Pediatric out-of-hospital cardiopulmonary resuscitation by helicopter emergency medical service, does it has added value compared to regular emergency medical service?

Moors, Xavier R.J.; Rijs, K.; Hartog, Dennis den; Stolker, Robert Jan

doi:10.1007/s00068-017-0815-5

Cited by 14 publications

(15 citation statements)

References 10 publications

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“…Caution is also needed in interpreting our metaanalysis subgroup analysis results as these are observational in nature. However, we believe that the results of the within-study comparisons of different team composition performances in four studies [8,28,32,38], together with insights from our recent study [7], are credible and supportive of higher overall intubation success, first-pass success, and lower complication rates associated with physician teams. Our results were also robust when sensitivity analysis and meta-regressions were performed.…”

Section: Discussionmentioning

confidence: 70%

“…Five studies [7,8,28,32,38] compared outcomes between different intubator groups, and one study [37] described outcomes before and after implementation of national guidelines. Of the 46 described team compositions, 22 studies utilised non-physicians with no relaxants (n = 7602), 12 utilised non-physicians with relaxants (n = 2185), and 12 utilised physicians, all with relaxants (n = 1780).…”

Section: Search Resultsmentioning

confidence: 99%

“…Seven studies were in trauma patients (n = 500) [21,26,34,[39][40][41]44], six in arrested patients (n = 804) [5,17,25,29,33,38], and three in head injury patients (n = 414) [6,31,37], and the remaining studies comprised a mixed population of all patients requiring airway management (n = 9849). There was no association between team composition and type of paediatric patients treated (P = 0.875).…”

Section: Outcomes By Clinical Populationmentioning

confidence: 99%

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Success and complications by team composition for prehospital paediatric intubation: a systematic review and meta-analysis

et al. 2020

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Background: Clinical team composition for prehospital paediatric intubation may affect success and complication rates. We performed a systematic review and meta-analysis to determine the success and complication rates by type of clinical team. Methods: We searched MEDLINE, EMBASE, and CINAHL for interventional and observational studies describing prehospital intubation attempts in children with overall success, first-pass success, and complication rates. Eligible studies, data extraction, and assessment of risk of bias were assessed independently by two reviewers. We performed a random-effects meta-analysis of proportions. Results: Forty studies (1989 to 2019) described three types of clinical teams: non-physician teams with no relaxants (22 studies, n = 7602), non-physician teams with relaxants (12 studies, n = 2185), and physician teams with relaxants (12 studies, n = 1780). Twenty-two (n = 3747) and 18 (n = 7820) studies were at low and moderate risk of bias, respectively. Non-physician teams without relaxants had lower overall intubation success rate (72%, 95% CI 67-76%) than non-physician teams with relaxants (95%, 95% CI 93-98%) and physician teams (99%, 95% CI 97-100%). Physician teams had higher first-pass success rate (91%, 95% CI 86-95%) than non-physicians with (75%, 95% CI 69-81%) and without (55%, 95% CI 48-63%) relaxants. Overall airway complication rate was lower in physician teams (10%, 95% CI 3-22%) than non-physicians with (30%, 95% CI 23-38%) and without (39%, 95% CI 28-51%) relaxants. Conclusion: Physician teams had higher rates of intubation success and lower rates of overall airway complications than other team types. Physician prehospital teams should be utilised wherever practicable for critically ill children requiring prehospital intubation.

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Section: Discussionmentioning

confidence: 70%

Section: Search Resultsmentioning

confidence: 99%

Section: Outcomes By Clinical Populationmentioning

confidence: 99%

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Success and complications by team composition for prehospital paediatric intubation: a systematic review and meta-analysis

et al. 2020

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“…In contrast, a lower cancellation rate for pediatric involvement of 27% was found in another Dutch HEMS region [23]. Concerning incidents involving a child, it was shown that HEMS have an increased success rate for Advanced Life Support restricted procedures, and an additional 2.5 lives are saved per 100 dispatches [18,20,29]. However, identifying children in need of acute trauma care remains challenging, as van der Sluijs et al showed an undertriage rate of 16.3% based on data derived from several Dutch trauma regions [30].…”

Section: Incidents With Pediatric Involvementmentioning

confidence: 99%

Characteristics of helicopter emergency medical services (HEMS) dispatch cancellations during a six-year period in a Dutch HEMS region

et al. 2021

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Background For decades, Helicopter Emergency Medical Services (HEMS) contribute greatly to prehospital patient care by performing advanced medical interventions on-scene. Unnecessary dispatches, resulting in cancellations, cause these vital resources to be temporarily unavailable and generate additional costs. A previous study showed a cancellation rate of 43.5% in our trauma region. However, little recent data about cancellation rates and reasons exist, despite revision of dispatch protocols. This study examines the current cancellation rate in our trauma region over a six-year period. Additionally, cancellation reasons are evaluated per type of dispatch and initial incident report, upon which HEMS is dispatched. Methods This retrospective study analyzed the data of the Dutch HEMS Lifeliner 1 (North-West region of the Netherlands, covering a population of 5 million inhabitants), analyzing all subsequent cases between April 1st 2013 and April 1st 2019. Patient characteristics, type of dispatch (primary; based on dispatcher criteria versus secondary, as judged by the first ambulance team on site), initial incident report received by the EMS dispatch center, and information regarding day- or nighttime dispatches were collected. In case of cancellation, cancel rate and reason per type of dispatch and initial incident report were assessed. Results In total, 18,638 dispatches were included. HEMS was canceled in 54.5% (95% CI 53.8–55.3%) of cases. The majority of canceled dispatches (76.1%) were canceled because respiratory, hemodynamic, and neurologic parameters were stable. Dispatches simultaneously activated with EMS (primary dispatch) were canceled in 58.3%, compared to 15.1% when HEMS assistance was requested by EMS based on their findings on-scene (secondary dispatch). A cancellation rate of 54.6% was found in trauma related dispatches (n = 12,148), compared to 52.2% in non-trauma related dispatches (n = 5378). Higher cancellation rates exceeding 60% were observed in the less common dispatch categories, e.g., anaphylaxis (66.3%), unknown incident report (66.0%), assault with a blunt object (64.1%), obstetrics (62.8%), and submersion (61.9%). Conclusion HEMS cancellations are increased, compared to previous research in our region. Yet, the cancellations are acceptable as the effect on HEMS’ unavailbility remains minimized. Focus should be on identifying the patient in need of HEMS care while maintaining overtriage rates low. Continuous evaluation of HEMS triage is important, and dispatch criteria should be adjusted if necessary.

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“…Securing the airways patency in prehospital conditions may be a challenge for paramedics [1]. The endotracheal intubation still remains the golden standard, however, the use of it is limited by the necessity of having experienced medical personnel [2][3][4]. When performing the rescuing procedures by firefighters-paramedics the use of supraglottic airway devices (SADs) is a more appropriate method.…”

Section: Introductionmentioning

confidence: 99%

Securing the airway patency by firefighters with the use of CombiTube. A pilot data

Frass

Robak

Smereka

et al. 2018

Disaster Emerg Med J

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INTRODUCTION:The protection of the airways with the use of vomer devices for ventilation is one of the elements of the procedure in cardiopulmonary resuscitation. One of the alternative ways to protect the airways from endotracheal intubation is the CombiTube tube. The aim of the study was to assess the ability to protect airway patency using CombiTube during simulated cardiopulmonary resuscitation performed by firefighters. METHOD:This study was a prospective randomized crossover simulation study. The study included 56 firefighters who performed airway patency protection with the use of CombiTube during simulated cardiopulmonary resuscitation with and without chest compressions. RESULTS:The median duration of securing airway patency with CombiTube device during scenario without and with chest compressions was: 21 s (IQR; 14−25.5) vs. 21.5 s (IQR; 15−27), respectively. The vast majority of attempts to insert CombiTube resulted in the insertion of the device to the esophagus: 92.8% vs. 91.1% (with and without chest compressions, respectively). The insertion of CombiTube to the trachea was observed in 7.1% vs. 8.9% during scenarios with and without chest compression, respectively. Study participants assessed the easiness of performing the procedure at 19 points (IQR, 13−22) for scenario without chest compression, and 18.5 points (IQR, 14−21.5) for scenario with uninterrupted chest compressions. CONCLUSIONS:Firefighters are able to secure the airway patency with the use of CombiTube tube after a short training. Compressing the chest during resuscitation does not prolong the procedure of maintaining the airway patency with CombiTube. The tip of the CombiTube tube is inserted into the esophagus in over 91% of cases. KEY WORDS: airway management, firefighter, prehospital, cardiopulmonary resuscitation, medical simulationDisaster Emerg Med J 2018; 3(2): 46-50

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Pediatric out-of-hospital cardiopulmonary resuscitation by helicopter emergency medical service, does it has added value compared to regular emergency medical service?

Cited by 14 publications

References 10 publications

Success and complications by team composition for prehospital paediatric intubation: a systematic review and meta-analysis

Success and complications by team composition for prehospital paediatric intubation: a systematic review and meta-analysis

Characteristics of helicopter emergency medical services (HEMS) dispatch cancellations during a six-year period in a Dutch HEMS region

Securing the airway patency by firefighters with the use of CombiTube. A pilot data

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