Hypoxia and hypotension in patients intubated by physician staffed helicopter emergency medical services - a prospective observational multi-centre study

Background The effective treatment of airway compromise in trauma and non-trauma patients is important. Hypoxia and hypotension are predictors of negative patient outcomes and increased mortality, and may be important quality indicators of care provided by emergency medical services. Excluding cardiac arrests, critical trauma and non-trauma patients remain the two major groups to which helicopter emergency medical services (HEMS) are dispatched. Several studies describe the impact of pre-hospital hypoxia or hypotension on trauma patients, but few studies compare this in trauma and non-trauma patients. The primary aim was to describe the incidence of pre-hospital hypoxia and hypotension in the two groups receiving pre-hospital tracheal intubation (TI) by physician-staffed HEMS. Methods Data were collected prospectively over a 12-month period, using a uniform Utstein-style airway template. Twenty-one physician-staffed HEMS in Europe and Australia participated. We compared peripheral oxygen saturation and systolic blood pressure before and after definitive airway management. Data were analysed using Cochran–Mantel–Haenszel methods and mixed-effects models. Results Eight hundred forty three trauma patients and 422 non-trauma patients receiving pre-hospital TI were included. Non-trauma patients had significantly lower predicted mean pre-intervention SpO2 compared to trauma patients. Post-intervention and admission SpO2 for the two groups were comparable. However, 3% in both groups were still hypoxic at admission. For hypotension, the differences between the groups were less prominent. However, 9% of trauma and 10% of non-trauma patients were still hypotensive at admission. There was no difference in short-term survival between trauma (97%) and non-trauma patients (95%). Decreased level of consciousness was the most frequent indication for TI, and was associated with increased survival to hospital (cOR 2.8; 95% CI: 1.4–5.4). Conclusions Our results showed that non-trauma patients had a higher incidence of hypoxia before TI than trauma patients, but few were hypoxic at admission. The difference for hypotension was less prominent, but one in ten patients were still hypotensive at admission. Further investigations are needed to identify reversible causes that may be corrected to improve haemodynamics in the pre-hospital setting. We found high survival rates to hospital in both groups, suggesting that physician-staffed HEMS provide high-quality emergency airway management in trauma and non-trauma patients.publishedVersio

Bioimprinted lipases in PVA nanofibers as efficient immobilized biocatalysts

Immobilization of lipases from Pseudomonas fluorescens (Lipase AK), Burkholderia (Pseudomonas) cepacia (Lipase PS) and lipase B from Pseudozyma (Candida) antarctica (CaLB) was investigated by entrapment in electrospun poly(vinyl alcohol) (PVA) nanofibers. The activity and selectivity of the lipases entrapped in PVA nanofibers were characterized in kinetic resolution of racemic secondary alcohols using acylation in organic media. Potential bioimprinting effect of eight substrate mimicking additives [polyethylene glycols (PEGs), non-ionic detergents (NIDs) and various organosilanes] was tested with the fiber-entrapped lipases. The nanofibrous lipase biocatalyst entrapped in the presence of the additives were also characterized by rheology, differential scanning calorimetry and scanning electron microscopy. In addition to the known lipase-bioimprinting agents (PEGs, NIDs), phenyl- and octyltriethoxysilane also enhanced substantially the biocatalytic properties of lipases in their electrospun PVA fiber-entrapped forms. The reasons of bioimprinting effect of several additives were rationalized by docking studies in the open and closed form of CaLB

Reporting Helicopter Emergency Medical Services in Major Incidents: A Delphi Study

Peer reviewe

Emergency Thoracostomy as a Safe and Effective Intervention in Prehospital Trauma : A Five Year Experience from the Hungarian Air Ambulance

Traumatic tension pneumothorax is one of the most frequent causes of early mortality among the severely injured. Different methods are recommended for chest decompression. The aim of this study is to examine whether emergency thoracostomy can improve the real 30-day survival compared to the expected Revised Trauma Score (RTS) based survival, the Return of Spontaneous Circulation (ROSC) rate in Traumatic Cardiac Arrest (TCA), reduce the occurrence of tension pneumothorax (tPTX) and to determine the complication rate of the intervention

Reporting Helicopter Emergency Medical Services in Major Incidents: A Delphi Study

Objective: Research on helicopter emergency medical services (HEMS) in major incidents is predominately based on case descriptions reported in a heterogeneous fashion. Uniform data reported with a consensus-based template could facilitate the collection, analysis, and exchange of experiences. This type of database presently exists for major incident reporting at www.majorincidentreporting.net. This study aimed to develop a HEMS-specific major incident template. Methods: This Delphi study included 17 prehospital critical care physicians with current or previous HEMS experience. All participants interacted through e-mail. We asked these experts to define data variables and rank which were most important to report during an immediate prehospital medical response to a major incident. Five rounds were conducted. Results: In the first round, the experts suggested 98 variables. After 5 rounds, 21 variables were determined by consensus. These variables were formatted in a template with 4 main categories: HEMS background information, the major incident characteristics relevant to HEMS, the HEMS response to the major incident, and the key lessons learned. Conclusion: Based on opinions from European experts, we established a consensus-based template for reporting on HEMS responses to major incidents. This template will facilitate uniformity in the collection, analysis, and exchange of experience