Anatolij Truhlar

Use of the Laryngeal Mask Airway Supreme in pre-hospital difficult airway management.

a Helicopter Emergency Medical Service ‘‘Christoph 6’’ Hradec Kralove, Hradec Kralove Region Emergency Medical Services, Czech Republic b Department of Anaesthesiology and Intensive Care Medicine, Charles University Prague, Faculty of Medicine Hradec Kralove, University Hospital Hradec Kralove, Czech Republic c Department of Anesthesiology and Pain Medicine, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA

Effect of introduction of a standardized protocol in dispatcher-assisted cardiopulmonary resuscitation

BACKGROUND The two most commonly used dispatch tools are medical priority dispatch (MPD) and criteria based dispatch (CBD), but there are countries still using non-standardized emergency call processing. We compared selected characteristics of DA-CPR before and after implementation of a standardized protocol in a non-MPD and non-CBD system. METHODS Observational study of DA-CPR recordings during 4-month periods before (PER1) and after (PER2) the standardized protocol had been implemented. Selected performance characteristics included times to event verification, identification of cardiac arrest, DA-CPR instructions, and first chest compression, which were compared between PER1 and PER2. The secondary goal was to compare survival to hospital discharge. RESULTS A total of 152 call recordings with DA-CPR were evaluated in PER1 and 174 in PER2. Median times to cardiac arrest recognition were 46s in PER1 and 37s in PER2 (p=0.002), to first compression 2min 35s in PER1 and 2min 25s in PER2 (p=0.549). Admission to hospital with return of spontaneous circulation (ROSC) was achieved in 39 patients (31.9%) in PER1 and 57 (45.6%) in PER2 (p<0.05), discharge from hospital (CPC 1-2) in 9.0% and 14.4% patients in PER1 and PER2, respectively. If ventricular fibrillation was the initial rhythm, survival rate (CPC 1-2) was 32.3% in PER1 and 38.7% in PER2 (p=0.523). CONCLUSION Implementation of a standardized DA-CPR protocol resulted in faster identification of cardiac arrest, response team dispatching and arrival at scene. These factors were associated with a trend to better survival.

Comparison of cold crystalloid and colloid infusions for induction of therapeutic hypothermia in a porcine model of cardiac arrest

IntroductionLarge-volume cold intravenous infusion of crystalloids has been used for induction of therapeutic hypothermia after cardiac arrest. However, the effectiveness of cold colloids has not been evaluated. Therefore, we performed an experimental study to investigate the cooling effect of cold normal saline compared to colloid solution in a porcine model of ventricular fibrillation.MethodsVentricular fibrillation was induced for 15 minutes in 22 anesthetized domestic pigs. After spontaneous circulation was restored, the animals were randomized to receive either 45 ml/kg of 1°C cold normal saline (Group A, 9 animals); or 45 ml/kg of 1°C cold colloid solution (Voluven®, 6% hydroxyethyl starch 130/0.4 in 0.9% NaCl) during 20 minutes (Group B, 9 animals); or to undergo no cooling intervention (Group C, 4 animals). Then, the animals were observed for 90 minutes. Cerebral, rectal, intramuscular, pulmonary artery, and subcutaneous fat body temperatures (BT) were recorded. In the mechanical ex-vivo sub study we added a same amount of cold normal saline or colloid into the bath of normal saline and calculated the area under the curve (AUC) for induced temperature changes.ResultsAnimals treated with cold fluids achieved a significant decrease of BT at all measurement sites, whereas there was a consistent significant spontaneous increase in group C. At the time of completion of infusion, greater decrease in pulmonary artery BT and cerebral BT in group A compared to group B was detected (−2.1 ± 0.3 vs. -1.6 ± 0.2°C, and −1.7 ± 0.4 vs. -1.1 ± 0.3°C, p < 0.05, respectively). AUC analysis of the decrease of cerebral BT revealed a more vigorous cooling effect in group A compared to group B (−91 ± 22 vs. -68 ± 23°C/min, p = 0.046). In the mechanical sub study, AUC analysis of the induced temperature decrease of cooled solution revealed that addition of normal saline led to more intense cooling than colloid solution (−7155 ± 647 vs. -5733 ± 636°C/min, p = 0.008).ConclusionsIntravenous infusion of cold normal saline resulted in more intense decrease of cerebral and pulmonary artery BT than colloid infusion in this porcine model of cardiac arrest. This difference is at least partially related to the various specific heat capacities of the coolants.

Assessment of regional ventilation with the electrical impedance tomography in a patient after asphyxial cardiac arrest.

Survival from cardiac arrest presenting initially with asystole r pulseless electrical activity is very unlikely unless all relevant eversible causes are recognized and treated effectively.1 In some atients, extensive differential diagnosis is needed to ascertain he cause of cardiac arrest, especially if differentiation between ardiovascular and respiratory aetiology is necessary. Routine iniial evaluation, including chest X-ray may not be sufficient to iagnose alterations in distribution of ventilation that may be resent in some respiratory disorders. Although examination with hest ultrasound could assess lung and pleural cavity pathologies,2 his technique requires expertise and does not directly quantify egional ventilation, while the benefits of computed tomography CT) should always be weighted to the risks and disadvantages f patient’s intra-hospital transportation. Use of a non-invasive ethod, an electrical impedance tomography (EIT), which has lready been used for assessment of lung volumes and distribution f ventilation under various clinical conditions,3,4 has not become ommon in post-resuscitation care. We report the case of a 61-year-old man admitted after sucessful resuscitation from asystolic out-of-hospital cardiac arrest OHCA) following a short period of severe dyspnoea. His per-