Clinical Characteristics and Prehospital care in Prehospital Cardiac Arrest Patients by Paramedic's Reports

AbstractPurpose:The purpose of this study was to determine the complication rates associated with the use of the endotracheal tube (ET) a the use of the esophageal obturator airway/esophageal gastric tube airway (EOA/EGT during the treatment of patients with prehospital cardiac arrest.Methods:A descriptive, quasi-experimental study of 509 consecutive adults, cardiac arrest patients was conducted. Patients were examined prospectively for airway intervention type and complications. Some patients were examined at their final destinations (field, morgue, funeral home), while other patients were examined by EMS providers in the field when airway adjuncts were switched. Also, airways were evaluated for complications by emergency physicians at destination emergency departments.Results:The airway in use at the time of examination was the esophageal obturator airway (EOA) or esophageal gas lube airway (EGTA) in 208 patients (40.1%); the ET (endotracheal tube) in 232 patients (45.6%); and an oral or nasopha ryngeal airway in 47 patients (9.2%). Twenty-two patients (4.3%) had both an EOA/EGTA and an ET tube in place at the time of the examination. The survival rates were similar between the EOA/EGTA and the ET groups (28% and 32%, respectively). The complication rates overall also were similar, but the serious or potentially lethal complication rate was 3.3 times more common with the use of the EOA/EGTA than with the ET tube (8.7% versus 2.6%, respectively).Conclusions:The complication rate for the EOA/EGTA is unacceptably high, and careful thought must be given to its continued use. Serious questions also arise concerning the complication rates associated with the use of the ET: is the complication rate of 2.5% acceptable or should other airway alternative be considered for use in prehospital care?

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Improving Reliability of Abstracted Prehospital Care Data: Use of Decision Rules

Prehospital and Disaster Medicine ◽

10.1017/s1049023x00028016 ◽

1991 ◽

Vol 6 (1) ◽

pp. 15-20 ◽

Cited By ~ 5

Author(s):

Ronald F. Maio ◽

Richard E. Burney

Keyword(s):

Cardiovascular Disease ◽

Cardiac Arrest ◽

Random Sample ◽

Prehospital Care ◽

Data Use ◽

Decision Rules ◽

Bystander Cpr ◽

Prehospital Cardiac Arrest

AbstractOur experience suggests that even with standard definitions, information on ambulance report forms may be abstracted inconsistently.Hypothesis:The use of written decision rules will improve agreement between paramedics abstracting data from records of prehospital cardiac arrest.Methods:Sixty-three ambulance reports were selected by a random sample of all out-of-hospital cardiac arrests. Four paramedic abstractors each were given a set of definitions for use in abstracting data and one pair, randomly assigned, also was given a set of decision rules. Abstractors recorded whether there was: (1) underlying cardiovascular disease; (2) a witnessed arrest; (3) bystander CPR; and (4) the presenting rhythm. Agreement between pairs of abstractors was determined by computing kappa values.Results:Kappa values for each variable, for abstractors without and with decision rules were: (1) 0.23, 0.33; (2) 0.39, 0.41; (3) 0.43, 0.66; and (4) 0.65, 0.80. Kappa values consistently were higher for the pair of abstractors using decision rules. The degree of improvement varied with the difficulty of the decision required.Conclusion:The addition of decision rules to variable definitions is worthwhile but does not ensure good or excellent levels of agreement in data abstracted from records by paramedics.

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Journal club: The use of the esophageal obturator airway versus the endotracheal tube in prehospital cardiac arrest

The American Journal of Emergency Medicine ◽

10.1016/0735-6757(87)90308-1 ◽

1987 ◽

Vol 5 (1) ◽

pp. 79-84

Author(s):

Howard A. Werman ◽

Eric A. Davis ◽

Douglas A. Rund ◽

Gregory P. Hess ◽

Frank Birinyi ◽

...

Keyword(s):

Cardiac Arrest ◽

Endotracheal Tube ◽

Journal Club ◽

Prehospital Cardiac Arrest

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The frequency of ‘Occult’ ventricular fibrillation masquerading as a flat line in prehospital cardiac arrest

Annals of Emergency Medicine ◽

10.1016/s0196-0644(88)80561-4 ◽

1988 ◽

Vol 17 (8) ◽

pp. 813-817 ◽

Cited By ~ 24

Author(s):

Richard O Cummins ◽

Douglas Austin

Keyword(s):

Cardiac Arrest ◽

Ventricular Fibrillation ◽

Prehospital Cardiac Arrest

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Association of obesity with worsened prehospital cardiac arrest

Journal of Nutritional & Environmental Medicine ◽

10.1080/13590840500191596 ◽

2005 ◽

Vol 15 (1) ◽

pp. 1-8

Author(s):

Rade B. Vukmir

Keyword(s):

Cardiac Arrest ◽

Prehospital Cardiac Arrest

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Out-of-Hospital Resuscitation: Have We Gone Too Far?

Prehospital and Disaster Medicine ◽

10.1017/s1049023x00004180 ◽

2006 ◽

Vol 21 (6) ◽

pp. 445-450 ◽

Cited By ~ 4

Author(s):

Corita Grudzen

Keyword(s):

Cardiac Arrest ◽

Prehospital Care ◽

Sudden Cardiac Arrest ◽

Hospital Setting ◽

The United States ◽

Spontaneous Circulation ◽

Emergency Medical ◽

Clinical Scenarios ◽

Life Sustaining Treatment ◽

Future Policy

AbstractAmericans are living longer and are more likely to be chronically or terminally ill at the time of death. Although surveys indicate that most people prefer to die at home, the majority of people in the United States die in acute care hospitals. Each year, approximately 400,000 persons suffer sudden cardiac arrest in the US, the majority occurring in the out-of-hospital setting. Mortality rates are high and reach almost 100% when prehospital care has failed to restore spontaneous circulation. Nonetheless, patients who receive little benefit or may wish to forgo life-sustaining treatment often are resuscitated. Risk versus harm of resuscitation efforts can be differentiated by various factors, including cardiac rhythm. Emergency medical services policy regarding resuscitation should consider its utility in various clinical scenarios. Patients, family members, emergency medical providers, and physicians all are important stakeholders to consider in decisions about out-of-hospital cardiac arrest. Ideally, future policy will place greater emphasis on patient preferences and quality of life by including all of these viewpoints.

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Variation in Out-of-Hospital Cardiac Arrest Management

Advances in Emergency Medicine ◽

10.1155/2016/6813718 ◽

2016 ◽

Vol 2016 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

Jason M. Jones ◽

Joseph A. Tyndall ◽

Christine M. Van Dillen

Keyword(s):

Cardiac Arrest ◽

Airway Management ◽

Prehospital Care ◽

Management Strategies ◽

Retrospective Chart Review ◽

Airway Device ◽

Care Providers ◽

One Airway ◽

Time And Energy ◽

Hospital Cardiac Arrest

Objective. To evaluate variation in airway management strategies in one suburban emergency medical services system treating patients experiencing out-of-hospital cardiac arrest (OHCA). Method. Retrospective chart review of all adult OHCA resuscitation during a 13-month period, specifically comparing airway management decisions. Results. Paramedics demonstrated considerable variation in their approaches to airway management. Approximately half of all OHCA patients received more than one airway management attempt (38/77 [49%]), and one-quarter underwent three or more attempts (25/77 [25%]). One-third of patients arrived at the emergency department with a different airway device than initially selected (25/77 [32%]). Conclusion. This study confirmed our hypothesis that paramedics’ selection of ventilation strategies in cardiac arrest varies considerably. This observation raises concern because airway management diverts time and energy from interventions known to improve outcomes in OHCA management, such as cardiopulmonary resuscitation and defibrillation. More research is needed to identify more focused airway management strategies for prehospital care providers.

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