Multidisciplinary residential home intervention to improve outcomes for frail residents

Background Residential homes provide accommodation and assistance with personal care only and are not required to have registered nurses on site. However, their residents often have a combination of comorbidity, polypharmacy, frailty and mental-health conditions with poor access to healthcare to meet these needs. Integrated healthcare for older people is a key NHS priority in the Long-Term Plan and the Five-Year Forward View. We describe development and implementation of multi-disciplinary intervention to integrate healthcare and promote interprofessional education. Methods A multi-disciplinary residential home quality improvement project in two cycles by a team comprising senior and trainee general practitioners, trainees in geriatrics, psychiatry, pharmacist and residential home senior staff. The intervention was underpinned by the framework for enhanced health in care homes including Comprehensive Geriatric Assessment (CGA) and mental-health review. Each intervention session included an educational presentation by a team member consideration of each resident in a pre-evaluation multi-disciplinary discussion followed by a structured clinical assessment and discussion of proposed management. Results Three residential homes participated with a total 34 residents receiving intervention. In one residential home, there was a 75% reduction in admissions for those reviewed and a reduction in overall admission costs. Polypharmacy was reduced by an average of 2 medications per resident across the three sites. There was a 63% increase in cardio-pulmonary resuscitation decisions and 76% increase in advance care planning discussions. Conclusion This was an effective model for multi-disciplinary trainees working with a perceived impact on physical and mental health, and valuable opportunities for sharing learning.

Honey Bee Venom Re-Challenge During Specific Immunotherapy: Prolonged Cardio-Pulmonary Resuscitation Allowed Survival in a Case of Near Fatal Anaphylaxis

BACKGROUND Specific immunotherapy for patients with honey bee hypersensitivity is commonly applied. Re-challenge with venom is performed to prove protection.CASE PRESENATION We report a case of near fatal anaphylaxis with asystolia for 24 minutes in a 35-years-old patient with mastocytosis after honey bee sting challenge despite 5-years of specific immunotherapy. Successful cardio-pulmonary resuscitation (CPR) was applied for 32 minutes.CONCLUSION This intervention demonstrates, that in anaphylaxis with cardio-vascular arrest prolonged CPR for up to 40 minutes might be appropriate to overcome half time span of massively released histamine. Failure of specific immunotherapy was possibly due to sensitization to the allergen Api m10, probably underrepresented in commercial honey bee venom extracts. Also, molecular analyses might alert to potential unsuccessful outcome of venom specific immunotherapy especially in high-risk patients such as mastocytosis.

Abstract 11964: Citizen Responders Provide Emotional Support for Relatives to Out-of-Hospital Cardiac Arrest Patients

Introduction: A citizen responder (CR) system to activate volunteer citizens by a smartphone application (HeartRunner) to nearby cardiac arrests was implemented in 2017 in the Capital Region of Denmark. Participating in resuscitation may not only involve provision of cardio-pulmonary resuscitation (CPR) but also include provision of emotional support for relatives to the cardiac arrest patient. We examined the proportion of CR who reported provision of support to relatives to out-of-hospital cardiac arrest (OHCA) patients during resuscitation attempt. Hypothesis: We hypothesized that CR not only deliver CPR but also provide emotional support to relatives of OHCA patients. Methods: All CR activated by the HeartRunner app received a follow-up questionnaire 90 minutes after the alarm including questions about how CRs participated in resuscitation and whether they provided emotional support to relatives present during the resuscitation attempt. All surveys from March 12, 2020 to June 1, 2021, from CR who accepted an alarm and arrived at the cardiac arrest location were included. Results: A total of 1,868 CR responded to the survey (median age 37 years (IQR 28-37). Half (54.4%) were male and 23.9% health care professionals. CRs arrived before the emergency medical services (EMS) in almost 1/3 (28.9%) of OHCA cases with CR activation, with 227 CRs (41.9%) performing CPR and 139 (25.7%) attaching an automated external defibrillator. In total, more than 433 CRs (23.2%) reported provision of support for relatives at the OHCA location. Even though a higher proportion of support was observed among CR who arrived before the EMS, almost 12% reported provision of support to relatives even when arriving after EMS (Figure). Conclusions: Citizen responders provide not only resuscitative efforts but offer emotional support to relatives to OHCA patients. Citizen responders may be an important resource for both EMS personnel and relatives who are present at the cardiac arrest scene.

A STUDY TO EVALUATE THE EFFECTIVENESS OF SIMULATION TRAINING ON KNOWLEDGE & PRACTICE OF CARDIO PULMONARY RESUSCITATION (CPR) AMONG FIRE& SAFETY STUDENTS IN A SELECTED INSTITUTION AT MANGALORE

Heart disease is the world's largest killer disease claiming 17.5 million lives every year. An Indian dies of heart problem in every 29 seconds. As many as 20,000 new heart patients develop every day in India, six cores Indians suffer from heart disease and 30% more are at high risk by 2020. This study undertaken to evaluate the effectiveness of simulation training on knowledge & practice of cardio pulmonary resuscitation (CPR) among re and safety students in a selected institution at Mangalore. The Objectives of the study were To assess the knowledge and practice of re & Safety students regarding CPR., Evaluate the effectiveness of simulation training on cardiopulmonary resuscitation among re and safety students. Compare the post test knowledge with practice on CPR and To nd the association between pre-test knowledge and practice score on CPR with selected demographic variables .A quantitative approach one group pre-test post –test was adopted to evaluate the effectiveness of simulation teaching module Knowledge of participants on CPR was assessed by using structured knowledge questionnaire and observational checklist was administered to assess the practical knowledge level. The study concluded that the simulation training on CPR was very effective to improve knowledge and practice of cardio pulmonary resuscitation (CPR) among re and safety students.

Effectiveness on Simulation Teaching Regarding Cardio Pulmonary Resuscitation among Workers of State Transport Depot

Introduction: Cardiopulmonary resuscitation is the technique of life-saving procedure in that artificial ventilation uses external chest compressions to maintain circulation flow of the heart and oxygenation during cardiac arrest. Many peoples in the developed and developing countries have taken known education of Cardiopulmonary resuscitation training which was launched jointly by Universal Medical Assistance International Center. Objectives: 1. To evaluate the previous knowledge and skill regarding CPR among workers of ST Depot. 2. To evaluate effectiveness and correlation the post-test knowledge and skill score regarding CPR among workers of ST Depot. 3. To identify the association with the post-test skill score regarding CPR among workers of ST Depot. Methodology: In this study, will the effectiveness of simulation teaching regarding cardiopulmonary resuscitation the sample will be the 100 ST depot workers. The workers will select according to inclusion and exclusion criteria as well as the Purposive sampling technique. One group pre-test and post-test design. It will be conducted at State Transport Depot. Wardha Maharashtra, India respectively. The data will be collected by using questionnaires and an observational checklist for simulation teaching on cardiopulmonary resuscitation. Conclusion: It is concluded that the effectiveness of simulation teaching on CPR was found to be effective in improving the knowledge and skill of workers of ST depot.

Impact of COVID-19 lockdown on the procedural and intra-hospital outcome of STEMI patients

Background While during the COVID-19 pandemic the number of patients presenting with ST-segment elevation myocardial infarction (STEMI) decreased, no change in patient or system delay could be shown due to local lockdown (LD) policy. Not much is known about the influence of LD on procedural details and intrahospital outcome of these patients. Methods Data was obtained from 511 patients treated for acute STEMI (24hours from symptom onset) from January 2019 to March 8th 2021 at two primary PCI (pPCI) centers in Germany. Patients presenting as intra-hospital STEMI, patients showing no culprit lesion and patients undergoing direct CABG were excluded. Overall, 456 patients (74% male, mean age 64±12) were included. These patients were divided into two groups: complete lockdown (LD; n=58; March 21st–April 20th 2020 and December 16th 2020–March 7th 2021) and no complete lockdown (No-LD; n=398)). Results There were no differences in pre-hospital care between the groups: Telemedicine (LD 23.5% vs. No-LD 34.9%; p=0.11), pre-alarm of the cath-lab staff (LD 59.6% vs. 66.6%, p=0.32) and direct admission to the cath-lab (LD 44.8% vs. No-LD 49.8%, p=0.58) were performed as often as in No-LD times. Neither the pain to first medical contact (LD 188±272 Min vs. No-LD 236±317 Min, p=0.29) nor the door to balloon time (55±54 Min vs. No-LD 49±58 Min, p=0.470) as well as other periods showed any difference. All over cardio-pulmonary resuscitation (CPR; LD 19.0% vs. No-LD 14.3%, p=0.35) or presentation with cardiogenic shock (25.9% vs 23.9%, p=0.74) was equally presented in both groups. However, left ventricular assist devices were implanted more often during LD (6.9% vs. No-LD 1.8%; p=0.017). Primary radial access was performed in the majority of the cases (LD 60.3% vs. No-LD 58.8%, p=0.82). During LD the culprit lesion was RCA in most cases (46.6% vs. No-LD LAD 46.7%, p=0.341). Stent thrombosis was not more common in out-of-hospital STEMI patients during LD (6.9% vs. 8.0%, p=0.76). Thrombus aspiration was performed in 10.3% during lockdown (vs. No-LD 4.5%, p=0.06), GP-IIb-IIIa inhibitors were not administered more often (LD 19.0% vs. No-LD 19.4%, p=0.92) and no reflow phenomenon was not seen more frequent (LD 20.7% vs. No-LD 21.3% p=0.91). TIMI III flow could be established in the majority of the cases (LD 86.0% vs. No-LD 91.5%, p=0.20). During further hospital stay, neither the frequency of ventilator (LD 17.2% vs. No-LD 17.0%, p=0.98) nor vasopressor use (LD 20.7% vs. No-LD 20.1% p=0.925) differed. Left ventricular function (47±13% vs. No-LD 45±12%; p=0.34) and maximum creatinkinase (LD 1827±1687 U/l vs. No-LD: 2292±4100 U/l, p=0.40) showed no difference between the groups as did intrahospital death (LD 10.3% vs. No-LD 11.6%, p=0.79). Conclusion Despite the known decline in STEMI patients during LD periods, patient care, procedural details and inta-hospital outcome of the ones presenting to a pPCI hospital do not change during LD periods. FUNDunding Acknowledgement Type of funding sources: None.