Air Medical Journal最新文献_第4页

Contextualizing Pseudo-Pulseless Electrical Activity in Cardiac Arrest: A Meta-Analysis and Systematic Review

Air Medical Journal Pub Date : 2025-01-01 DOI: 10.1016/j.amj.2024.11.010

Omar Elhalwagy MBBS , Ben Singer MBBS , Gareth Grier MBBCh , Abilius Wong MBBS

{"title":"Contextualizing Pseudo-Pulseless Electrical Activity in Cardiac Arrest: A Meta-Analysis and Systematic Review","authors":"Omar Elhalwagy MBBS , Ben Singer MBBS , Gareth Grier MBBCh , Abilius Wong MBBS","doi":"10.1016/j.amj.2024.11.010","DOIUrl":"10.1016/j.amj.2024.11.010","url":null,"abstract":"<div><h3>Objective</h3><div>Nonshockable cardiac arrest rhythms have demonstrably poor outcomes. Pseudo-pulseless electrical activity (PEA), a subset of PEA in which visible cardiac contractility is present, is being described more frequently in recent literature. Physiology suggests that presence of cardiac motion even without a palpable pulse is energetically more favorable than true PEA, which is more like asystole. Therefore, we hypothesize that there is an increase in the survivability of PEA compared with asystole which may in part be due to a subset of pseudo-PEA.</div></div><div><h3>Methods</h3><div>A PICOST research question was generated which guided the composition of a systematic review and meta-analysis in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist.</div></div><div><h3>Results</h3><div>A total of 494,355 patients were identified from 12 pieces of literature. Meta-analyses revealed an overall increased survivability of PEA compared with asystole (odds ratio [OR] 2.08, 95% confidence interval [CI] 1.52-2.86). When differentiating between location of arrest, PEA was more survivable in both in-hospital cardiac arrest and out-of-hospital cardiac arrest than asystole (out-of-hospital cardiac arrest OR 4.17, 95% CI 3.78-4.60, and in-hospital cardiac arrest OR 1.60, 95% CI 1.42-1.79). Finally, when comparing neurological outcome of PEA with asystole, PEA was more favorable (OR 3.32, 95% CI 1.39-7.94).</div></div><div><h3>Conclusion</h3><div>Pseudo-PEA may be one of the explanations attributed to better outcomes of PEA, especially neurological, due to the presence of cerebral and coronary flow. The presence of PEA likely requires evidence-based tailored management with presence of pseudo-PEA being more like a profound shock state. More evidence is required to investigate the true incidence of pseudo-PEA and its outcomes compared with true PEA.</div></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"44 1","pages":"Pages 83-92"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143464311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Air Transport Medicine: From the Field

Air Medical Journal Pub Date : 2025-01-01 DOI: 10.1016/j.amj.2024.11.005

Michael P. McCartin MD, Stephen H. Thomas MD, Ira J. Blumen MD, Candice Schaper MSN, RN, Teri Campbell MSN, RN, Michelle Lambright BSN, RN, James Price MBBS, Ed B.G. Barnard PhD

引用次数: 0

The Physiological Impact of Neonatal Air Transport: A Review of The Literature

Air Medical Journal Pub Date : 2025-01-01 DOI: 10.1016/j.amj.2024.10.003

Ian Braithwaite RN(CH), BEng, MSc, Cath Harrison BMedSci, BM, BS, DTM&H, FRCPCH

{"title":"The Physiological Impact of Neonatal Air Transport: A Review of The Literature","authors":"Ian Braithwaite RN(CH), BEng, MSc, Cath Harrison BMedSci, BM, BS, DTM&H, FRCPCH","doi":"10.1016/j.amj.2024.10.003","DOIUrl":"10.1016/j.amj.2024.10.003","url":null,"abstract":"<div><h3>Objective</h3><div>This review aims to enhance our understanding around whether neonatal air transport has an adverse physiological impact on patients.</div></div><div><h3>Methods</h3><div>A literature search included articles describing both ground and air transport. Eligible studies had to include patient outcome and/or response to the journey in such a way that the physiological impact of neonatal transport could be compared between the 2 groups.</div></div><div><h3>Results</h3><div>The search produced 13 eligible studies. Six were prospective observational cohort studies, and the remainder were retrospective. When assessing outcome, studies used a physiological stability score, the rate and severity of intraventricular hemorrhage, the type and frequency of clinical interventions during the journey, or a specific clinical parameter. Three of the studies sought to understand the physiological impact of transport by investigating the variation in the physical forces experienced.</div></div><div><h3>Conclusion</h3><div>The current published evidence does not suggest one mode of transport is preferable to another when considering patient stability and outcome. Neonatal fixed wing or helicopter transport has not been shown to be more physiologically challenging for the patient than road transport, even by teams who are regularly flying patients in the highest-risk groups (extremely preterm, in the first hours of life).</div></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"44 1","pages":"Pages 93-98"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143464312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

A Comparative Evaluation of Selection Processes for Helicopter Emergency Medical Service Paramedics in Australasia

Air Medical Journal Pub Date : 2025-01-01 DOI: 10.1016/j.amj.2024.11.012

Watudura Silva BBiomedSci , Ben Fisk PhD , Joanne N. Caldwell-Odgers PhD , Benjamin N. Meadley PhD

{"title":"A Comparative Evaluation of Selection Processes for Helicopter Emergency Medical Service Paramedics in Australasia","authors":"Watudura Silva BBiomedSci , Ben Fisk PhD , Joanne N. Caldwell-Odgers PhD , Benjamin N. Meadley PhD","doi":"10.1016/j.amj.2024.11.012","DOIUrl":"10.1016/j.amj.2024.11.012","url":null,"abstract":"<div><h3>Objective</h3><div>Providing transparency on the state of selection processes in helicopter emergency medical services (HEMS) across different services is a vital step in developing universal standards for HEMS aircrew. This study aimed to consolidate, rate, and evaluate information on selection processes from 9 HEMS across Australia and New Zealand.</div></div><div><h3>Methods</h3><div>This was a descriptive study combining objective and subjective assessment of selection to HEMS teams. Service leaders representing air medical services across Australasia participated in semistructured interviews to detail their selection processes. Selection assessments were then scored by independent subject matter experts (SMEs) using a predefined rating scale to evaluate characteristics of selection, including physiological intensity and task complexity. Furthermore, SMEs explored themes of service leaders’ opinions on selection to HEMS teams.</div></div><div><h3>Results</h3><div>In evaluating the objective data in the context of service demographics, this study found that although job tasks were similar between services, selection processes and components differed significantly. However, qualitative exploration of service leaders’ opinion on selection criteria, job tasks, and staff expectations closely aligned.</div></div><div><h3>Conclusion</h3><div>This study finds shortcomings in the state of HEMS team selection processes and suggests a critical job task analysis at each service to verify the qualitative evaluations. These results may aid HEMS team leadership in developing evidence-based selection tests to ensure equitable and fair processes at their services, ensuring staff are suitable and safe to perform their critical roles.</div></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"44 1","pages":"Pages 60-66"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143464112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Droplet Formation in Drugs During Extreme Temperature Conditions in the Emergency Medical Service, a Problem?

Air Medical Journal Pub Date : 2025-01-01 DOI: 10.1016/j.amj.2024.10.007

Johannes Moeckel MD , Volker Wenzel MD , Verena Angerer PhD , Roland Albrecht MD , Urs Pietsch MD

{"title":"Droplet Formation in Drugs During Extreme Temperature Conditions in the Emergency Medical Service, a Problem?","authors":"Johannes Moeckel MD , Volker Wenzel MD , Verena Angerer PhD , Roland Albrecht MD , Urs Pietsch MD","doi":"10.1016/j.amj.2024.10.007","DOIUrl":"10.1016/j.amj.2024.10.007","url":null,"abstract":"<div><h3>Objective</h3><div>Because of high-altitude operations, cold exposure is common for helicopter emergency medical services. However, drug emulsions such as propofol and etomidate are prone to degradation and the formation of lipid droplets, possibly large enough to cause pulmonary embolism, when frozen. Amiodarone may be prone to crystallization, possibly causing phlebitis, when exposed to cold temperatures. The aim of this study was to microscopically identify physical changes in common emergency drugs under cold exposure.</div></div><div><h3>Methods</h3><div>Exposure time frames and temperature ranges were chosen according to real-world data collected on a rescue helicopter in Switzerland. Samples were stored in a laboratory freezer with a temperature range of −2.3°C (27.7°F) for 1 hour, 0.6°C to −3.6°C (33.1°F-25.5°F) for 12 hours, and −22°C (−7.6°F) for 1 hour and 12 hours. Analysis was performed under a light microscope.</div></div><div><h3>Results</h3><div>No physical changes in the form of large lipid droplets or crystallization were found in the samples stored at −2.3°C (27.7°F). Lipid droplets were found in the propofol samples stored at 0.6°C to −3.4°C (33.1°F-25.5°F) and −22°C (−7.6°F) over 12 hours.</div></div><div><h3>Conclusion</h3><div>There was no observation of physical changes under temperature conditions commonly found in helicopter emergency medical services. However, lipid droplets could be observed in the propofol samples with long exposure times or under deep frozen temperature conditions. These findings highlight the need to establish a safe threshold for cold exposure of medications in the prehospital environment.</div></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"44 1","pages":"Pages 114-116"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143464126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Effect of a Standardized Education Program for Interhospital Transport of Critically Ill Patients on Knowledge and Confidence in South Korea: A Pilot Study

Air Medical Journal Pub Date : 2025-01-01 DOI: 10.1016/j.amj.2024.11.002

Hwayoon Jung EMT , Ki Hong Kim MD , Seulki Choi MD , Hanna Yoon MD , Garam Lee RN , Youdong Sohn MD, PhD , Young Sun Ro MD, DrPH , Kyoung Jun Song MD, PhD , Sang Do Shin MD, PhD

{"title":"Effect of a Standardized Education Program for Interhospital Transport of Critically Ill Patients on Knowledge and Confidence in South Korea: A Pilot Study","authors":"Hwayoon Jung EMT , Ki Hong Kim MD , Seulki Choi MD , Hanna Yoon MD , Garam Lee RN , Youdong Sohn MD, PhD , Young Sun Ro MD, DrPH , Kyoung Jun Song MD, PhD , Sang Do Shin MD, PhD","doi":"10.1016/j.amj.2024.11.002","DOIUrl":"10.1016/j.amj.2024.11.002","url":null,"abstract":"<div><div>Critical care transport (CCT) education and training for health care providers are important for patient safety. In this study, a structured education and training program for CCT was implemented as a pilot in South Korea, and the effects of improving knowledge and confidence among health care providers were evaluated. This retrospective observational study analyzed pre- and post-test scores and survey responses from participants in the education program. The education program consisted of a didactic lecture, skill practice, and simulation for 9 categories lasting 80 hours. The participants included nurses and emergency medical technicians with experience in emergency or critical care. The study consisted of 2 phases, with data collected through web-based evaluation forms and structured questionnaires. The program involved 20 participants across the 2 phases. Posteducation assessments revealed significant improvements in knowledge and confidence in CCT practices. The participants were especially satisfied with their skill in trauma management and advanced CCT simulations. The Korean Critical Care Transport Curriculum education program effectively enhanced the knowledge and confidence of health care providers in CCT. This standardized education model should be considered by policy makers and stakeholders to improve patient safety in emergency medical systems.</div></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"44 1","pages":"Pages 34-39"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143464139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Editor's Note: Priming the Pump

Air Medical Journal Pub Date : 2025-01-01 DOI: 10.1016/j.amj.2024.11.006

David J. Dries MSE, MD

引用次数: 0

Caretaker or Caregiver?

Air Medical Journal Pub Date : 2025-01-01 DOI: 10.1016/j.amj.2024.10.008

Janie Kofford Ford RN, CFRN, MSN, AGACNP-BC

引用次数: 0

Reducing Deep Sedation and Benzodiazepine Use in Mechanically Ventilated Patients During Critical Care Transport: A Quality Improvement Initiative 在危重监护运输过程中减少机械通气患者深度镇静和苯二氮卓类药物的使用：一项质量改进倡议

Air Medical Journal Pub Date : 2024-11-01 DOI: 10.1016/j.amj.2024.08.003

Matthew E. Anton MD , Antonia L. Altomare DO, MPH , Amanda R. Blais PharmD , Jeremy C. Patten NRP , Kalle J. Fjeld MD , Alyson M. Esteves PharmD, BCPS, BCCCP , Matthew A. Roginski MD, MPH

{"title":"Reducing Deep Sedation and Benzodiazepine Use in Mechanically Ventilated Patients During Critical Care Transport: A Quality Improvement Initiative","authors":"Matthew E. Anton MD , Antonia L. Altomare DO, MPH , Amanda R. Blais PharmD , Jeremy C. Patten NRP , Kalle J. Fjeld MD , Alyson M. Esteves PharmD, BCPS, BCCCP , Matthew A. Roginski MD, MPH","doi":"10.1016/j.amj.2024.08.003","DOIUrl":"10.1016/j.amj.2024.08.003","url":null,"abstract":"<div><h3>Objective</h3><div>Deep sedation of mechanically ventilated patients is associated with poorer outcomes, including longer hospital length of stay and more ventilator days. In contrast, light sedation is associated with decreased hospital and intensive care unit length of stay, lower ventilator days, and decreased mortality. This study sought to decrease the use of unindicated deep sedation and benzodiazepine use in mechanically ventilated patients during critical care transport. Previous work identified > 90% of intubated, nonparalyzed patients were deeply sedated in this critical care transport system.</div></div><div><h3>Methods</h3><div>This study was conducted at a critical care transport service affiliated with a rural academic medical center. Chart review of all mechanically ventilated adults transported between January and November 2023 with no indication for deep sedation was performed. Improvement initiatives were implemented using Plan-Do-Study-Act cycles and included transport crew education, guideline revision, and enhanced performance feedback.</div></div><div><h3>Results</h3><div>A 25% reduction in the proportion of deeply sedated patients was achieved.</div></div><div><h3>Conclusion</h3><div>Deep sedation is not universally indicated in critical care transport of mechanically ventilated patients. This quality improvement initiative achieved its main aim of reducing the proportion of deeply sedated patients by 25% with the implementation of 3 Plan-Do-Study-Act cycles.</div></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"43 6","pages":"Pages 512-517"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142758765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Anti-D Immunoglobulin May Have Effect if Given Within 10 Days 如果在10天内服用抗d免疫球蛋白可能有效果

Air Medical Journal Pub Date : 2024-11-01 DOI: 10.1016/j.amj.2024.09.009

Çiğdem Akalın Akkök MD, PhD, Emek Köse PhD

引用次数: 0