Analysis of the quality of chest compressions during resuscitation in an understaffed team — randomised crossover manikin study

INTRODUCTION: According to the chain of survival, chest compressions (CCs) are crucial in every cardiac arrest patient. It is very challenging to provide high-quality resuscitation in a two-paramedic team. The task of an automatic chest compression device (ACCD) is to relieve the rescuer and improve the quality of CCs. Its influence on the quality of the whole resuscitation as well as the survival of patients is still subject to discussion worldwide. This study aimed to assess the quality of CCs during resuscitation in a two-paramedic team using ACCD.  MATERIAL AND METHODS: This research was designed as a prospective, randomised, cross-over, high-fidelity simulation study. Fifty-two double paramedic teams took part in the research. The role of the participants was to conduct full advanced resuscitation in a human patient’s simulator. Each team provided resuscitation twice. Once with an ACCD and once using manual compressions. Chest compression quality parameters, as well as chest compression fraction (CCF), were measured.  RESULTS : Statistically significant differences were found between manual and automated compressions in: mean depth (48 ± 4 mm vs. 56 ± 3 mm, p < 0.0001), mean rate (117 ± 9 mm vs. 103 ± 1 mm, p < 0.0001), percentage of CC with correct depth (46 ± 25 vs. 87 ± 13, p < 0.0001), rate (72 ± 22 vs. 96 ± 4, p < 0.0001), and recoil (55 ± 23 vs. 89 ± 13, p < 0.0001). CCF was also higher when the ACCD was used (74 ± 7% vs. 83 ± 2%, p < 0.0001).  CONCLUSIONS: The use of an ACCD increases the quality of compressions by improving CCF, chest recoil, and the percentage of compressions performed with adherence to guidelines.

Supraglottic devices — future or everyday life?

The most common cause of upper respiratory tract obstruction in an unconscious or unresponsive patient is the loss of muscle tone in the upper airway. Consequently, this leads to a reduction in the tone of the epiglottis, collapse of the tongue and closure of the airway at the level of the pharynx, preventing respiration. Diagnosing airway obstruction is associated with the implementation of urgent procedures aimed at restor­ing and maintaining patency. Among the techniques of restoring airway patency anatomically, we prefer extending the head and pushing the posterior mandible forward. Airway ventilation is not always possible through the use of non-surgical methods. Ventilating patients with obstructed airways using a self-inflating bag can prove to be very difficult. In such situations, it is necessary to use airway adjuncts. The purpose, regardless of the circumstances, is to remove anatomical barriers, prevent gastric aspiration and to facilitate proper lung ventilation. Endotracheal intubation is the gold standard for instrumentally maintaining a secure airway. The procedure, however, is reserved for experienced personnel because of how difficult it is to perform and the many complications that arise with it. In situations where difficulty is encountered, an alternative device to secure airway patency is needed

Assessment of Chest Compression Quality — a systematic review

INTRODUCTION: High-quality chest compression (CC) is a crucial factor that determines the survival of cardiac arrest patients. Adequate quality should be featured by appropriate compression rate and depth, and full chest recoil after each compression. The ranges are strictly determined in Resuscitation Guidelines. All these parameters are interdependent. Currently, there is a need to find or develop a universal index that will enable the definition and determination of the overall quality of CCs.  MATERIAL AND METHODS: A systematic review of the MEDLINE, EMBASE, COCHRANE, and GOOGLE SCHOLAR databases was performed. The authors aimed to find papers in which the quality of CC was assessed. The extracted information included measurement of the CC quality in a direct and objective manner — by analysing the depth, rate, and recoil of CC, position of the hands, duty cycle, and indirectly by evaluating chest compression fraction (CCF). Papers describing the quality of CC based on a combination of various components of the CC quality were selected for analysis.  RESULTS: In total 1604 publications were obtained. Among them, 21 articles satisfied the search criteria. In most of the papers, it was suggested that compressions should have been considered as correct when they met simultaneously all quality criteria. Only three papers presented any mathematical formula that could have been used for further comparisons.  CONCLUSIONS: Although many proposals have been developed, no single, universal, and commonly accepted indicator of resuscitation quality has been so far designed and subsequently applied. Further work on this subject is warranted and strongly recommended.

Techniki ewakuacji poszkodowanego w poszczególnych fazach prowadzenia działań w środowisku taktycznym

Działanie w warunkach bojowych i realizacja zadań związanych z dużym ryzykiem może prowadzić do dużych strat sanitarnych. Priorytetem jest podjęcie czynności mających na celu wykonanie zadania bojowego przy jednoczesnym zminimalizowaniu strat własnych. Ewakuacja poszkodowanych z pola walki jest uzależniona od aktualnej sytuacji taktycznej, zmieniającego się środowiska oraz dostępnych sił i środków. Przemieszczanie rannego ze strefy CUF (care under fire) do TFC [tactical field care) odbywa się na różnych poziomach zaawansowania, wynikających z wiedzy i taktycznego wyszkolenia żołnierzy oraz dostępności sprzętu ewakuacyjnego. Szybka i bezpieczna ewakuacja poszkodowanego ze strefy zagrożenia do strefy opieki medycznej umożliwia zastosowanie procedur zwiększających prawdopodobieństwo przeżycia na polu walki.Combat operations and the implementation of high-risk tasks can generate a high number of dead and wounded soldiers. Taking steps to minimize losses during combat tasks is treated as a priority. The evacuation of casualties from the battlefield depends on the current tactical situation, the changing environment, and the available forces and means. Moving the wounded from the CUF (Care Under Fire) area to TFC (Tactical Field Care) takes place at various levels, resulting from the knowledge and tactical training of the soldiers and the availability of emergency equipment. Rapid and safe evacuation of casualties from the danger zone to the medical care zone enables the use of procedures that significantly increase the battlefield survival rate

Active shooters — how close are they?

Recent terrorist attacks in the United States, Canada and Western Europe have shown an increase in the incidence of “Active Shooters” [1]. These ruthless and desperate assassins usually attack urban and poorly protected areas (lack of armed protection) that are densely populated [2]. Utilizing their strength, they realize that their plan is to maximize the number of casualties, without counting on the consequences of their actions. The basis of their action may be based on extremely radical views. Frequent outcomes for active shooters include suicide during an attack (90%) or the resolution of the threat by the authorities [3]. In response to the ever-increasing number of assassinations and the risk of such incidents in one’s immediate surroundings, comprehensive education should be widely spread. Thus, it is important to promote appropriate behaviour, rules of reaction during an attack by an armed assailant, as well as cooperation with incoming service personnel. Such actions will not only help one prevent, but also allow one to prepare for such incidences

Use of video laryngoscopes by inexperienced personnel in difficult intubations

The current gold standard in securing airway patency remains to be endotracheal intubation. It is the only method, which allows for nearly 100% protection of the bronchial tree from aspiration of gastric contents as well as providing the most ideal circumstances for control of ventilation parameters. Endotracheal intu- bation, although in many aspects superior to other methods of securing airways, can only be performed by skilled and experienced personnel in ideal conditions. An example of such conditions are in an operating room in the preoperative period when an anesthesiologist is able to proficiently perform the task with all of the tools and equipment needed at hand. However, in many situations, especially in emergencies, such ideal conditions are difficult or impossible to achieve. One of the many reasons behind this is often the lack of experienced personnel at the scene of an emergency. Another significant difficulty arises from trauma patients who must maintain an immobilized cervical spine, as well as those patients who are undergoing active cardiopulmonary resuscitation when providing high quality chest compressions is the highest priority. Therefore, it seems reasonable to look for the methods which on one hand will secure an airway with a tube inserted directly into the larynx, and on the other hand will make the procedure more accessible to less expe- rienced personnel by maintaining the proper patient safety throughout the whole procedure. A noteworthy method, which achieves this goal, is the use of the video laryngoscopes for endotracheal intubation. The participation in a short introductory training, regarding the use of the device itself, is sufficient to allow for the efficient intubation. The parameters which can be used to compare these different intubation methods include the ease of use, the rate of effectiveness of the first intubation trial as well as the total time needed for the procedure. The authors of this article attempt to compare classic laryngoscopes to video-assisted laryngoscopes. 

TACTICAL MEDICINE INSPIRING CIVILIAN RESCUE MEDICINE IN THE MANAGEMENT OF HAEMORRHAGE

   Accidents remain to be the most common cause of death amongst men of ages 10–39 and women of ages 5–24. The sudden occurrence of simultaneous multiple events or a mass casualty event with many patients suffering severe injuries, including severe haemorrhage, requires emergency medical personnel to modify the algorithms, which dictate their actions. The military war mission in Iraq and Afghanistan brought many experiences, which were used and applied to guidelines, which are now used for the management of patients experiencing trauma in the civilian sector. The current trauma ITLS (International Trauma Life Support) guidelines suggest to use compression bands or haemostatic dressings in order to control bleeding in case of massive haemorrhage. An example of this recommendation being used can be seen in the regional par­amedic station in Poznan, Poland, where each ambulance is outfitted with “rescue packages” to be used in the event of massive haemorrhage. This practice can also be seen in Great Britain as well as Germany, where local protocols recommend the use of medical equipment taken from tactical medicine. The use of such tools allows for achieving a greater chance of rapid and effective haemostatic control in the event of massive haemorrhaging. These tools allow for more efficient use of time at the scene of the event, reducing the time a patient spends at the scene, allowing more rapid transport to hospital and more specialised surgical support. Reducing the time spent at the scene of an event while carrying out important procedures such as stabilising the patient’s airway, stopping haemorrhage and immobilising the patient, markedly improves the survival of trauma patients

Emergency healthcare providers perception of workplace dangers in the polish Emergency Medical Service: a multi-centre survey study

INTRODUCTION: There are many risk factors that account for hazards in paramedics’ and ambulance nurses’ profession. Driving a vehicle, having contact with patients, making difficult medical decisions, doing night shifts and working in a stressful environment, all of those features negatively affect their health. The aim of the study was to evaluate paramedics’ and ambulance nurses attitude towards personal safety, to assess their subjective feeling of danger, as well as identify types of hazards they experience. MATERIAL AND METHODS: The study was carried out via a diagnostic survey method, an anonymous questionnaire. Among 572 responders there were nurses and paramedics, who work in non-physician medical rescue teams in Poland. RESULTS: Most of the surveyed medics (40.5%) have rated the level of danger of their occupation to 4 on a scale from 1 to 5, with the greatest hazard being posed by patients under the influence of designer drugs. As many as 43% of medics have had back-related problems and 41% have suffered injuries at work. Notwithstanding, a majority of respondents have admitted that if they could plan their career again, they would choose the same profession. CONCLUSIONS: Prehospital healthcare providers have generally rated their work as dangerous. More attention should be paid to teach first responders how to deal with aggression and how to handle stress. Efforts should be made to increase paramedics’ and nurses’ awareness about health problems related to shift work

Implementation of extended cardiopulmonary resuscitation procedure in in-hospital cardiac arrest: a preliminary simulated study

INTRODUCTION: The survival rate of patients after in-hospital cardiac arrest (IHCA) is poor. The implementation of novel technologies to conventional cardio-pulmonary resuscitation (CPR) may improve clinical outcomes.   Aim: To evaluate efficacy of extended CPR (ECPR) performed by physicians in the simulated scenario of IHCA.   MATERIAL AND METHODS: High-fidelity simulations were performed in a simulation room equipped with a full spectrum of emergency devices. Earlier, the physicians (n = 60, five courses) participated in a threeday training in the use of extracorporeal techniques. Eventually, 12 participants were divided into 4-member teams that were involved in three stages (assessed in terms of duration and quality) of scenario such as 1. Advanced Life Support (ALS) activities; 2. preparation of the extracorporeal membrane oxygenation device (ECMO); 3. cannulation and activation of ECMO.   RESULTS: All teams completed successfully scenario within recommended time of 60 minutes (ranged from 33 min. 55 sec. to 37 min.) after IHCA. In details, decision to activate ECMO team was taken between 8 min. 45 sec. and 14 min. 15 sec of scenario, ECMO device prepared within 10 min. 5 sec. to 15 min. 30 sec. whereas peripheral vessels cannulated in 4 min. 14 sec. to 6 min. 10 sec. Of note, all evaluated times were the shortest for teams with decisive leaders.   CONCLUSIONS: Implementation of ECPR procedure is possible within recommended time after IHCA. It has also been shown that training with application of high-fidelity simulation techniques is of paramount importance in achievement and maintenance of ECPR skills, not only manual but also in effective communication