The Pragmatic Airway Resuscitation Trial
|
|
|
- Angelica Paul
- 5 years ago
- Views:
Transcription
1 The Pragmatic Airway Resuscitation Trial Henry E. Wang, MD, MS Professor and Vice Chair for Research Department of Emergency Medicine The University of Texas Health Science Center at Houston McGovern Medical School at UTHealth McGovern Medical School at UTHealth
2 Disclosures NIH Grant Support UH2/UH3-HL PI, Pragmatic Airway Resuscitation Trial McGovern Medical School at UTHealth
3 What is Bag-Valve-Mask Ventilation? McGovern Medical School at UTHealth
4 What is Endotracheal Intubation? McGovern Medical School at UTHealth
5 What is EMS? Emergency Medical Services Emergency acute care Rapid assessment, stabilization, triage Transport to receiving hospital Uncontrolled prehospital environment McGovern Medical School at UTHealth
6 System of US EMS Care Basic Life Support (BLS) Emergency Medical Technician (EMT) CPR Bag-valve-mask ventilation Automated external defibrillators No intubation or drugs Advanced Life Support (EMS) Paramedic Intubation IV medications Manual defibrillation Few EMS physician systems in US McGovern Medical School at UTHealth
7 Why Intubate in the Field? Provide direct conduit to lungs Improve ventilation Prevent aspiration Parallels in-hospital care Ultimate goal Save lives McGovern Medical School at UTHealth
8 Does Prehospital Intubation Improve Outcomes (Save Lives)? McGovern Medical School at UTHealth
9 Does Intubation Save Lives? >20 studies of prehospital intubation and outcome (survival) Recurrent theme: Prehospital intubation associated with increased risk of death Prehospital intubation associated with poorer neurological outcome McGovern Medical School at UTHealth
![Prehospital Intubation of Children Gausche, JAMA 2000 RCT [BVM ± ETI] vs.](/docs-images/95/123675443/images/10-4.jpg "BVM-only 830 children No difference in survival No difference in neurological outcome McGovern")
10 Prehospital Intubation of Children Gausche, JAMA 2000 RCT [BVM ± ETI] vs. BVM-only 830 children No difference in survival No difference in neurological outcome McGovern Medical School at UTHealth
11 Are Poor Outcomes Due to Errors? McGovern Medical School at UTHealth
12 Endotracheal Tube Misplacement Katz and Falk, Annals Emerg Med 1999 N=108 prehospital intubations Systematic reconfirmation in ED 25% tube misplacement rate 2/3 esophageal 1/3 above vocal cords McGovern Medical School at UTHealth
13 Oxygen Desaturation and Bradycardia Dunford, Annals Emerg Med 2004 San Diego RSI Trial N=152 RSI patients Continuously recorded waveforms: Heart Rate Oxygen Saturation End-Tidal Capnography McGovern Medical School at UTHealth
14 Oxygen Desaturation and Bradycardia SaO2 HR ETCO2 Dunford, et al. Ann Emerg Med 2004
15 Oxygen Desaturation and Bradycardia SaO2 HR ETCO2 Oxygen Desaturation: 31 (57%) Bradycardia: 6 (19%) Dunford, et al. Ann Emerg Med 2004
16 Does Intubation Interact with Other Interventions?
17 CPR Chest Compressions ACLS Guidelines: Avoid CPR Chest Compression Interruptions New CPR detection technology Can see delivered chest compressions McGovern Medical School at UTHealth
18 Example of CPR Interruption from Intubation
19 Example of CPR Interruption from Intubation ETCO 2 Signal
20 Example of CPR Interruption from Intubation ETCO 2 Signal ET Tube Placement
21 Example of CPR Interruption from Intubation 30 sec CPR Interruption ETCO 2 Signal ET Tube Placement
22 Intubation-Associated Chest Compression Interruptions Wang, Annals EM 2009 Pittsburgh N=100 Review of CPR process files and audio recordings Identified all CPR interruptions due to intubation efforts McGovern Medical School at UTHealth
23 Intubation-Associated CPR Interruptions Percentage of Patients Total Number of CPR Interruptions Pittsburgh, n=100 Wang, et al., Ann Emerg Med 2009 McGovern Medical School at UTHealth
24 Intubation-Associated CPR Interruptions Percentage of Patients Median: 2 Interruptions (IQR: 1-3) Min 1, Max 9 30% >2 Interruptions Total Number of CPR Interruptions Pittsburgh, n=100 Wang, et al., Ann Emerg Med 2009 McGovern Medical School at UTHealth
25 Duration of Intubation-Associated CPR Interruptions First Subsequent Sum Duration (sec) Wang, et al., Ann Emerg Med 2009
26 Duration of Intubation-Associated CPR Interruptions First First CPR Interruption Median: 46.5 sec (IQR: ) Min 7, Max 221 ~30% >60 sec Subsequent Sum Duration (sec) Wang, et al., Ann Emerg Med 2009
27 Duration of Intubation-Associated CPR Interruptions First Subsequent First CPR Interruption Median: 46.5 sec (IQR: ) Min 7, Max 221 ~30% >60 sec Subsequent CPR Interruptions Median: 35 sec (IQR: 21-58) Min 7, Max 199 ~20% >60 sec Sum Duration (sec) Wang, et al., Ann Emerg Med 2009
28 Duration of Intubation-Associated CPR Interruptions First Subsequent First CPR Interruption Median: 46.5 sec (IQR: ) Min 7, Max 221 ~30% >60 sec Subsequent CPR Interruptions Median: 35 sec (IQR: 21-58) Min 7, Max 199 ~20% >60 sec Sum Wang, et al., Ann Emerg Med Duration (sec) Sum of All CPR Interruptions Median: sec (IQR: ) Min 13, Max 446 ~25% >180 sec
29 Does Training Play a Role?
30 Intubation is Difficult in Prehospital Mosh Pit There s no such thing as an easy prehospital airway Paramedics need exceptional intubation skills
31 How Many Intubations Do You Need to Graduate in the US? Emergency Med Residents 35 Anesthesia Residents CRNA Students 200 Paramedic Students 5 McGovern Medical School at UTHealth
32 Paramedic Student Operating Room Training Hours 0 Percentage of Programs hrs 5-8 hrs 9-16 hrs hrs >32 hrs OR Hours Johnston, et al., Acad Emerg Med 2006
33 Paramedic Student Operating Room Training Hours Percentage of Programs Median hours hrs 5-8 hrs 9-16 hrs hrs >32 hrs OR Hours Johnston, et al., Acad Emerg Med 2006
34 Paramedic Student Operating Room Barriers Competition from other students Widespread Laryngeal Mask Airway use Anesthesiologists medicolegal concerns McGovern Medical School at UTHealth
35 Intubation Skill Skill ( Proficiency ) = Baseline Training + Regular Application McGovern Medical School at UTHealth
36 Intubations Per Paramedic Pennsylvania 2003 Wang, et al. Crit Care Med 2005
37 Intubations Per Paramedic Pennsylvania 2003 Median ETI: 1 (IQR 0-3) 39% performed no ETI 67% performed 2 or fewer ETI Wang, et al. Crit Care Med 2005
38 We Have a Problem... Prehospital ETI clinical benefit not proven Prone to error Difficult Interacts with other interventions Performed under worst possible conditions Limited training McGovern Medical School at UTHealth
39 There is an Alternative McGovern Medical School at UTHealth
40 Supraglottic Airways (SGA) Easier technique Less training required Similar ventilation to ETI Increasing use as primary airway in OHCA King Laryngeal Tube (LT) Laryngeal Mask Airway (LMA) i-gel
41 SGA vs ETI Unexpected Results McGovern Medical School at UTHealth
42 Resuscitation Outcomes Consortium Endotracheal Intubation Versus Supraglottic Airway Insertion After Out-of-Hospital Cardiac Arrest Henry E. Wang, MD, MS Department of Emergency Medicine, University of Alabama at Birmingham Danny Syzdlo, MS; John Stouffer, EMT-P; Steve Lin, MDCM; Jestin Carlson, MD; Christian Vaillancourt, MD; Gena Sears, BSN; Richard Verbeek, MD; Raymond Fowler, MD; Ahamed Idris, MD; Karl Koenig, EMT-P; James Christenson, MD; Anush Minokadeh, MD; Joseph Brandt, EMT-P; Thomas Rea, MD; and the ROC Investigators
43 ETI vs. SGA in Cardiac Arrest ROC PRIMED Trial 10,455 OHCA 8,457 ETI 1,968 SGA 909 King 296 Combitube 239 LMA 518 Unknown
44 ETI Wins over SGA (Oops ) Wang, Resuscitation 2012
45 ETI Wins over SGA (Oops ) Wang, Resuscitation 2012
46 ETI Wins over SGA (Oops ) Wang, Resuscitation 2012
47 ETI Wins over SGA (Oops ) Wang, Resuscitation 2012
48 ETI Wins over SGA (Oops ) Wang, Resuscitation 2012
49 ETI Wins over SGA (Oops ) Wang, Resuscitation 2012
50 ETI vs. SGA Meta Analysis of Observational Studies Neurologically Intact Survival To Hospital Discharge Outcomes Better with Intubation than SGA Benoit, Resuscitation, 2015
51 A Randomized Trial is Necessary Confounding-by-indication Randomization is only way to overcome confounding-by-indication McGovern Medical School at UTHealth
52 Three Landmark Airway Management Clinical Trials McGovern Medical School at UTHealth
53 Pragmatic Airway Resuscitation Trial (PART) Wang, et al, JAMA 2018
54 Resuscitation Outcomes Consortium Laryngeal Tube vs. Endotracheal Intubation in Adult Out-of-Hospital Cardiac Arrest HE Wang, RH Schmicker, MR Daya, SW Stephens, AH Idris, JN Carlson, MR Colella, H Herren, M Hansen, NJ Richmond, JCJ Puyana, TP Aufderheide, RE Gray, PC Gray, M Verkest, PC Owens, AM Brienza, KJ Sternig, SJ May, GR Sopko, ML Weisfeldt, G Nichol The University of Texas Health Science Center at Houston, University of Alabama at Birmingham, University of Texas Southwestern Medical Center, Medical College of Wisconsin, University of Pittsburgh, Oregon Health and Science University, University of Washington
55 Objective Compare effectiveness of initial laryngeal tube (LT) vs. initial ETI upon outcomes in adult OHCA
56 Design Multicenter cluster randomized trial with crossover Exception from Informed Consent 21 CFR EMS agencies Alabama Dallas-Fort Worth Milwaukee Pittsburgh Portland
57 Funding Requirements NHLBI program for low-cost pragmatic clinical trials Pragmatic emphasis Adherence to standard practices Focus on outcomes Less emphasis on mechanisms Capped funding ($2.35M) US sites only
58 Enrollment Criteria Inclusion Adult out-of-hospital cardiac arrest Treated by EMS Requiring advanced airway or BVM Exclusion Children Pregnant women Prisoners Trauma Interfacility Transports Initial care by non-study EMS agency Do not enroll bracelet
59 Interventions Adult Out-of-Hospital Cardiac Arrest Laryngeal Tube Advanced EMS: LT Basic EMS: BVM (or LT) Endotracheal Intubation Advanced EMS: ETI Basic EMS: BVM CONTINUE RESUSCITATION
60 Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct 2015 Cluster Randomization with Crossover Randomization Cluster K E L B J F G M A C D H I LT ETI Cluster-Crossover Schedule
61 Outcomes Primary outcome 72-hour survival Pragmatic considerations Limitations of funding Secondary outcomes ROSC on ED arrival Survival to hospital discharge Favorable neurologic outcome on hospital discharge (MRS 3) Airway management course, adverse events
62 Data Analysis Intention-to-treat Generalized estimating equations Accounted for randomization cluster and interim analyses Other analyses A priori defined subgroups Per-protocol and as-treated analyses Post-hoc multivariable adjusted analyses Sample size estimate Data from ROC PRIMED trial Power 85%, alpha 0.05, 5% loss in precision due to clustering, 4.5% difference in 72h survival Estimated minimum sample size 2,612 Increased sample size to 3,000
63 Results 56 Cluster Enrollment Periods 30 LT Periods 1,968 Patients Screened 26 ETI Periods 1,872 Patients Screened 463 Patients Excluded 373 Patients Excluded 1,505 Patients Assigned to LT 1,499 Patients Assigned to ETI
64 Patient Characteristics Characteristic LT N=1,505 ETI N=1,499 Age years, median (IQR) 64 (53, 76) 64 (53, 76) Male 61.7% 60.1% EMS Witnessed Arrest 13.3% 12.8% Bystander Witnessed Arrest 37.7% 37.8% Bystander CPR 55.5% 55.4% EMS Dispatch-to-Arrival minutes, med (IQR) 2.1 (1.1, 3.8) 2.1 (1.0, 3.7) Shockable ECG Rhythm 20.0% 18.0% Epinephrine Given 92.0% 93.7% Transported to Hospital 60.2% 59.3% Hospital Therapeutic Hypothermia 52.6% 46.3% Hospital Coronary Catheterization 23.7% 18.3% Similar Between Groups
65 LT
66 LT
67 LT
68 Primary and Secondary Outcomes 72h Survival 27.9% 24.3% ROSC Δ = 3.6% ( %) P= % 15.4% 10.8% 8.1% Hospital Discharge Δ = 2.7 ( ) P=0.01 Δ = 2.9% ( %) P= % 5.0% Favorable Neuro Status Δ = 2.1% ( %) P=0.02 LT ETI
69 Primary and Secondary Outcomes 72h Survival 27.9% 24.3% ROSC Δ = 3.6% ( %) P= % 15.4% 10.8% 8.1% Hospital Discharge Δ = 2.7 ( ) P=0.01 LT Δ = 2.9% ( %) P=0.04 ETI 7.1% 5.0% LT better than ETI over all outcomes Favorable Neuro Status Δ = 2.1% ( %) P=0.02
70 Airways-2 Trial Benger, et al, JAMA 2018
71 Airways-2 Design RCT United Kingdom 4 EMS agencies Population 21 million 40% of UK population Adult OHCA Intubation vs i-gel Cluster randomized By study paramedic N=1,523 medics Hospital Survival with Favorable Neuro Status Estimated n=9,070 patients June 2015 August 2017
72 Airways-2 Primary Findings
73 Airways-2 Primary Findings No difference between i-gel and ETI
74 Important Secondary Finding ~18% received BVM only When limited to 7,576 receiving i-gel or ETI: i-gel 163 of 4,158 (3.9%) good outcome ETI 88 of 3,418 (2.6%) good outcome Risk difference 1.4% (95% CI: %)
75 Important Secondary Finding ~18% received BVM only When limited to 7,576 receiving i-gel or ETI: i-gel 163 of 4,158 (3.9%) good outcome ETI 88 of 3,418 (2.6%) good outcome Risk difference 1.4% (95% CI: %) Per-Protocol i-gel better than ETI
76 Cardiac Arrest Airway Management Trial (CAAM) Jabre, et al., JAMA 2018
77 CAAM Design RCT France and Belgium SAMUs 20 EMS centers MD + RN + Driver Adult OHCA BVM vs. ETI Intervention by medical team ETI post-rosc Per-Patient Randomization Sealed envelopes 28d Survival with Favorable Neuro Status Non-inferiority design 1% Non-inferiority margin Estimated n=2,000 March Jan 2017
78 Primary Result 28-day Survival with Favorable Neuro Status (CPC 1-2) BVM 44 / 1018 (4.3%) ETI 43 / 1022 (4.2%) Difference = 0.11% (1-sided 97.5% CI: -1.64% to infinity) Non-inferiority p=0.11
79 Primary Result 28-day Survival with Favorable Neuro Status (CPC 1-2) BVM 44 / 1018 (4.3%) ETI 43 / 1022 (4.2%) Difference = 0.11% (1-sided 97.5% CI: -1.64% to infinity) Non-inferiority p=0.11 This is an uninterpretable result
80 Very Important Secondary Findings
81 Very Important Secondary Findings
82 Very Important Secondary Findings
83 Summing Up the Trials Characteristic PART Airways-2 CAAM Setting USA UK France, Belgium Comparison LT vs. ETI i-gel vs. ETI BVM vs. ETI Practitioners Paramedics, Some EMTs Paramedics Physicians (SAMUs) Sample Size 3,000 9,296 2,043 Randomization Cluster Randomized by EMS Agencies Cluster Randomized by Medic Primary Outcome 72-hour Survival Hospital Survival w/favorable Neuro Status Per Patient (sealed envelopes) 28-Day Survival w/favorable Neuro Status BVM-only rate ~12% ~18% N/A Primary Finding LT better than ETI No difference between i-gel and ETI Inconclusive Important Secondary Findings Low ETI Success Rate i-gel Better Than ETI BVM Poorer Ventilation, Higher Aspiration
84 The Big Picture PART SGA (LT) is better than ETI Airways-2 At best, ETI is no better than SGA (i-gel) CAAM BVM is not the answer
85 Next Chapters Mechanistic data Chest compressions Lung ventilations SGA Safety Data Implementation strategies Other patient groups Trauma (PACT) Peds (Pedi-PART) Hospital airway practices McGovern Medical School at UTHealth
86 Questions? Henry E. Wang, MD, MS Department of Emergency Medicine The University of Texas Health Science Center at Houston McGovern Medical School at UTHealth
Science Behind Resuscitation. Vic Parwani, MD ED Medical Director CarolinaEast Health System August 6 th, 2013
Science Behind Resuscitation Vic Parwani, MD ED Medical Director CarolinaEast Health System August 6 th, 2013 Conflict of Interest No Financial or Industrial Conflicts Slides: Drs. Nelson, Cole and Larabee
Science Behind CPR Update from Darrell Nelson, MD, FACEP Emergency Medicine Wake Forest University Health Sciences
Science Behind CPR Update from 2010 Darrell Nelson, MD, FACEP Emergency Medicine Wake Forest University Health Sciences FRAMING THE DISCUSSION NO ONE SURVIVES CARDIAC ARREST, EXCEPT ON TV Conflicts of
GETTING TO THE HEART OF THE MATTER. Ritu Sahni, MD, MPH Lake Oswego Fire Department Washington County EMS Clackamas County EMS
GETTING TO THE HEART OF THE MATTER Ritu Sahni, MD, MPH Lake Oswego Fire Department Washington County EMS Clackamas County EMS TAKE HOME POINTS CPR is the most important thing Train like we fight Measure
Supplementary Online Content
Supplementary Online Content Hasegawa K, Hiraide A, Chang Y, Brown DFM. Association of prehospital advancied airway management with neurologic outcome and survival in patients with out-of-hospital cardiac
Regionalization of Post-Cardiac Arrest Care
Regionalization of Post-Cardiac Arrest Care David A. Pearson, MD, FACEP, FAAEM Department of Emergency Medicine Disclosures I have no financial interest, arrangement, or affiliations and no commercial
Resuscitation Outcomes Consortium: Overview and Update
Resuscitation Outcomes Consortium: Overview and Update RESUSCITATION OUTCOMES CONSORTIUM OPALS PRG Annual Meeting Ottawa 2006 Resuscitation Outcomes Consortium: Overview Mandate and Overview Partners Project
Adult Advanced Cardiovascular Life Support. Emergency Procedures in PT
Adult Advanced Cardiovascular Life Support Emergency Procedures in PT BLS Can be learned & practiced by the general public Includes: CPR First Aid (e.g. choking relief) Use of AED ACLS Used by healthcare
CONTRAVERSIES IN PREHOSPITAL ADVANCED AIRWAY MANAGEMENT. Dennis Allin MD, FACEP, FAAEM Chair, Department of Emergency Medicine University of Kansas
CONTRAVERSIES IN PREHOSPITAL ADVANCED AIRWAY MANAGEMENT Dennis Allin MD, FACEP, FAAEM Chair, Department of Emergency Medicine University of Kansas DISCLOSURES I have no financial interests to disclose
University of Washington. From the SelectedWorks of Kent M Koprowicz
University of Washington From the SelectedWorks of Kent M Koprowicz 2007 Site variation in EMS Treatment, Transport and Survival in relation to Restoration of Spontaneous Circulation (ROSC) for Adult Out-of-Hospital
Disclosure. Co-investigators 1/23/2015
The impact of chest compression fraction on clinical outcomes from shockable out-of-hospital cardiac arrest during the ROC PRIMED trial Sheldon Cheskes, MD CCFP(EM) FCFP Medical Director, Sunnybrook Centre
One Good Attempt Doesn t Deserve Another: What Happens When You Limit ET Tube Placement to One Try?
One Good Attempt Doesn t Deserve Another: What Happens When You Limit ET Tube Placement to One Try? John K. Griswell, MD, FACEP The challenge... How do we take care of the airway needs of our patients
The evidence behind ACLS: the importance of good BLS
The evidence behind ACLS: the importance of good BLS Benjamin S. Abella, MD, MPhil, FACEP CRS Center for Resuscitation Science Clinical Research Director Center for Resuscitation Science Vice Chair of
The studies that EMS must do. Disclosures. Objectives
The studies that EMS must do David C. Cone, MD Professor of Emergency Medicine EMS Section Chief Yale University School of Medicine Editor-in-Chief Academic Emergency Medicine President 2007-2008 National
Lesson learnt from big trials. Sung Phil Chung, MD Gangnam Severance Hospital, Yonsei Univ.
Lesson learnt from big trials Sung Phil Chung, MD Gangnam Severance Hospital, Yonsei Univ. Trend of cardiac arrest research 1400 1200 1000 800 600 400 200 0 2008 2009 2010 2011 2012 2013 2014 2015 2016
Controversies in Chest Compressions & Airway Management During CPR. Bob Berg
Controversies in Chest Compressions & Airway Management During CPR Bob Berg No Financial Conflicts of Interest Employment: University of Pennsylvania AHA Volunteer AHA GWTG-R & Systems of Care committees
But unfortunately, the first sign of cardiovascular disease is often the last. Chest-Compression-Only Resuscitation Gordon A.
THE UNIVERSITY OF ARIZONA Sarver Heart Center 1 THE UNIVERSITY OF ARIZONA Sarver Heart Center 2 But unfortunately, the first sign of cardiovascular disease is often the last 3 4 1 5 6 7 8 2 Risk of Cardiac
2015 AHA Guidelines: Pediatric Updates
2015 AHA Guidelines: Pediatric Updates Advances in Pediatric Emergency Medicine December 9, 2016 Karen O Connell, MD, MEd Associate Professor of Pediatrics and Emergency Medicine Emergency Medicine and
ROC PRIMED Questions and Answers
ROC PRIMED Questions and Answers 1) What is the ROC PRIMED study? ROC PRIMED stands for the Resuscitation Outcomes Consortium Prehospital Resuscitation using an IMpedance valve and Early versus Delayed
Rowan County EMS. I m p r o v i n g C a r d i a c A r r e s t S u r v i v a l. Christopher Warr NREMT-P Lieutenant.
Rowan County EMS I m p r o v i n g C a r d i a c A r r e s t S u r v i v a l Christopher Warr NREMT-P Lieutenant Rowan County EMS christopher.warr@rowancountync.gov September 9, 2012 2:44 11:44:00 Mr.
Trial of Continuous or Interrupted Chest Compressions during CPR
Original Article Trial of Continuous or Interrupted Chest Compressions during CPR Graham Nichol, M.D., M.P.H., Brian Leroux, Ph.D., Henry Wang, M.D., Clifton W. Callaway, M.D., Ph.D., George Sopko, M.D.,
Pediatric Cardiac Arrest General
Date: November 15, 2012 Page 1 of 5 Pediatric Cardiac Arrest General This protocol should be followed for all pediatric cardiac arrests. If an arrest is of a known traumatic origin refer to the Dead on
The 2015 BLS & ACLS Guideline Updates What Does the Future Hold?
The 2015 BLS & ACLS Guideline Updates What Does the Future Hold? Greater Kansas City Chapter Of AACN 2016 Visions Critical Care Conference Nicole Kupchik RN, MN, CCNS, CCRN, PCCN, CMC Independent CNS/Staff
Epinephrine Cardiovascular Emergencies Symposium 2018
Epinephrine Cardiovascular Emergencies Symposium 218 Corey M. Slovis, M.D. Vanderbilt University Medical Center Metro Nashville Fire Department Nashville International Airport Nashville, TN High Quality
Cardiac Arrest January 2017 CPR /3/ Day to Survival Propensity Matched
Cardiac Arrest January 217 Corey M. Slovis, M.D. Vanderbilt University Medical Center Metro Nashville Fire Department Nashville International Airport Nashville, TN CPR 217 Used data based on protocol that
Portage County EMS Annual Skills Labs
Portage County EMS Annual Skills Labs Scope: Provide skills labs for all Emergency Medical Responders and First Response EMTs to assure proficiency of skills and satisfy the Wisconsin State approved Operational
journal of medicine The new england Trial of Continuous or Interrupted Chest Compressions during CPR abstract
The new england journal of medicine established in 1812 December 3, 2015 vol. 373 no. 23 Trial of Continuous or Interrupted Chest Compressions during CPR Graham Nichol, M.D., M.P.H., Brian Leroux, Ph.D.,
Cardiopulmonary Resuscitation in Adults
Cardiopulmonary Resuscitation in Adults Fatma Özdemir, MD Emergency Deparment of Uludag University Faculty of Medicine OVERVIEW Introduction Pathophysiology BLS algorithm ALS algorithm Post resuscitation
in Cardiac Arrest Management Sean Kivlehan, MD, MPH May 2014
in Cardiac Arrest Management Sean Kivlehan, MD, MPH May 2014 1. Capnography 2. Compressions 3. CPR Devices 4. Hypothermia 5. Access 6. Medications Outline Capnography & Termination Significantly Associated
Emergency Cardiac Care Guidelines 2015
Emergency Cardiac Care Guidelines 2015 VACEP 2016 William Brady, MD University of Virginia Guidelines 2015 Basic Life Support & Advanced Cardiac Life Support Acute Coronary Syndrome Pediatric Advanced
Manual Defibrillation. CPR AGE: 18 years LOA: Altered HR: N/A RR: N/A SBP: N/A Other: N/A
ROC AMIODARONE, LIDOCAINE OR PLACEBO FOR OUT OF HOSPITAL CARDIAC ARREST DUE TO VENTRICULAR FIBRILLATION OR TACHYCARDIA (ALPS) STUDY: MEDICAL CARDIAC ARREST MEDICAL DIRECTIVE An Advanced Care Paramedic
Airway Management Essentials Self-Study Guide
Airway Management Essentials Self-Study Guide Fourth Quarter 2010 Self-Study Guide Learning Objectives Cognitive Domain 1. Describe the various conditions that cause concern during treatment in the field
Don t let your patients turn blue! Isn t it about time you used etco 2?
Don t let your patients turn blue! Isn t it about time you used etco 2? American Association of Critical Care Nurses National Teaching Institute Expo Ed 2013 Susan Thibeault MS, CRNA, APRN, CCRN, EMT-P
2015 Interim Training Materials
2015 Interim Training Materials ACLS Manual and ACLS EP Manual Comparison Chart Assessment sequence Manual, Part 2: The Systematic Approach, and Part BLS Changes The HCP should check for response while
Answer: It s ALL Hot!
Answer: It s ALL Hot! What s Hot in Resuscitation? Ben Bobrow, MD FACEP Chair BLS Subcommittee Associate Professor Maricopa Medical Center Emergency Medicine Department System measurement Bystander Dispatch-assisted
INSIGHTS AND BEST PRACTICES FOR EMS AGENCIES
2018 ESO EMS INDEX: INSIGHTS AND BEST PRACTICES FOR EMS AGENCIES AUTHORS DR. BRENT MYERS, CHIEF MEDICAL OFFICER, ESO ALLEN JOHNSON, VICE PRESIDENT FOR HEALTH DATA EXCHANGE, ESO CONTEXT AND OVERVIEW FOR
EMS System Key Performance Indicator Data Quality Rules Clinical Group/ Key Performance Indicators (KPIs)
EMS System Key Performance Indicator Data Quality Rules 1. Critical Trauma Patient Management 1.1 Percent of Step 1 and Step 2 trauma patients with an EMS scene time of less than 10 minutes. (arrival-to-departure
Lessons Learned From Cardiac Resuscitation Research: What Matters at the Bedside?
Lessons Learned From Cardiac Resuscitation Research: What Matters at the Bedside? JILL LEY, MS, RN, CNS, FAAN CLINICAL NURSE SPECIALIST SURGICAL SERVICES CALIFORNIA PACIFIC MEDICAL CENTER CLINICAL PROFESSOR,
Key statistics from the National Cardiac Arrest Audit: Paediatric arrests April 2012 to March 2017
Key statistics from the National Cardiac Arrest Audit: Paediatric arrests April 12 to March 17 Supported by Resuscitation Council (UK) and Intensive Care National Audit & Research Centre (ICNARC) Data
Improving Outcome from In-Hospital Cardiac Arrest
Improving Outcome from In-Hospital Cardiac Arrest National Teaching Institute San Diego, CA Nicole Kupchik RN, MN, CCNS, CCRN, PCCN, CMC Independent CNS/Staff Nurse Objectives 1. Discuss the AHA in-hospital
Classification of Cardiopulmonary Resuscitation Chest Compression Patterns: Manual Versus Automated Approaches
ORIGINAL CONTRIBUTION Classification of Cardiopulmonary Resuscitation Chest Compression Patterns: Manual Versus Automated Approaches Henry E. Wang, MD, MS, Robert H. Schmicker, MS, Heather Herren, RN,
MICHIGAN. State Protocols. Pediatric Cardiac Table of Contents 6.1 General Pediatric Cardiac Arrest 6.2 Bradycardia 6.
MICHIGAN State Protocols Protocol Number Protocol Name Pediatric Cardiac Table of Contents 6.1 General Pediatric Cardiac Arrest 6.2 Bradycardia 6.3 Tachycardia PEDIATRIC CARDIAC PEDIATRIC CARDIAC ARREST
ACLS. Advanced Cardiac Life Support Practice Test Questions. 1. The following is included in the ACLS Survey?
1. The following is included in the ACLS Survey? a. Airway, Breathing, Circulation, Differential Diagnosis b. Airway, Breathing, Circulation, Defibrillation c. Assessment, Breathing, Circulation, Defibrillation
1/24/2018. Taking Mechanical CPR to New Heights: Use of Automated Chest Compression Devices in Helicopter EMS Transport.
Taking Mechanical CPR to New Heights: Use of Automated Chest Compression Devices in Helicopter EMS Transport NAEMSP 2018 Annual Meeting January 8-13, 2018 San Diego, CA John W. Lyng, MD, FACEP, FAEMS,
New ACLS/Post Arrest Guidelines: For Everyone? Laurie Morrison, Li Ka Shing, Knowledge Institute, St Michael s Hospital, University of Toronto
New ACLS/Post Arrest Guidelines: For Everyone? Laurie Morrison, Li Ka Shing, Knowledge Institute, St Michael s Hospital, University of Toronto COI Declaration Industry and ROC ALS Taskforce ILCOR Author
Regional Approach to Cardiovascular Emergencies Cardiac Arrest Resuscitation System A Regional Approach: Developing Continuity From Scene to CCU
Regional Approach to Cardiovascular Emergencies Cardiac Arrest Resuscitation System A Regional Approach: Developing Continuity From Scene to CCU R. Darrell Nelson, MD, FACEP Emergency Medicine Wake Forest
Pediatric CPR. Mustafa SERİNKEN MD Professor of Emergency Medicine, Pamukkale University, TURKEY
Pediatric CPR Mustafa SERİNKEN MD Professor of Emergency Medicine, Pamukkale University, TURKEY What are the differences? Normal limits ADULT CARDIOPULMONARY ARREST CAUSES INFANTS AND CHILDREN İschemic
Code Talkers NONE. Disclosures Brady & Slovis. Lay Provider Care. Cardiac Arrest 2017 Resuscitation & Post-arrest Management
X 10/27/2017 Code Talkers 2017 Cardiac Arrest 2017 Resuscitation & Post-arrest Management What makes sense - & doesn t - in cardiac arrest management William Brady, MD University of Virginia Corey Slovis,
Michigan Pediatric Cardiac Protocols. Date: November 15, 2012 Page 1 of 1 TABLE OF CONTENTS
Date: November 15, 2012 Page 1 of 1 TABLE OF CONTENTS Pediatric Asystole Section 4-1 Pediatric Bradycardia Section 4-2 Pediatric Cardiac Arrest General Section 4-3 Pediatric Narrow Complex Tachycardia
SUMMARY OF MAJOR CHANGES 2010 AHA GUIDELINES FOR CPR & ECC
SUMMARY OF MAJOR CHANGES 2010 AHA GUIDELINES FOR CPR & ECC The following is a summary of the key issues and changes in the AHA 2010 Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiac
Sudden Cardiac Arrest
Sudden Cardiac Arrest Amit Sharma, MD, FACP, FACC Interventional Cardiologist Rockledge Regional Medical Center Assistant Professor of Medicine University of Central Florida Disclosures No relevant financial
Michigan Pediatric Cardiac Protocols. Date: November 15, 2012 Page 1 of 1 TABLE OF CONTENTS
Date: November 15, 2012 Page 1 of 1 TABLE OF CONTENTS Pediatric Asystole Section 4-1 Pediatric Bradycardia Section 4-2 Pediatric Cardiac Arrest General Section 4-3 Pediatric Narrow Complex Tachycardia
Guideline of Singapore CPR
KACPR Symposium Guideline of Singapore CPR Lim Swee Han MBBS (NUS), FRCS Ed (A&E), FRCP (Edin), FAMS Senior Consultant, Department of Emergency Medicine, Singapore General Hospital Adjunct Associate Professor,
Victorian Ambulance Cardiac Arrest Registry (VACAR)
Victorian Ambulance Cardiac Arrest Registry (VACAR) Dr Karen Smith (PhD) VACAR Chair Manager Research and Evaluation Ambulance Victoria Smith K, Bray J, Barnes V, Lodder M, Cameron P, Bernard S and Currell
FANSHAWE COLLEGE PARAMEDIC PROGRAMS Paramedic Evidence Based Medicine Paramedic Critically Appraised Topic
Title: Endotracheal intubation following the bag valve mask (BVM) when assisting ventilations for a pediatric patient. Reported by: Martha Helmers 2 nd Party appraiser: Clinical Scenario: Two medics were
18% Survival from In-Hospital Cardiac Arrest Ways we can do better! National Teaching Institute Denver, CO Class Code: 149 A
18% Survival from In-Hospital Cardiac Arrest Ways we can do better! National Teaching Institute Denver, CO Class Code: 149 A Nicole Kupchik RN, MN, CCNS, CCRN, PCCN Independent CNS/Staff Nurse Objectives
Advanced airway placement (ETT vs SGA)
Advanced airway placement (ETT vs SGA) Among adults who are in cardiac arrest in any setting (P), does tracheal tube insertion as first advanced airway (I), compared with insertion of a supraglottic airway
RACE CARS: Hospital Response. David A. Pearson, MD Department of Emergency Medicine Carolinas Medical Center February 23, 2012
L MODULE 9 RACE CARS: Hospital Response David A. Pearson, MD Department of Emergency Medicine Carolinas Medical Center February 23, 2012 2 Objectives: Post-cardiac arrest syndrome Therapeutic hypothermia
PROBLEM: Shock refractory VF/pVT BACKGROUND: Both in 2015 CoSTR. Amiodarone favoured.
Question Should AMIODARONE vs LIDOCAINE be used for adults with shock refractory VF/pVT PROBLEM: Shock refractory VF/pVT BACKGROUND: Both in 2015 CoSTR. Amiodarone favoured. OPTION: AMIODARONE plus standard
All under the division of cardiovascular medicine University of Minnesota
The Team 1) Demetris Yannopoulos M.D. Medical Director, 2) Kim Harkins, Program Manager 3) Lucinda Klann, CARES Data Manager 4) Esther Almeida, Administrative Assistant All under the division of cardiovascular
Advanced Cardiovascular Life Support for Healthcare Providers 2016 Course
Advanced Cardiovascular Life Support for Healthcare Providers 2016 Course This course follows American Heart Association 2016 guidelines. INTRODUCTION Activity Summary Target Audience Educational Objectives
Hanna K. Al-Makhamreh, M.D., FACC Interventional Cardiologist
Hanna K. Al-Makhamreh, M.D., FACC Interventional Cardiologist Introduction. Basic Life Support (BLS). Advanced Cardiac Life Support (ACLS). Cardiovascular diseases (CVDs) are the number one cause of death
Resuscitation Guidelines update. Dr. Luis García-Castrillo Riesgo EuSEM Vice president
Resuscitation Guidelines update Dr. Luis García-Castrillo Riesgo EuSEM Vice president There are no COIs to disclose in this presentation. CPR Mile Stones 1958 -William Kouwenhoven, cardiac massage. 1967
CARDIOPULMONARY RESUSCITATION QUALITY: WIDESPREAD VARIATION IN DATA INTERVALS USED FOR ANALYSIS
Accepted manuscript of: Talikowska, M. and Tohira, H. and Bailey, P. and Finn, J. 2016. Cardiopulmonary resuscitation quality: Widespread variation in data intervals used for analysis. Resuscitation. 102:
Ventilation strategies during out-of-hospital cardiac arrest: a problem that should not be neglected
Review Article Page 1 of 5 Ventilation strategies during out-of-hospital cardiac arrest: a problem that should not be neglected Wei Gu 1,2, Chun-Sheng Li 1,2 1 Department of Emergency, Beijing Chao-Yang
Paramedic CAT (Critically Appraised Topic) Worksheet
Paramedic CAT (Critically Appraised Topic) Worksheet Title: Manual CPR Vs. Mechanical CPR Report By: Meghan Beals 2 nd Party Appraiser: Clinical Scenario: You are called to the home of a 65 year old female
VanderbiltEM.com. Prehospital STEMIs. EMS Today 2018 Research That Should Be On Your Radar Screen 3/1/2018
EMS Today 2018 Research That Should Be On Your Radar Screen Corey M. Slovis, M.D. Vanderbilt University Medical Center Metro Nashville Fire Department Nashville International Airport Nashville, TN VanderbiltEM.com
US National Standards & Guidelines Capnography for Emergency Care
US National Standards & Guidelines 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Part 7.1: Adjuncts for Airway Control and Ventilation Even
IN HOSPITAL CARDIAC ARREST AND SEPSIS
IN HOSPITAL CARDIAC ARREST AND SEPSIS MARGARET DISSELKAMP, MD OVERVIEW Background Epidemiology of in hospital cardiac arrest (IHCA) Use a case scenario to introduce new guidelines Review surviving sepsis
CAPNOGRAPHY. 1.1 To set forth the policy and procedure for performing continuous end-tidal waveform capnography.
OFFICE OF MEDICAL AFFAIRS DIRECTIVE 2009-02 CAPNOGRAPHY 1. PURPOSE 1.1 To set forth the policy and procedure for performing continuous end-tidal waveform capnography. 2. SCOPE 2.1 This procedure applies
EMS System Key Performance Indicators / Clinical Measures Updated: Jan. 18, 2017 Clinical Group/ Key Performance Indicators (KPIs)
EMS System Key Indicators / Clinical Measures Updated: Jan. 18, 2017 Key Indicators (KPIs) 1. Critical Trauma Patient Management 1.1 Percent of Step 1 and Step 2 trauma patients with an EMS scene time
Disclosures. Extra-Corporeal Membrane Oxygenation During Cardio- Pulmonary Resuscitation ECPR April 22, 2016 ECG. Case. Case. Case Summary 4/22/2016
Extra-Corporeal Membrane Oxygenation During Cardio- Pulmonary Resuscitation ECPR April 22, 2016 Nothing to disclose. Disclosures Ivan J Chavez MD Case ECG History 60 y/o male No prior history of CAD In
San Benito County EMS Agency Section 700: Patient Care Procedures
Purpose: To outline the steps EMTs & paramedics will take to manage possible life threats in any child or adult patient they encounter. This policy is in effect for all treatment protocols & is to be referred
Paediatric Resuscitation. EMS Rounds Gurinder Sangha MD Paediatric Emergency Fellow June 18, 2009
Paediatric Resuscitation EMS Rounds Gurinder Sangha MD Paediatric Emergency Fellow June 18, 2009 Essentials of Resuscitation Airway Breathing Circulation AIRWAY Differences in Paediatric Airway Shorter
JUST SAY NO TO DRUGS?
JUST SAY NO TO DRUGS? THE EVIDENCE BEHIND MEDICATIONS USED IN CARDIAC RESUSCITATION NTI 2014 CLASS CODE 148 Nicole Kupchik RN, MN, CCNS, CCRN, PCCN Objectives 1. Discuss the historical evidence supporting
ACLS/ACS Updates 2015
ACLS/ACS Updates 2015 Advanced Cardiovascular Life Support by: Fareed Al Nozha, JBIM, ABIM, FKFSH&RC(Cardiology) Consultant Cardiologist Faculty, National CPR Committee, ACLS Program Head, SHA Dr Abdulhalim
POTENTIAL UTILITY OF NEAR-INFRARED SPECTROSCOPY IN OUT-OF-HOSPITAL CARDIAC ARREST: AN ILLUSTRATIVE CASE SERIES
POTENTIAL UTILITY OF NEAR-INFRARED SPECTROSCOPY IN OUT-OF-HOSPITAL CARDIAC ARREST: AN ILLUSTRATIVE CASE SERIES Adam Frisch, MD, Brian P. Suffoletto, MD, MS, Rachel Frank, EMT, Christian Martin-Gill, MD,
AVOIDING THE CRASH: OPTIMIZE YOUR PRE, PERI, AND POST AIRWAY MANAGEMENT AVOIDING THE CRASH 1: DON T INTUBATE, OPTIMIZE PRE-AIRWAY MANAGEMENT
AVOIDING THE CRASH: OPTIMIZE YOUR PRE, PERI, AND POST AIRWAY MANAGEMENT Robert J. Vissers MD Chief, Emergency Medicine, Quality Chair, Legacy Emanuel Medical Center Adjunct Associate Professor, OHSU Portland,
Most Important EMS Articles EAGLES 2017
Most Important EMS Articles EAGLES 2017 Corey M. Slovis, M.D. Vanderbilt University Medical Center Metro Nashville Fire Department Nashville International Airport Nashville, TN Overview Best antiarrhythmic
Most Important EMS Articles EAGLES 2017
Most Important EMS Articles EAGLES 2017 Corey M. Slovis, M.D. Vanderbilt University Medical Center Metro Nashville Fire Department Nashville International Airport Nashville, TN Overview Best antiarrhythmic
Evidence Based EMS: The Science Behind Your Care
Evidence Based EMS: The Science Behind Your Care Sean Kivlehan, MD, MPH, NREMT-P September 2016 RESPONSE AIRWAY BREATHING CIRCULATION DISABILITY RESPONSE AIRWAY BREATHING CIRCULATION DISABILITY Eisenberg,
Overview and Latest Research on Out of Hospital Cardiac Arrest
L MODULE 1 Overview and Latest Research on Out of Hospital Cardiac Arrest Jamie Jollis, MD Co PI RACE CARS 2 Out of Hospital Cardiac Arrest in U.S. 236 000 to 325 000 people in the United States each year
MECHANICAL CHEST COMPRESSION DEVICES. Erica Simon, DO, MHA Military EMS & Disaster Medicine Fellow SAUSHEC
MECHANICAL CHEST COMPRESSION DEVICES Erica Simon, DO, MHA Military EMS & Disaster Medicine Fellow SAUSHEC Disclaimer The view(s) expressed herein are those of the author and do not reflect the official
Advanced Cardiac Life Support (ACLS) Science Update 2015
1 2 3 4 5 6 7 8 9 Advanced Cardiac Life Support (ACLS) Science Update 2015 What s New in ACLS for 2015? Adult CPR CPR remains (Compressions, Airway, Breathing Chest compressions has priority over all other
HIGH QUALITY CPR: IS IT TIME FOR MECHANICAL ASSISTANCE?
HIGH QUALITY CPR: IS IT TIME FOR MECHANICAL ASSISTANCE? EMERGENCY NURSES ASSOCIATION - 2018 Nicole Kupchik MN, RN, CCNS, CCRN-K, PCCN-CMC Objectives Discuss issues with CPR performance in hospitals Describe
5 Key EMS Articles for 2012
5 Key EMS Articles for 2012 Corey M. Slovis, M.D. Vanderbilt University Medical Center Metro Nashville Fire Department Nashville International Airport Nashville, TN 5 Key Topics Cardiac Arrest Trauma
OUT-OF-HOSPITAL CARDIAC
CARING FOR THE CRITICALLY ILL PATIENT Association of Prehospital Advanced Airway Management With Neurologic Outcome and Survival in Patients With Out-of-Hospital Cardiac Arrest Kohei Hasegawa, MD, MPH
What works? What doesn t? What s new? Terry M. Foster, RN
What works? What doesn t? What s new? Terry M. Foster, RN 2016 Changes Updated every 5 years Last update was 2010 All recommendations have been heavily researched with studies involving large number of
Out-of-Hospital Cardiac Arrest In North Carolina. Christopher Granger, M.D. Director, Duke CCU
Out-of-Hospital Cardiac Arrest In North Carolina Christopher Granger, M.D. Director, Duke CCU Disclosure Research contracts: AstraZeneca, Novartis, GSK, Sanofi-Aventis, BMS, The Medicines Company, Astellas,
Bone Voyage Administrating ALS Medications via the Intra- Osseous Route. Jon Jui MD, MPH
Bone Voyage Administrating ALS Medications via the Intra- Osseous Route Jon Jui MD, MPH Do ALS Medications lead to Improved Survival in Out of Hospital Cardiac Arrest? Intravenous drug administration during
Beth Cetanyan, RN AHA RF Aka The GURU
* Beth Cetanyan, RN AHA RF Aka The GURU *Discuss common causes of Pediatric CA *Review current PALS Guidelines *Through case presentations and discussion, become more comfortable and confident in providing
Update on Sudden Cardiac Death and Resuscitation
Update on Sudden Cardiac Death and Resuscitation Ashish R. Panchal, MD, PhD Medical Director Center for Emergency Medical Services Assistant Professor Clinical Department of Emergency Medicine The Ohio
2016 Top Papers in Critical Care
2016 Top Papers in Critical Care Briana Witherspoon DNP, APRN, ACNP-BC Assistant Director of Advanced Practice, Neuroscience Assistant in Division of Critical Care, Department of Anesthesiology Neuroscience
Tracheal Intubation in ICU: Life saving or life threatening?
Tracheal Intubation in ICU: Life saving or life threatening? Prof. Sheila Nainan Myatra Department of Anaesthesia, Critical Care & Pain Tata Memorial Hospital Mumbai, India sheila150@hotmail.com Three
9/13/2018. Palliative Care and Hospice Research Updates from Objectives. Disclosure: White, Patrick, M.D.
Palliative Care and Hospice Research Updates from 2017-2018 Patrick White MD, HMDC, FACP, FAAHPM Chief Medical Officer, BJC Home Care Assistant Professor of Medicine, Washington University School of Medicine
WORKSHEET for Evidence-Based Review of Science for Veterinary CPCR
RECOVER 2011 1 of 6 WORKSHEET for Evidence-Based Review of Science for Veterinary CPCR 1. Basic Demographics Worksheet author(s) James Barr Mailing address: 4474 TAMU Texas A&M University College Station,
North Carolina College of Emergency Physicians Standards for EMS Medications and Skills Use
. The baseline medications and skills required in all systems and Specialty Care Transport Programs) with EMS personnel credentialed at the specified level. S. The equipment required in all Specialty Care
The ALS Algorithm and Post Resuscitation Care
The ALS Algorithm and Post Resuscitation Care CET - Ballarat Health Services Valid from 1 st July 2018 to 30 th June 2020 2 Defibrillation Produces simultaneous mass depolarisation of myocardial cells
EMS Subspecialty Certification Review Course. Learning Objectives
EMS Subspecialty Certification Review Course 1.1.2 Airway Compromise / Respiratory Failure 1.1.2.1 Devices for securing airway 1.1.2.2 Portable ventilator management 1.1.2.3 Pros and cons of drug assisted
Management of Cardiac Arrest Based on : 2010 American Heart Association Guidelines
Management of Cardiac Arrest Based on : 2010 American Heart Association Guidelines www.circ.ahajournals.org Elham Pishbin. M.D Assistant Professor of Emergency Medicine MUMS C H E S Advanced Life Support
Aiming for high quality CPR: why it matters and how we can get there. Benjamin S. Abella, MD, MPhil, FACEP
Aiming for high quality CPR: why it matters and how we can get there Benjamin S. Abella, MD, MPhil, FACEP Clinical Research Director Center for Resuscitation Science Department of Emergency Medicine University