Shu-Hsien Hsu

The Effect of Successful Intubation on Patient Outcomes After Out-of-Hospital Cardiac Arrest in Taipei

Study objective: The effect of out‐of‐hospital intubation in patients with out‐of‐hospital cardiac arrest remains controversial. The Taipei City paramedics are the earliest authorized to perform out‐of‐hospital intubation among Asian areas. This study evaluates the association between successful intubation and out‐of‐hospital cardiac arrest survival in Taipei. Methods: We analyzed 6 years of Utstein‐based registry data from nontrauma adult patients with out‐of‐hospital cardiac arrest who underwent out‐of‐hospital airway management including intubation, laryngeal mask airway, or bag‐valve‐mask ventilation. The primary analysis was intubation success on patient outcomes. The primary outcome was survival to discharge and the secondary outcomes included sustained return of spontaneous circulation and favorable neurologic survival. Sensitivity analysis was performed with intubation attempts rather than intubation success. Subgroup analysis of advanced life support–serviced districts was also performed. Results: A total of 10,853 cases from 2008 to 2013 were analyzed. Among out‐of‐hospital cardiac arrest patients receiving airway management, successful intubation, laryngeal mask airway, and bag‐valve‐mask ventilation was reported in 1,541, 3,099, and 6,213 cases, respectively. Compared with bag‐valve‐mask device use, successful out‐of‐hospital intubation was associated with improved chances of sustained return of spontaneous circulation (adjusted odds ratio [aOR] 1.91; 95% confidence interval [CI] 1.66 to 2.19), survival to discharge (aOR 1.98; 95% CI 1.57 to 2.49), and favorable neurologic outcome (aOR 1.44; 95% CI 1.03 to 2.03). The results were comparable in sensitivity and subgroup analyses. Conclusion: In nontrauma adult out‐of‐hospital cardiac arrest in Taipei, successful out‐of‐hospital intubation was associated with improved odds of sustained return of spontaneous circulation, survival to discharge, and favorable neurologic outcome.

US-CAB protocol for ultrasonographic evaluation during cardiopulmonary resuscitation: Validation and potential impact

BACKGROUND We previously developed a US-CAB protocol for evaluation of circulatory-airway-breathing status during cardiopulmonary resuscitation (CPR). This study aimed at validating its application in real CPR scenarios and the potential impact on CPR outcomes. METHODS The US-CAB protocol was implemented at the emergency department of National Taiwan University Hospital since January 2016. The US images, initiation time and operation duration of each US-CAB procedure, and relevant CPR information were recorded for analysis. RESULTS From January 2016 to March 2017, 177 cardiac arrest patients receiving US-CAB were included. The durations of US-C-A-B procedure were 9.0 ± 1.4, 7.5 ± 1.5, and 16.0 ± 1.9 s, respectively. Cardiac activity was identified in 47 cases (26.6%), with higher rates of return of spontaneous circulation (ROSC) (95.7% vs. 21.5%, p < .0001) and survival to hospital discharge (25.5% vs. 10.0%, p < .01). Detection of cardiac activity after 10 min of CPR exhibited 100% sensitivity, specificity, positive and negative predictive value for ROSC. Cardiac tamponade was noted in eight patients. ROSC was achieved in two (25.0%) after pericardiocentesis, and aortic dissection was diagnosed in one (12.5%). Confirmation of correct intubation was significantly faster by US than by capnography (7.4 ± 1.4 vs. 38.3 ± 110.2 s, p < .001). US detected 21 (11.9%) esophageal intubations and 3 (1.7%) one-lung intubations. All were promptly corrected. CONCLUSION The US-CAB protocol is feasible in real CPR scenarios. It confers diagnostic value and prognostic implications which potentially impact the efficacy and outcomes of CPR. However, a future prospective multi-center study to validate its feasibility and indicate the need of structured training is mandated.

Data on evaluation of proficiency for the US-CAB curriculum

Data presented in this article relates to the research article entitled “US-CAB protocol for ultrasonographic evaluation during cardiopulmonary resuscitation: validation and potential impact” (Lien et al., in press). The article provides data regarding proficiency of the 10 emergency residents attending the US-CAB curriculum. Assessments included immediate evaluation at the end of training and re-evaluation 6 months later. A written test, and the ultrasound image acquisition were required in the immediate evaluation The re-evaluation included the written test and performance on the same healthy volunteer.