Samuel Stipulante

Air versus ground transport of patients with acute myocardial infarction: experience in a rural-based helicopter medical service.

Aims Primary prehospital Helicopter Emergency Medical Service (HEMS) interventions may play a role in timely reperfusion therapy for patients with ST-segment elevation myocardial infarction (STEMI). We designed a prospective study involving patients with acute myocardial infarction aimed at the evaluation of the potential benefit of such primary HEMS interventions as compared with classical Emergency Medical Services ground transport. Methods and results This prospective study was conducted from 1 July 2007 to 15 June 2012. Successive patients with STEMI eligible for percutaneous coronary intervention were included. Simulated ground-based access times were computed using a digital cartographic program, allowing the estimation of healthcare system delay from call to admission to the catheterization laboratory. During the study period, 4485 patients benefited from HEMS activations. Of these patients, 342 (8%) suffering from STEMI were transferred for primary percutaneous coronary intervention. The median primary response time was 11 min (interquartile range: 8–14 min) using the helicopter and 32 min (25–44 min) using road transport. The median transport time was 12 min (9–15 min) using HEMS and 50 min (36–56 min) by road. The median system delay using HEMS was 52 min (45–60 min), whereas this time was 110 min (95–126 min) by road. Finally, the system delay median gain was 60 min (47–72 min). Conclusion Using HEMS in a rural region allows STEMI patients to benefit from appropriate rescue care with delays similar to those seen in urban settings.

Dispatcher-Assisted Telephone Cardiopulmonary Resuscitation Using a French-Language Compression-Ventilation Pediatric Protocol

Objective Out-of-hospital cardiac arrest (OHCA) in pediatrics is a devastating event associated with poor survival rates. Although telephone dispatcher-assisted cardiopulmonary resuscitation (CPR; T-CPR) instructions improve the frequency and quality of bystander CPR for OHCA in adults, this support remains undeveloped in children. Our objective was to assess the effectiveness of a pediatric T-CPR protocol in untrained and trained bystanders. Secondarily, we sought to determine the feasibility and the effectiveness of ventilation in such a protocol. Methods Eligible adults with no CPR experience were recruited in a movie theater in Liege, as well as bachelor nursing students in Liege. All volunteers were randomly assigned either to T-CPR or to no–T-CPR using randomization. The volunteers were exposed to a pediatric manikin model cardiac arrest. On the basis of Cardiff evaluation test, data were collected to evaluate CPR performance. Results A total of 115 volunteers were assigned to 4 groups: untrained nonguided group (n = 27), untrained guided group (n = 32), trained nonguided group (n = 26), and trained guided group (n = 30). We found an improvement in CPR performance in the guided groups. Most volunteers (81.2%) in untrained guided group and 83.3% in the trained guided group were able to give 2 ventilations after each compressions cycle. Conclusions In a pediatric manikin model of OHCA, T-CPR instructions including mouth-to-mouth ventilations and chest compressions produced a significant increase in resuscitation performance not only among previously untrained but also among trained volunteers.

Interactive videoconferencing versus audio telephone calls for dispatcher-assisted cardiopulmonary resuscitation using the ALERT algorithm: a randomized trial.

Objectives The ALERT algorithm, a telephone cardiopulmonary resuscitation (CPR) protocol, has been shown to help bystanders initiate CPR. Mobile phone communications may play a role in emergency calls and improve dispatchers’ understanding of the rescuer’s situation. However, there is currently no validated protocol for videoconference-assisted CPR (v-CPR). We initiated this study to validate an original protocol of v-CPR and to evaluate the potential benefit in comparison with classical telephone-CPR (t-CPR). Materials and methods We developed an algorithm for v-CPR, adapted from the ALERT t-CPR protocol. A total of 180 students were recruited from secondary school and assigned randomly either to t-CPR or to v-CPR. A manikin was used to evaluate CPR performance. Results The mean chest compression rate was higher in the v-CPR group (v-CPR: 110±16 vs. t-CPR: 86±28; P<0.0001), whereas depth was comparable between both groups (v-CPR: 48±13 vs. t-CPR: 47±16 mm; P=0.64). Hand positioning was correct in 91.7% with v-CPR, but only 68% with t-CPR (P=0.001). There was almost no ‘hands-off’ period in the v-CPR group [v-CPR: 0 (0–0.4) vs. t-CPR: 7 (0–25.5) s; P<0.0001], but the median no-flow time was increased in the v-CPR group [v-CPR: 146 (128–173.5) vs. t-CPR: 122 (105–143.5) s, P<0.0001]. The overall score of CPR performance was improved in the v-CPR group (P<0.001). Conclusion The v-CPR protocol allows bystanders to reach compression rates and depths close to guidelines and to reduce ‘hands-off’ events during CPR.

Dispatcher assisted telephone cardiopulmonary resuscitation using a french-language compression-ventilation pediatric protocol

Introduction: The aim of this study was to examine the incidence of musculoskeletal problems (i.e. pain, weakness, decreased joint range of movement) in critical care patients post discharge. Post intensive care syndrome (PICS) is now a widely used term to describe the collection of problems patients develop due to their stay in intensive care. ICU survivors have been found to have a high risk of developing not only psychological problems but physical problems such as Intensive Care Unit Acquired Weakness (ICUAW) and chronic pain [1, 2]. Methods: Discharged patients from ICU attended a 5 week multidisciplinary rehabilitation programme as part of a quality improvement initiative within Glasgow Royal Infirmary ICU. Participants completed a one-one musculoskeletal assessment with an ICU physiotherapist. Ethics approval was waived as the programme was part of a quality improvement initiative. Results: Data was collected from 47 of the 48 patients who attended the programme (median age was 52 (IQR, 44-57), 67% of the patients were men, median ICU length of stay (LOS) was 15 days (IQR 9-25) and median APACHE II was 23 (IQR 18-27). 66% of participants (n = 47) reported a new incidence of pain since discharge from ICU, 28% reporting lower limb (LL) pain and 25% reporting shoulder pain. Bilateral symptoms were reported in 84% of those who complained of lower limb pain in contrast to 25% of those with shoulder pain. In relation to muscle weakness, 74% of participants presented with LL weakness compared with 51% in the upper limb (UL). UL joint range of movement was reduced in 40% of participants and a 19% reduction for the LL. 23% of all participants reported numbness in UL/LL or both. Conclusions: Musculoskeletal problems especially shoulder pain and bilateral LL pain and weakness remain a significant problem for survivors of critical illness. This may have implications regarding falls risks, exercise capacity and reduce the likelihood of patients returning to work. Shoulder pain was found to be one of the most common complaints of pain supporting other research [1] with contributing factors such as the position of ventilator tubing, dialysis lines or central lines hypothesised. Collecting this data has helped raise awareness of these problems and may strengthen the case for more equipment for active mobilisation in ICU and herald a need for increased understanding in downstream wards on ICUAW.