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Abstract 4: Everything But The Kitchen Sink…A Quality Improvement Study
2017 Critical Care Transport Medicine Conference Scientific Forum / Air Medical Journal 36 (2017) 208e215
limitation of this being a small trial. Of note, the VL group had more airways reported as being difficult by the flight crew than the DL group. We recommend a larger study to fully evaluate the use of field VL in the pediatric population.
http://dx.doi.org/10.1016/j.amj.2017.04.014 Abstract 4: Everything But The Kitchen Sink…A Quality Improvement Study Matthew Burkey, NRP, Julie Newill, BSN, RN, CCRN, RNC, Kim Riggert, BSN, RN, CCRN, Shannon Williams, NRP, FP-C, Jessica Miller, BSN, RN, CCRN, Calica Patton, NRP, Mikele Wissing, BSN, RN, CCRN d Children’s Hospital & Medical Center, Omaha, Nebraska Objectives: A Plan/Do/Check/Act (PDCA) Quality Improvement Project was utilized to evaluate the current contents of a critical care pediatric/neonatal transport team’s transport packs. Pediatric/ neonatal inter-facility transport requires the team to bring clinical expertise and resources to the bedside of critically ill children at referring community hospitals. The transport team must carry a comprehensive transport bag with equipment needed to care for critically ill neonates and children with a wide range of illnesses and injuries. Goals included: Reduce weight of current bag, increase efficiency of restocking, and to ensure appropriate pediatric/ neonatal equipment available and easily accessible. Methods: Survey sent to all transport staff. Survey questions included: should there be a different bag for each mode of transport? What equipment is essential for transport? What equipment is “nice to have”? Where could we decrease waste in the transport bag? Should there be a different bag for neonatal specific equipment? Survey results were reviewed by the shared governance committee for transport. Results: From survey results and discussions in the shared governance committee, the following items were removed or combined from the transport bag: all IV equipment was combined into one small bag; NG and suction equipment were combined into one small bag; point of care testing equipment all moved together into one small bag to decrease damage to equipment that was in a different location; 25% of transports are neonatal transport, the decision was made to move the neonatal specific equipment to a bag on the transport incubator. This included: Umbilical line equipment, neonatal specific chest drains, a Neo-Tee, neonatal arterial line monitoring, and other neonatal monitoring equipment. A mock set-up for the bag with the proposed changes was done. Staff had the opportunity to look at the bag. After 2 weeks, a quick PDCA cycle was completed by a survey sent out to staff with the changes and asking for comments on the changes before they were instituted. The results from this survey had no additional comments or changes. The new bag configuration was put into service. Conclusions: After the two PDCA cycles were completed, the weight of the bag went from 22.7 kg to 20.7 kg, a decreased of 8%. This decrease was vital for air operations. Extraneous and duplicate equipment was removed from the bag to ensure that all needed emergency equipment was available for transport. The neonatal equipment items were moved to the transport incubator, this helped reduce the weight of the bag and kept all neonatal equipment together in one place. This made it easier to organize the pediatric equipment in one bag, helping with efficiency in emergent situations and with restocking. Additional survey results will be available at the time of the conference and added.
http://dx.doi.org/10.1016/j.amj.2017.04.015
213
Abstract 6: Identification of a Pre-Arrest Systolic Blood Pressure Inflection Point for Air Medical Cardiopulmonary Arrest Victims Aurore Richard, DO d Arrowhead Regional Medical Center, Department of Emergency Medicine, Colton, California Jared Johns, DO d Arrowhead Regional Medical Center, Department of Emergency Medicine, Colton, California Allen Wolfe, RN d Air Methods Corporation, Englewood, Colorado David Olvera, FP-C d Air Methods Corporation, Englewood, Colorado Alin Gragossian, DO d Lincoln Memorial University, Harrogate, Tennessee Eliana Vaezazizi d University of California at San Diego, San Diego, California Daniel Davis, MD d Arrowhead Regional Medical Center, Department of Emergency Medicine, Colton, California; Air Methods Corporation, Englewood, Colorado Introduction: Existing studies that identify vital sign thresholds have focused on the relationship between early physiology and eventual mortality. However, the timing of death may be delayed for hours, days, or even weeks. Thus, the immediate clinical significance is limited and may not be useful in guiding aggressive therapy to avoid cardiopulmonary arrest. Objectives: To identify a systolic blood pressure (SBP) threshold that indicates imminent cardiopulmonary arrest. Methods: This was a retrospective, observational study that analyzed physiological data from adult helicopter emergency medical service (EMS) patients suffering cardiopulmonary arrest after arrival of air medical providers. We limited the analysis to a subgroup of patients deteriorating from a primary perfusion problem as defined by the Advanced Resuscitation Training (ART) taxonomy [hemorrhage, sepsis, heart failure, massive pulmonary embolus, tension pneumothorax, and pericardial tamponade]. All pre-arrest SBP values were plotted over time, with the moment of cardiopulmonary arrest defined as “time zero.” Multiple linear regression was used to define a best-fit curve to identify a “terminal inflection point” beyond which cardiopulmonary arrest was inevitable. In addition, 95% confidence intervals were calculated to quantify variability in SBP values as the terminal inflection point was approached. Results: A total of 181 arrest victims were identified over the sixmonth study period, of which 53 patients had complete data for analysis and were determined to have a perfusion-related etiology of arrest. Of these, 33 (62%) were traumatic arrest victims and 20 (38%) were medical arrest victims. A fifth-degree equation demonstrated moderate goodness-of-fit (r¼-0.47, p<0.0001). A clear terminal inflection point at SBP 80 mmHg, with arrest occurring within 2-3 minutes. Confidence intervals were wide at 30 minutes prior to arrest but narrowed considerably as the terminal inflection point was approached. Conclusions: While SBP variability was observed 30 minutes prior to arrest, convergence to a terminal inflection point at 80 mmHg was observed, with cardiopulmonary arrest occurring within 2-3 minutes. This suggests a predictable physiological pattern for perfusion-related deterioration from a variety of arrest etiologies. Such a threshold may be useful in guiding aggressive therapies to reverse deterioration and avoid cardiopulmonary arrest.
http://dx.doi.org/10.1016/j.amj.2017.04.016 Abstract 8: The Use of LUCAS-2 vs. Manual CPR in Helicopter EMS Ralph Frascone, MD d Regions Hospital EMS, St. Paul, Minnesota and Life Link III, Minneapolis, Minnesota Megan Hartigan, RN, BS d Life Link III, Minneapolis, Minnesota
limitation of this being a small trial. Of note, the VL group had more airways reported as being difficult by the flight crew than the DL group. We recommend a larger study to fully evaluate the use of field VL in the pediatric population.
http://dx.doi.org/10.1016/j.amj.2017.04.014 Abstract 4: Everything But The Kitchen Sink…A Quality Improvement Study Matthew Burkey, NRP, Julie Newill, BSN, RN, CCRN, RNC, Kim Riggert, BSN, RN, CCRN, Shannon Williams, NRP, FP-C, Jessica Miller, BSN, RN, CCRN, Calica Patton, NRP, Mikele Wissing, BSN, RN, CCRN d Children’s Hospital & Medical Center, Omaha, Nebraska Objectives: A Plan/Do/Check/Act (PDCA) Quality Improvement Project was utilized to evaluate the current contents of a critical care pediatric/neonatal transport team’s transport packs. Pediatric/ neonatal inter-facility transport requires the team to bring clinical expertise and resources to the bedside of critically ill children at referring community hospitals. The transport team must carry a comprehensive transport bag with equipment needed to care for critically ill neonates and children with a wide range of illnesses and injuries. Goals included: Reduce weight of current bag, increase efficiency of restocking, and to ensure appropriate pediatric/ neonatal equipment available and easily accessible. Methods: Survey sent to all transport staff. Survey questions included: should there be a different bag for each mode of transport? What equipment is essential for transport? What equipment is “nice to have”? Where could we decrease waste in the transport bag? Should there be a different bag for neonatal specific equipment? Survey results were reviewed by the shared governance committee for transport. Results: From survey results and discussions in the shared governance committee, the following items were removed or combined from the transport bag: all IV equipment was combined into one small bag; NG and suction equipment were combined into one small bag; point of care testing equipment all moved together into one small bag to decrease damage to equipment that was in a different location; 25% of transports are neonatal transport, the decision was made to move the neonatal specific equipment to a bag on the transport incubator. This included: Umbilical line equipment, neonatal specific chest drains, a Neo-Tee, neonatal arterial line monitoring, and other neonatal monitoring equipment. A mock set-up for the bag with the proposed changes was done. Staff had the opportunity to look at the bag. After 2 weeks, a quick PDCA cycle was completed by a survey sent out to staff with the changes and asking for comments on the changes before they were instituted. The results from this survey had no additional comments or changes. The new bag configuration was put into service. Conclusions: After the two PDCA cycles were completed, the weight of the bag went from 22.7 kg to 20.7 kg, a decreased of 8%. This decrease was vital for air operations. Extraneous and duplicate equipment was removed from the bag to ensure that all needed emergency equipment was available for transport. The neonatal equipment items were moved to the transport incubator, this helped reduce the weight of the bag and kept all neonatal equipment together in one place. This made it easier to organize the pediatric equipment in one bag, helping with efficiency in emergent situations and with restocking. Additional survey results will be available at the time of the conference and added.
http://dx.doi.org/10.1016/j.amj.2017.04.015
213
Abstract 6: Identification of a Pre-Arrest Systolic Blood Pressure Inflection Point for Air Medical Cardiopulmonary Arrest Victims Aurore Richard, DO d Arrowhead Regional Medical Center, Department of Emergency Medicine, Colton, California Jared Johns, DO d Arrowhead Regional Medical Center, Department of Emergency Medicine, Colton, California Allen Wolfe, RN d Air Methods Corporation, Englewood, Colorado David Olvera, FP-C d Air Methods Corporation, Englewood, Colorado Alin Gragossian, DO d Lincoln Memorial University, Harrogate, Tennessee Eliana Vaezazizi d University of California at San Diego, San Diego, California Daniel Davis, MD d Arrowhead Regional Medical Center, Department of Emergency Medicine, Colton, California; Air Methods Corporation, Englewood, Colorado Introduction: Existing studies that identify vital sign thresholds have focused on the relationship between early physiology and eventual mortality. However, the timing of death may be delayed for hours, days, or even weeks. Thus, the immediate clinical significance is limited and may not be useful in guiding aggressive therapy to avoid cardiopulmonary arrest. Objectives: To identify a systolic blood pressure (SBP) threshold that indicates imminent cardiopulmonary arrest. Methods: This was a retrospective, observational study that analyzed physiological data from adult helicopter emergency medical service (EMS) patients suffering cardiopulmonary arrest after arrival of air medical providers. We limited the analysis to a subgroup of patients deteriorating from a primary perfusion problem as defined by the Advanced Resuscitation Training (ART) taxonomy [hemorrhage, sepsis, heart failure, massive pulmonary embolus, tension pneumothorax, and pericardial tamponade]. All pre-arrest SBP values were plotted over time, with the moment of cardiopulmonary arrest defined as “time zero.” Multiple linear regression was used to define a best-fit curve to identify a “terminal inflection point” beyond which cardiopulmonary arrest was inevitable. In addition, 95% confidence intervals were calculated to quantify variability in SBP values as the terminal inflection point was approached. Results: A total of 181 arrest victims were identified over the sixmonth study period, of which 53 patients had complete data for analysis and were determined to have a perfusion-related etiology of arrest. Of these, 33 (62%) were traumatic arrest victims and 20 (38%) were medical arrest victims. A fifth-degree equation demonstrated moderate goodness-of-fit (r¼-0.47, p<0.0001). A clear terminal inflection point at SBP 80 mmHg, with arrest occurring within 2-3 minutes. Confidence intervals were wide at 30 minutes prior to arrest but narrowed considerably as the terminal inflection point was approached. Conclusions: While SBP variability was observed 30 minutes prior to arrest, convergence to a terminal inflection point at 80 mmHg was observed, with cardiopulmonary arrest occurring within 2-3 minutes. This suggests a predictable physiological pattern for perfusion-related deterioration from a variety of arrest etiologies. Such a threshold may be useful in guiding aggressive therapies to reverse deterioration and avoid cardiopulmonary arrest.
http://dx.doi.org/10.1016/j.amj.2017.04.016 Abstract 8: The Use of LUCAS-2 vs. Manual CPR in Helicopter EMS Ralph Frascone, MD d Regions Hospital EMS, St. Paul, Minnesota and Life Link III, Minneapolis, Minnesota Megan Hartigan, RN, BS d Life Link III, Minneapolis, Minnesota