Impact of an Advanced Cardiac Life Support Process Improvement Initiative on Leadership Role Comfort

Extracorporeal Cardiopulmonary Resuscitation (ECPR) in the Emergency Department (ED) requires optimized advanced cardiac life support (ACLS). An ACLS leader monitors compressions, orders medications, performs rhythm checks, directs defibrillation, and times events. This role was reassigned from physicians to nurses. Nurse led ACLS may allow physicians to assess ECPR inclusion criteria. There is limited research on ACLS leader role comfort for nurses. We hypothesized an ECPR initiative in the ED would improve personnel comfort in the ACLS leader role. ECPR initiative implementation included didactics and simulation training. A survey was distributed to ED residents, attending physicians, and nurses, and included six Likert-scale items on comfort with the ACLS leader role. Surveys were administered 6 months prior to and 3 months after implementation. There were 91 respondents at baseline and 100 respondents in the follow-up, resulting in a 43% and 48% response rate, respectively. We used Mann-Whitney tests to compare ordinal variables and non-parametric tests to assess the impact of initiative completion and level of experience on a cumulative score for comfort. We observed no significant changes for the six comfort items from the baseline survey regardless of respondent group. In the post-period, nurses (22.6/30) and resident physicians (23.9/30) had significantly lower mean cumulative comfort scores when compared to attending physicians (27.5/30) (p\u3c .001). Experience leading ACLS in the past 12 months was a significant predictor of cumulative comfort score for nurses in the post-period (p = .029), even when completion of ECPR requirements was controlled. While most report comfort acting in the role of ACLS leader there was no significant improvement post-initiative. These findings, combined with the significance of experience leading ACLS on comfort for nurses and resident physicians, suggest continued experiential learning and opportunities for simulation

Incidence of adverse events for procedural sedation and analgesia for cardioversion using thiopental in elderly patients: a multicenter prospective observational study

Aim The incidence and characteristics of thiopental‐related adverse events (AEs) in elderly patients during procedural sedation and analgesia (PSA) have not been well studied. We aimed to characterize thiopental‐related AE in elderly patients during PSA and compare the incidence of AE in elderly patients with non‐elderly adults. Methods This is a secondary analysis of the Japanese Procedural Sedation and Analgesia Registry (JPSTAR). We included all adult patients who received thiopental for PSA in the emergency departments and excluded patients who received concomitant sedative(s) in addition to thiopental or patients with missing body weight data. We compared the incidence of AE between the non‐elderly (18–64 years) and elderly groups (≥65 years). Results The JPSTAR had data on 379 patients who received thiopental for PSA and included 311 patients for analysis. Most (222/311, 71.3%) were elderly. Cardioversion was the most common reason for PSA (96.1%). The AE incidence between groups overall was similar, however, hypoxia was significantly more frequent in the elderly compared with the non‐elderly group (10.3% versus 2.2%; adjusted odds 5.63, 95% confidence interval 1.27–25.0). The initial and total doses of thiopental were significantly lower in the elderly group than in the non‐elderly group (1.95 mg/kg versus 2.21 mg/kg and 2.33 mg/kg versus 2.93 mg/kg, respectively). Conclusions Although elderly patients received lower doses of thiopental, hypoxic events were significantly more frequent in this group compared with the non‐elderly patients. However, the AE incidence was similar

Association between capnography and recovery time after procedural sedation and analgesia in the emergency department

Abstract Aim Capnography is recommended for use in procedural sedation and analgesia (PSA); however, limited studies assess its impact on recovery time. We investigated the association between capnography and the recovery time of PSA in the emergency department (ED). Methods This study was a secondary analysis of a multicenter PSA patient registry including eight hospitals in Japan. We included all patients who received PSA in the ED between May 2017 and May 2021 and divided the patients into capnography and no‐capnography groups. The primary outcome was recovery time, defined as the time from the end of the procedure to the cessation of monitoring. The log‐rank test and multivariable analysis using clustering for institutions were performed. Results Of the 1265 screened patients, 943 patients who received PSA were enrolled and categorized into the capnography (n = 150, 16%) and no‐capnography (n = 793, 84%) groups. The median recovery time was 40 (interquartile range [IQR]: 25–63) min in the capnography group and 30 (IQR: 14–55) min in the no‐capnography group. In the log‐rank test, the recovery time was significantly longer in the capnography group (p = 0.03) than in the no‐capnography group. In the multivariable analysis, recovery time did not differ between the two groups (adjusted hazard ratio, 0.95; 95% confidence interval, 0.77–1.17; p = 0.61). Conclusion In this secondary analysis of the multicenter registry of PSA in Japan, capnography use did not associate with shorter recovery time in the ED

Do Video Calls Improve Dispatcher-Assisted First Aid for Infants with Foreign Body Airway Obstruction? A Randomized Controlled Trial/Simulation Study

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sj-docx-1-hkj-10.1177_10249079231166331 – Supplemental material for Comparison of distance education and in-person education in procedural sedation and analgesia: A randomized controlled trial

Supplemental material, sj-docx-1-hkj-10.1177_10249079231166331 for Comparison of distance education and in-person education in procedural sedation and analgesia: A randomized controlled trial by Shinya Takeuchi, Tatsuya Norii, Marisa Rivera and Yosuke Homma in Hong Kong Journal of Emergency Medicine</p

Effect of prehospital advanced airway management on out‐of‐hospital cardiac arrest due to asphyxia: A JAAM‐OHCA registry‐based observational study in Japan

Abstract Aim To investigate the relationship between prehospital advanced airway management (AAM) and neurological outcomes in patients with asphyxia‐related out‐of‐hospital cardiac arrest (OHCA). Methods We retrospectively analyzed data from the Japanese Association for Acute Medicine OHCA registry between June 2014 and December 2017. Patients with asphyxia‐related cardiac arrest aged ≥18 years were included. The primary outcome was a 1‐month favorable neurological outcome (cerebral performance category [CPC] 1–2). Results Of the 34,754 patients in the 2014–2017 JAAM‐OHCA Registry, 1956 were included in our analysis. Cerebral performance category 1–2 was observed in 31 patients (1.6%), while CPC 3–5 was observed in 1925 patients (98.4%). Although prehospital AAM was associated with unfavorable neurological outcomes (odds ratio [OR], 0.269; 95% confidence interval [CI], 0.114–0.633; p = 0.003) in the univariate analysis, the association was not significant in the multivariate analysis. Compared with the AAM group, the non‐AAM group showed increased rates of cardiac arrest after emergency medical service contact (4.3 vs. 7.2%, p = 0.009) and Glasgow Coma Scale ≥4 at hospital admission (1.9% vs. 4.7%, p = 0.004). Among the 903 patients for whom the time to return of spontaneous circulation (ROSC) could be calculated, the time from witnessed cardiac arrest to ROSC was significantly shorter (median, 8.5 vs. 37.0 min; p < 0.001) for those with favorable neurological outcomes than for those without. Conclusion Prehospital AAM is not associated with improved neurological outcomes among those with asphyxia‐related OHCA. However, the time from cardiac arrest to the first ROSC was significantly shorter among those with favorable outcomes

Ambulance traffic crashes in Japan: Characteristics of casualties, and efforts to improve ambulance safety

Background: An ambulance traffic crash not only leads to injuries among Emergency Medical Service (EMS) professionals but also injures patients or their companions during transportation. We aimed to describe the incidence of ambulance crashes, seating location, and seatbelt use for casualties (i.e., both fatal and non-fatal injuries), ambulance safety efforts, and to identify factors affecting the number of ambulance crashes in Japan. Methods: We conducted a nationwide survey of all fire departments in Japan. The survey queried each fire department about the number of ambulance crashes between January 1, 2017, and December 31, 2019, the number of casualties, their locations, and seatbelt usage. Additionally, the survey collected information on fire department characteristics, including the number of ambulance dispatches, and their safety efforts including emergency vehicle operation training and seatbelt policies. We used regression methods including a zero-inflated negative binomial model to identify factors associated with the number of crashes. Results: Among the 726 fire departments in Japan, 553 (76.2%) responded to the survey, reporting a total of 11,901,210 ambulance dispatches with 1,659 ambulance crashes (13.9 for every 100,000 ambulance dispatches) that resulted in a total of 130 casualties during the 3-year study period (1.1 in every 100,000 dispatches). Among the rear cabin occupants, seatbelt use was limited for both EMS professionals (n= 3/29, 10.3%) and patients/companions (n= 3/26, 11.5%). Only 46.7% of the fire departments had an internal policy regarding seatbelt use. About three-fourths of fire departments (76.3%) conducted emergency vehicle operation training internally. The output of the regression model revealed that fire departments that conduct internal emergency vehicle operation training had fewer ambulance crashes compared to those that do not (odds of being an excessive zero -2.20, 95% CI: -3.6 to -0.8). Conclusion: Two-thirds of fire departments experienced at least one crash during the study period. The majority of rear cabin occupants who were injured in ambulance crashes were not wearing a seatbelt. Although efforts to ascertain seatbelt compliance were limited, Japanese fire departments have attempted a variety of methods to reduce ambulance crashes including internal emergency vehicle operation training, which was associated with fewer ambulance crashes.</p

A core outcome set for resuscitative endovascular balloon occlusion of the aorta: A consensus based approach using a modified Delphi method

BACKGROUND: The utilization of resuscitative endovascular balloon occlusion of the aorta (REBOA) in trauma has grown exponentially in recent years. However, inconsistency in reporting of outcome metrics related to this intervention has inhibited the development of evidence-based guidelines for REBOA application. This study sought to attain consensus on a core outcome set (COS) for REBOA. METHODS: A review of "landmark" REBOA articles was performed, and panelists (first and senior authors) were contacted for participation in a modified Delphi study. In round 1, panelists provided a list of potential core outcomes. In round 2, using a Likert scale (I [not important] to 9 [very important]), panelists scored the importance of each potential outcome. Consensus for core outcomes was defined a priori as greater than 70% of scores receiving 7 to 9 and less than 15% of scores receiving Ito 3. Feedback was provided after round 2, and a third round was performed to reevaluate variables not achieving consensus and allow a final "write-in" round by the experts. RESULTS: From 17 identified panelists, 12 participated. All panelists ( 12 of 12, 100%) participated in each subsequent round. Panelists initially identified 34 unique outcomes, with two outcomes later added upon write-in request alter round 2. From 36 total potential outcomes, 20 achieved consensus as core outcomes, and this was endorsed by 100% of the participants. CONCLUSION: Panelists successfully achieved consensus on a COS for REBOA-related research. This REBOA-COS is recommended for all clinical trials related to REBOA and should help enable higher-quality study designs, valid aggregation of published data, and development of evidence-based practice management guidelines. Copyright (C) 2021 Wolters Kluwer Health, Inc. All rights reserved

2022 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces

This is the sixth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. This summary addresses the most recently published resuscitation evidence reviewed by International Liaison Committee on Resuscitation Task Force science experts. Topics covered by systematic reviews include cardiopulmonary resuscitation during transport; approach to resuscitation after drowning; passive ventilation; minimizing pauses during cardiopulmonary resuscitation; temperature management after cardiac arrest; use of diagnostic point-of-care ultrasound during cardiac arrest; use of vasopressin and corticosteroids during cardiac arrest; coronary angiography after cardiac arrest; public-access defibrillation devices for children; pediatric early warning systems; maintaining normal temperature immediately after birth; suctioning of amniotic fluid at birth; tactile stimulation for resuscitation immediately after birth; use of continuous positive airway pressure for respiratory distress at term birth; respiratory and heart rate monitoring in the delivery room; supraglottic airway use in neonates; prearrest prediction of in-hospital cardiac arrest mortality; basic life support training for likely rescuers of high-risk populations; effect of resuscitation team training; blended learning for life support training; training and recertification for resuscitation instructors; and recovery position for maintenance of breathing and prevention of cardiac arrest. Members from 6 task forces have assessed, discussed, and debated the quality of the evidence using Grading of Recommendations Assessment, Development, and Evaluation criteria and generated consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections, and priority knowledge gaps for future research are listed