Cardiopulmonary Resuscitation in Special Circumstances

Cardiopulmonary resuscitation (CPR) in special circumstances includes the emergency intervention for special causes, special environments and special patients. Special causes cover the potential reversible causes of cardiac arrest that must be identified or excluded during any resuscitation, divided into two groups, 4Hs and 4Ts: hypoxia, hypo-/hyperkalaemia and other electrolyte disorders, hypo-/hyperthermia, hypervolemia, tension pneumothorax, tamponade (cardiac), thrombosis (coronary or pulmonary) and toxins. The special environments section includes recommendations for the treatment of cardiac arrest occurring in specific locations: cardiac surgery, catheterisation laboratory, dialysis unit, dental surgery, commercial airplanes or air ambulances, field of play, difficult environment (e.g. drowning, high altitude, avalanche and electrical injuries) or mass casualty incident. CPR for special patients gives guidance for the patients with severe comorbidities (asthma, heart failure with ventricular assist devices, neurological disease and obesity) and pregnancy women or elderly people

Prehospital Emergency Care in Acute Trauma Conditions

It is well known at this moment that a systems and systematic approach to trauma care cases is ideal. The prehospital controversies of in-the-field care in trauma cases, resuscitation, and transport, ground or air, are still debated. The most controversial is rapid transport to definitive care (“scoop and run”) versus field stabilization in trauma, which remains a topic of debate and resulted in great variability of prehospital policy. Emergency medical services, including ground and air transportation, significantly extend the reach of tertiary care facilities, leading to rapid transport of critically ill patients. Emergency medical services (EMS) providers are the first link to a trauma care system, and trauma triage made by EMS personnel is also a very important factor in a good outcome of trauma patients. The assessment of patient and the treatment delivered by the first medical crew could have a large impact over the clinical evolution and output of trauma patient; that way, it is necessary to apply a systematic approach in this pathology, guided by clear and simple-to-follow recommendations applied on the scene. Recent review of the literature on helicopter emergency medical services (HEMS) showed an overall benefit of 2.7 additional lives saved per 100 HEMS activations

AED: Optimal Use of Automated External Defribilators in BLS and ILS

The use of Automatic External Defibrillators (AED) present in public access defibrillation programs (PAD) in cardiopulmonary resuscitation (CPR) is a challenge in the effective treatment of cardiac arrest, especially for adult patients. It is already known that the majority of adult cases of out-of-hospital cardiac arrest arise from ventricular fibrillation (VF). The most important factor in determining survival from VF is the time from collapse to defibrillation. If laypersons are trained to perform Basic Life Support (BLS) and to attempt defibrillation using an automatic external defibrillator before the emergency medical services arrive, the survival rate of an out-of-hospital cardiac arrest can be increased. In many countries, the number of public access AEDs has increased but implementation of AED use and CPR performed by public bystanders has not been sufficiently frequent. In fact, only a minority of individuals demonstrate sufficient knowledge and willingness to operate an AED, suggesting that the public is not yet sufficiently prepared. It is also very important to support the permanent campaign of training as many laypersons, starting from school, to properly use such defibrillators in public places. Considering these facts, PAD is an effective way and may be a cost-effective way to improve outcomes in cardiac arrest

Time delays to reach dispatch centres in different regions in Europe. Are we losing the window of opportunity? - The EUROCALL study

Aim: In out of hospital cardiac arrest (OHCA) the start of Cardiopulmonary Resuscitation (CPR) by a single rescuer may be delayed considerably if the total time (TT) to connect the telephone call to the Emergency Medical Communication Centre (EMCC) is prolonged. EUROCALL investigated the TT-EMCC and its components using different calling procedures. Methods: This prospective, multicentre, randomised study was performed in April 2013. Telephone calls were randomly allocated to time of call, and to those connecting directly to the EMCC (1-step procedure) and those diverted before connecting to the EMCC (2-step procedure). Results: Twenty-one EMCCs from 11 countries participated in the study. Time to first ringtone was similar between 1-step 3.7 s (IQR 1.0-5.2) and 2-step calls 4.0 s (IQR 2.4-5.2). For the 1878 1-step calls, the median TT-EMCC was 11.7 s (IQR 8.7-18.5). For the 1550 2-step calls, the median time from first ringtone to first call-taker was 7 s (IQR 4.6-11.9) and from first call-taker to EMCC was 18.7 s (IQR 13.4-29.9). Median TT-EMCC was 33.2 s (IQR 24.7-46.1) and was significantly longer than the TT-EMCC observed with the 1-step procedure (P <0.0001). Significant differences existed among participating regions between and within different countries both for 1-step and 2-step procedures. Conclusion: TT-EMCC was significantly shorter in a 1-step procedure compared to a 2-step procedure. Regional differences existed between countries but also within countries. This may be relevant in cases of OHCA and other situations where patient outcome is critically time-dependent. (C) 2016 Elsevier Ireland Ltd. All rights reserved.Peer reviewe

First-response treatment after out-of-hospital cardiac arrest:a survey of current practices across 29 countries in Europe

Background: In Europe, survival rates after out-of-hospital cardiac arrest (OHCA) vary widely. Presence/absence and differences in implementation of systems dispatching First Responders (FR) in order to arrive before Emergency Medical Services (EMS) may contribute to this variation. A comprehensive overview of the different types of FR-systems used across Europe is lacking. Methods: A mixed-method survey and information retrieved from national resuscitation councils and national EMS services were used as a basis for an inventory. The survey was sent to 51 OHCA experts across 29 European countries. Results: Forty-seven (92%) OHCA experts from 29 countries responded to the survey. More than half of European countries had at least one region with a FR-system. Four categories of FR types were identified: (1) firefighters (professional/voluntary); (2) police officers; (3) citizen-responders; (4) others including off-duty EMS personnel (nurses, medical doctors), taxi drivers. Three main roles for FRs were identified: (a) complementary to EMS; (b) part of EMS; (c) instead of EMS. A wide variation in FR-systems was observed, both between and within countries. Conclusions: Policies relating to FRs are commonly implemented on a regional level, leading to a wide variation in FR-systems between and within countries. Future research should focus on identifying the FR-systems that most strongly influence survival. The large variation in local circumstances across regions suggests that it is unlikely that there will be a 'one-size fits all' FR-system for Europe, but examining the role of FRs in the Chain of Survival is likely to become an increasingly important aspect of OHCA research

The European guideline on management of major bleeding and coagulopathy following trauma: sixth edition

Background: Severe trauma represents a major global public health burden and the management of post-traumatic bleeding continues to challenge healthcare systems around the world. Post-traumatic bleeding and associated traumatic coagulopathy remain leading causes of potentially preventable multiorgan failure and death if not diagnosed and managed in an appropriate and timely manner. This sixth edition of the European guideline on the management of major bleeding and coagulopathy following traumatic injury aims to advise clinicians who care for the bleeding trauma patient during the initial diagnostic and therapeutic phases of patient management. Methods: The pan-European, multidisciplinary Task Force for Advanced Bleeding Care in Trauma included representatives from six European professional societies and convened to assess and update the previous version of this guideline using a structured, evidence-based consensus approach. Structured literature searches covered the period since the last edition of the guideline, but considered evidence cited previously. The format of this edition has been adjusted to reflect the trend towards concise guideline documents that cite only the highest-quality studies and most relevant literature rather than attempting to provide a comprehensive literature review to accompany each recommendation. Results: This guideline comprises 39 clinical practice recommendations that follow an approximate temporal path for management of the bleeding trauma patient, with recommendations grouped behind key decision points. While approximately one-third of patients who have experienced severe trauma arrive in hospital in a coagulopathic state, a systematic diagnostic and therapeutic approach has been shown to reduce the number of preventable deaths attributable to traumatic injury. Conclusion: A multidisciplinary approach and adherence to evidence-based guidelines are pillars of best practice in the management of severely injured trauma patients. Further improvement in outcomes will be achieved by optimising and standardising trauma care in line with the available evidence across Europe and beyond

Perception of inappropriate cardiopulmonary resuscitation by clinicians working in emergency departments and ambulance services : The REAPPROPRIATE international, multi-centre, cross sectional survey

Introduction: Cardiopulmonary resuscitation (CPR) is often started irrespective of comorbidity or cause of arrest. We aimed to determine the prevalence of perception of inappropriate CPR of the last cardiac arrest encountered by clinicians working in emergency departments and out-of-hospital, factors associated with perception, and its relation to patient outcome. Methods: A cross-sectional survey was conducted in 288 centres in 24 countries. Factors associated with perception of CPR and outcome were analyzed by Cochran-Mantel-Haenszel tests and conditional logistic models. Results: Of the 4018 participating clinicians, 3150 (78.4%) perceived their last CPR attempt as appropriate, 548 (13.6%) were uncertain about its appropriateness and 320 (8.0%) perceived inappropriateness; survival to hospital discharge was 370/2412 (15.3%), 8/481 (1.7%) and 8/294 (2.7%) respectively. After adjusting for country, team and clinician's characteristics, the prevalence of perception of inappropriate CPR was higher for a non-shockable initial rhythm (OR 3.76 [2.13-6.64]; P 79 years) and in case of a "poor" first physical impression of the patient (3.45 [2.36-5.05]; P 79 years) and a "poor" first physical impression (0.26 [0.19-0.35]; P <0.0001). Conclusions: The perception of inappropriate CPR increased when objective indicators of poor prognosis were present and was associated with a low survival to hospital discharge. Factoring clinical judgment into the decision to (not) attempt CPR may reduce harm inflicted by excessive resuscitation attempts.Peer reviewe

EuReCa ONE—27 Nations, ONE Europe, ONE Registry A prospective one month analysis of out-of-hospital cardiac arrest outcomes in 27 countries in Europe

AbstractIntroductionThe aim of the EuReCa ONE study was to determine the incidence, process, and outcome for out of hospital cardiac arrest (OHCA) throughout Europe.MethodsThis was an international, prospective, multi-centre one-month study. Patients who suffered an OHCA during October 2014 who were attended and/or treated by an Emergency Medical Service (EMS) were eligible for inclusion in the study. Data were extracted from national, regional or local registries.ResultsData on 10,682 confirmed OHCAs from 248 regions in 27 countries, covering an estimated population of 174 million. In 7146 (66%) cases, CPR was started by a bystander or by the EMS. The incidence of CPR attempts ranged from 19.0 to 104.0 per 100,000 population per year. 1735 had ROSC on arrival at hospital (25.2%), Overall, 662/6414 (10.3%) in all cases with CPR attempted survived for at least 30 days or to hospital discharge.ConclusionThe results of EuReCa ONE highlight that OHCA is still a major public health problem accounting for a substantial number of deaths in Europe.EuReCa ONE very clearly demonstrates marked differences in the processes for data collection and reported outcomes following OHCA all over Europe. Using these data and analyses, different countries, regions, systems, and concepts can benchmark themselves and may learn from each other to further improve survival following one of our major health care events

Microstructural, Electrochemical and In Vitro Analysis of Mg-0.5Ca-xGd Biodegradable Alloys

The subject of Mg-based biodegradable materials, used for medical applications, has been extensively studied throughout the years. It is a known fact that alloying Mg with biocompatible and non-toxic elements improves the biodegradability of the alloys that are being used in the field of surgical applications. The aim of this research is to investigate the aspects concerning the microstructure, electrochemical response (corrosion resistance) and in vitro cytocompatibility of a new experimental Mg-based biodegradable alloy&mdash;Mg&ndash;0.5%Ca with controlled addition of Gd as follows: 0.5, 1.0, 1.5, 2.0 and 3.0 wt.%&mdash;in order to establish improved biocompatibility with the human hard and soft tissues at a stable biodegradable rate. For this purpose, scanning electron microscopy (SEM), energy-dispersive spectroscopy (EDS), light microscopy (LM) and X-ray diffraction (XRD) were used for determining the microstructure and chemical composition of the studied alloy and the linear polarization resistance (LPR) method was used to calculate the corrosion rate for the biodegradability rate assessment. The cellular response was evaluated using the 3-(4,5-dimethyltiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) test followed by fluorescence microscopy observation. The research led to the discovery of a dendritic &alpha;-Mg solid solution, as well as a lamellar Mg2Ca and a Mg5Gd intermetallic compound. The in vivo tests revealed 73&ndash;80% viability of the cells registered at 3 days and between 77 and 100% for 5 days, a fact that leads us to believe that the experimental studied alloys do not have a cytotoxic character and are suitable for medical applications

Microstructural, Electrochemical and In Vitro Analysis of Mg-0.5Ca-xGd Biodegradable Alloys

The subject of Mg-based biodegradable materials, used for medical applications, has been extensively studied throughout the years. It is a known fact that alloying Mg with biocompatible and non-toxic elements improves the biodegradability of the alloys that are being used in the field of surgical applications. The aim of this research is to investigate the aspects concerning the microstructure, electrochemical response (corrosion resistance) and in vitro cytocompatibility of a new experimental Mg-based biodegradable alloy—Mg–0.5%Ca with controlled addition of Gd as follows: 0.5, 1.0, 1.5, 2.0 and 3.0 wt.%—in order to establish improved biocompatibility with the human hard and soft tissues at a stable biodegradable rate. For this purpose, scanning electron microscopy (SEM), energy-dispersive spectroscopy (EDS), light microscopy (LM) and X-ray diffraction (XRD) were used for determining the microstructure and chemical composition of the studied alloy and the linear polarization resistance (LPR) method was used to calculate the corrosion rate for the biodegradability rate assessment. The cellular response was evaluated using the 3-(4,5-dimethyltiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) test followed by fluorescence microscopy observation. The research led to the discovery of a dendritic α-Mg solid solution, as well as a lamellar Mg2Ca and a Mg5Gd intermetallic compound. The in vivo tests revealed 73–80% viability of the cells registered at 3 days and between 77 and 100% for 5 days, a fact that leads us to believe that the experimental studied alloys do not have a cytotoxic character and are suitable for medical applications