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Intraosseous access education on an Advanced Life Support course
Poster Presentations / Resuscitation 83 (2012) e24–e123
AP122 Intraosseous access education on an Advanced Life Support course Matthew Ibrahim 1,∗ , Kevin Cairney 2 1 2
Newham University Hospital, Barts Health NHS Trust, London, UK South London NHS Trust, London, UK
Purpose of the study: Current European Resuscitation Council guidelines for resuscitation recommend IO route for delivery of drugs if intravenous (IV) access cannot be achieved.1 The purpose of this study was to assess the feasibility, educational and clinical value of introducing a vascular access station on the Advanced Life Support (ALS) course. Material and methods: The Resuscitation Council (UK) allowed the authors to augment the current ALS curriculum to accommodate a forty five minute vascular access station on day one of the course. The station covered the indications, contraindications and psycho-motor skills of intraosseous (IO) insertion for adult resuscitation. Instructors received a brief train the trainer session before commencing the taught IO session. Candidates were asked to complete a pre and post vascular access station questionnaire. Results: The majority of the candidates were junior doctors working in either medicine or emergency medicine. All nineteen candidates completed the questionnaire. Results showed a 46% increase in candidate awareness of IO access following the station and a 78% increase in confidence regarding insertion of an IO. A paired t-test was conducted on both the questions relating to awareness and confidence and showed a p value <0.0005. Candidates were also asked to comment on the sessions presentation style, content and simulation aids using a Likert scale. All respondents felt that the content was either good or very good. Conclusion: Although n was small, it is the authors believes that it is feasible and beneficial to incorporate IO education within the already established ALS course.
e71
In our case, external defibrillation was unsuccessful and cardiopulmonary resuscitation (CPR) was started according to guidelines. Despite using hypertonic sodium bicarbonate, after 20 min of CPR and 10 defibrillations attempted, the patient persisted in ventricular fibrillation (VF) and thus a 20% lipid emulsion infusion was started at a rate of 0.25 mL kg/min after 1 mL/kg bolus over 1 min. ECMO was placed after 107 min of VF and 53 unsuccessful defibrillation attempts, performing chest compressions with the LUCASTM. Therapeutic hypothermia was initiated for cerebral protection, with a target temperature of 33 ◦ C. Patient finally recovered a stable sinus rhyhm, 118 min after the ECMO was started. When the patient was extubated the neurological examination revealed paresthesias in both lower limbs with slight cognitive dysfunction. The use of hypertonic sodium bicarbonate, electrolyte replacement and a 20% lipid emulsion may be key interventions in the early management of toxicity by class I antiarrhythmics. Therapeutic hypothermia can be used safely in Brugada syndrome. The use of ECMO to provide cardiovascular support during refractory VF due to intrinsic cardiac disease or drug overdose has been successfully used. http://dx.doi.org/10.1016/j.resuscitation.2012.08.182 AP124 Survival of pediatric out-of-hospital cardiorespiratory arrests treated by the EMS SUMMA 112 Madrid Jose Maria Navalpotro Pascual ∗ , Alonso Mateos Rodriguez, Francisco A. Peinado Vallejo, Susana Navalpotro Pascual, Vicente Sanchez-Brunete Ingelmo, Juan A. Valenciano Rodriguez SUMMA 112, MADRID, Spain
Reference [1].Deakin C, Nolan J, Soar J, et al. European Resuscitation Council guidelines for resuscitation 2010 section 4-Adult Advanced Life Support. Resuscitation 2010;81:1305–52.
http://dx.doi.org/10.1016/j.resuscitation.2012.08.181 AP123 Use of hypothermia and extracorporeal membrane oxygenation after an unusual response to the ajmaline challenge in apatient with Brugada syndrome Jacobo Moreno ∗ , Lidia Gomez, JaumeFontanals, Paola Antonio Berruezo, Josep Brugada
Berne,
Hospital Clínic Barcelona, Barcelona, Spain We present the case of a 27-year-old man who developed sustained ventricular fibrillation (VF) after an ajmaline test for Brugada syndrome (BS) testing. The BS is a cardiac disorder associated to mutations in SCN5A gene with high risk of sudden cardiac death. The novelty of this case was the therapeutic use of a lipid emulsion infusion associated with extracorporeal membrane oxygenation (ECMO) and hypothermia as a bridge for a Class I antiarrhythmic toxicity with sustained ventricular fibrillation abnormally prolonged in time, with the help of the Lund University Cardiac Arrest System (LUCAS TM).
Objective: To describe the epidemiologic profile of pediatric out-of-hospital cardiorespiratory arrests (POHCRA) in Madrid and their survival at hospital arrival. Methods: A retrospective observational clinical cohort study was conducted from January 2008 to December 2009 including 1165 POHCRA treated by the EMS SUMMA 112. The following independent endpoints were studied: patient’s age and sex, initial rhythm of the arrest, arrest cause (traumatic/non traumatic), whether POHCRA was or was not witnessed and whether it was witnessed by EMS personnel or bystanders, whether cardiopulmonary resuscitation (CPR) was initiated prior to EMS arrival and whether EMS was present at the scene when the POHCRA occurred. When the patient arrived alive to the hospital was considered as the dependent endpoint. Results: Four of 26 (15.4%) patients with POHCRA were alive at hospital arrival (2.2% of total OHCRA treated during this period). Most patients were male (57.7%). In patients aged under 14 the initial rhythm was bradycardia/asystole (88.0%), pulseless electrical activity (8.0%) and ventricular fibrillation/tachycardia (VF/VT, 4.0%). Survival was 100% for VF/VT and 13.6% for bradycardia/asystole. Survival was 50% if POHCRA was witnessed by EMS personnel, 16.7% if it was witnessed by bystanders and 0% if it was not witnessed. Survival was 13.3% and 0% if CPR was or not was initiated, respectively, prior to EMS arrival and increased to 100% if EMS was present at the scene when the POHCRA occurred. Survival was 60% if POHCRA occurred in a health center, 6.7% at home and 0% outdoors. Global survival was 15.4%.
AP122 Intraosseous access education on an Advanced Life Support course Matthew Ibrahim 1,∗ , Kevin Cairney 2 1 2
Newham University Hospital, Barts Health NHS Trust, London, UK South London NHS Trust, London, UK
Purpose of the study: Current European Resuscitation Council guidelines for resuscitation recommend IO route for delivery of drugs if intravenous (IV) access cannot be achieved.1 The purpose of this study was to assess the feasibility, educational and clinical value of introducing a vascular access station on the Advanced Life Support (ALS) course. Material and methods: The Resuscitation Council (UK) allowed the authors to augment the current ALS curriculum to accommodate a forty five minute vascular access station on day one of the course. The station covered the indications, contraindications and psycho-motor skills of intraosseous (IO) insertion for adult resuscitation. Instructors received a brief train the trainer session before commencing the taught IO session. Candidates were asked to complete a pre and post vascular access station questionnaire. Results: The majority of the candidates were junior doctors working in either medicine or emergency medicine. All nineteen candidates completed the questionnaire. Results showed a 46% increase in candidate awareness of IO access following the station and a 78% increase in confidence regarding insertion of an IO. A paired t-test was conducted on both the questions relating to awareness and confidence and showed a p value <0.0005. Candidates were also asked to comment on the sessions presentation style, content and simulation aids using a Likert scale. All respondents felt that the content was either good or very good. Conclusion: Although n was small, it is the authors believes that it is feasible and beneficial to incorporate IO education within the already established ALS course.
e71
In our case, external defibrillation was unsuccessful and cardiopulmonary resuscitation (CPR) was started according to guidelines. Despite using hypertonic sodium bicarbonate, after 20 min of CPR and 10 defibrillations attempted, the patient persisted in ventricular fibrillation (VF) and thus a 20% lipid emulsion infusion was started at a rate of 0.25 mL kg/min after 1 mL/kg bolus over 1 min. ECMO was placed after 107 min of VF and 53 unsuccessful defibrillation attempts, performing chest compressions with the LUCASTM. Therapeutic hypothermia was initiated for cerebral protection, with a target temperature of 33 ◦ C. Patient finally recovered a stable sinus rhyhm, 118 min after the ECMO was started. When the patient was extubated the neurological examination revealed paresthesias in both lower limbs with slight cognitive dysfunction. The use of hypertonic sodium bicarbonate, electrolyte replacement and a 20% lipid emulsion may be key interventions in the early management of toxicity by class I antiarrhythmics. Therapeutic hypothermia can be used safely in Brugada syndrome. The use of ECMO to provide cardiovascular support during refractory VF due to intrinsic cardiac disease or drug overdose has been successfully used. http://dx.doi.org/10.1016/j.resuscitation.2012.08.182 AP124 Survival of pediatric out-of-hospital cardiorespiratory arrests treated by the EMS SUMMA 112 Madrid Jose Maria Navalpotro Pascual ∗ , Alonso Mateos Rodriguez, Francisco A. Peinado Vallejo, Susana Navalpotro Pascual, Vicente Sanchez-Brunete Ingelmo, Juan A. Valenciano Rodriguez SUMMA 112, MADRID, Spain
Reference [1].Deakin C, Nolan J, Soar J, et al. European Resuscitation Council guidelines for resuscitation 2010 section 4-Adult Advanced Life Support. Resuscitation 2010;81:1305–52.
http://dx.doi.org/10.1016/j.resuscitation.2012.08.181 AP123 Use of hypothermia and extracorporeal membrane oxygenation after an unusual response to the ajmaline challenge in apatient with Brugada syndrome Jacobo Moreno ∗ , Lidia Gomez, JaumeFontanals, Paola Antonio Berruezo, Josep Brugada
Berne,
Hospital Clínic Barcelona, Barcelona, Spain We present the case of a 27-year-old man who developed sustained ventricular fibrillation (VF) after an ajmaline test for Brugada syndrome (BS) testing. The BS is a cardiac disorder associated to mutations in SCN5A gene with high risk of sudden cardiac death. The novelty of this case was the therapeutic use of a lipid emulsion infusion associated with extracorporeal membrane oxygenation (ECMO) and hypothermia as a bridge for a Class I antiarrhythmic toxicity with sustained ventricular fibrillation abnormally prolonged in time, with the help of the Lund University Cardiac Arrest System (LUCAS TM).
Objective: To describe the epidemiologic profile of pediatric out-of-hospital cardiorespiratory arrests (POHCRA) in Madrid and their survival at hospital arrival. Methods: A retrospective observational clinical cohort study was conducted from January 2008 to December 2009 including 1165 POHCRA treated by the EMS SUMMA 112. The following independent endpoints were studied: patient’s age and sex, initial rhythm of the arrest, arrest cause (traumatic/non traumatic), whether POHCRA was or was not witnessed and whether it was witnessed by EMS personnel or bystanders, whether cardiopulmonary resuscitation (CPR) was initiated prior to EMS arrival and whether EMS was present at the scene when the POHCRA occurred. When the patient arrived alive to the hospital was considered as the dependent endpoint. Results: Four of 26 (15.4%) patients with POHCRA were alive at hospital arrival (2.2% of total OHCRA treated during this period). Most patients were male (57.7%). In patients aged under 14 the initial rhythm was bradycardia/asystole (88.0%), pulseless electrical activity (8.0%) and ventricular fibrillation/tachycardia (VF/VT, 4.0%). Survival was 100% for VF/VT and 13.6% for bradycardia/asystole. Survival was 50% if POHCRA was witnessed by EMS personnel, 16.7% if it was witnessed by bystanders and 0% if it was not witnessed. Survival was 13.3% and 0% if CPR was or not was initiated, respectively, prior to EMS arrival and increased to 100% if EMS was present at the scene when the POHCRA occurred. Survival was 60% if POHCRA occurred in a health center, 6.7% at home and 0% outdoors. Global survival was 15.4%.