Joseph S. Goode

Two-thumb versus two-finger chest compression during CPR in a swine infant model of cardiac arrest

STUDY OBJECTIVE To test the hypothesis that two-thumb chest compression generates higher arterial and coronary perfusion pressures than the current American Heart Association-approved two-finger method. DESIGN Randomized, crossover experimental trial. SETTING AND PARTICIPANTS Animal laboratory experiment with seven swine of either sex weighing 9.4 kg (SD, 0.8 kg), representing infants less than 1 year old. INTERVENTIONS Animals were sedated with IM ketamine/xylazine, intubated with a 6.0 Hi-Lo endotracheal tube, anesthetized with alpha-chloralose, and paralyzed with pancuronium. ECG was monitored continuously. Left femoral arterial and Swan-Ganz catheters were placed. Cardiac arrest was induced with an IV bolus of KCl and verified by ECG and pressure tracings. Five American Heart Association-certified basic rescuers were randomly assigned to perform external chest compressions for one minute by either the currently recommended two-finger method or the two-thumb and thorax-squeeze method. After all five completed their first trial, rescuers crossed over to the other method for a second minute of compressions. Ventilation was performed with a bag-valve device, and no drugs were given during CPR. After three complete cycles, the fourth through sixth cycles of compressions were recorded. Every compression was analyzed for arterial systolic, diastolic, mean, and coronary perfusion pressures. One thousand fifty compressions were analyzed with repeated-measures analysis of variance and Scheffé multiple comparisons. RESULTS Systolic blood pressure, diastolic blood pressure, mean arterial pressure, and coronary perfusion pressure were all significantly higher (P < .001) with the two-thumb thoracic squeeze technique: systolic blood pressure, 59.4 versus 41.6 mm Hg; diastolic blood pressure, 21.8 versus 18.5 mm Hg; mean arterial pressure, 34.2 versus 26.1 mm Hg; and coronary perfusion pressure, 15.1 versus 12.2 mm Hg. CONCLUSION The two-thumb method of chest compression generates significantly higher arterial and coronary perfusion pressures than the two-finger method in this infant model of cardiac arrest.

Quality of life in spinal cord injured individuals and their caregivers during the initial 6 months following rehabilitation.

Addressing quality of life (QOL) issues in the spinal cord injured (SCI) population is imperative as the majority survive their initial injury and longevity now approaches that of the general population. The purpose of this mixed method, descriptive, longitudinal feasibility study was to describe and compare QOL in 10 adult SCI individuals and their family caregivers (FCs) during the initial 6 months following rehabilitation. Instruments used were the SF-36 and two horizontal visual analog scales, one for pain and one for QOL. Participants completed the instruments and a face-to-face in-depth interview at 1-, 3-, and 6-months following inpatient rehabilitation. SCI individuals reported low physical function, role physical (RP), and role emotional (RE) scores on the SF-36, while reporting high general health (GH), mental health and social functioning on the SF-36. FCs reported lower RP, GH and vitality scores, while reporting higher physical functioning and RE scores. On the visual analog scales, persons with SCI reported lower QOL while FCs reported more pain at 3 and 6 months. This study suggests that more work is needed to identify interventions which could enhance QOL during the transition from rehabilitation to home for SCI individuals and their FCs.

Respiratory dialysis. A new concept in pulmonary support.

Use of a new intravenous oxygenator made of hollow fiber membranes arranged around a centrally positioned balloon is reported. In vitro studies using fluorescent image tracking velocimetry and gas exchange analysis demonstrated enhanced convective mixing with balloon pulsations and augmented gas flux (100% increase in pO2) compared with the device in its static configuration. In vivo observations confirmed a greater than 50% increase in O2 flux with balloon activation. Those parameters that produce radial flow and convective mixing in vitro enhance gas flux in vivo, thus confirming the efforts to exceed the fluid limit translate into improved gas exchange.

Translaryngeal jet ventilation and end-tidal PCO2 monitoring during varying degrees of upper airway obstruction

STUDY OBJECTIVES To explore the ventilatory adequacy of translaryngeal jet ventilation (TLJV) during partial upper airway obstruction and the usefulness of monitoring end-tidal CO2 (PETCO2) during this condition. DESIGN Prospective, nonrandomized, sequential crossover design. SETTING AND PARTICIPANTS Apneic dog model (five dogs; mean weight, 23 kg). INTERVENTIONS Animals were intubated with a 9.0-mm endotracheal tube with the tip positioned above the cricothyroid membrane. Upper airway obstructions of 40%, 69%, and 80% were created. TLJV was performed through the cricothyroid membrane using a 13-gauge catheter with 100% oxygen, 45 psi, 15 breaths per minute, and 30% inspiratory time for 15 minutes at each upper airway obstruction. Data collected at baseline (no upper airway obstruction) and one-minute intervals included arterial blood pressures, continuous PaCO2 measurements, and PETCO2 at the TLJV catheter tip and above the level of obstruction. Arterial blood gases were obtained at 0 and 15 minutes. Data were analyzed using Pearsons correlation, analysis of variance, and Turkeys multiple comparisons (significance, P less than .05). MEASUREMENTS AND RESULTS Baseline values for all variables did not significantly differ at the onset of each testing phase. Mean pH increased significantly from baseline during 69% upper airway obstruction (7.36 to 7.54, P less than .05) and 80% upper airway obstruction (7.39 to 7.61, P less than .01). Mean PaCO2 decreased significantly from baseline during all upper airway obstructions: 40% upper airway obstruction (39.9 to 33.6 mm Hg, P less than .01), 69% upper airway obstruction (38.3 to 25.6 mm Hg, P less than .001), and 80% upper airway obstruction (36.2 to 18.2 mm Hg, P less than .001). PaCO2, PETCO2, and pH differed significantly between each level of upper airway obstruction (P less than .01). PETCO2 was significantly correlated with PaCO2 (r = .84, P less than .001) and did not significantly differ from PaCO2. No signs of barotrauma were observed in any animal at any degree of upper airway obstruction. CONCLUSION TLJV during partial upper airway obstruction in our model provided safe and adequate-to-supranormal minute ventilation. In fact, marked hypocapnia and alkalemia occurred at levels of 69% and 80% upper airway obstruction, thus dispelling concepts that TLJV may cause hypercapnia during partial upper airway obstruction. PETCO2 correlates well with PaCO2 and may be valuable for monitoring ventilation when using TLJV in the nonobstructed or partially obstructed upper airway.

Development of a Simulation and Internet Based Pilot Intervention to Evaluate Adherence to a Patient Transfer Protocol in the Real World Environment.: Research Abstract: 58

• Curricular Effectiveness: Internet curriculum combined with hands on training using a low fidelity simulator (Laerdal TuffKelly Move MannequinTM) + structured protocol was effective for improvement of knowledge. Improved transfer skills were demonstrated across the protocol and in each 10 point transfer protocol step • Satisfaction: Subjects reacted positively and demonstrated a high level of satisfaction with the intervention both at the end of the simulation training and at the 4 week follow-up measurement point • Retention: Follow-up real world patient transfer observations at 4 weeks demonstrated significant improvement from baseline in adherence to the steps of the 10 point protocol. Observations at 12 weeks demonstrated regression toward baseline. However no definitive conclusions could be reached as unit personnel turnover closely paralleled reduction in adherence • Tools: Hand held computer units with data entry via a Graphic User Interface (GUI) allowed unobtrusive data collection in both the simulation laboratory and the clinical setting • Primary Aim: To improve direct patient care personnel skills and adherence according to a 10 point transfer protocol using an internet and simulation-based training program • Design: Prospective educational intervention conducted as a pilot study at the University of Pittsburgh and the University of Pittsburgh Medical Center (IRB# 0511041) • Hierarchical Task Analysis: Deconstructed transfer processes in consultation with certified ergonomic experts and direct care providers. Developed a universally applicable 10 point transfer protocol to be used as a primary measurement instrument • Transfer Data: Observed and scored transfers on four nursing units of the UPMC Institute for Rehabilitation and Research at UPMC South Side and UPMC St. Margaret and also during simulation training scenarios at WISER • Data Collection: Automated through use of HP IPAQTM devices, Laerdal SimManTM log files and through the WISER Simulation Information Management System (SIMS)

Computerized Intraoperative Monitoring System at Montefiore University Hospital

Intraoperative data collection in the operating rooms of Montefiore University Hospital in Pittsburgh is performed on two systems. One is mainly used for cardiac surgery cases, another one is a UNIX based Apollo workstation network for various other data collection purposes.

Automated Data Collection in a Simulated Respiratory Circuit

A system was developed for automated collection of volume, flow and pressure readings in a simulated respiratory circuit.