Acute Myocardial Infarction During the COVID-19 Pandemic: An Update on Clinical Characteristics and Outcomes

The outbreak of coronavirus disease 2019 (COVID-19) has rapidly become a worldwide pandemic. On top of respiratory complications, COVID-19 is associated with major direct and indirect cardiovascular consequences, with the latter probably being even more relevant, especially in the setting of time-dependent cardiovascular emergencies. A growing amount of data suggests a dramatic decline in hospital admissions for acute myocardial infarction (AMI) worldwide during the COVID-19 pandemic, mostly since patients did not activate emergency medical systems because hospitals were perceived as dangerous places regarding the infection risk. Moreover, during the COVID-19 pandemic, patients with AMI had a significantly higher in-hospital mortality compared to those admitted before COVID-19, potentially due to late arrival to the hospital. Finally, no consensus has been reached regarding the most adequate healthcare management pathway for AMI and shared guidance on how to handle patients with AMI during the pandemic is still needed. In this review, we will provide an update on epidemiology, clinical characteristics, and outcomes of patients with AMI during the COVID-19 pandemic, with a special focus on its collateral cardiac impact.

Differences in Perceived Occupational Stress by Demographic Characteristics, of European Emergency Medical Services Personnel during the COVID-19 Virus Pandemic—An International Study

Objectives: The outbreak of the COVID-19 pandemic has brought commercial, social, and economic consequences in every country that has experienced substantial SARS-CoV-2 infection rates. The complete change in the environment that took place due to the outbreak of the pandemic can lead to stressful situations, especially among healthcare personnel. Material and methods: The research were conducted during the COVID-19 pandemic between the 27 March 2020 and the 20 April 2020. The research included 1984 employees of emergency medical systems in seven European countries. An internet-based questionnaire format was adopted for the study (ΩMc-Donald > 0.7). Results: The highest level of stress was experienced by personnel in the United Kingdom M = 4.03, and the lowest by Norwegian employees M = 2.89. High levels of stress were also experienced by nurses from Spain and Poland. Women actively working in the healthcare system during the pandemic experienced higher stress levels than men. Conclusions: Women working in European emergency medical systems are more vulnerable to work-related stress, while carrying out emergency medical procedures during the pandemic. Differences in the level of stress experienced while carrying out duties in pre-hospital conditions were only found among Spanish emergency medical system personnel.

Analgesia in pediatric trauma patients in physician-staffed Austrian helicopter rescue: a 12-year registry analysis

Background As pediatric patients are typically rare among helicopter emergency medical systems (HEMS), children might be at risk for oligo-analgesia due to the rescuer’s lack of experience and the fear of side effects. Methods In this retrospective analysis, data was obtained from the ÖAMTC HEMS digital database including 14 physician staffed helicopter bases in Austria over a 12-year timeframe. Primary missions involving pediatric trauma patients (< 15 years) not mechanically ventilated on-site were included. Analgesia was assessed and compared between the age groups 0–5, 6–10 and 11–14 years. Results Of all flight missions, 8.2% were dedicated to children < 15 years. Analgetic drugs were administered in 31.4% of all primary missions (3874 of 12,324), wherefrom 2885 were injured and non-ventilated (0–5 yrs.: n = 443; 6–10 yrs.: n = 902; 11–14 yrs.: n = 1540). The majority of these patients (> 75%) suffered moderate to severe pain, justifying immediate analgesia. HEMS physicians typically chose a monotherapy with an opioid (n = 1277; 44.3%) or Esketamine (n = 1187; 41.1%) followed by the combination of both (n = 324; 11.2%). Opioid use increased (37.2% to 63.4%) and Esketamine use decreased (66.1% to 48.3%) in children < 6 vs. > 10 years. Esketamine was more often administered in extremity (57.3%) than in head (41.5%) or spine injuries (32.3%). An intravenous access was less often established in children < 6 years (74.3% vs. 90.8%; p < 0.001). Despite the use of potent analgesics, 396 missions (13.7%) were performed without technical monitoring. Particularly regarding patient data at handover in hospital, merely < 10% of all missions featured complete documentation. Therefore, sufficient evaluation of the efficacy of pain relief was not possible. Yet, by means of respiratory measures required during transport, severe side effects such as respiratory insufficiency, were barely noted. Conclusions In the physician-staffed HEMS setting, pediatric trauma patients liberally receive opioids and Esketamine for analgesia. With regard to severe respiratory insufficiency during transport, the application of these potent analgesics seems safe.

Challenges of organizational structure and human resources in pre-hospital emergency medical systems for cardiopulmonary resuscitation: A qualitative study

Background: Study about cardiopulmonary resuscitation in pre-hospital setting in Iran is limited. In present study we explored the challenges of the organizational structure and the human resources in pre-hospital emergency medical systems for cardiopulmonary resuscitation.Methods: This qualitative study was conducted using the content analysis approach. Data were collected through semi-structured interviews in 2020 until saturation was achieved. Sixteen people with the work experience at geographical bases were selected purposefully. Data were analyzed based on the Graneheim and Lundman’s approach. The main questions in this part included: What has been your experience with cardiopulmonary resuscitation? What were the challenges you experienced in cardiopulmonary resuscitation? Please explain more about the challenges of organizational structure and human resources?Results: By analyzing the data, the information was placed in two main categories 1) “the challenges of human resources” includes four sub categories (lack of experience and skills, intrapersonal challenges, non-targeted performance, and weakness in education as the existing challenges) and 2) “the challenges of organizational structure” includes three sub categories (improper structure and access, lack of organizational support, and shortages of the facilities and the equipment as the existing challenges).Conclusions: Results revealed that pre-hospital emergency medical systems personnel face various problems, challenges and limitations in cardiopulmonary resuscitation. Therefore, the ability of these personnel to manage these challenges should be increased through the opportunity to acquire clinical knowledge and skills in order to improve patient-centered services.

Focused cardiac ultrasound in out-of-hospital cardiac arrest: a literature review

Focused cardiac ultrasound (FoCUS) is emerging in emergency medical systems, particularly in the context of prognostication in out-of-hospital cardiac arrest. However, FoCUS has not been formally incorporated into UK guidelines because of a lack of evidence. Furthermore, concerns have been raised that FoCUS can distract people from providing other essential and evidenced elements of care. This broad literature search aims to shed light on the practice of FoCUS in cardiac arrest by reviewing articles related to in-hospital and out-of-hospital practice. The findings are conspicuous by the lack of high-quality studies, particularly regarding prognostication. Association between ultrasound findings and outcome are asserted, as is the feasibility of paramedic use of FoCUS, although the evidence is from small and non-randomised studies and subject to bias.

Challenges of Organisational Structure and Human Resources in Pre Hospital Emergency Medical Systems for Cardiopulmonary Resuscitation: A Qualitative Study

Introduction: Studies about Cardiopulmonary Resuscitation (CPR) in pre hospital setting in Iran is limited. Despite the importance of this issue, numerous challenges in this area are left unattended. Aim: To explore the challenges of the organisational structure and the human resources in pre hospital Emergency Medical Systems (EMSs) for CPR. Materials and Methods: This qualitative study was conducted using content analysis approach. Data was collected through semi-structured interviews in 2020, until saturation was achieved. The participants were 16 Iranian emergency medical staff who were selected through a purposive sampling method. Data were analysed based on the Graneheim UH and Lundman B approach. Results: Thirteen participants were males and the rest were females. The mean age of the participants was 33.06±7.85 years and their mean work experience was 10.62±6.63 years. By analysing the data, the information was placed in two main categories- “the challenges of human resources” which includes four sub categories (lack of experience and skills, intrapersonal challenges, non targeted performance and weakness in education as the existing challenges), and “the challenges of organisational structure” which includes three sub categories (improper structure and access, lack of organisational support and shortages of the facilities and the equipment as the existing challenges). Conclusion: Results from the present study revealed that pre hospital EMSs staff had to face various problems, challenges and limitations in CPR. Therefore, the ability of these staff to manage these challenges should be increased through the opportunity to acquire clinical knowledge and skills in order to improve patient-centered services.

In-hospital Emergencies Versus Out-of-hospital Emergencies Admitted to ICU: Is the Outcome Different? An Observational Study

Background: Rapid Response Systems (RRS) are now commonly implemented throughout hospital health systems to manage in-hospital emergencies (IHE). There is limited data on characteristics and outcomes of such patients admitted to an intensive care unit (ICU). The goal was to determine whether the hospital mortality of ICU patients was different depending on their admission pathway: in-hospital via rapid response teams (RRT), or out-of-hospital emergencies (OHE) via prehospital emergency medical systems. Results: Out of 422 ICU admissions (Timone University Hospital ICU), 241 patients were retrospectively (2019-2020) included: 74 IHE versus 167 OHE. In-hospital mortality rates did not differ between both cohorts (n = 31(42%) vs. 63(39%) respectively, NS). IHE patients were older and had more comorbidities (immunosuppression and ongoing malignancy). OHE patients had more severe organ failures at presentation with more frequent mechanical ventilation support. Independent global hospital mortality risk factors were ongoing malignancy (OR = 10.4 [2.7-40], p < 0.001), SAPS II (OR = 1.05 [1.03-1.08], p < 0.0001) and SOFA scores (OR = 1.14 [1.01-1.3], p < 0.05), hemorrhagic stroke as admission diagnosis (OR = 8.4 [2.7-26], p < 0.001), and arterial lactate on arrival (OR = 1.11 [1.03-1.2], p < 0.01). Conclusion: This study provides a thorough and comprehensive analysis of characteristics and outcomes of ICU admissions following a mature rapid response activation system, compared to the “conventional” out-of-hospital admission pathway. Despite the more vulnerable background of IHE patients, hospital mortality does not differ, supporting the use of early RRS to identify deteriorating ward patients.