Łukasz Szarpak

Simulated endotracheal intubation of a patient with cervical spine immobilization during resuscitation: a randomized comparison of the Pentax AWS, the Airtraq, and the McCoy Laryngoscopes

BACKGROUNDnTracheal intubation during cardiopulmonary resuscitation is a high-risk procedure. The aim of this study was to compare efficacy of intubation with the Pentax AWS, Airtraq, and McCoy laryngoscopes in patients with cervical spine immobilization during resuscitation in a randomized, controlled simulation trial.nnnMETHODSnWe compared times to intubation, success rate, Cormack and Lehane grading, and ease of intubation when using Pentax AWS, Airtraq, and McCoy in randomized order.nnnRESULTSnSixty-seven paramedics were trained in the use of the Pentax AWS, Airtraq, and McCoy laryngoscopes with a METIman Prehospital manikin. Participants performed tracheal intubation in patients with cervical spine immobilization during resuscitation scenario. We measured success rates, times for tracheal intubation, the glottic view, and ease of intubation.nnnRESULTSnThe primary study end point, overall success rate, was highest when using Pentax AWS (94.0%) and was lower in Airtraq (86.6%; P = .017) and in McCoy (85.1%; P = .019). Time to first effective ventilation was achieved significantly shorter when using Pentax AWS (25.4 ± 6.7 seconds) than Airtraq (35.6 ± 5.1 seconds; P < .001) or McCoy (38.5 ± 10.3 seconds; P < .001). The quality of glottic view and ease of use were best with Pentax AWS.nnnCONCLUSIONSnThe Pentax AWS videolaryngoscope provided a better view of the vocal cords, less insertion time, and higher success rate of the endotracheal intubation compared with the Airtraq or McCoy laryngoscopes in adults with simulated cervical spine immobilization during resuscitation.

Comparison of 3 different intraosseous access devices for adult during resuscitation. Randomized crossover manikin study

BACKGROUNDnThe study was designed to investigate the success rate and time of insertion intraosseous access during simulated resuscitation.nnnMATERIAL AND METHODSnThis was a randomized crossover study involving 107 paramedics. They were timed from start of insertion attempt to successful insertion and asked to score perceived difficulty of intraosseus access devices. Bone injection gun (BIG) (WaisMed Company, Houston, TX), EZ-IO (Vidacare, Shavano Park, TX) and Jamshidi (Carefusion, San Diego, CA) were used in this study.nnnRESULTSnSuccess rates for first intraosseus iniecition attempt were higher for the BIG (91.59%) than EX-IO (82.66%) or Jamshidi (47.66%). Mean procedure time was 2.0±0.7 vs 3.1±0.9 minutes for EZ-IO vs 4.2±1.0 minutes for Jamshidi.nnnCONCLUSIONSnThe use of BIG is associated with excellent success rates for insertion and appears easier to use than EZ-IO or Jamshidi Intraosseus Needle. Further work to evaluate the use of the intraosseus access device in the emergency medical services is required.

Does the use of a chest compression system in children improve the effectiveness of chest compressions? A randomised crossover simulation pilot study

BACKGROUNDnProviding high-quality chest compressions is a key element affecting the effectiveness of cardiopulmonary resuscitation (CPR).nnnAIMnTo evaluate the effectiveness of standard (manual) chest compressions (Standard BLS, standard basic life support) and those performed with the use of the Lifeline ARM chest compression system (ARM; Defibtech).nnnMETHODSnThe study was designed as a randomised crossover study. In total, 37 nurses participated in the study. They performed a randomized 2-min asynchronous resuscitation using the Standard BLS method or the ARM system. The following parameters were measured: the total number of chest compressions, the frequency of compressions (min-1), compression depth (mm), and the percentage of correctly performed chest compressions and total chest decompressions. The authors also analysed the participants preferences concerning the use of particular CPR techniques in the clinical setting.nnnRESULTSnThe results obtained during the simulation study with the application of the ARM system were statistically significantly better than those with the Standard BLS method (p < 0.05) in the case of all analysed parameters.nnnCONCLUSIONSnDuring the simulated child resuscitation performed by the nurses, the application of the Lifeline ARM chest compression system significantly improved the effectiveness of chest compressions.

Comparison of the TruView PCD video laryngoscope and macintosh laryngoscope for pediatric tracheal intubation by novice paramedics: a randomized crossover simulation trial.

AbstractThe aim of the present study was to evaluate whether the TruView video laryngoscope (TruView) facilitates pediatric endotracheal intubation (ETI) more quickly and safely than conventional Macintosh laryngoscope (MAC) in three manikin-based airway scenarios. This was a randomized crossover manikin study including 120 novice paramedics. The participants performed tracheal intubations using both TruView and MAC on a pediatric manikin in a control scenario (A), chest compression scenario (B), and chest compression cervical stabilization scenario (C). The sequence of scenarios was randomized. The primary outcome was time to intubation. Secondary outcomes were overall success rates, incidence of dental trauma, and ease of intubation. All intubation attempts were assessed by a trained assistant. The overall success rate was significantly higher with the TruView compared than the MAC in scenario B (100 vs. 81.7xa0%; pu2009=u20090.011) and scenario C (100 vs. 68.3xa0%; pu2009<u20090.001). The intubation time was significantly lower with the TruView than the MAC (18.5 vs. 24.3xa0s, pu2009=u20090.017, for scenario A; 21.6 vs. 25.7xa0s, pu2009=u20090.023, for scenario B; and 28.9 vs. 45.4xa0s, pu2009<u20090.001, for scenario C). Glottic view quality was better with TruView than the MAC in all scenarios, pu2009<u20090.001.n Conclusions: The TruView offers better intubation conditions than the MAC on a pediatric manikin in the control scenario, chest compression scenario, and chest compression scenario with cervical stabilization scenario. The TruView may be used to elevate the epiglottis for orotracheal intubation. Further clinical studies are necessary to confirm these initial positive findings.n Trial Registration: clinicaltrials.gov Identifier: NCT02289872.What is Known:•Prehospital pediatric intubation using a standard laryngoscope is varied and ranges from 63.4 to 82xa0%.What is New:•This is the first study showing efficiency of pediatric endotracheal intubation using the TruView PCD by paramedics in tree simulation scenarios.•TruView PCD offers better pediatric intubation conditions than the Macintosh laryngoscope.

Tracheal intubation with a VivaSight-SL endotracheal tube by paramedics in a cervical-immobilized manikin.

Our results indicate that our technique enables one to identify and rule out parotid duct injuries in patients with deep penetrating facial soft tissue trauma using commonly available materials in the ED. The technique was performed for the first time by two of the authors with very little technical difficulty. Both patients also had no complications of parotid duct injury such as salivary fistula, sialocele, abscess formation, wound dehiscence, or parotitis at follow-up. The advantages of this technique include the ability to avoid surgical exploration and resultant potential additional trauma. If the fluorescein dye test is negative, sparing a trip to the operating room could help contain costs. The lacrimal probe could cause ductal injury, however only a small length of probe needs to be inserted. Injury is likely a greater risk using a lacrimal probe alone because it must be advanced much farther into the wound bed. A less rigid material such as prolene suture may not cannulate the papilla as easily and is difficult to visualize. Injection of another dye such as methylene blue could be attempted, but is not recommended due to tissue staining and difficulty identifying structures [3]. Other methods to identify parotid duct injury like sialography and sialoendoscopy are not as readily available and require more experience [4,5]. Fluorescein has been safely applied in several othermedical applications [6–9].

The quality of a newly developed infant chest compression method applied by paramedics: a randomised crossover manikin trial

BACKGROUNDnThe aetiology of sudden cardiac arrest in infants is different from that in adults, with respiratory failure, sudden infant death syndrome, and drowning being the primary causes in the former. According to the European Resuscitation Council (ERC) and American Heart Association (AHA) recommendations, the quality of chest compressions (CC) is a key element affecting the effectiveness of cardiopulmonary resuscitation (CPR). The current ERC and AHA guidelines recommend the two-finger technique (TFT) or two-thumb encircling hands technique (TTHT) for external CCs during infant CPR.nnnAIMnThe aim of the randomised crossover manikin trial was to assess the CC quality during simulated resuscitation in infants performed by paramedics.nnnMETHODSnA prospective, randomised, crossover, single-centre study was conducted between June and August 2016. The study material consisted of 120 fully trained and licensed paramedics (39 females, 32.5%) with a minimum of five years of professional experience (mean 7.5 ± 4.8 years) in emergency medicine (mean age, 30.5 ± 5.5 years). The participants performed CCs using three techniques: TFT (the rescuer compresses the sternum with the tips of two fingers); TTHT; and the new two-thumb technique (nTTT). The novel method of CCs in an infant consists of using two thumbs directed at the angle of 90 degrees to the chest while closing the fingers of both hands in a fist.nnnRESULTSnThe median CC rate when using the TFT, the TTHT, and nTTT methods varied and amounted to 134 min-1 vs. 126 min-1 vs. 114 min-1, respectively. There was a statistically significant difference in the median CC frequency between TFT and TTHT (p < 0.001), TFT and nTTT (p < 0.001), and between TTHT and nTTT (p < 0.001). The highest percentage of compressions with the frequency recommended by the ERC guidelines (100-120 min-1) was achieved by the study participants only with the nTTT. The median CC depth during the TFT was 28 mm (interquartile range [IQR] 27-30 mm) and was significantly lower than in the static TTHT (40.5 [IQR 39-41] mm; p < 0.001) and nTTT (40 [IQR 39-41] mm; p < 0.001). The percentage of adequate depth CCs was correctly obtained with TTHT and nTTT. The largest proportion of total decompression of the chest was observed with the nTTT technique (96 [IQR 96-98] %), followed by TFT (95.5 [IQR 85.5-99] %) and TTHT (5 [IQR 3-7] %). In all scenarios, the correct placement of the CC point was achieved in more than 90% of cases.nnnCONCLUSIONSnOur novel infant CC method provides the highest percentage of CCs with the frequency recommended by the ERC guidelines as compared with standard techniques. It also allows optimal CC depth.

The effect of strength training on quality of prolonged basic cardiopulmonary resuscitation

BACKGROUNDnProviding high-quality chest compressions and rescue breaths are key elements in the effectiveness of cardio-pulmonary resuscitation.nnnAIMnTo investigate the effects of a strength training programme on the quality of prolonged basic cardiopulmonary resuscitation on a manikin.nnnMETHODSnThis was a quasi-experimental trial. Thirty-nine participants with prior basic life support knowledge were randomised to an experimental or control group. They then performed a test of 10 min of chest compressions and mouth-to-mouth ventilation on manikins equipped with a skill reporter tool (baseline or test 1). The experimental group participated in a four-week strength training programme focused on the muscles involved in chest compressions. Both groups were subsequently tested again (test 2).nnnRESULTSnAfter training, the experimental group significantly increased the mean depth of compression (53.7 ± 2.3 mm vs. 49.9 ± 5.9 mm; p = 0.003) and the correct compression fraction (68.2 ± 21.0% vs. 46.4 ± 29.1%; p = 0.004). Trained subjects maintained chest compression quality over time better than the control group. The mean tidal volume delivered was higher in the experimental than in the control group (701.5 ± 187.0 mL vs. 584.8 ± 113.6 mL; p = 0.040) and above the current resuscitation guidelines. In test 2, the percentage of rescue breaths with excessive volume was higher in the experi-mental group than in the controls (31.5 ± 19.6% vs. 15.6 ± 13.0%; p = 0.007).nnnCONCLUSIONSnA simple strength training programme has a significant impact on the quality of chest compressions and its maintenance over time. Additional training is needed to avoid over-ventilation of potential patients.

Comparison of Coopdech®, CoPilot®, Intubrite®, and Macintosh laryngoscopes for tracheal intubation during pediatric cardiopulmonary resuscitation: a randomized, controlled crossover simulation trial.

AbstractThe aim of the study was to compare the intubation times and success rates of various laryngoscopes during resuscitation in pediatric emergency intubation with uninterrupted chest compression on a standardized pediatric manikin model. This was a randomized crossover study with 107 paramedic participants. We compared times to successful intubation, intubation success rates, and glottic visibility using a Cormack–Lehane grade for Macintosh, Intubrite®, Coopdech®, and Copilot® laryngoscopes. One hundred seven paramedics (mean age 31.2u2009±u20097.5xa0years) routinely involved in the management of prehospital care participated in this study. Intubation success rates (overall effectiveness), which was the primary study endpoint, were highest for the Coopdech® and CoPilot® devices (100xa0%) and were lowest for Intubrite® (89.7xa0%, pu2009<u20090.001) and Macintosh (80.4xa0%, pu2009<u20090.001). The secondary study endpoint, time to first effective ventilation, was achieved fastest when using the Coopdech® laryngoscope (21.6u2009±u20096.2xa0s) and was significantly slower with all other devices (Intubrite® 25.4u2009±u200910.5xa0s, pu2009=u20090.006; CoPilot® 25.6u2009±u20097.4xa0s, pu2009=u20090.007; Macintosh 29.4u2009±u20098.2xa0s, pu2009<u20090.001).n Conclusion: We conclude that in child simulations managed by paramedics, the Coopdech® and Copilot® video laryngoscopes performed better than the standard Macintosh or Intubrite® laryngoscopes for endotracheal intubation during child chest compression.“What is Known”• Pediatric intubation performed by paramedics in prehospital conditions using a laryngoscope with Miller or Macintosh blades is varied and ranges from 63.4 to 82xa0%.“What is New”• This work is the first one evaluating mentioned airway devices in pediatric CPR provided by paramedics.• The results of this work can influence choice of airway device for clinical use in pediatric CPR.

Comparison of 3 video laryngoscopes against the Miller laryngoscope for tracheal intubation during infant resuscitation

Overcrowding (crowding, boarding, high volumes) 636 23% 21.5%-24.6% Financial, reimbursement, insurance, ACA, health care reform, EMR, charting, hospital policies 509 19% 17.0%-19.9% Clinical challenges, diagnosis, knowledge, fast pace, elderly and pediatric patients, community hospital 438 16% 14.5%-17.3% Nonacute use of ED, primary care, EMTALA abuse, chronic pain, psych patients, violent patients 393 14% 13.0%-15.6% Balance, shift work, odd hours, burnout 346 13% 11.3%-13.8% Legal, risk management, malpractice, defensive medicine 298 11% 9.7%-12.0% Define EM, specialty, consultants, midlevel providers, corporate groups 130 5% 3.9%-5.5% Patient safety (handoffs) 6 0.2% 0%-0.4%

Performance of the MDRD, CKD-EPI, and Cockcroft-Gault Formulas in Relation to Nutritional Status in Stable Renal Transplant Recipients.

BACKGROUNDnMonitoring of the function of the implanted kidney in renal transplant recipients (RTRs) is one of the superior elements of adequate therapeutic actions. The aim of this study was to assess the conventional and unconventional factors affecting the estimated glomerular filtration rate (eGFR) with the Modification of Diet in Renal Disease (MDRD), Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), and Cockcroft-Gault (C-G) formulas among the RTRs.nnnMETHODSnThe study included 144 RTRs (mean age 52 years). Clinical and laboratory data were analyzed; eGFR was calculated with MDRD, CKD-EPI, and C-G formulas. We compared the results with MDRD as a reference calculating the percentage of reclassifications of chronic kidney disease (CKD) stages. Nutritional status was assessed with a body composition analyzer, Tanita BCxa0418.nnnRESULTSnMultivariable linear regression analysis with MDRD and CKD-EPI formula as a dependent variable retained the following independent predictors: hemoglobin (Hb) (Bxa0= .365; Pxa0= .000), and red blood cell distribution width (RDW) (Bxa0=xa0-.191; Pxa0= .024). Analysis of variance showed the existence of statistically significant differences (all P for trendxa0<.05) between the CKD-EPI, MDRD, and C-G equations within the total scope of eGFR results (51.2 ± 21.2 vs 47.5 ± 18.7 vs 55.6 ± 20.6, respectively) as well as in quartiles of eGFR.nnnCONCLUSIONSnOur data indicate that (1) with a value of eGFR >60xa0mL/min/1.73 m(2), the MDRD formula shows values that are on average 11% lower than in the CKD-EPI and C-G formulas; (2) with a value of eGFRxa0<60xa0mL/min/1.73 m(2), the MDRD and CKD-EPI formulas do not show statistically significant differences.