One year experience with fast track algorithm in patients with refractory out-of-hospital cardiac arrest

Adler, Christoph; Paul, C.; Michels, Guido; Pfister, Roman; Sabashnikov, Anton; Hinkelbein, Jochen; Braumann, Simon; Djordjevic, llija; Blomeyer, Ralf; Krings, A.; Böttiger, Bernd W.; Baldus, Stephan; Stangl, R.

doi:10.1016/j.resuscitation.2019.07.035

Cited by 24 publications

(13 citation statements)

References 32 publications

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“…However, in patients being airlifted with ongoing CPR, we found that there is a relevant proportion of cases without recommended indication regarding reversible causes of cardiac arrest, suggesting an individual interpretation of the situation. The poor prognosis in this group of patients, with only 3% survival at discharge, is in accordance with recent studies [19,20]. However, precise criteria for patient selection and timing are still lacking.…”

Section: Discussionsupporting

confidence: 89%

Mechanical chest compression devices in the helicopter emergency medical service in Switzerland

Pietsch

Reiser

Wenzel

et al. 2020

Scand J Trauma Resusc Emerg Med

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Background: Over the past years, several emergency medical service providers have introduced mechanical chest compression devices (MCDs) in their protocols for cardiopulmonary resuscitation (CPR). Especially in helicopter emergency medical systems (HEMS), which have limitations regarding loading weight and space and typically operate in rural and remote areas, whether MCDs have benefits for patients is still unknown. The aim of this study was to evaluate the use of MCDs in a large Swiss HEMS system. Materials and methods: We conducted a retrospective observational study of all HEMS missions of Swiss Air rescue Rega between January 2014 and June 2016 with the use of an MCD (Autopulse®). Details of MCD use and patient outcome are reported from the medical operation journals and the hospitals' discharge letters. Results: MCDs were used in 626 HEMS missions, and 590 patients (94%) could be included. 478 (81%) were primary missions and 112 (19%) were interhospital transfers. Forty-nine of the patients in primary missions were loaded under ongoing CPR with MCDs. Of the patients loaded after return of spontaneous circulation (ROSC), 20 (7%) experienced a second CA during the flight. In interhospital transfers, 102 (91%) only needed standby use of the MCD. Five (5%) patients were loaded into the helicopter with ongoing CPR. Five (5%) patients went into CA during flight and the MCD had to be activated. A shockable cardiac arrhythmia was the only factor significantly associated with better survival in resuscitation missions using MCD (OR 0.176, 95% confidence interval 0.084 to 0.372, p < 0.001). Conclusion: We conclude that equipping HEMS with MCDs may be beneficial, with non-trauma patients potentially benefitting more than trauma patients.

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Section: Discussionsupporting

confidence: 89%

Mechanical chest compression devices in the helicopter emergency medical service in Switzerland

Pietsch

Reiser

Wenzel

et al. 2020

Scand J Trauma Resusc Emerg Med

View full text Add to dashboard Cite

show abstract

“…However, in patients being airlifted with ongoing CPR, we found that there is a relevant proportion of cases without recommended indication regarding reversible causes of cardiac arrest, suggesting an individual interpretation of the situation. The poor prognosis in this group of patients, with 3% survival at discharge, is in accordance with recent studies (17,18). However, precise criteria and timing for patient selection are still lacking.…”

Section: Discussionsupporting

confidence: 88%

“…However, precise criteria and timing for patient selection are still lacking. On the other hand, there is an increasing amount of literature showing that carefully selected patients may bene t from early transport with ongoing CPR for further treatment (17)(18)(19).…”

Section: Discussionmentioning

confidence: 99%

Mechanical Chest Compression Devices in the Helicopter Emergency Medical Service in Switzerland

Pietsch

Reiser

Wenzel³

et al. 2020

Preprint

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Background Over the past years, several emergency medical service providers have introduced mechanical chest compression devices (MCDs) in their protocols for cardiopulmonary resuscitation (CPR). Especially in helicopter emergency medical systems (HEMS), which have limitations regarding loading weight and space and typically operate in rural and remote areas, whether MCDs have benefits for patients is still unknown. The aim of this study was to evaluate the use of MCDs in a large Swiss HEMS system. Materials and Methods We conducted a retrospective observational study of all HEMS missions of Swiss Air rescue Rega between January 2014 and June 2016 with the use an MCD (Autopulse®). Details of MCD use and patient outcome are reported from the medical operation journals and the hospitals’ discharge letters. Results MCDs were used in 626 HEMS missions and 590 patients (94%) could be included. 478 (81%) were primary missions and 112 (19%) were interhospital transfers. 49 of the patients in primary missions were loaded under ongoing CPR with MCDs. In the patients loaded after return of spontaneous circulation (ROSC), 20 (7%) experienced a second CA during the flight. In interhospital transfers 102 (91%) only needed standby use of the MCD. Five (4.5%) patients were loaded into the helicopter with ongoing CPR. Five (4.5%) patients went into CA during flight and the MCD had to be activated. Conclusion We conclude that equipping HEMS with MCDs may be beneficial, with non-trauma patients potentially benefitting more than trauma patients.

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“…Overall, the rate of survival in patients transported by EMS under cardiopulmonary resuscitation is low, which is supported by current literature, but outcome data differs widely due to different study settings and criteria [16][17][18]. If patients with refractory cardiac arrest are transported early and with high quality CPR this might improves outcome [19]. One reason for 100% fatal outcome in our subgroup was, that patients quali ed for veno-arterial extracorporal life support (V-A-ECLS) under cardiopulmonary resuscitation bypassed the ED and were directly transferred to our cardiologic ICU via EMS.…”

Section: Discussionmentioning

confidence: 72%

Short-Term Outcome and Characteristics of Critical Care for Non-Trauma Patients in the Emergency Department

Kreß

Rüppel

Haake

et al. 2020

Preprint

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Background: Emergency medical care for critically ill patients varies between different emergency departments (ED) and health care systems, while resuscitation of trauma patients is always performed within the ED. In many ED critically ill patients are treated and stabilized while in many German ED they are transferred to intensive care units (ICU) without performing of critical care measures in the ED. Against this background we conducted this retrospective analysis of prospectively collected critically ill patients treated with an ED critical care concept in a 754-bed teaching hospital. Methods: The collective of prospectively collected critically ill patients (October 1st 2018 to March 31st 2019) was analysed after ethical approval. Patient characteristics, performed critical care measures, short-term outcomes and the comparison of admission characteristics between survivors and non-survivors were evaluated. Additionally the accordance of ED diagnoses and discharge diagnoses were analysed.Results: Overall 243/19,854 patients (1.22%) were treated within the resuscitation room. After exclusion of trauma patients, 193 critically ill patients were included. Overall mortality was 29% (n=56), 24-hour mortality was 13% (n=25). Patient characteristics (vital signs, blood gas analysis) differed significantly between survivors and non-survivors except for respiratory rate and pain scale. Conducted critical care measures (number ± standard deviation; e.g. endotracheal intubation, arterial-line): 4.06±1.73 (survivors) and 4.70±2.0 (non-survivors) p=0.0453. The length of ED stay was 148.2±202.7 min. Admission diagnoses matched with hospital discharge diagnoses in 73.7%.Conclusions: Critical care stabilisation of non-trauma patients was feasible in routine care. The observed mortality was high and non-survivors showed significantly more impaired vital parameters and blood gas analysis parameters. Vital parameters together with blood gas analysis enable ED risk stratification of CIP. Although a first diagnostic workup was performed within the ED, admission and discharge diagnoses matched only in 73.7%. However, stabilisation and diagnostic workup of CIP enables optimal allocation to specialized ICUs. Future (randomised) trials have to evaluate of resuscitation room stabilisation for non-trauma patients is beneficial in contrast to direct ICU admission. Trial registration: The study was registered retrospectively in the Clinical Trials Centre of the RWTH Aachen University (Germany), registration number CTC-A 20-131.

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One year experience with fast track algorithm in patients with refractory out-of-hospital cardiac arrest

Cited by 24 publications

References 32 publications

Mechanical chest compression devices in the helicopter emergency medical service in Switzerland

Mechanical chest compression devices in the helicopter emergency medical service in Switzerland

Mechanical Chest Compression Devices in the Helicopter Emergency Medical Service in Switzerland

Short-Term Outcome and Characteristics of Critical Care for Non-Trauma Patients in the Emergency Department

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