Mathias Maleczek, Karl Schebesta, Thomas Hamp, Achim Leo Burger, Thomas Pezawas, Mario Krammel, Bernhard Roessler
{"title":"ST-T segment changes in prehospital emergency physicians in the field: a prospective observational trial.","authors":"Mathias Maleczek, Karl Schebesta, Thomas Hamp, Achim Leo Burger, Thomas Pezawas, Mario Krammel, Bernhard Roessler","doi":"10.1186/s13049-022-01033-1","DOIUrl":"https://doi.org/10.1186/s13049-022-01033-1","url":null,"abstract":"<p><strong>Aims: </strong>Due to time-critical decision-making, physical strain and the uncontrolled environment, prehospital emergency management is frequently associated with high levels of stress in medical personnel. Stress has been known to cause ischemia like changes in electrocardiograms (ECGs), including arrhythmias and deviations in ST-T segments. There is a lack of knowledge regarding the occurrence of changes in ST-T segments in prehospital emergency physicians. We hypothesized that ST-T segment deviations occur in prehospital emergency physicians in the field.</p><p><strong>Methods: </strong>In this prospective observational trial, ST-T segments of emergency physicians were recorded using 12-lead Holter ECGs. The primary outcome parameter was defined as the incidence of ST-T segment changes greater than 0.1 mV in two corresponding leads for more than 30 s per 100 rescue missions. The secondary outcomes included T-wave inversions and ST-segment changes shorter than 30 s or smaller than 0.1 mV. Surrogate parameters of stress were measured using the NASA-Task Load Index and cognitive appraisal, and their correlation with ST-T segment changes were also assessed.</p><p><strong>Results: </strong>Data from 20 physicians in 36 shifts (18 days, 18 nights) including 208 missions were analysed. Seventy percent of previously healthy emergency physicians had at least one ECG abnormality; the mean duration of these changes was 30 s. Significantly more missions with ECG changes were found during night than day shifts (39 vs. 17%, p < 0.001). Forty-nine ECG changes occurred between missions. No ST-T segment changes > 30 s and > 0.1 mV were found. Two ST-T segment changes < 30 s or < 0.1 mV (each during missions) and 122 episodes of T-wave inversions (74 during missions) were identified. ECG changes were found to be associated with alarms when asleep and NASA task load index.</p><p><strong>Conclusion: </strong>ECG changes are frequent and occur in most healthy prehospital emergency physicians. Even when occurring for less than 30 s, such changes are important signs for high levels of stress. The long-term impact of these changes needs further investigation. Trial registration The trial was registered at ClinicalTrials.gov (NCT04003883) on 1.7.2019: https://clinicaltrials.gov/ct2/show/NCT04003883?term=emergency+physician&rank=2.</p>","PeriodicalId":501057,"journal":{"name":"Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine","volume":" ","pages":"47"},"PeriodicalIF":3.3,"publicationDate":"2022-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9288087/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40509505","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}
James Price, Kate Lachowycz, Alistair Steel, Lyle Moncur, Rob Major, Ed B G Barnard
{"title":"Intubation success in prehospital emergency anaesthesia: a retrospective observational analysis of the Inter-Changeable Operator Model (ICOM).","authors":"James Price, Kate Lachowycz, Alistair Steel, Lyle Moncur, Rob Major, Ed B G Barnard","doi":"10.1186/s13049-022-01032-2","DOIUrl":"https://doi.org/10.1186/s13049-022-01032-2","url":null,"abstract":"<p><strong>Background: </strong>Pre hospital emergency anaesthesia (PHEA) is a complex procedure with significant risks. First-pass intubation success (FPS) is recommended as a quality indicator in pre hospital advanced airway management. Previous data demonstrating significantly lower FPS by non-physicians does not distinguish between non-physicians operating in isolation or within physician teams. In several UK HEMS, the role of the intubating provider is interchangeable between the physician and critical care paramedic-termed the Inter-Changeable Operator Model (ICOM). The objectives of this study were to compare first-pass intubation success rate between physicians and critical care paramedics (CCP) in a large regional, multi-organisational dataset of trauma PHEA patients, and to report the application of the ICOM.</p><p><strong>Methods: </strong>A retrospective observational study of consecutive trauma patients ≥ 16 years old who underwent PHEA at two different ICOM Helicopter Emergency Medical Services in the East of England, 2015-2020. Data are presented as number (percentage) and median [inter-quartile range]. Fisher's exact test was used to compare proportions, reported as odds ratio (OR (95% confidence interval, 95% CI)), p value. The study design complied with the STROBE (Strengthening The Reporting of Observational studies in Epidemiology) reporting guidelines.</p><p><strong>Results: </strong>In the study period, 13,654 patients were attended. 674 (4.9%) trauma patients ≥ 16 years old who underwent PHEA were included in the final analysis: the median age was 44 [28-63] years old, and 502 (74.5%) were male. There was no significant difference in the FPS rate between physicians and CCPs-90.2% and 87.4% respectively, OR 1.3 (95% CI 0.7-2.5), p = 0.38. The cumulative first, second, third, and fourth-pass intubation success rates were 89.6%, 98.7%, 99.7%, and 100%. Patients who had a physician-operated initial intubation attempt weighed more and had a higher heart rate, compared to those who had a CCP-operated initial attempt.</p><p><strong>Conclusion: </strong>In an ICOM setting, we demonstrated 100% intubation success in adult trauma patients undergoing PHEA. There was no significant difference in first-pass intubation success between physicians and CCPs.</p>","PeriodicalId":501057,"journal":{"name":"Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine","volume":" ","pages":"44"},"PeriodicalIF":3.3,"publicationDate":"2022-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9264686/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40483100","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}
{"title":"Removal of the cervical collar from alpine rescue protocols? A biomechanical non-inferiority trial in real-life mountain conditions.","authors":"Guillaume Grenier, Marc-Antoine Despatis, Karina Lebel, Mathieu Hamel, Camille Martin, Patrick Boissy","doi":"10.1186/s13049-022-01031-3","DOIUrl":"https://doi.org/10.1186/s13049-022-01031-3","url":null,"abstract":"<p><strong>Background: </strong>Alpine skiing rescues are challenging because of the mountainous environment and risks of cervical spine motion (CSM) induced during victims' extrications (EXs) and downhill evacuations (DEs). The benefits of applying a cervical collar (CC) over manual in-line stabilization without CC (MILS) in terms of spinal motion restriction during simulated alpine rescues are undocumented. Our hypothesis was that CSM recorded using MILS alone is non-inferior to CSM recorded with a CC according to a 10 degrees margin.</p><p><strong>Methods: </strong>A total of 32 alpine extrications and 4 downhill evacuations on different slope conditions were performed using a high fidelity mannequin designed with a motion sensors instrumented cervical spine. The primary outcome was the peak extrication 3D excursion angle (Peak 3D θ<sub>EX,</sub>) of the mannequin's head. The secondary objectives were to describe the time to extrication completion (tEX) and to highlight which extrication manipulation is more likely to induce CSM.</p><p><strong>Results: </strong>The median Peak 3D θ<sub>EX</sub> recorded during flat terrain extrications using CC was 10.77° (95% CI 7.31°-16.45°) compared to 13.06° (95% CI 10.20°-30.36°) using MILS, and 16.09° (95% CI 9.07°-37.43°) for CC versus 16.65° (95% CI 13.80°-23.40°) using MILS on a steep slope. Peak 3D θ<sub>EX</sub> with CC or using MILS during extrications were equivalent according to a 10 degrees non-inferiority hypothesis testing (p < 0.05). Time to extrication completion (tEX) was significantly reduced using MILS without CC on a flat terrain with a median duration of 237,3 s (95% CI 197.8 s, 272.2 s) compared to 358.7 s (95% CI 324.1 s, 472.4 s). During downhill evacuations, CSM with and without CC across all terrain conditions were negligible (< 5°). When CC is used; its installation manipulation induces the highest CSM. When EXs are done using MILS without CC, the logroll initiation is the manipulation inducing the highest risk of CSM.</p><p><strong>Conclusion: </strong>For experienced ski patrollers, the biomechanical benefits of spinal motion restriction provided by CC over MILS during alpine skiing rescues appear to be marginal and CC use negatively affects rescue time.</p>","PeriodicalId":501057,"journal":{"name":"Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine","volume":" ","pages":"42"},"PeriodicalIF":3.3,"publicationDate":"2022-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9235139/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40405913","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}
Tim Nutbeam, Rob Fenwick, Jason E Smith, Mike Dayson, Brian Carlin, Mark Wilson, Lee Wallis, Willem Stassen
{"title":"A Delphi study of rescue and clinical subject matter experts on the extrication of patients following a motor vehicle collision.","authors":"Tim Nutbeam, Rob Fenwick, Jason E Smith, Mike Dayson, Brian Carlin, Mark Wilson, Lee Wallis, Willem Stassen","doi":"10.1186/s13049-022-01029-x","DOIUrl":"https://doi.org/10.1186/s13049-022-01029-x","url":null,"abstract":"<p><strong>Background: </strong>Approximately 1.3 million people die each year globally as a direct result of motor vehicle collisions (MVCs). Following an MVC some patients will remain trapped in their vehicle; these patients have worse outcomes and may require extrication. Following new evidence, updated multidisciplinary guidance for extrication is needed.</p><p><strong>Methods: </strong>This Delphi study has been developed, conducted and reported to CREDES standards. A literature review identified areas of expertise and appropriate individuals were recruited to a Steering Group. The Steering Group formulated initial statements for consideration. Stakeholder organisations were invited to identify subject matter experts (SMEs) from a rescue and clinical background (total 60). SMEs participated over three rounds via an online platform. Consensus for agreement / disagreement was set at 70%. At each stage SMEs could offer feedback on, or modification to the statements considered which was reviewed and incorporated into new statements or new supporting information for the following rounds. Stakeholders agreed a set of principles based on the consensus statements on which future guidance should be based.</p><p><strong>Results: </strong>Sixty SMEs completed Round 1, 53 Round 2 (88%) and 49 Round 3 (82%). Consensus was reached on 91 statements (89 agree, 2 disagree) covering a broad range of domains related to: extrication terminology, extrication goals and approach, self-extrication, disentanglement, clinical care, immobilisation, patient-focused extrication, emergency services call and triage, and audit and research standards. Thirty-three statements did not reach consensus.</p><p><strong>Conclusion: </strong>This study has demonstrated consensus across a large panel of multidisciplinary SMEs on many key areas of extrication and related practice that will provide a key foundation in the development of evidence-based guidance for this subject area.</p>","PeriodicalId":501057,"journal":{"name":"Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine","volume":" ","pages":"41"},"PeriodicalIF":3.3,"publicationDate":"2022-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9208189/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40103874","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}
Martina Hermann, Christina Hafner, Vincenz Scharner, Mojca Hribersek, Mathias Maleczek, Andreas Schmid, Eva Schaden, Harald Willschke, Thomas Hamp
{"title":"Remote real-time supervision of prehospital point-of-care ultrasound: a feasibility study.","authors":"Martina Hermann, Christina Hafner, Vincenz Scharner, Mojca Hribersek, Mathias Maleczek, Andreas Schmid, Eva Schaden, Harald Willschke, Thomas Hamp","doi":"10.1186/s13049-021-00985-0","DOIUrl":"10.1186/s13049-021-00985-0","url":null,"abstract":"<p><strong>Background: </strong>Although prehospital point-of-care ultrasound (POCUS) is gaining in importance, its rapid interpretation remains challenging in prehospital emergency situations. The technical development of remote real-time supervision potentially offers the possibility to support emergency medicine providers during prehospital emergency ultrasound. The aim of this study was to assess the feasibility of live data transmission and supervision of prehospital POCUS in an urban environment and so to improve patients' safety.</p><p><strong>Methods: </strong>Emergency doctors with moderate ultrasound experience performed prehospital POCUS in emergency cases (n = 24) such as trauma, acute dyspnea or cardiac shock using the portable ultrasound device Lumify™. The ultrasound examination was remotely transmitted to an emergency ultrasound expert in the clinic for real-time supervision via a secure video and audio connection. Technical feasibility as well as quality of communication and live stream were analysed.</p><p><strong>Results: </strong>Prehospital POCUS with remote real-time supervision was successfully performed in 17 patients (71%). In 3 cases, the expert was not available on time and in 1 case remote data transmission was not possible due to connection problems. In 3 cases tele-supervision was restricted to video only and no verbal communication was possible via the device itself due to power saving mode of the tablet.</p><p><strong>Conclusion: </strong>Remote real-time supervision of prehospital POCUS in an urban environment is feasible most of the time with excellent image and communication quality.</p><p><strong>Trial registration: </strong>ClinicalTrials Number NCT04612816.</p>","PeriodicalId":501057,"journal":{"name":"Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine","volume":" ","pages":"23"},"PeriodicalIF":0.0,"publicationDate":"2022-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8944068/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40326632","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}
{"title":"Letter to the editor in response to \"A 6-year case series of resuscitative thoracotomies performed by a helicopter emergency medical service in a mixed urban and rural area with a comparison of blunt versus penetrating trauma\".","authors":"E Ter Avest, L Carenzo","doi":"10.1186/s13049-022-01011-7","DOIUrl":"https://doi.org/10.1186/s13049-022-01011-7","url":null,"abstract":"","PeriodicalId":501057,"journal":{"name":"Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine","volume":" ","pages":"21"},"PeriodicalIF":3.3,"publicationDate":"2022-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8935825/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40311636","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}
{"title":"A cohort study of trauma patients in Sweden during the first months of the COVID-19 pandemic: a small reduction in trauma admissions.","authors":"Denise Bäckström, Andreas Wladis","doi":"10.1186/s13049-022-01001-9","DOIUrl":"https://doi.org/10.1186/s13049-022-01001-9","url":null,"abstract":"<p><strong>Background: </strong>Given that Swedish authorities have been widely viewed as having practiced an unusual approach to the COVID-19 pandemic and given that Sweden is notable for a low incidence of trauma, we wanted to learn how the pandemic may have affected the number of trauma admissions in Sweden.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study based on the Swedish trauma registry (Svenska Traumaregistret). The study period was March 1, 2020 to June 30, 2020. As a basis for comparison, the record for the same time during the previous year, 2019 was used.</p><p><strong>Results: </strong>During the four months of the first wave of COVID-19, 2020 there was a decline of 24.2% in the total number of trauma patients in Sweden. There was no significant change in 30-day mortality rates, 4.7% 2019 and 5.1% 2020, (p = 0.30). The number of injuries per patient was higher during the pandemic 3.8 injuries 2019 and 4.1 injuries 2020 (p = 0.02). The NISS 6, 2019 and 8, 2020 was higher during the pandemic.</p><p><strong>Conclusions: </strong>As a consequence of what were seen by many as all too lenient actions taken to deal with COVID-19 in Sweden during spring 2020, there was still a reduction in trauma admissions most likely due to an adherence to the voluntary recommendations, the reduction was not as prominent as what was seen in many countries with harsher restrictions and lockdowns.</p>","PeriodicalId":501057,"journal":{"name":"Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine","volume":" ","pages":"12"},"PeriodicalIF":3.3,"publicationDate":"2022-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8857878/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39799237","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}
Camilla Metelmann, Bibiana Metelmann, Michael P Müller, Bernd W Böttiger, Georg Trummer, Karl Christian Thies
{"title":"First responder systems can stay operational under pandemic conditions: results of a European survey during the COVID-19 pandemic.","authors":"Camilla Metelmann, Bibiana Metelmann, Michael P Müller, Bernd W Böttiger, Georg Trummer, Karl Christian Thies","doi":"10.1186/s13049-022-00998-3","DOIUrl":"https://doi.org/10.1186/s13049-022-00998-3","url":null,"abstract":"<p><strong>Background: </strong>Dispatching first responders (FR) to out-of-hospital cardiac arrest in addition to the emergency medical service has shown to increase survival. The promising development of FR systems over the past years has been challenged by the outbreak of COVID-19. Whilst increased numbers and worse outcomes of cardiac arrests during the pandemic suggest a need for expansion of FR schemes, appropriate risk management is required to protect first responders and patients from contracting COVID-19. This study investigated how European FR schemes were affected by the pandemic and what measures were taken to protect patients and responders from COVID-19.</p><p><strong>Methods: </strong>To identify FR schemes in Europe we conducted a literature search and a web search. The schemes were contacted and invited to answer an online questionnaire during the second wave of the pandemic (December 2020/ January 2021) in Europe.</p><p><strong>Results: </strong>We have identified 135 FR schemes in 28 countries and included responses from 47 FR schemes in 16 countries. 25 schemes reported deactivation due to COVID-19 at some point, whilst 22 schemes continued to operate throughout the pandemic. 39 schemes communicated a pandemic-specific algorithm to their first responders. Before the COVID-19 outbreak 20 FR systems did not provide any personal protective equipment (PPE). After the outbreak 19 schemes still did not provide any PPE. The majority of schemes experienced falling numbers of accepted call outs and decreasing registrations of new volunteers. Six schemes reported of FR having contracted COVID-19 on a mission.</p><p><strong>Conclusions: </strong>European FR schemes were considerably affected by the pandemic and exhibited a range of responses to protect patients and responders. Overall, FR schemes saw a decrease in activity, which was in stark contrast to the high demand caused by the increased incidence and mortality of OHCA during the pandemic. Given the important role FR play in the chain of survival, a balanced approach upholding the safety of patients and responders should be sought to keep FR schemes operational.</p>","PeriodicalId":501057,"journal":{"name":"Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine","volume":" ","pages":"10"},"PeriodicalIF":3.3,"publicationDate":"2022-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8857892/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39799231","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}
Phillip Almond, Sarah Morton, Matthew OMeara, Neal Durge
{"title":"A 6-year case series of resuscitative thoracotomies performed by a helicopter emergency medical service in a mixed urban and rural area with a comparison of blunt versus penetrating trauma.","authors":"Phillip Almond, Sarah Morton, Matthew OMeara, Neal Durge","doi":"10.1186/s13049-022-00997-4","DOIUrl":"https://doi.org/10.1186/s13049-022-00997-4","url":null,"abstract":"<p><strong>Background: </strong>Resuscitative thoracotomy (RT) is an intervention that can be performed in the prehospital setting for relieving cardiac tamponade and/or obtaining vascular control of suspected sub-diaphragmatic haemorrhage in patients in traumatic cardiac arrest. The aim of this retrospective case study is to compare the rates of return of spontaneous circulation (ROSC) in RTs performed for both penetrating and blunt trauma over 6 years in a mixed urban and rural environment.</p><p><strong>Methods: </strong>The electronic records of a single helicopter emergency medical service were reviewed between 1st June 2015 and 31st May 2021 for RTs. Anonymised data including demographics were extracted for relevant cases. Data were analysed with independent t-tests and Χ<sup>2</sup> tests. A p value < 0.05 was considered statistically significant.</p><p><strong>Results: </strong>Forty-four RTs were preformed within the 6 years (26 for blunt trauma). Eleven ROSCs were achieved (nine blunt, two penetrating) but no patient survived to discharge. In contrast to RTs for penetrating trauma, twelve of the RTs for blunt trauma had a cardiac output present on arrival of the prehospital team (p = 0.01). Two patients had an RT performed in a helicopter (one ROSC) and two on a helipad (both achieving ROSC), likely due to the longer transfer times seen in a more rural setting. Four of the RTs for blunt trauma (15%) were found to have a cardiac tamponade versus seven (39%) of the penetrating trauma RTs.</p><p><strong>Conclusion: </strong>Prehospital RT remains a procedure with low rates of survival but may facilitate a ROSC to allow patients to reach hospital and surgery, particularly when distances to hospitals are greater. A higher-than-expected rate of cardiac tamponade was seen in RTs for blunt trauma, although not caused by a right ventricular wound but instead due to underlying vessel damage.</p>","PeriodicalId":501057,"journal":{"name":"Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine","volume":" ","pages":"8"},"PeriodicalIF":3.3,"publicationDate":"2022-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8793242/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39963831","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}
SungJoon Park, Sung Woo Lee, Kap Su Han, Eui Jung Lee, Dong-Hyun Jang, Si Jin Lee, Ji Sung Lee, Su Jin Kim
{"title":"Optimal cardiopulmonary resuscitation duration for favorable neurological outcomes after out-of-hospital cardiac arrest.","authors":"SungJoon Park, Sung Woo Lee, Kap Su Han, Eui Jung Lee, Dong-Hyun Jang, Si Jin Lee, Ji Sung Lee, Su Jin Kim","doi":"10.1186/s13049-022-00993-8","DOIUrl":"https://doi.org/10.1186/s13049-022-00993-8","url":null,"abstract":"<p><strong>Background: </strong>A favorable neurological outcome is closely related to patient characteristics and total cardiopulmonary resuscitation (CPR) duration. The total CPR duration consists of pre-hospital and in-hospital durations. To date, consensus is lacking on the optimal total CPR duration. Therefore, this study aimed to determine the upper limit of total CPR duration, the optimal cut-off time at the pre-hospital level, and the time to switch from conventional CPR to alternative CPR such as extracorporeal CPR.</p><p><strong>Methods: </strong>We conducted a retrospective observational study using prospective, multi-center registry of out-of-hospital cardiac arrest (OHCA) patients between October 2015 and June 2019. Emergency medical service-assessed adult patients (aged ≥ 18 years) with non-traumatic OHCA were included. The primary endpoint was a favorable neurological outcome at hospital discharge.</p><p><strong>Results: </strong>Among 7914 patients with OHCA, 577 had favorable neurological outcomes. The optimal cut-off for pre-hospital CPR duration in patients with OHCA was 12 min regardless of the initial rhythm. The optimal cut-offs for total CPR duration that transitioned from conventional CPR to an alternative CPR method were 25 and 21 min in patients with initial shockable and non-shockable rhythms, respectively. In the two groups, the upper limits of total CPR duration for achieving a probability of favorable neurological outcomes < 1% were 55-62 and 24-34 min, respectively, while those for a cumulative proportion of favorable neurological outcome > 99% were 43-53 and 45-71 min, respectively.</p><p><strong>Conclusions: </strong>Herein, we identified the optimal cut-off time for transitioning from pre-hospital to in-hospital settings and from conventional CPR to alternative resuscitation. Although there is an upper limit of CPR duration, favorable neurological outcomes can be expected according to each patient's resuscitation-related factors, despite prolonged CPR duration.</p>","PeriodicalId":501057,"journal":{"name":"Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine","volume":" ","pages":"5"},"PeriodicalIF":3.3,"publicationDate":"2022-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8760684/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39823675","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}