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.

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.

Obrazowanie metodą optycznej koherentnej tomografii u pacjentów z ostrym zawałem serca

The aim of this paper is to present four cases of patients withacute myocardial infarction (MI). The primary percutaneouscoronary intervention (PCI) was guided with optical coherencetomography (OCT). The OCT inspection preceded by aspirationthrombectomy done in a native vessel allowed to assess thepathology of its wall and lumen which play a part in myocardialinfarction. Based on baseline OCT, the diameter and length ofthe stent was chosen, which did not always correlate withangiographic assessment. Moreover, using the OCT, one canaccurately assess the final effect of the procedure, providinginformation on the mechanism of possible complications. Thecurrent experience of the authors indicates that OCT imaging inacute myocardial infarction is feasible and helpful in optimizationof the primary PCI. Nevertheless, prolonged time of PCI andincreased volume of the contrast agent needed for OCT imagingmight be some limitation in unstable MI patients.W pracy została przedstawiona seria czterech przypadków pacjentów z ostrym zawałem mięśnia sercowego, u których pierwotną angioplastykę wieńcową wykonano pod kontrolą optycznej koherentnej tomografii (OCT). OCT poprzedzone trombektomią aspiracyjną, wykonane w natywnym naczyniu pozwala dokładnie ocenić patologię ściany naczynia i jego światła leżące u podłoża zawału. Na podstawie zakresu nieprawidłowości obserwowanych w OCT można precyzyjnie dobrać szerokość i długość stentu, co nie zawsze odpowiada ocenie angiograficznej. Ponadto wizualizacja za pomocą OCT pozwala ocenić efekt zabiegu, dostarczając informacji na temat mechanizmu ewentualnych powikłań. Dotychczasowe doświadczenie autorów pracy wskazuje, iż obrazowanie OCT w ostrym zawale serca jest wykonalne i na jego podstawie można uzyskać cenne dodatkowe informacje, które pomagają w optymalizacji procedury, niemniej wiąże się ono z wydłużeniem czasu trwania zabiegu i zwiększeniem ilości podanego kontrastu, co w przypadku pacjentów niestabilnych może być pewnym ograniczeniem

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

Pattern of failure in endometrial cancer patients

Abstract Objective: The aim of this study was to evaluate selected clinical, histological and diagnostic factors as prognostics of time and location of endometrial cancer recurrence. We also attempted to design a more efficient follow-up protocols for patients with recurrent endometrial cancer. Methods: A retrospective review of 196 patients with recurrent endometrial cancer treated at the Department of Gynecologic Oncology, Maria Sklodowska-Curie Memorial Cancer Center, Warsaw, was done. Recurrence was analyzed by site, presence or absence of symptoms and methods of detection. We focused our attention on the impact of specific disease characteristics on pattern and risk of recurrence. Results: Vast majority of recurrences (88%) occurred within the first 3 years after the primary treatment, whereas 71% within the first two years after the completion of the treatment. More than half of the patients (55%) were symptomatic when relapse occurred, while no statistically significant differences were found in time to relapse between the symptomatic and the asymptomatic group. Disease-free time observed when vaginal relapse occurred was significantly shorter compared to distant sites (p=0.049). Histological maturity of primary tumor seems to be a prognostic of disease-free time (p=0.039). Also patients with histological type I and II seem to have different courses of the disease (p=0.064). Among recurrent endometrial cancer cases, pelvic examination, abdominal or pelvic ultrasound and chest x-ray could detect 95% of relapses. Conclusions: A follow-up program in the first three years after the primary treatment of endometrial cancer is useful in detecting recurrent disease. There is no reason to use an intensive program of follow-up in patients with low risk primary disease. Pelvic examination, vaginal and abdominal ultrasound, chest x-ray are good and not expensive methods in relapse detection. There is no clinical justification for the routine use of the Pap smear in the follow-up of patients with endometrial cancer

Results of Fullerton Test in older people. Group comparison due to the Nordic Walking and long walks undertaking

Introduction: Standardly, high level of physical activity is prescribed to the older patients. However, it is worth to examine if every kind of physical activity give the same amount of health benefits, or is it dependent on its modality.Aim: The purpose of above studies is to measure the differences in Fullerton subtests results in group who does vs in group who does not undertake regular long walks (LW) and Nordic Walking (NW).Material and methods: Subtests of Fullerton tests were used to examine the physical performance of patients. Physical activity questionnaire was used to distinguish groups of patients who do vs do not engage in long walks and Nordic Walking regularly.Results: There were no statistically significant differences in Fullerton scores due to NW-engagement. In contrary, group engaged in LW walked 42.41 meters more in 6-minute walk tests than group who do not undertake such activity. Moreover, Upper Right and Left Limbs Strength tests and its mean scores were better in LW-group by 4.23, 4.6 and 4.09 repetitions, respectively.Conclusions: There was no statistically significant differences in results of Fullerton subtests between group of NW-engaged older people comparing to group who do not undertake NW. Group of participants engaged in long walks had better scores aerobic capacity and upper limbs strength tests

Cognitive Functioning in Older People. Results of the First Wave of Cognition of Older People, Education, Recreational Activities, Nutrition, Comorbidities, Functional Capacity Studies (COPERNICUS)

Background: Cognitive reserve is a way of explaining why some individuals with a high degree of brain pathology are without clinical manifestations. In this study, factors related to systemic diseases, body composition, aerobic capacity, past and current behavior were examined and included as predictors of cognitive function.Materials and Methods: 407 subjects (60–88 years old) underwent physical examination and cognitive function assessment [Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and Trail Making Test Part B (TMT B)]. Predictors of cognitive functioning were evaluated: occupational status (OS), diet, mental and touristic activities were assessed using an ad hoc questionnaire. Aerobic capacity was measured using a six-minute walk test (6MWT).Results: With each year of age there is a decrease in MMSE score by 0.18 points. Varicose veins on lower extremities and low OS were also significantly associated with MMSE result. For every year of having hypertension, low OS and not being abroad in the last 3 years, there was 0.17, 0.30, and 0.16 less points, respectively, and 0.15 more point per one additional meter walked in 6MWT in the MoCA score. With each year of age and for low OS there was there were 0.31 and 0.21 s more to complete TMT B, respectively.Conclusion: Education, OS, presence of systemic diseases and social and tourist activities, aerobic capacity and body composition could be considered as factors contributing to cognitive functioning in older people. However, the relationship of above mentioned factors with education level and cognitive function may be not fully orthogonal

Critical considerations in management of patients with left ventricular assist device in an Emergency Department practice

In recent years, mechanical circulatory support has become an increasingly used treatment strategy for end-stage heart failure. Due to technological progress and higher availability of this therapy, the number of patients receiving left ventricular assist devices (LVAD) is increasing. A natural consequence of this is occurrence of complications related to this therapy. A patient presenting to an emergency department (ED) expects the highest level of care. Emergency department staff should have basic knowledge and skills to provide initial diagnostic and therapeutic interventions for patients with LVAD in life-threatening conditions. The most common reasons for patients with LVADs presenting to the ED are bleeding, heart rhythm disorders, stroke, or infections. This article aims to present the basic information that may be useful during the first medical contact in an emergency department. The authors have discussed the issue of diagnosis, and differences in laboratory findings and indicate where to best seek help. The article is dedicated to physicians, nurses, and paramedics working in emergency departments

Examination of a patient with left ventricular assist device in an emergency condition — proposal for adaptation of the ABCDE examination algorithm

Heart failure is becoming a medical issue that concerns more and more patients. The most effective treatment method is heart transplantation, however, more people are waiting for the procedure than there are available donors. The improvement of left ventricular assist device (LVAD) method was possible because of the joining forces of technological and medical advances. In recent years more patients have undergone the LVAD treatment. It has been a considerable challenge for medics in prehospital conditions. Device malfunction, bleeding, chest pain, or collapse pose a threat to life for those patients. The aim of this paper was to adjust the ABCDE examination algorithm to be applied for patients with LVAD. Additionally, the author has described the method in detail. The article itself and the modification of the algorithm are based on the analyses of available source literature. The biggest challenge for medics who examine patients with LVAD is a lack of pulse and inability to measure the pressure in a classical method. The most visible differences in the examination scheme have been observed in points C and E. The authors have identified the need for simulation-based trainings dedicated to medical staff working in prehospital conditions. Additionally, a special system informing emergency services about LVAD patients living in their area should be implemented