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.

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.

Abstract 113: Signs of Perfusion During Cardiopulmonary Resuscitation as Noted by First Responders is Predictive of Good Neurologic Outcome in Cardiac Arrest

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Johanna C Moore ◽  
Michael Grahl ◽  
Tracy Marko ◽  
Ariel Blythe-Reske ◽  
Amber Lage ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Life Support ◽  
Cerebral Performance Category ◽  
First Responders ◽  
Small Sample ◽  
Neurologic Outcome ◽  
Discharge Data ◽  
Good Neurologic Outcome ◽  
Neurologically Intact

Background: Rates of neurologically intact survival after cardiac arrest remain abysmal. Neuro-prognostication intra-arrest is challenging, with few real-time factors that can be used to determine patient prognosis. During the implementation of a new cardiopulmonary resuscitation (CPR) protocol in a large urban pre-hospital system, first responders prospectively recorded the presence of signs of perfusion during CPR. Hypothesis: Positive signs of perfusion would be a predictor of a good neurologic outcome in this observational study, as defined by Cerebral Performance Category (CPC) Score of 1 or 2. Methods: Basic life support first responders (n = 420) and paramedics (n = 207) underwent training including didactic and hands-on sessions to learn the new protocol, which included active compression-decompression CPR with an impedance threshold device. In addition to patient demographics and circumstances of cardiac arrest, signs of perfusion during CPR were prospectively recorded and included improved color, pulse during CPR, gasping, and movement during CPR. Chart review was performed to determine CPC score at discharge. Data were analyzed using descriptive statistics and calculation of unadjusted odds ratios. Results: The new protocol began May 1, 2017. Cases from May 2017-November 2017 (n= 102) were reviewed, with complete data available for 96 patients (94%). The median age was 56 (range 25-97), 54/91 (59%) male, 43/102 (42%) witnessed, 31/90 (34%) shockable rhythm, and 51/102 (50%) receiving bystander CPR. Improved color during CPR was seen in 23/102 (23%), pulse during CPR in 17/102 (17%), gasping in 18/102 (18%), and movement during CPR in 5/102 (5%). Any sign of perfusion during CPR was seen in 47/102 (46%), and 13/96 (13.5%) had a CPC score of 1 or 2 at discharge. The unadjusted OR for any sign of perfusion during CPR for a CPC score of 1 or 2 was 26 (95% CI 3 - 213) and for any sign of perfusion during CPR for ROSC was 9 (95% CI 3 - 24). Conclusions: Positive signs of perfusion during CPR noted by first responders strongly predicted ROSC and neurologically intact survival in this small sample. This suggests the importance of prospectively recording signs of perfusion during resuscitation, and communicating these observations during transfer of care.

Abstract 01: The Importance of Time to Cooling in Out-Of-Hospital Cardiac Arrest Patients to Influence Neurologically Intact Survival: A Sub-Analysis of the Princess Trial

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Akil Awad ◽  
Fabio Silvio Taccone ◽  
Martin Jonsson ◽  
Sune Forsberg ◽  
Jacob Hollenberg ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Propensity Score ◽  
Life Support ◽  
Cerebral Performance Category ◽  
Neurologic Outcome ◽  
Secondary Outcome ◽  
Control Group ◽  
Shockable Rhythm ◽  
Good Neurologic Outcome ◽  
Hospital Cardiac Arrest

Background: Early initiation of hypothermia has shown to be important to reduce brain injuries in experimental cardiac arrest models. The aim of this study was to investigate the association between time to initiate cooling and neurological intact survival in patients with out-of-hospital cardiac arrest (OHCA). Methods: A secondary analysis of prospectively collected data from the PRINCESS trial (NCT01400373) including 677 OHCA patients randomized to transnasal evaporative intra-arrest cooling or standard advanced life support and cooling started subsequent to hospital arrival. Time to randomization was used a proxy measurement for time to initiate cooling. An early treatment group was defined as patients randomized by the EMS <20 minutes from the time of the cardiac arrest. Propensity scores were used to find matching patients in the control group. Patients with initial shockable rhythms were analyzed as a predefined subgroup. The primary outcome was good neurologic outcome, Cerebral Performance Category (CPC) 1-2 at 90 days. Secondary outcome was complete recovery (CPC 1). Results: In total 406 patients were randomized <20 minutes from the cardiac arrest and were propensity score matched (1:1). In the propensity score matched analysis the proportion of patients with CPC 1-2 was 21.7% in the intervention and 17.2% in the control group, odds ratio (OR) 1.33, 95% confidence interval (CI) 0.80-2.21, p=0.273. In patients with initial shockable rhythm (79 intervention, 79 control) the difference in CPC 1-2 was 48.1% versus 32.0%, OR 2.05, 95%CI 1.00-4.21, p=0.0498. The proportion of patients with complete neurologic recovery, CPC 1, was 19.7% in the intervention and 13.3% in the control group, OR 1.60, 95% CI 0.92-2.79, p=0.097. In patients with initial shockable rhythm the proportion with CPC 1 was 45.6% versus 24.6%, OR 2.81, 95% CI 1.23-6.42, p=0.014. Conclusions: In this ancillary study of OHCA patients receiving intra-arrest cooling, there were differences in survival with good neurologic outcome and in complete neurological recovery in favor of early intra-arrest cooling patient group compared to standard care. These differences were statistically significant in the subgroup of patients with initial shockable rhythms.

Abstract 13104: Comparison of Patient Characteristics and Outcomes Between Adult Non-traumatic Out-of-hospital Cardiac Arrests With and Without Extracorporeal Cardiopulmonary Resuscitation - A Community-wide Evaluation

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Patrick Chow-In Ko ◽  
Nai-Kuan Chou ◽  
Matthew Huei-Ming Ma ◽  
Yu-Wen Chen ◽  
Tzong-Luen Wang ◽  
...  
Keyword(s):  
Life Support ◽  
Cerebral Performance Category ◽  
Advanced Life Support ◽  
Patient Characteristics ◽  
Spontaneous Circulation ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Hospital Arrival ◽  
Advanced Airway ◽  
Younger Age ◽  
Bystander Cpr

Objectives: The outcome of patients after OHCA is poor. Return to spontaneous circulation (ROSC) dramatically decreases with the duration of CPR. Extracorporeal membrane oxygenation has been proposed to assist CPR (ECPR) in OHCA. This study was to investigate the effects and characteristics of ECPR for adult non-traumatic (ANT) OHCA versus Non-ECPR on a community-wide basis. Methods: A prospective four-year observational database collected from a community-wide OHCA web registry in an urban EMS (emergency medical services) was studied. The EMS ambulance teams were capable with advanced airway, intravenous (iv) fluid skills, basic and advanced life support and automated external defibrillator techniques. Outcomes included survival and cerebral performance category scale (CPC) at discharge. ANT OHCA with and without ECPR in emergency were compared by regression analysis including factors of patient, pre-hospital and hospital characteristics and outcomes. Results: Comparing OHCA receiving ECPR (n=79) to those without (n=959), ECPR group were younger (median age 56 vs 78 p<0.001) and had higher portion for men (89 vs 64% p<0;001), witnessed arrest (Wit) (60.8 vs 32.5% p<0.001), bystander CPR (BCPR) (53.2 vs 36.8% p=0.005), initial shockable rhythms (SR) (74.6 vs 12.2% p<0.001) and therapeutic hypothermia (TH) (22.8 vs 1.1%, p<0.001). They (EPCR vs non-ECPR) had no difference for prehospital time intervals (22.5 vs 23 min.), laryngeal mask airway treatment (55.7 vs 52.8%), EMS iv epinephrine (20.3 vs 15.5%), endotracheal intubation (6.3 vs 8.0%), prehospital ROSC (11.4 vs 6% p=0.09), and ROSC upon hospital arrival (10.1 vs 8.5%). Outcomes were better in ECPR for discharged survival (41 vs 7% p<0.001) and CPC 1or2 (20.8 vs 3.8% p<0.001). After adjusting for Wit, BCPR, SR, TH, age and sex, both survival (adjusted odds ratio: 3.6 [95% 2.0-6.6]) and good CPC 1or2 (adjusted OR: 2.9 [95% 1.2-6.9]) were still significantly higher in ECPR. Conclusions: In current emergency practice for ANT OHCA, ECPR tended to apply to patients of younger age, men, witnessed arrest, BCPR, and initially shockable rhythms regardless of positive ROSC upon hospital arrival, that can independently lead to higher survival and good neurological outcome compared to non-ECPR.

Abstract 351: Predictors of Neurological Outcome After Out-of-Hospital Cardiac Arrest With Ventricular Fibrillation Witnessed by Emergency Medical Service P.ersonnel., JCS-ReSS Study

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Katsutaka Hashiba ◽  
Yoshio Tahara ◽  
Kazuo Kimura ◽  
Tsutomu Endo ◽  
Kouichi Tamura ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Ventricular Fibrillation ◽  
Airway Management ◽  
Neurological Outcome ◽  
Medical Service ◽  
Life Support ◽  
Advanced Life Support ◽  
Advanced Airway ◽  
Favorable Neurological Outcome ◽  
Hospital Cardiac Arrest

Background: Effective advanced life support is one of the important link in the chain of survival. In Japan, the emergency medical service (EMS) personnel can perform defibrillation, advanced airway management, intravenous access and administration of epinephrine as an advanced life support intervention for the treatment of out-of-hospital cardiac arrest (OHCA). However, whether these interventions performed by EMS improves neurological outcomes remains unclear. Objective: To evaluate predictors of favorable neurological outcome in patients suffering OHCA with ventricular fibrillation (VF) witnessed by an EMS personnel. Methods: The Fire and Disaster Management Agency (FDMA) of Japan developed a nationwide database of a prospective population-based cohort using an Utstein-style template for OHCA patients since January 2005. To evaluate data after the publication of Guideline2010, data from January 2011 to December 2015 of this database was used for the current analysis. A multivariate logistic-regression analysis was performed to assess factors associated with favorable neurological outcome (defined as Cerebral Performance Category 1 or 2) 1 month after cardiac arrest. Results: Of the 629,471 patients documented for the study period, 2,301 adult patients with an OHCA of cardiac origin and VF for the initial rhythm witnessed by an EMS personnel were included in the present analysis. The overall mortality was 49.6%. Rate of return of spontaneous circulation and favorable neurological outcome were 53.4% and 44.8%, respectively. High age (OR0.387, 95%CI0.316-0.472, p<0.001), delayed defibrillation (OR0.598, 95%CI0.493-0.723, p<0.001), advanced airway management (OR0.305, 95%CI0.223-0.413, p<0.001), administration of epinephrine (OR0.356, 95%CI0.213-0.585, p<0.001) and multiple attempts of defibrillation (OR0.484, 95%CI0.402-0.582, p<0.001) were negatively associated with favorable neurological outcome. Conclusion: In patients with VF witnessed by EMS personnel, resuscitation efforts should simply focus on early defibrillation and CPR without advanced interventions.

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.

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