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A pilot study of mechanical chest compression with the LifeLine ARM device during simulated cardiopulmonary resuscitation
Accepted Manuscript Title: A pilot study of mechanical chest compression with the LifeLine ARM device during simulated cardiopulmonary resuscitation Authors: Jolanta MAJER MD Jaroslaw KEDZIORA MD Marcin MADZIAŁA MSc, EMT-P PII: DOI: Reference:
S2352-5568(16)30215-6 http://dx.doi.org/doi:10.1016/j.accpm.2017.01.007 ACCPM 236
To appear in: Received date: Accepted date:
14-11-2016 26-1-2017
Please cite this article as: Jolanta MAJERJaroslaw KEDZIORAMarcin MADZIAŁA A pilot study of mechanical chest compression with the LifeLine ARM device during simulated cardiopulmonary resuscitation (2017), http://dx.doi.org/10.1016/j.accpm.2017.01.007 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
1 A pilot study of mechanical chest compression with the LifeLine ARM device during simulated cardiopulmonary resuscitation
Jolanta MAJER, MD
ip t
Department of Emergency Medicine, Blessed Virgin Mary Memorial Voivodship Specialist
cr
Hospital in Czestochowa, Poland
Jaroslaw KEDZIORA, MD
us
Department of Anaesthesiology and Intensive Care, Wroclaw Medical University, Wroclaw,
an
Poland
Marcin MADZIAŁA, MSc, EMT-P
Ac ce pt e
d
M
Department of Emergency Medicine, Medical University of Warsaw, Warsaw, Poland
Corresponding Author Marcin Madziala
Department of Emergency Medicine Medical University of Warsaw
4 Lindleya Str., 02-005 Warsaw, Poland [email protected] Phone: +48 519160829
We have read with great interest the recent article by Cotte et al. [1] published in Anaesthesia Critical Care & Pain Medicine regarding fluid resuscitation in Ebola Virus Disease
Page 1 of 4
2 (EVD). The authors performed a prospective observational study and indicated that inserting central venous catheters (CVCs) is a safe and reliable way of obtaining IV access in Ebola Treatment Units (ETUs), provided adequately trained personnel are available. CVCs enable optimizing fluid infusion compared to peripheral venous catheters (PVCs). Undoubtedly due to the risk associated with EVD contact, medical personnel must
ip t
wear chemical, biological, radiological, and nuclear (CBRN) personal protective equipment (PPE). As shown in several studies, performing many medical procedures while wearing CBRN-PPE may be difficult or impossible [2-4], as is the case for gaining intravascular access.
cr
One of the key elements in the treatment of EVD is the implementation of fluid resuscitation
us
[5]. To do this, intravascular access using a catheter with a sufficiently high flow is required. In emergency medicine settings, there are many potential methods for fluid resuscitation, including access to peripheral veins, central veins or the intraosseous route, which was
an
evaluated in many publications for its efficiency and procedure time [6]. Taking into account the above publications, it is impossible not to agree with Dr. Szarpak’s opinion [7] that it is
M
worth considering IO as a method of obtaining intravascular access, because first-attempt IO access has been shown to be highly effective and statistically significantly quicker than PVCs
d
and CVCs, which is crucial in emergency conditions.
Ac ce pt e
Another important aspect of possible exposure to EVD is the fact that medical personnel should have knowledge on the potential signs indicating the possibility of contact with a patient with EVD and during the epidemic, the PPE with adequate quality should be applied. As was correctly pointed out by Szarpak [7], it is the Emergency Medicine Team staff who is mainly exposed to such patients, due to the nature of services provided in the prehospital care. Accordingly, the aim of the study was to compare the overall time required to establish intraosseous (IO) infusion with the NIO device and the equivalent time for peripheral IV infusion, performed by novice physicians with CBRN-PPE (Dräger CPS 7900; Dräger Safety AG & Co, KGaA, Lübeck, Germany). The study involved 24 novice physicians. Before the study, all study participants took part in training on obtaining peripheral vein and IO accesses. Intravenous access was obtained with standard intravenous cannula (18G; BD Venflon™ Pro Safety; BD Medical, Franklin Lakes, NJ, USA). For intraosseous access, the NIO device was used (NIO, Persys Medical, Houston, Texas) to make sure that the participants were familiar with the equipment. Intravascular access was performed using a training manikin. After procedure completion, each participant filled out a questionnaire in which
Page 2 of 4
3 they subjectively rated the ease of NIO use versus a peripheral IV line (easier, the same, harder). The success rate of the first intravascular access attempt with the NIO device was 95.8% versus 45.8% during PVCs (p<0.001). Procedure times were significantly shorter for NIO (18.58 s; interquartile range [IQR], 16–21.5 s) as compared with PVCs (44 s; IQR, 336–
ip t
55.5 s) (p < 0.001). All participants indicated that IO access was easier to obtain compared with IV access.
In conclusion our study provides evidence that the intravascular access obtained by the
cr
physician wearing CBRN-PPE is more effective when using an IO device compared with the
us
standard venous cannula. More studies are required to confirm these results.
an
REFERENCES
1. Cotte J, Cordier PY, Bordes J, Janvier F, Esnault P, Kaiser E, et al. Fluid resuscitation in
Crit Care Pain Med. 2015;34317-20.
M
Ebola Virus Disease: a comparison of peripheral and central venous accesses. Anaesth
d
2. Szarpak L, Truszewski Z, Smereka J, Madziała M, Czyzewski L. Comparison of two
Ac ce pt e
intravascular access techniques when using CBRN-PPE: A randomized crossover manikin trial. Am J Emerg Med. 201;34:1170-2. 3. Szarpak L, Madziała M, Smereka J. Comparison of endotracheal intubation performed with 3 devices by paramedics wearing chemical, biological, radiological, and nuclear personal protective equipment. Am J Emerg Med. 2016;34:1902-3. 4. Lamhaut L, Dagron C, Apriotesei R, Gouvernaire J, Elie C, Marx JS, et al. Comparison of intravenous and intraosseous access by pre-hospital medical emergency personnel with and without CBRN protective equipment. Resuscitation. 2010 ;81:65-8. 5. Bah E.I., Lamah MC, Fletcher T, Jacob ST, Brett-Major DM, Sall AA, et al. Clinical presentation of patients with Ebola virus disease in Conakry, Guinea. N Engl J Med. 2015;372:40-7 6. Szarpak L, Kurowski A, Adamczyk P, Czyzewski L, Truszewski Z, Zaśko P. Are junior doctors trained to use to use intraosseous access? Am J Emerg Med. 2016;34:107.
Page 3 of 4
4 7. Szarpak L. Fluid resuscitation in Ebola Virus Disease: Witch method of intravascular access choice? Anaesth Crit Care Pain Med. 2016 Sep 16. pii: S2352-5568(16)30141-2.
Ac ce pt e
d
M
an
us
cr
ip t
doi: 10.1016/j.accpm.2016.08.004.
Page 4 of 4
S2352-5568(16)30215-6 http://dx.doi.org/doi:10.1016/j.accpm.2017.01.007 ACCPM 236
To appear in: Received date: Accepted date:
14-11-2016 26-1-2017
Please cite this article as: Jolanta MAJERJaroslaw KEDZIORAMarcin MADZIAŁA A pilot study of mechanical chest compression with the LifeLine ARM device during simulated cardiopulmonary resuscitation (2017), http://dx.doi.org/10.1016/j.accpm.2017.01.007 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
1 A pilot study of mechanical chest compression with the LifeLine ARM device during simulated cardiopulmonary resuscitation
Jolanta MAJER, MD
ip t
Department of Emergency Medicine, Blessed Virgin Mary Memorial Voivodship Specialist
cr
Hospital in Czestochowa, Poland
Jaroslaw KEDZIORA, MD
us
Department of Anaesthesiology and Intensive Care, Wroclaw Medical University, Wroclaw,
an
Poland
Marcin MADZIAŁA, MSc, EMT-P
Ac ce pt e
d
M
Department of Emergency Medicine, Medical University of Warsaw, Warsaw, Poland
Corresponding Author Marcin Madziala
Department of Emergency Medicine Medical University of Warsaw
4 Lindleya Str., 02-005 Warsaw, Poland [email protected] Phone: +48 519160829
We have read with great interest the recent article by Cotte et al. [1] published in Anaesthesia Critical Care & Pain Medicine regarding fluid resuscitation in Ebola Virus Disease
Page 1 of 4
2 (EVD). The authors performed a prospective observational study and indicated that inserting central venous catheters (CVCs) is a safe and reliable way of obtaining IV access in Ebola Treatment Units (ETUs), provided adequately trained personnel are available. CVCs enable optimizing fluid infusion compared to peripheral venous catheters (PVCs). Undoubtedly due to the risk associated with EVD contact, medical personnel must
ip t
wear chemical, biological, radiological, and nuclear (CBRN) personal protective equipment (PPE). As shown in several studies, performing many medical procedures while wearing CBRN-PPE may be difficult or impossible [2-4], as is the case for gaining intravascular access.
cr
One of the key elements in the treatment of EVD is the implementation of fluid resuscitation
us
[5]. To do this, intravascular access using a catheter with a sufficiently high flow is required. In emergency medicine settings, there are many potential methods for fluid resuscitation, including access to peripheral veins, central veins or the intraosseous route, which was
an
evaluated in many publications for its efficiency and procedure time [6]. Taking into account the above publications, it is impossible not to agree with Dr. Szarpak’s opinion [7] that it is
M
worth considering IO as a method of obtaining intravascular access, because first-attempt IO access has been shown to be highly effective and statistically significantly quicker than PVCs
d
and CVCs, which is crucial in emergency conditions.
Ac ce pt e
Another important aspect of possible exposure to EVD is the fact that medical personnel should have knowledge on the potential signs indicating the possibility of contact with a patient with EVD and during the epidemic, the PPE with adequate quality should be applied. As was correctly pointed out by Szarpak [7], it is the Emergency Medicine Team staff who is mainly exposed to such patients, due to the nature of services provided in the prehospital care. Accordingly, the aim of the study was to compare the overall time required to establish intraosseous (IO) infusion with the NIO device and the equivalent time for peripheral IV infusion, performed by novice physicians with CBRN-PPE (Dräger CPS 7900; Dräger Safety AG & Co, KGaA, Lübeck, Germany). The study involved 24 novice physicians. Before the study, all study participants took part in training on obtaining peripheral vein and IO accesses. Intravenous access was obtained with standard intravenous cannula (18G; BD Venflon™ Pro Safety; BD Medical, Franklin Lakes, NJ, USA). For intraosseous access, the NIO device was used (NIO, Persys Medical, Houston, Texas) to make sure that the participants were familiar with the equipment. Intravascular access was performed using a training manikin. After procedure completion, each participant filled out a questionnaire in which
Page 2 of 4
3 they subjectively rated the ease of NIO use versus a peripheral IV line (easier, the same, harder). The success rate of the first intravascular access attempt with the NIO device was 95.8% versus 45.8% during PVCs (p<0.001). Procedure times were significantly shorter for NIO (18.58 s; interquartile range [IQR], 16–21.5 s) as compared with PVCs (44 s; IQR, 336–
ip t
55.5 s) (p < 0.001). All participants indicated that IO access was easier to obtain compared with IV access.
In conclusion our study provides evidence that the intravascular access obtained by the
cr
physician wearing CBRN-PPE is more effective when using an IO device compared with the
us
standard venous cannula. More studies are required to confirm these results.
an
REFERENCES
1. Cotte J, Cordier PY, Bordes J, Janvier F, Esnault P, Kaiser E, et al. Fluid resuscitation in
Crit Care Pain Med. 2015;34317-20.
M
Ebola Virus Disease: a comparison of peripheral and central venous accesses. Anaesth
d
2. Szarpak L, Truszewski Z, Smereka J, Madziała M, Czyzewski L. Comparison of two
Ac ce pt e
intravascular access techniques when using CBRN-PPE: A randomized crossover manikin trial. Am J Emerg Med. 201;34:1170-2. 3. Szarpak L, Madziała M, Smereka J. Comparison of endotracheal intubation performed with 3 devices by paramedics wearing chemical, biological, radiological, and nuclear personal protective equipment. Am J Emerg Med. 2016;34:1902-3. 4. Lamhaut L, Dagron C, Apriotesei R, Gouvernaire J, Elie C, Marx JS, et al. Comparison of intravenous and intraosseous access by pre-hospital medical emergency personnel with and without CBRN protective equipment. Resuscitation. 2010 ;81:65-8. 5. Bah E.I., Lamah MC, Fletcher T, Jacob ST, Brett-Major DM, Sall AA, et al. Clinical presentation of patients with Ebola virus disease in Conakry, Guinea. N Engl J Med. 2015;372:40-7 6. Szarpak L, Kurowski A, Adamczyk P, Czyzewski L, Truszewski Z, Zaśko P. Are junior doctors trained to use to use intraosseous access? Am J Emerg Med. 2016;34:107.
Page 3 of 4
4 7. Szarpak L. Fluid resuscitation in Ebola Virus Disease: Witch method of intravascular access choice? Anaesth Crit Care Pain Med. 2016 Sep 16. pii: S2352-5568(16)30141-2.
Ac ce pt e
d
M
an
us
cr
ip t
doi: 10.1016/j.accpm.2016.08.004.
Page 4 of 4