COMPARISON OF TWO INTRAOSSEOUS ACCESS DEVICES EMPLOYED DURING SIMULATED CARDIOPULMONARY RESUSCITATION. A PROSPECTIVE, RANDOMIZED, CROSSOVER, MANIKIN STUDY

BACKGROUND: Intraosseous injection is an alternative method used regarding unsuccessful intravenous access during many emergency situations. The aim of the present study was to compare injections made by the Bone Injection Gun (BIG) with NIO Adult intraosseous access devices during simulated CPR performed by paramedics. METHODS: 40 paramedics took part in this prospective, randomized, crossover, manikin study. The participants were chosen at random, while each paramedic performed an intraosseous injection with the Bone Injection Gun (BIG) or with the NIO Adult Intraosseous access device. The effectiveness of the intraosseous injection was analyzed as times T1, T2, and T3. Time T1 is de ned as the time-lapse from placing the intraosseous device into one’s hand to performing the intraosseous injection; Time T2 is the time-lapse from placing the intraosseous device into one’s hand to the moment of stabilizing it at the injection site; while Time T3 is de ned as the time-lapse from putting the intraosseous device into one’s hand, attaching the syringe with a test aspiration, to connecting the infusion line. Attitudes toward the use of intraosseous access during resuscitation were also analyzed in the present study. RESULTS: The ef cacy of intraosseous access obtained with the use of NIO was at 100% where the ef cacy of the use of BIG was at 95%. The average time of T1 was similar in the groups randomized to use BIG and NIO, repre- sented as 5.4±3.5 vs. 3.5±2.5 s, respectively (p=0.014); the average time of T2 was 17.5±4.5 vs. 3.5±2.5 s, respectively (p<0.001); while the average time of T3 was 25±5.5 vs. 11.5±2.5 s, respectively (p<0.001). No- tably, 90% of the study’s participating paramedics preferred to use the NIO during cardiopulmonary resuscitation (p < 0.001). CONCLUSIONS: The present study shows that after a short period of training paramedics can perform an intraos- seous injection with a high degree of ef ciency. Thus, the authors stress the need for training medical personnel to have the skill to perform intraosseous injections along with knowledge and understanding of the indications and contraindication for IO access

Randomized trial of the chest compressions effectiveness comparing 3 feedback CPR devices and standard basic life support by nurses

Background: Out-of-hospital cardiac arrest is a leading cause of mortality and serious neurological morbidity inEurope.We aimto investigate the effect of 3 cardiopulmonary resuscitation (CPR) feedback devices on effectivenessof chest compression during CPR.Methods: Thiswas prospective, randomized, crossover, controlled trial. Following a brief didactic session, 140 volunteernurses inexperienced with feedback CPR devices attempted chest compression on amanikin using 3 CPRfeedback devices (TrueCPR, CPR-Ezy, and iCPR) and standard basic life support (BLS) without feedback.Results: Comparison of standard BLS, TrueCPR, CPR-Ezy, and iCPR showed differences in the effectiveness of chestcompression (compressions with correct pressure point, correct depth, and sufficient decompression),which are,respectively, 37.5%, 85.6%, 39.5%, and 33.4%; compression depth (44.6 vs 54.5 vs 45.6 vs 39.6mm); and compressionrate (129.4 vs 110.2 vs 101.5 vs 103.5 min-1).Conclusions: During the simulated resuscitation scenario, only TrueCPR significantly affected the increased effectivenesscompression compared with standard BLS, CPR-Ezy, and iCPR. Further studies are required to confirmthe results in clinical practice

Czy zastosowanie systemu kompresji klatki piersiowej u dzieci poprawia efektywność jej uciskania? Symulacyjne randomizowane krzyżowe badanie pilotażowe

Background: Providing high-quality chest compressions is a key element affecting the effectiveness of cardiopulmonary resuscitation (CPR). Aim: To evaluate the effectiveness of standard (manual) chest compressions (Standard BLS, standard basic life support) and those performed with the use of the Lifeline ARM chest compression system (ARM; Defibtech). Methods: The study was designed as a randomised crossover study. In total, 37 nurses participated in the study. They performed a randomized 2-min asynchronous resuscitation using the Standard BLS method or the ARM system. The following parameters were measured: the total number of chest compressions, the frequency of compressions (min–1), compression depth (mm), and the percentage of correctly performed chest compressions and total chest decompressions. The authors also analysed the participants’ preferences concerning the use of particular CPR techniques in the clinical setting. Results: The results obtained during the simulation study with the application of the ARM system were statistically significantly better than those with the Standard BLS method (p < 0.05) in the case of all analysed parameters. Conclusions: During the simulated child resuscitation performed by the nurses, the application of the Lifeline ARM chest compression system significantly improved the effectiveness of chest compressions.  Wstęp: Zapewnienie wysokiej jakości uciskania klatki piersiowej stanowi kluczowy element wpływający na skuteczność resuscytacji krążeniowo-oddechowej. Cel: Celem pracy była ocena efektywności uciskania klatki piersiowej metodą standardową (bezprzyrządową) (Standard BLS, standard basic life support) oraz z wykorzystaniem systemu kompresji klatki piersiowej Lifeline ARM (ARM; Defibtech). Metody: Badanie zaprojektowano jako randomizowane badanie krzyżowe. Wzięło w nim udział 37 pielęgniarek. Wykonywały one w sposób randomizowany 2-minutową asynchroniczną resuscytację z wykorzystaniem metody Standard BLS lub systemu ARM. Mierzono następujące parametry: całkowitą liczbę uciśnięć klatki piersiowej, częstotliwość uciśnięć (min–1), głębokość ucisku (mm) oraz odsetek poprawnie wykonanych uciśnięć klatki piersiowej i całkowitych dekompresji klatki piersiowej. Analizowano także preferencje uczestników badania dotyczące zastosowania danej techniki resuscytacji krążeniowo-oddechowej podczas pracy klinicznej. Wyniki: Wyniki uzyskane w badaniu symulacyjnym podczas resuscytacji z wykorzystaniem systemu ARM były statystycznie istotnie lepsze niż w przypadku metody Standard BLS (p < 0,05) w przypadku wszystkich analizowanych parametrów. Wnioski: Podczas badania w warunkach symulowanej resuscytacji dziecka wykonywanej przez pielęgniarki zastosowanie systemu kompresji klatki piersiowej Lifeline ARM w znaczący sposób poprawiało efektywność uciskania klatki piersiowej.

Comparison of direct intubation and Supraglottic Airway Laryngopharyngeal Tube (S.A.L.T.) for endotracheal intubation during cardiopulmonary resuscitation. Randomized manikin study

Background: Airway control is a potentially lifesaving procedure, but intubation by direct laryngoscopy may be difficult. The aim of this study was to assess the success rate of tracheal intubation using the Macintosh laryngoscope and Supraglottic Airway Laryngopharyngeal Tube (S.A.L.T) device. Methods: This is a randomised cross-over study involving 120 paramedics utilising the Macintosh laryngoscope and S.A.L.T. during simulated cardiopulmonary resuscitation (CPR) on a manikin. We compared times to successful intubation and intubation success rates for intubation using Macintosh and S.A.L.T. performed by paramedics, during CPR with and without chest compression. Results: Mean intubation times for conventional laryngoscopic intubation and S.A.L.T. without chest compressions were 31.52 ± 7.23 s and 17.97 ± 5.33 s, respectively (P < 0.001). Conclusions: Intubation via the S.A.L.T. was more successful than conventional laryngoscopic intubation, regardless of whether chest compressions were interrupted or not.Background: Airway control is a potentially lifesaving procedure, but intubation by direct laryngoscopy may be difficult. The aim of this study was to assess the success rate of tracheal intubation using the Macintosh laryngoscope and Supraglottic Airway Laryngopharyngeal Tube (S.A.L.T) device. Methods: This is a randomised cross-over study involving 120 paramedics utilising the Macintosh laryngoscope and S.A.L.T. during simulated cardiopulmonary resuscitation (CPR) on a manikin. We compared times to successful intubation and intubation success rates for intubation using Macintosh and S.A.L.T. performed by paramedics, during CPR with and without chest compression. Results: Mean intubation times for conventional laryngoscopic intubation and S.A.L.T. without chest compressions were 31.52 ± 7.23 s and 17.97 ± 5.33 s, respectively (P < 0.001). Conclusions: Intubation via the S.A.L.T. was more successful than conventional laryngoscopic intubation, regardless of whether chest compressions were interrupted or not