Helena Jäntti

Influence of chest compression rate guidance on the quality of cardiopulmonary resuscitation performed on manikins

AIMSnThe adequate chest compression rate during CPR is associated with improved haemodynamics and primary survival. To explore whether the use of a metronome would affect also chest compression depth beside the rate, we evaluated CPR quality using a metronome in a simulated CPR scenario.nnnMETHODSnForty-four experienced intensive care unit nurses participated in two-rescuer basic life support given to manikins in 10min scenarios. The target chest compression to ventilation ratio was 30:2 performed with bag and mask ventilation. The rescuer performing the compressions was changed every 2min. CPR was performed first without and then with a metronome that beeped 100 times per minute. The quality of CPR was analysed with manikin software. The effect of rescuer fatigue on CPR quality was analysed separately.nnnRESULTSnThe mean compression rate between ventilation pauses was 137+/-18compressions per minute (cpm) without and 98+/-2cpm with metronome guidance (p<0.001). The mean number of chest compressions actually performed was 104+/-12cpm without and 79+/-3cpm with the metronome (p<0.001). The mean compression depth during the scenario was 46.9+/-7.7mm without and 43.2+/-6.3mm with metronome guidance (p=0.09). The total number of chest compressions performed was 1022 without metronome guidance, 42% at the correct depth; and 780 with metronome guidance, 61% at the correct depth (p=0.09 for difference for percentage of compression with correct depth).nnnCONCLUSIONSnMetronome guidance corrected chest compression rates for each compression cycle to within guideline recommendations, but did not affect chest compression quality or rescuer fatigue.

Airway management by physician-staffed Helicopter Emergency Medical Services – a prospective, multicentre, observational study of 2,327 patients

BackgroundDespite numerous studies on prehospital airway management, results are difficult to compare due to inconsistent or heterogeneous data. The objective of this study was to assess advanced airway management from international physician-staffed helicopter emergency medical services.MethodsWe collected airway data from 21 helicopter emergency medical services in Australia, England, Finland, Hungary, Norway and Switzerland over a 12-month period. A uniform Utstein-style airway template was used for collecting data.ResultsThe participating services attended 14,703 patients on primary missions during the study period, and 2,327 (16xa0%) required advanced prehospital airway interventions. Of these, tracheal intubation was attempted in 92xa0% of the cases. The rest were managed with supraglottic airway devices (5xa0%), bag-valve-mask ventilation (2xa0%) or continuous positive airway pressure (0.2xa0%). Intubation failure rates were 14.5xa0% (first-attempt) and 1.2xa0% (overall). Cardiac arrest patients showed significantly higher first-attempt intubation failure rates (odds ratio: 2.0; 95xa0% CI: 1.5-2.6; pu2009<u20090.001) compared to non-cardiac arrest patients. Complications were recorded in 13xa0%, with recognised oesophageal intubation being the most frequent (25xa0% of all patients with complications). For non-cardiac arrest patients, important risk predictors for first-attempt failure were patient age (a non-linear association) and administration of sedatives (reduced failure risk). The patient’s sex, provider’s intubation experience, trauma type (patient category), indication for airway intervention and use of neuromuscular blocking agents were not risk factors for first-attempt intubation failure.ConclusionsAdvanced airway management in physician-staffed prehospital services was performed frequently, with high intubation success rates and low complication rates overall. However, cardiac arrest patients showed significantly higher first-attempt failure rates compared to non-cardiac arrest patients. All failed intubations were handled successfully with a rescue device or surgical airway.Trial registrationStudy registration: www.clinicaltrials.govNCT01502111. Registered 22 December 2011.

Quality of cardiopulmonary resuscitation on manikins: on the floor and in the bed.

Background: In general, in‐hospital resuscitation is performed in a bed and out‐of‐hospital resuscitation on the floor. The surface under the patient may affect the cardiopulmonary resuscitation (CPR) quality; therefore, we evaluated CPR quality (the percentage of chest compressions of correct depth) and rescuers fatigue (the mean compression depth minute by minute) when CPR is performed on a manikin on the floor or in the bed.

Airway management in out-of-hospital cardiac arrest in Finland: current practices and outcomes

BackgroundThough airway management methods during out-of-hospital cardiac arrest (OHCA) remain controversial, no studies on the topic from Finland have examined adherence to OHCA recommendations in real life. In response, the aim of this study was to document the interventions, success rates, and adverse events in airway management processes in OHCA, as well as to analyse survival at hospital discharge and at follow-up a year later.MethodsDuring a 6-month study period in 2010, data regarding all patients with OHCA and attempted resuscitation in southern and eastern Finland were prospectively collected. Emergency medical services (EMS) documented the airway techniques used and all adverse events related to the process. Study endpoints included the frequency of different techniques used, their success rates, methods used to verify the correct placement of the endotracheal tube, overall adverse events, and survival at hospital discharge and at follow-up a year later.ResultsA total of 614 patients were included in the study. The incidence of EMS-attempted resuscitation was determined to be 51/100,000 inhabitants per year. The final airway technique was endotracheal intubation (ETI) in 413 patients (67.3xa0%) and supraglottic airway device (SAD) in 188 patients (30.2xa0%). The overall success rate of ETI was 92.5xa0%, whereas that of SAD was 85.0xa0%. Adverse events were reported in 167 of the patients (27.2xa0%). Having a prehospital EMS physician on the scene (pu2009<u2009.001, OR 5.05, 95xa0% CI 2.94–8.68), having a primary shockable rhythm (pu2009<u2009.001, OR 5.23, 95xa0% CI 3.05–8.98), and being male (pu2009=u2009.049, OR 1.80, 95xa0% CI 1.00–3.22) were predictors for survival at hospital discharge.ConclusionsThis study showed acceptable ETI and SAD success rates among Finnish patients with OHCA. Adverse events related to airway management were observed in more than 25xa0% of patients, and overall survival was 17.8xa0% at hospital discharge and 14.0xa0% after 1xa0year.

Nationwide survey of resuscitation education in Finland

AIMSnGood-quality cardiopulmonary resuscitation (CPR) is highlighted in the International Resuscitation Guidelines, but clinically the quality of CPR is often poor. Education of CPR has a major role in the primary skills imparted to students. Different methods can be used to teach CPR quality. We evaluated the current status of their usage in Finland institutes teaching students of emergency medicine at different levels.nnnMETHODSnThe following institutes were included in an anonymous survey: medical schools (teaching future physicians), universities of applied sciences (paramedics), colleges (emergency medical technicians) and emergency services college (fire-fighters). Hours of teaching theory lessons of CPR and hours of small group training were evaluated. In particular, we focussed on the teaching methods for adequate chest compression rate and depth.nnnRESULTSnTwenty-one of 30 institutes responded to the questionnaire. The median for hours of theory lessons of CPR was 8h (range: 2-28 h). The median for hours of small group training was 10 (range: 3-40 h). The methods of teaching adequate chest compression rate were instructors visual estimation in 28.5% of the institutions, watch in 33.3%, metronome in 9.5% and manikins graphic in 28.5% of institutions. The methods of teaching adequate chest compression depth were instructors visual estimation in 33.3%, in manikins light indicators in 23.8% and manikins graphics in 52.3% of institutions.nnnCONCLUSIONnThe hours of theoretic lessons and small group training vary widely among different institutes. In one-third of institutions, the instructors visual estimation was a sole method used to teach adequate chest compression rate and depth. Different technical methods were surprisingly seldom used.

Hypoxia and hypotension in patients intubated by physician staffed helicopter emergency medical services - a prospective observational multi-centre study

BackgroundThe effective treatment of airway compromise in trauma and non-trauma patients is important. Hypoxia and hypotension are predictors of negative patient outcomes and increased mortality, and may be important quality indicators of care provided by emergency medical services. Excluding cardiac arrests, critical trauma and non-trauma patients remain the two major groups to which helicopter emergency medical services (HEMS) are dispatched. Several studies describe the impact of pre-hospital hypoxia or hypotension on trauma patients, but few studies compare this in trauma and non-trauma patients. The primary aim was to describe the incidence of pre-hospital hypoxia and hypotension in the two groups receiving pre-hospital tracheal intubation (TI) by physician-staffed HEMS.MethodsData were collected prospectively over a 12-month period, using a uniform Utstein-style airway template. Twenty-one physician-staffed HEMS in Europe and Australia participated. We compared peripheral oxygen saturation and systolic blood pressure before and after definitive airway management. Data were analysed using Cochran–Mantel–Haenszel methods and mixed-effects models.ResultsEight hundred forty three trauma patients and 422 non-trauma patients receiving pre-hospital TI were included. Non-trauma patients had significantly lower predicted mean pre-intervention SpO2 compared to trauma patients. Post-intervention and admission SpO2 for the two groups were comparable. However, 3% in both groups were still hypoxic at admission. For hypotension, the differences between the groups were less prominent. However, 9% of trauma and 10% of non-trauma patients were still hypotensive at admission. There was no difference in short-term survival between trauma (97%) and non-trauma patients (95%). Decreased level of consciousness was the most frequent indication for TI, and was associated with increased survival to hospital (cOR 2.8; 95% CI: 1.4–5.4).ConclusionsOur results showed that non-trauma patients had a higher incidence of hypoxia before TI than trauma patients, but few were hypoxic at admission. The difference for hypotension was less prominent, but one in ten patients were still hypotensive at admission. Further investigations are needed to identify reversible causes that may be corrected to improve haemodynamics in the pre-hospital setting. We found high survival rates to hospital in both groups, suggesting that physician-staffed HEMS provide high-quality emergency airway management in trauma and non-trauma patients.Trial registrationClinicaltrials.gov Identifier: NCT01502111. Registered 22 Desember 2011.

Witnessed out‐of‐hospital cardiac arrest˗ effects of emergency dispatch recognition

Survival from an out‐of‐hospital cardiac arrest (OHCA) depends on the sequence of interventions in “the chain of survival”. If OHCA is recognized in the emergency medical communication centre (EMCC), the proper emergency medical service (EMS) should be dispatched and cardiopulmonary resuscitation (CPR) instructions should be given to a bystander. The study aimed to examine the impact of OHCA recognition in the EMCC on survival rates and the main elements of the chain of survival.