home.

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