RESUMEN
AIM: Recently three large post product placement studies, comparing mechanical chest compression (cc) devices to those who received manual cc, found equivalent outcome results for both groups. Thus the question arises whether those results could be replicated using the devices on a daily routine. METHODS: We prospectively enrolled 948 patients over a 12 months period. Chi-Square test and Mann-Whitney-U test were used to assess differences between "manual" and "mechanical" cc subgroups. Uni- and multivariate Cox regression hazard analysis were used to assess the influence of cc type on survival. RESULTS: A mechanical cc device was used in 30.1% (n=283) cases. Patients who received mechanical cc had a significantly worse neurological outcome - measured in cerebral performance category (CPC) - than the manual cc group (56.8% vs. 78.6%, p=0.009). Patients receiving mechanical cc were significantly younger, more were male and were more likely to have bystander CPR and an initially shock-able ECG rhythm. There was no difference in the quality of CPR that might explain the worse outcome in mechanical cc patients. CONCLUSION: Even with high quality CPR in both, manual and mechanical cc groups, outcome in patients who received mechanical cc was significantly worse. The anticipated benefits of a higher compression ratio and a steadier compression depth of a mechanical cc device remain uncertain. In this study selection for mechanical cc was not standardized, and was non-random. This merits further investigation. Further research on how mechanical cc is chosen and used should be considered. CLINICAL TRIAL REGISTRATION: https://ekmeduniwien.at/core/catalog/2013/ (EK-Nr:1221/2013).
Asunto(s)
Reanimación Cardiopulmonar/métodos , Circulación Cerebrovascular/fisiología , Servicios Médicos de Urgencia , Masaje Cardíaco/instrumentación , Paro Cardíaco Extrahospitalario/terapia , Anciano , Anciano de 80 o más Años , Austria/epidemiología , Electrocardiografía , Diseño de Equipo , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Paro Cardíaco Extrahospitalario/mortalidad , Paro Cardíaco Extrahospitalario/fisiopatología , Presión , Pronóstico , Estudios Prospectivos , Tasa de Supervivencia/tendencias , Tórax , Factores de Tiempo , Resultado del TratamientoRESUMEN
BACKGROUND: The outcome of patients after out-of-hospital cardiac arrest (OHCA) is poor and gets worse after prolonged resuscitation. Recently introduced attempts like an early installed emergency extracorporeal life support (E-ECLS) in patients with persisting cardiac arrest at the emergency department (ED) are tried. The "Vienna Cardiac Arrest Registry" (VICAR) was introduced August 2013 to collect Utstein-style data. The aim of this observational study was to identify the incidence of patients which fulfil "load&go"-criteria for E-ECLS at the ED. METHODS: VICAR was retrospectively analyzed for following criteria: age <75 years; witnessed OHCA; basic life support; ventricular fibrillation/ventricular tachycardia; no return-of-spontaneous-circulation (ROSC) within 15 min of advanced-life-support, which were supposed as potential optimal criteria for "load&go" plus successful E-ECLS treatment at the ED. The observation period was from August 1, 2013 to July 31, 2014. RESULTS: Over 948 OHCA patients registered during the study period; data were exploitable for 864 patients. Of all patients, "load&go"-criteria were fulfilled by 55 (6%). However, 96 (11%) were transported with on-going CPR to the ED. Of these 96 patients, only 16 (17%) met the "load&go"-criteria. Similarly, among the 96 patients, 12 adults were treated with E-ECLS at the ED, with only 5 meeting the criteria. Among these 12 patients, favourable neurological outcome (CPC 1/2) was obtained in 1 patient without criteria. CONCLUSION: Further promotion of these criteria within the ambulance crews is needed. May be these criteria could serve as a decision support for emergency physicians/paramedics, which patients to transport with on-going CPR to the ED for E-ECLS.
Asunto(s)
Reanimación Cardiopulmonar/métodos , Oxigenación por Membrana Extracorpórea/métodos , Paro Cardíaco Extrahospitalario/terapia , Adulto , Anciano , Servicios Médicos de Urgencia , Servicio de Urgencia en Hospital , Oxigenación por Membrana Extracorpórea/estadística & datos numéricos , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Sistema de Registros , Estudios RetrospectivosRESUMEN
BACKGROUND: Carbon monoxide (CO) poisoning poses danger to both patients and emergency medical services (EMS) personnel, as its symptoms are nonspecific and EMS is currently not equipped to detect CO in ambient air. OBJECTIVE: We aimed to assess the degree of non-fire-related CO exposure at the high-volume EMS system of a city with 2 million inhabitants. METHODS: The EMS system was equipped with handheld CO detectors (Dräger Pac 3500), which were added to EMS standard backpacks and had to be carried to the patient at all times. During a period of one year, all alarms by those devices were recorded, sources of CO were confirmed by the fire department, and hospital follow-up was conducted for both patients and exposed EMS staff. RESULTS: During the study period, there were 40 alarms, including two false alarms. Alarms occurred during the whole year, with a peak during the winter months. The median ambient CO concentration was 167 parts per million; gas heating systems were the main source of CO. One hundred ten patients and 108 EMS personnel were exposed. One hundred fifteen persons, including 22 EMS staff, had to be hospitalized, which represents one out of 1,000 total EMS patients. CONCLUSIONS: Carbon monoxide poisoning was found to be a significant matter for a high-volume EMS system. Handheld CO detectors helped in identifying those cases. Key words: carbon monoxide; emergency care, prehospital; equipment and supplies; poisoning.