Comparison of two intraosseous access devices in adult patients under resuscitation in the emergency...
1
Poster Presentations / Resuscitation 83 (2012) e24–e123 e69 collapse to induction of PCPS were 43 min for neurologically intact patients, 61 min. for vegetative or brain death patients, 64 min for patients who died. Neurological outcomes of 33 patients with ven- tricular fibrillation/ventricular tachycardia as initial rhythm were as follows: 11 (33%) neurologically intact, 8 (24%) vegetative state or brain death, 14 (42%) dead. For 9 patients with pulseless electric activity (PEA) and 6 patients with asystole, outcomes were as fol- lows in the same order shown above: PEA 2 (22%), 1 (11%), 6 (67%), asystole 0 (0%), 2 (33%), 4 (67%). Average length of hospital stay for patients with neurologically intact, vegetative state or brain death, death were 15.9 days, 27.1 days, 3.5 days, respectively. Conclusion: ECPR yields 29% survival with good neurological outcome to otherwise futile patient population. http://dx.doi.org/10.1016/j.resuscitation.2012.08.175 AP117 Cardiovascular emergencies in the Advanced Paramedic Clinical Activity Study (APCAS) Niamh Cummins 1,∗ , Mark Dixon 1 , Carrie Garavan 1 , Eric Landymore 1 , Noel Mulligan 1 , Cathal O’Donnell 2 1 Centre for Prehospital Research, Graduate Medical School, University of Limerick, Limerick, Ireland 2 National Ambulance Service, Dublin, Ireland Purpose: The Advanced Paramedic (AP) is a relatively recent role in Ireland and refers to a prehospital practitioner with Advanced Life Support (ALS) skills. 1 ALS resuscitation may increase the prob- ability of survival to hospital discharge in non-trauma cardiac arrest patients. 2 The APCAS was initiated to provide an evaluation of the impact of the AP programme on patient care. The purpose of this study was to determine if APs as currently trained can accurately diagnose cardiovascular emergencies in the field and predict the requirement for hospital admission. Materials & methods: A prospective study was initiated whereby each emergency call received over a 6-month period was recorded by the attending AP (n = 17). The AP provided a clinical diagnosis for each patient and also predicted if hospital admis- sion was required. Cardiovascular cases were divided into eight distinct categories for analysis. The data was cross-referenced with the working diagnosis of the receiving emergency physician and the hospital admission records. Results: Cardiovascular cases (n = 138) comprised 10% of all emergency calls in APCAS. Overall concordance with the receiv- ing emergency physician represents 69% for AP diagnosis and is mirrored with 66% correct hospital admission prediction. Concor- dance was highest in the categories of cardiac arrest and myocardial infarction. A total of n = 21 cardiac arrests were recorded in the study and return of spontaneous circulation (ROSC) was achieved in n = 4 cases with n = 2 survivors. Concordance was lowest in non- specific cases such as cardiac episode (chest pain/discomfort). Conclusions: Cardiovascular emergencies represent a signif- icant proportion of AP case workloads and frequently require ALS interventions. AP diagnosis and admission prediction for car- diovascular cases is similar to other jurisdictions 3 despite the relative recency of the Irish AP programme. Recognition of non- concordance case types may drive future AP practice in areas such as “treat and discharge” and also identify priorities for AP education. References [1].Pre-hospital Emergency Care Council. PHECC Education and Training Standards 2011. Naas; 2011. [2].Bakolos, et al. Advanced life support versus basic life support in the pre-hospital setting: a meta-analysis. Resuscitation 2011;82:1130–7. [3].Bright, Pocock. Prehospital recognition of acute myocardial infarction. Canadian Journal of Emergency Medicine 2002;4:212–4. http://dx.doi.org/10.1016/j.resuscitation.2012.08.176 AP118 Comparison of two intraosseous access devices in adult patients under resuscitation in the emergency department: A prospec- tive, randomized study Bernd A. Leidel 1,∗ , Chlodwig Kirchhoff 2 , Volker Braunstein 2 , Vik- toria Bogner 2 , Peter Biberthaler 2 , Karl-Georg Kanz 2 1 Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, InterdisziplinäreRettungsstelle und Aufnahmestation, Berlin, Germany 2 Klinikum der UniversitätMünchen, ChirurgischeKlinik und Poliklinik - Innenstadt, München, Germany Purpose of the study: Current guidelines recommend intraosseous (IO) vascular access in adults if peripheral venous access is unavailable. Most available data derive from children, animal models, cadaver studies or the prehospital setting. There- fore we compared two different IO access devices in adults under resuscitation in the hospital setting. Methods: This prospective, randomized clinical study compared two different IO access devices in adults (≥18 years of age) under trauma or medical resuscitation admitted to our emergency depart- ment with impossible peripheral venous access. Each adult was randomized to either spring- loaded BIG Bone Injection Gun or battery-powered EZ-IO. Outcome measures included success rates on first attempt, procedure times and complications. Results: Forty consecutive adults under resuscitation were enrolled. Twenty patients received the BIG, another twenty patients the EZ-IO. Over all success rate on first attempt was 85% and mean procedure time 2.0 ± 0.9 min. Comparing the two devices, success rate on first attempt was 80% for the BIG versus 90% for the EZ- IO and mean procedure time was 2.2 ± 1.0 min for the BIG versus 1.8 ± 0.9 min for the EZ-IO. The differences between both IO devices were not statistically significant. No other relevant complications like infection, extravasation or bleeding were observed. Conclusions: IO vascular access was a reliable and safe method to gain rapid vascular access for in-hospital adult emergency patients under resuscitation. Further studies are necessary regard- ing comparative effectiveness of different IO devices. http://dx.doi.org/10.1016/j.resuscitation.2012.08.177 AP119 Clarified causes of inhospital cardiac arrest Daniel Bergum 1,∗ , Trond Nordseth 1 , Ole Christian Mjølstad 2 , Aleksandra Kepka 3 , Eirik Skogvoll 1 , Bjørn Olav Haugen 2 1 Norwegian University of Science and Technology Dept. of Circula- tion and Imaging, St. Olavs University Hospital Dept. of Anesthesiology and Emergency medicine, The Norwegian Air Ambulance Foundation, Trondheim, Norway 2 Norwegian University of Science and Technology Dept. of Circula- tion and Imaging, St. Olavs University Hospital Dep. of Cardiology, Trondheim, Norway 3 St. Olavs University Hospital, Dept. of Pathology, Trondheim, Norway Introduction: Causes of in-hospital cardiac arrest (INCA) often reflect underlying disease. Some are detectable and treatable. We sought to analyse the aetiology of INCA according to prevalence. One way to categorize potential treatable causes is cardiac versus “The 4Hs and 4Ts”. 1–3
-
Upload
karl-georg -
Category
Documents
-
view
213 -
download
0
Transcript of Comparison of two intraosseous access devices in adult patients under resuscitation in the emergency...
uscita
cpptaoalapd
o
h
A
CA
NL
1
o2
iLapisdr
wrdsdtt
eimdisis
iAdrca
R
[1
[2
[3
Poster Presentations / Res
ollapse to induction of PCPS were 43 min for neurologically intactatients, 61 min. for vegetative or brain death patients, 64 min foratients who died. Neurological outcomes of 33 patients with ven-ricular fibrillation/ventricular tachycardia as initial rhythm weres follows: 11 (33%) neurologically intact, 8 (24%) vegetative stater brain death, 14 (42%) dead. For 9 patients with pulseless electricctivity (PEA) and 6 patients with asystole, outcomes were as fol-ows in the same order shown above: PEA 2 (22%), 1 (11%), 6 (67%),systole 0 (0%), 2 (33%), 4 (67%). Average length of hospital stay foratients with neurologically intact, vegetative state or brain death,eath were 15.9 days, 27.1 days, 3.5 days, respectively.
Conclusion: ECPR yields 29% survival with good neurologicalutcome to otherwise futile patient population.
ttp://dx.doi.org/10.1016/j.resuscitation.2012.08.175
P117
ardiovascular emergencies in the Advanced Paramedic Clinicalctivity Study (APCAS)
iamh Cummins 1,∗, Mark Dixon 1, Carrie Garavan 1, Ericandymore 1, Noel Mulligan 1, Cathal O’Donnell 2
Centre for Prehospital Research, Graduate Medical School, Universityf Limerick, Limerick, IrelandNational Ambulance Service, Dublin, Ireland
Purpose: The Advanced Paramedic (AP) is a relatively recent rolen Ireland and refers to a prehospital practitioner with Advancedife Support (ALS) skills.1 ALS resuscitation may increase the prob-bility of survival to hospital discharge in non-trauma cardiac arrestatients.2 The APCAS was initiated to provide an evaluation of the
mpact of the AP programme on patient care. The purpose of thistudy was to determine if APs as currently trained can accuratelyiagnose cardiovascular emergencies in the field and predict theequirement for hospital admission.
Materials & methods: A prospective study was initiatedhereby each emergency call received over a 6-month period was
ecorded by the attending AP (n = 17). The AP provided a clinicaliagnosis for each patient and also predicted if hospital admis-ion was required. Cardiovascular cases were divided into eightistinct categories for analysis. The data was cross-referenced withhe working diagnosis of the receiving emergency physician andhe hospital admission records.
Results: Cardiovascular cases (n = 138) comprised 10% of allmergency calls in APCAS. Overall concordance with the receiv-ng emergency physician represents 69% for AP diagnosis and is
irrored with 66% correct hospital admission prediction. Concor-ance was highest in the categories of cardiac arrest and myocardial
nfarction. A total of n = 21 cardiac arrests were recorded in thetudy and return of spontaneous circulation (ROSC) was achievedn n = 4 cases with n = 2 survivors. Concordance was lowest in non-pecific cases such as cardiac episode (chest pain/discomfort).
Conclusions: Cardiovascular emergencies represent a signif-cant proportion of AP case workloads and frequently requireLS interventions. AP diagnosis and admission prediction for car-iovascular cases is similar to other jurisdictions3 despite theelative recency of the Irish AP programme. Recognition of non-oncordance case types may drive future AP practice in areas suchs “treat and discharge” and also identify priorities for AP education.
eferences
].Pre-hospital Emergency Care Council. PHECC Education and Training Standards2011. Naas; 2011.
].Bakolos, et al. Advanced life support versus basic life support in the pre-hospitalsetting: a meta-analysis. Resuscitation 2011;82:1130–7.
tion 83 (2012) e24–e123 e69
].Bright, Pocock. Prehospital recognition of acute myocardial infarction. CanadianJournal of Emergency Medicine 2002;4:212–4.
http://dx.doi.org/10.1016/j.resuscitation.2012.08.176
AP118
Comparison of two intraosseous access devices in adult patientsunder resuscitation in the emergency department: A prospec-tive, randomized study
Bernd A. Leidel 1,∗, Chlodwig Kirchhoff 2, Volker Braunstein 2, Vik-toria Bogner 2, Peter Biberthaler 2, Karl-Georg Kanz 2
1 Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin,InterdisziplinäreRettungsstelle und Aufnahmestation, Berlin, Germany2 Klinikum der UniversitätMünchen, ChirurgischeKlinik und Poliklinik- Innenstadt, München, Germany
Purpose of the study: Current guidelines recommendintraosseous (IO) vascular access in adults if peripheral venousaccess is unavailable. Most available data derive from children,animal models, cadaver studies or the prehospital setting. There-fore we compared two different IO access devices in adults underresuscitation in the hospital setting.
Methods: This prospective, randomized clinical study comparedtwo different IO access devices in adults (≥18 years of age) undertrauma or medical resuscitation admitted to our emergency depart-ment with impossible peripheral venous access. Each adult wasrandomized to either spring- loaded BIG Bone Injection Gun orbattery-powered EZ-IO. Outcome measures included success rateson first attempt, procedure times and complications.
Results: Forty consecutive adults under resuscitation wereenrolled. Twenty patients received the BIG, another twenty patientsthe EZ-IO. Over all success rate on first attempt was 85% and meanprocedure time 2.0 ± 0.9 min. Comparing the two devices, successrate on first attempt was 80% for the BIG versus 90% for the EZ-IO and mean procedure time was 2.2 ± 1.0 min for the BIG versus1.8 ± 0.9 min for the EZ-IO. The differences between both IO deviceswere not statistically significant. No other relevant complicationslike infection, extravasation or bleeding were observed.
Conclusions: IO vascular access was a reliable and safe methodto gain rapid vascular access for in-hospital adult emergencypatients under resuscitation. Further studies are necessary regard-ing comparative effectiveness of different IO devices.
http://dx.doi.org/10.1016/j.resuscitation.2012.08.177
AP119
Clarified causes of inhospital cardiac arrest
Daniel Bergum 1,∗, Trond Nordseth 1, Ole Christian Mjølstad 2,Aleksandra Kepka 3, Eirik Skogvoll 1, Bjørn Olav Haugen 2
1 Norwegian University of Science and Technology Dept. of Circula-tion and Imaging, St. Olavs University Hospital Dept. of Anesthesiologyand Emergency medicine, The Norwegian Air Ambulance Foundation,Trondheim, Norway2 Norwegian University of Science and Technology Dept. of Circula-tion and Imaging, St. Olavs University Hospital Dep. of Cardiology,Trondheim, Norway3 St. Olavs University Hospital, Dept. of Pathology, Trondheim, Norway
Introduction: Causes of in-hospital cardiac arrest (INCA) oftenreflect underlying disease. Some are detectable and treatable. We
sought to analyse the aetiology of INCA according to prevalence.One way to categorize potential treatable causes is cardiac versus“The 4Hs and 4Ts”.1–3
