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

PERFORMANCE OF CHEST COMPRESSIONS WITH THE USE OF THE NEW MECHANICAL CHEST COMPRESSION MACHINE LIFELINE ARM: A RANDOMIZED CROSSOVER MANIKIN STUDY IN NOVICE PHYSICIANS

BACKGROUND: The Lifeline ARM (ARM; De btech, Guilford, USA) is a new mechanical chest compression device. The aim of the current study was to compare the quality of single rescuer cardiopulmonary resuscitation (CPR) with and without ARM device. METHODS: In this randomized crossover manikin trial forty-four novice physicians participated. Thirty minutes of training was allotted for manual CPR and then for the ARM. The following day, every participant performed a 2-min CPR single rescuer scenario, once with manual CPR and once with the ARM. The primary outcome measure of the study is effective compression; de ned as compressions performed with the correct of depth of 50–60 mm, complete decompressions, and the correct pressure point of CC. RESULTS: The ARM, compared with manual CPR, carried out more effective compressions (96 [interquartile range, IQR; 94–98] vs. 36 [IQR; 33–41]%, p < 0.001). The compressions preformed with the use of the ARM, furthermore, were with a correct CC rate (100 [IQR; 99–101] vs. 130 [IQR; 124–140] min-1; p<0.001) and a correct depth (97 [IQR; 96–98] vs. 37 [IQR; 31–39]%; p<0.001). The result of resuscitation with ARM was signi cantly better than manual CPR (p<0.05) for all of the analyzed chest compression parameters (percentage of CC too deep, percentage of CC too shallow, percentage of correct pressure points and percentage of correct pressure releases), as well as for the ventilation parameters (tidal volume, ventilation rate, minute-volume, gastric in ations). CONCLUSION: During this simulated trial, when CPR was performed by novice physicians, the ARM signi cantly improved the quality of CPR. Further clinical trials should provide motivation to con rm the potential bene ts of ARM use during CPR

COMPARISON OF ENDOTRACHEAL INTUBATION WITH THE AIRTRAQ AVANT® AND THE MACINTOSH LARYNGOSCOPE DURING INTERMITTENT OR CONTINUOUS CHEST COMPRESSION: A RANDOMIZED, CROSSOVER STUDY IN MANIKINS

BACKGROUND: Endotracheal intubation (ETI) currently is the gold standard of securing an airway during cardio- pulmonary resuscitation. PURPOSE: The aim of this study was to evaluate ETI with the Airtraq Avant (ATQ) compared to a conventional Macintosh laryngoscope when used by paramedics during resuscitation with and without chest compression (CC). METHODS: Forty-seven paramedics were recruited into a randomized crossover trial in which each performed ETI with ATQ and MAC in both scenarios. The primary endpoint was time to successful intubation, while secondary endpoints included intubation success, laryngoscopic view on the glottis, dental compression, and rating of the given device. RESULTS: In the manikin scenario without CC, nearly all participants performed ETI successfully both with ATQ and MAC, with a shorter intubation time using MAC 20.5 s [IQR, 17.5–22], compared to ATQ 24.5 s [IQR, 22–27.5] (p = 0.002). However, in the scenarios with continuous CC, the results with ATQ were signi cantly better than with MAC for all analyzed variables (success of rst attempt at ETI, time to intubation (TTI) [MAC 27 s [IQR, 25.5–34.5], compared to ATQ 25.7s [IQR, 21.5–28.5] (p=0.011), Cormack-Lehane grade and rating). The success rate in scenarios with CC was 82.9% vs. 91.5% for MAC Laryngoscope vs. ATQ, respectively (p=0.021). CONCLUSIONS: The ATQ provides bene ts in terms of ETI success rate, TTI, and glottic view when compared to MAC during ETI with continuous CC

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