AAGBI: Safer pre-hospital anaesthesia 2017

Lockey, David; Crewdson, Kate; Davies, Gareth E.; Jenkins, B. J.; Klein, A. A.; Laird, Colville; Mahoney, Peter F.; Nolan, Jerry P.; Pountney, A.; Shinde, Sandeep; Tighe, S. Q. M.; Russell, M. Q.; Price, James; Wright, Cassandra J. C.

doi:10.1111/anae.13779

Cited by 107 publications

(91 citation statements)

References 46 publications

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“…A new RSI protocol was introduced in March 2015 to standardise practices and improve teamwork as recommended in recent guidelines . The protocol is a comprehensive process description of the missions, including RSI, defining all actions from getting the alert to handing over the patient at the hospital.…”

Section: Methodsmentioning

confidence: 99%

A before‐and‐after observational study of a protocol for use of the C‐MAC videolaryngoscope with a Frova introducer in pre‐hospital rapid sequence intubation

2018

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Results using videolaryngoscopy in pre-hospital rapid sequence intubation are mixed. A bougie is not commonly used with videolaryngoscopy. We hypothesised that using videolaryngoscopy and a bougie as core elements of a standardised protocol that includes a drugs and a laryngoscopy algorithm would result in a high first-pass tracheal intubation success rate. We employed videolaryngoscopy (C-MAC) combined with a bougie (Frova intubating introducer) in an anaesthetist-staffed helicopter emergency medical service. Data for adult tracheal intubation were collected prospectively as part of the airway registry of our unit for 22 months after implementation of the protocol (n = 543) and compared with controls (n = 238) treated in the previous year before the implementation. The mean first-pass success rate (95%CI) was 98.2% (96.6-99.0%) in the study group and 85.7% (80.7-89.6%) in the control group, p < 0.0001. Combining C-MAC videolaryngoscopy and bougie with a standardised rapid sequence induction protocol leads to a high first attempt intubation success rate when performed by an anaesthetist-led helicopter emergency medical service team.

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Section: Methodsmentioning

confidence: 99%

A before‐and‐after observational study of a protocol for use of the C‐MAC videolaryngoscope with a Frova introducer in pre‐hospital rapid sequence intubation

2018

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“…In addition, point‐of‐care testing, combined with standard laboratory tests, allows the goal‐directed administration of fibrinogen and other coagulation factors and transfusion of allogeneic blood products in order to immediately treat trauma‐induced coagulopathy . This new approach to haemostatic resuscitation is one of the key elements in the European Trauma Treatment Guidelines , alongside admission of patients to designated trauma centres , whole‐body computed tomography (CT) trauma scans on admission, damage control surgery, permissive hypotension, restrictive fluid resuscitation and administration of tranexamic acid.…”

Section: Introductionmentioning

confidence: 99%

Change of transfusion and treatment paradigm in major trauma patients

et al. 2017

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Trauma promotes trauma-induced coagulopathy, which requires urgent treatment with fixed-ratio transfusions of red blood cells, fresh frozen plasma and platelet concentrates, or goal-directed administration of coagulation factors based on viscoelastic testing. This retrospective observational study compared two time periods before (2005-2007) and after (2012-2014) the implementation of changes in trauma management protocols which included: use of goal-directed coagulation management; admission of patients to designated trauma centres; whole-body computed tomography scanning on admission; damage control surgery; permissive hypotension; restrictive fluid resuscitation; and administration of tranexamic acid. The incidence of massive transfusion (≥ 10 units of red blood cells from emergency department arrival until intensive care unit admission) was compared with the predicted incidence according to the trauma associated severe haemorrhage score. All adult (≥ 16 years) trauma patients primarily admitted to the University Hospital Zürich with an injury severity score ≥ 16 were included. In 2005-2007, the observed and trauma associated severe haemorrhage score that predicted the incidence of massive transfusion were identical, whereas in 2012-2014 the observed incidence was less than half that predicted (3.7% vs. 7.5%). Compared to 2005-2007, the proportion of patients transfused with red blood cells and fresh frozen plasma was significantly lower in 2012-2014 in both the emergency department (43% vs. 17%; 31% vs. 6%, respectively), and after 24 h (53% vs. 27%; 37% vs. 16%, respectively). The use of tranexamic acid and coagulation factor XIII also increased significantly in the 2012-2014 time period. Implementation of a revised trauma management strategy, which included goal-directed coagulation management, was associated with a reduced incidence of massive transfusion and a reduction in the transfusion of red blood cells and fresh frozen plasma.

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“…TVAA introduced CPIs for Pre‐Hospital Emergency Anaesthesia (PHEA) in March 2017 following recommendations in the AAGBI document “Safer pre‐hospital anaesthesia 2017.” Following the success of this process, it was decided to develop performance indicators for pre‐hospital blood transfusion.…”

Section: Discussionmentioning

confidence: 99%

Developing clinical performance indicators for pre‐hospital blood transfusion: The Thames Valley Air Ambulance approach

Raitt¹,

Curry

Lewis³

et al. 2020

Transfusion Medicine

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Objective: In this article, we describe how we developed and validated key performance indicators (KPIs) for pre-hospital blood transfusion and offer suggestions for other organisations wishing to develop performance metrics.Background: KPIs are metrics that compare actual care against an ideal structure, process or outcome standard. An increasing number of UK-based pre-hospital critical care services now carry blood components to enable pre-hospital blood transfusion.Methods: A working group of pre-hospital physicians and paramedics was formed to create and validate performance indicators that reflected a high-quality pre-hospital transfusion. This was performed by literature searching and reviewing consensus documents that guide the best practice and then adjusting the indicators as the process evolved. Results: Throughout the year, the performance against the domains was monitored monthly and outputs communicated within the clinical staff of the organisation; at the end of the year, the domains were amended. The final list of performance indicators was as follows: (a) rationale for transfusion documented in the notes; (b) rationale for transfusion in line with Thames Valley Air Ambulance blood transfusion guideline; (c) aggressive management of hypothermia; (d) tranexamic acid administered within an hour of injury; (e) evidence of bleeding in hospital; (f) monitoring of adverse effects of blood transfusion; (g) overall-was the use of blood justified; and (h) no units wasted this month. Conclusions:This study has shown that it is feasible to devise and implement clinical performance indicators for pre-hospital blood transfusion and that their use has increased the focus on this important area.

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AAGBI: Safer pre-hospital anaesthesia 2017

Cited by 107 publications

References 46 publications

A before‐and‐after observational study of a protocol for use of the C‐MAC videolaryngoscope with a Frova introducer in pre‐hospital rapid sequence intubation

A before‐and‐after observational study of a protocol for use of the C‐MAC videolaryngoscope with a Frova introducer in pre‐hospital rapid sequence intubation

Change of transfusion and treatment paradigm in major trauma patients

Developing clinical performance indicators for pre‐hospital blood transfusion: The Thames Valley Air Ambulance approach

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