Agata Dabrowska

High-fidelity simulation — the first DCD-ECMO procedure in Poland

Mateusz Puslecki, Marcin Ligowski, Marek Dabrowski, Maciej Sip, Sebastian Stefaniak, Tomasz Klosiewicz, Lukasz Gasiorowski, Marek Karczewski, Tomasz Malkiewicz, Malgorzata Ladzinska, Marcin Zielinski, Aleksander Pawlak, Agata Dabrowska, Piotr Ziemak, Bartlomiej Perek, Marcin Misterski, Slawomir Katarzynski, Piotr Buczkowski, Wojciech Telec, Ilona Kiel-Puslecka, Michal Kiel, Michael Czekajlo, Marek Jemielity Poznan University of Medical Sciences, Department of Cardiac Surgery and Transplantology, Clinical Hospital SKPP, Poznan, Poland Poznan University of Medical Sciences, Department of Rescue and Disaster Medicine, Poznan, Poland Polish Society of Medical Simulation, Poland Poznan University of Medical Sciences, Center for Medical Simulation, Poznan, Poland Poznan University of Medical Sciences, Department of Intensive Care and Pain Treatment, Poznan, Poland Poznan University of Medical Sciences, Department of Transplantology, General, Vascular and Plastic Surgery, Poznan, Poland Poznan University of Medical Sciences, Department of Anesthesiology and Intensive Care, Clinical Hospital H. Święcickiego, Poznan, Poland Voivodeship Emergency Medical Services, Poznan, Poland Poznan University of Medical Sciences, Department of Palliative Medicine, Poznan, Poland ZF RTW, Częstochowa, Poland Hunter Holmes McGuire VA Medical Center, Department of Surgery, Richmond, United States of America Lublin Medical University, Lublin, Poland

ETView® video-tube versus Intubrite® laryngoscope for endotracheal intubation during cardiopulmonary resuscitation: Preliminary data ☆

Sir, Securing the airway is one of the basic procedures performed in patients in cardiac arrest. European Resuscitation Council Guidelines strongly suggests minimizing interruptions in chest compressions [1,2]. The effectiveness of direct laryngoscopy performed by the Emergency Medical Service staff assessed in many studies is insufficient [3]. Therefore, it may be helpful to use alternative methods of intubation, including the ETView VivaSight SL (ETView; ETView Ltd., Misgav, Israel), which is a endotracheal tube with integrated camera [4,5] supgraglottic airway devices [2,6,7], or different videolaryngoscopes [3,8]. The aim of this studywas to evaluate the effectiveness of the first attempt of endotracheal intubation and the time to perform the procedure during the simulated adult CPR. The study involved 35 novice physicians with no previous experience in videolaryngoscopy. All participants declared their ability to perform endotracheal intubation using a Macintosh laryngoscope. Before the study, all the participants took part in a 10-min demonstration. During the study we used the ETView VivaSight SL and Intubrite (Intubrite Llc, Vista, CA, USA) videolaryngoscope. In both cases, we used the endotracheal tube size 7.0 ID with the previously

An innovative panel to assess endothelial integrity of pedicled and skeletonized internal thoracic artery used as aortocoronary bypass graft: a randomized comparative histologic and immunohistochemical study

Background Optimal preservation of endothelial integrity of the vessels used as aortocoronary grafts is a crucial determinant of long-term clinical success of coronary artery bypass grafting (CABG). The purpose of this study was to evaluate an impact of two common techniques to harvest left internal thoracic artery (LITA) on endothelial integrity. Methods One hundred twenty consecutive patients (84 males and 36 females) with a mean age of 64.9±8.8 years undergoing CABG were randomized to receive pedicled (group P; n=60) or skeletonized (group S; n=60) LITA grafts. During surgery LITA was harvested by the same experienced cardiac surgeon. The most peripheral surplus segments of LITA were obtained and then analysed histologically under light microscope. Additionally, endothelial expression of CD31, CD34, CD133 and nitric oxide synthase (eNOS) were evaluated by means of immunohistochemistry. Results In both groups, no cases of major arterial wall damage such as disruption, dissection, thrombosis or subadventitial hematoma were noted on LITA cross sections. Immunohistochemical assessment of protein expression revealed no differences in endothelial expression of CD133, CD34 antigens (markers of regeneration potential) and eNOS (indicating preserved functional integrity) between studied groups. Contrary to them, endothelial immunoreactivity of CD31, a marker of the morphological integrity of the endothelium, was revealed to be stronger in group P. Conclusions The skeletonized method of LITA harvesting may be associated with worse preservation of morphological integrity of endothelium but without compromising functional integrity and potential for tissue regeneration.

Intraosseous access — future, present and everyday life

Today, intraosseous access (IO) is not only an alternative method of administration of pharmacotherapy or fluids; it is often used in life-threatening conditions. Although previously, it was a method commonly used in paediatrics or in the military, for several years it has been advocated as the primary access point for patients in a critical condition. While this applies mainly to children, it may also include adults in a hospital setting, as well as in the emergency department. Oftentimes it is used when intravenous access is difficult or the patient is seriously ill. Many scientific circles at the American Heart Association (AHA) and European Resuscitation Council (ERC) approve this method.

Emergency intubation in prehospital care

Endotracheal intubation in emergency situations is a challenge even for the most experienced medical professionals [1,2]. Due to the fact that every prehospital patient should be treated as a patient with full stomach, there is a real risk of vomiting or regurgitation and aspiration of stomach content to respiratory tract, followed by aspiration pneumonia. In addition, intubation in prehospital conditions is associated with the pressure of time, as the patient in most cases has a life-threatening hypoxaemia.Moreover, intubation is repeatedly performed under unfavorable conditions such as poor lighting or inconvenient positions of the rescuer. In cases of suspected cervical spine injury, it is necessary to stabilize the victims head and spine with cervical collar which also reduces the effectiveness of endotracheal intubation [3]. Of course, there are many alternative devices for airway management in both trauma and non-trauma patients.Many studies have compared endotracheal intubation with Laryngeal Mask Airways [4], iGEL [5], Combitube or EasyTube [6]. However, it should be noticed that although these methods can be used by professionals who do not have the authority or ability to perform endotracheal intubation, such as firefighters or water rescuers, these methods will never replace endotracheal intubation. Properly placed endotracheal tube fully isolates the airway from the outside environment. That allows to provide continuous chest compressions during resuscitation, even when positive airway pressure is applied. In the case of supraglottic airway devices, increased pressure in the esophagus, or ventilation with large respiratory volumes, as well as movement of the patients body may cause leakage which in

Chest compressions in infants

Cardiopulmonary resuscitation on infants and children is associated with extreme emotions and stress among members of resuscitation team. Formost healthcare professionals in the pre-hospital care system, infant sudden cardiac arrest is a rare incident. Detailed knowledge of the guidelines and regular training is essential to ensure a high quality of resuscitation. Only proper chest compressions are able to provide adequate high coronary perfusion pressure and consequently maintain oxygenation of the cardiomyocytes and provide them with an energy reserve [1]. It is easy to make a mistake even in such simple operations as chest compressions while working under stress conditions [2]. Professionalmedical teams have equipment formechanical chest compression. It has been estimated that the use of these devices in children also significantly improves chest compression quality parameters such as rate, depth, correct recoil. It also allows to minimize unnecessary interruptions [1]. The key to improve survival is resuscitation provided by bystanders, and services such as fire brigade or water rescue. In addition, before ambulance arrival, a medical dispatcher instructs witnesses on how to perform resuscitation. First people at the scene are often parents of the injured infant who are unable to carry out complicated procedures. The first-aid rescue techniquesmust therefore be simple and at the same time highly effective so that even those without appropriate medical training could provide high quality chest compressions. In the present day, first aid training is widely available to the public. Also a large part of citizens declare their willingness to provide first aid in cases of sudden cardiac arrest [3]. Nonetheless, the outcome of pediatric out-of-hospital sudden cardiac arrest remains unsatisfactory. That is why it is important to look for new techniques that would make it even easier to provide good resuscitation.

AED use in public places: a study of acquisition time

BACKGROUND Sudden cardiac arrest (SCA) is a frequent cause of death in the developed world. Early defibrillation, preferably within the first minutes of the incident, significantly increases survival rates. Accessible automated external defibrillators (AED) in public areas have been promoted for many years, and several locations are equipped with these devices. AIM The aim of the study was to assess the real-life availability of AEDs and assess possible sources of delay. METHODS The study took place in the academic towns of Poznan, Lodz, and Warsaw, Poland. The researchers who were not aware of the exact location of the AED in the selected public locations had to deliver AED therapy in simulated SCA scenarios. For the purpose of the trial, we assumed that the SCA takes place at the main entrance to the public areas equipped with an AED. RESULTS From approximately 200 locations that have AEDs, 78 sites were analysed. In most places, the AED was located on the ground floor and the median distance from the site of SCA to the nearest AED point was 15 m (interquartile range [IQR] 7-24; range: 2-163 m). The total time required to deliver the device was 96 s (IQR 52-144 s). The average time for discussion with the person responsible for the AED (security officer, staff, etc.) was 16 s (IQR 0-49). The AED was located in open access cabinets for unrestricted collection in 29 locations; in 10 cases an AED was delivered by the personnel, and in 29 cases AED utilisation required continuous personnel assistance. The mode of accessing the AED device was related to the longer discussion time (p < 0.001); however, this did not cause any significant delay in therapy (p = 0.132). The AED was clearly visible in 34 (43.6%) sites. The visibility of AED did not influence the total time of simulated AED implementation. CONCLUSIONS We conclude that the access to AED is relatively fast in public places. In the majority of assessed locations, it meets the recommended time to early defibrillation of under 3 min from the onset of the cardiac arrest; however, there are several causes for possible delays. The AED signs indicating the location of the device should be larger. AEDs should also be displayed in unrestricted areas for easy access rather than being kept under staff care or in cabinets.

Zastosowanie AED w miejscach publicznych: badanie czasu użycia

BACKGROUND Sudden cardiac arrest (SCA) is a frequent cause of death in the developed world. Early defibrillation, preferably within the first minutes of the incident, significantly increases survival rates. Accessible automated external defibrillators (AED) in public areas have been promoted for many years, and several locations are equipped with these devices. AIM The aim of the study was to assess the real-life availability of AEDs and assess possible sources of delay. METHODS The study took place in the academic towns of Poznan, Lodz, and Warsaw, Poland. The researchers who were not aware of the exact location of the AED in the selected public locations had to deliver AED therapy in simulated SCA scenarios. For the purpose of the trial, we assumed that the SCA takes place at the main entrance to the public areas equipped with an AED. RESULTS From approximately 200 locations that have AEDs, 78 sites were analysed. In most places, the AED was located on the ground floor and the median distance from the site of SCA to the nearest AED point was 15 m (interquartile range [IQR] 7-24; range: 2-163 m). The total time required to deliver the device was 96 s (IQR 52-144 s). The average time for discussion with the person responsible for the AED (security officer, staff, etc.) was 16 s (IQR 0-49). The AED was located in open access cabinets for unrestricted collection in 29 locations; in 10 cases an AED was delivered by the personnel, and in 29 cases AED utilisation required continuous personnel assistance. The mode of accessing the AED device was related to the longer discussion time (p < 0.001); however, this did not cause any significant delay in therapy (p = 0.132). The AED was clearly visible in 34 (43.6%) sites. The visibility of AED did not influence the total time of simulated AED implementation. CONCLUSIONS We conclude that the access to AED is relatively fast in public places. In the majority of assessed locations, it meets the recommended time to early defibrillation of under 3 min from the onset of the cardiac arrest; however, there are several causes for possible delays. The AED signs indicating the location of the device should be larger. AEDs should also be displayed in unrestricted areas for easy access rather than being kept under staff care or in cabinets.