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AP041 Joining the EuReCA – The Romanian Registry on Cardiac arrest – a year later
Abstracts, Resuscitation 2011 – Implementation / Resuscitation 82S1 (2011) S1–S34 patients. Electrocardiograhic aspects were: ventricular fibrillation (15), asystole (3), pulseless ventricular tachycardia (2). Treatment of the CA included: external defibrillation (18), intubation (9), epinephrine (7), amiodarone (5). CA was reversible after the first or the second external shock in 13 cases, and more of three external shock in 1 case. Six patients died. Factors outfitters CA were: ST-elevation in the anterior territory extended, supraventricular tachycardia at admission, cardiogenic shock. Conclusion: In ED practice, immediate defibrillation has improved the prognosis of CA complicating the STEMI.
AP041 Joining the EuReCA – The Romanian Registry on Cardiac arrest – a year later Horea Sabau 1 , Oana Tudorache 2 , Horea Pop 4 , Valentin Georgescu 3 , Victor Strambu 5 , Ioana Dimitriu 3 , Mirela Sorina Nicolau 6 , Diana Cimpoesu 8 , Hadrian Borcea 9 , Alice Branzea 7
S19
In 44 cases out-of-hospital resuscitation was documented, succeeding in 16 patients (36%). 11 of these died later in hospital (survival rate after CPR 11%). 29 of the patients (66%) had no severe burns, 8 had more than 10% of the body surface burnt. Cyanide antidotes were available in 37 cases, administered in 2 cases. Reported CO-Hb-Levels, detected before as well as after hospital admission, predominantly ranged below 40%. Conclusions: Cardiac Arrest following severe smoke inhalation is quite common, even without concomitant severe burns. Attention should be paid to the out-of hospital treatment, where most deaths occur. The use of cyanide antidotes is rare, although largely available and recommended by the ERC Guidelines. Low CO-Hb-levels may suggest an additive cyanide intoxication, but the observed survival was not worse than in patients receiving an antidote.[1 Recently started investigations will provide further evidence of the role of cyanide intoxication in severe smoke inhalation. References: 1. Fortin JL, et al. Prehospital Administration of Hydroxocobalamin for Smoke Inhalation-Associated Cyanide Poisoning. Clin Toxicol 2006;44:37–44.
1
CNRR, Cluj- Napoca, Romania Department of Emergency Medicine, “Saint Pantelimon” Emergency Hospital, Bucharest, Romania 3 Department of Anesthetics and Intensive Care, “Saint Pantelimon” Emergency Hospital, Bucharest, Romania 4 Faculty of Mathematics and Computer Science, University “Babes Bolyai”, Cluj- Napoca, Romania 5 Department of Surgery, “Saint Pantelimon” Emergency Hospital, Bucharest, Romania 6 Department of Anesthetics and Intensive Care, “Saints Cozma and Damian” Hospital, Bucharest, Romania 7 National Institute of Geriatrics “Ana Aslan”, Bucharest, Romania 8 Department of Emergency Medicine, “Saint Spiridon” Emergency Hospital, Iasi, Romania 9 Department of Emergency Medicine, County Emergency Hospital, Oradea, Romania 2
Background: The Romanian Registry on Cardiac Arrest (RRCA) is a database designed to analyze information regarding cardio respiratory arrests gathered through a specific reporting chart based on the Utstein reporting system. The initiative started an year ago, being given a boost by the EuReCA Project. Materials and Methods: After one year of experience with the RRCA, we decided to extend the survey to several Pre-hospital emergency services. We added a number of 9 emergency services and compared the results of the resuscitation teams. Results: As the RRSC reveals, in our country, there is a maximum of cardio respiratory arrest risk in the 7th decade of life, as about 25% of the registered cases show so. Regarding the DNAR cases, over 95% haven’t had any precise indication and resuscitation was attempted in all this cases. More than 90% of the registered cases were witnessed by lay persons, but most of them did not perform BLS before EMS arrival. The emergency call-EMS arrival time is shorter then years before implementing the actual pre hospital EMS and so does the cardiac arrest-BLS time. Regarding the response time and the quality of medical response, the smaller cities afford including a doctor in the EMS team providing ALS on the scene. Conclusions: Dramatic events occur at an early age in Romania, so recommendations regarding the screening and prophylaxis of heart-threatening conditions should be done. There is a great need for education in resuscitation addressed to laypersons and for the implementation and use of Public Access Defibrillators (PAD), supported by the local communities. There is need for a more precise legislation regarding DNAR criteria, and the Registry can prove it. Every emergency team which consents to apply this feed-back method has the possibility to increase performances.
AP043 Can More Accurate Measurement of Chest Compression Depth Help Nurses do Better CPR on Soft Surfaces? Isabelle Banville, Lizabeth Rose, Patty O’Hearn, Timothy Campbell, Richard Nova, Fred Chapman Physio-Control, Redmond, WA, USA Background: Quality of CPR performed on soft surfaces is often poor, even with real-time feedback. Current feedback devices cannot distinguish between compression of the chest and deflection of the underlying surface, and therefore can give erroneous guidance. A novel device more accurately estimates compression depth by measuring changes in magnetic field strength between a backpad and a chestpad. We tested whether performing CPR on a mattress with real-time feedback from that device, or simply training with it, improved CPR quality. Materials and Methods: Critical care nurses performed two 2-minutes sets of continuous chest compressions on a weighted manikin placed on a backboard on a hospital bed with foam mattress. Participants performed a baseline set of compressions without feedback, followed by 10 minutes of rest, training and practice with the novel Guidelines 2010-compliant feedback device. Then a second set of compressions was performed immediately with (FB) or without (NoFB) real-time feedback, as randomized. Results: The 20 participants (1 male) weighed 68.6±11 kg (mean±SD) and were 165.3±6 cm tall. At baseline for all nurses, the chest compression depth was 36.8±8.8 mm with a rate of 109±18/min. Six nurses had incomplete release in >10% of compressions. For the second set, done after training with the feedback device, compression depth increased to 49±9 mm when feedback was used (n=11) and to 40±9 mm without feedback (n=9), results which differed significantly (p=0.03). There was no difference in compression rate (94±9 vs 103±12, p=0.08), or incomplete release (3/9 vs 2/11 nurses, p=NS) between FB and NoFB. Compared to baseline, training with and using feedback significantly improved depth (p<0.02 (95% CI: [2.5, 17.3 mm]) and training alone trended toward improved depth (p=0.06 (95% CI: [-0.4, 11.5 mm]). Conclusions: In a realistic simulation on a hospital bed, feedback from a novel device improved nurses compression depth, and simply training with the device may provide some improvement.
AP044 Development of nurse initiated defibrillation programme to improve the clinical outcome of patients with cardiac arrest
AP042
K.W. Lam, K.W. Au Yeung, K.Y. Lai
Resuscitation following cardiac arrest in special circumstances: Fire smoke poisoning
Queen Elizabeth Hospital, Hong Kong, Hong Kong
Guido Kaiser 1 , Markus Roessler 2 1
GIZ-Nord Poisons Centre, University Medical Center, Göttingen, Germany Department of Anaesthesiology, Emergency and Intensive Care Medicine, University Medical Center, Göttingen, Germany 2
Background: Poisoning rarely causes cardiac arrest, but sometimes is a “reversible cause” necessitating special treatment beyond standard ALS procedures. Among accidental poisonings, fire smoke inhalation is a frequent cause of death, but little is reported about incidence, conditions and outcome of corresponding CPR situations. Materials and Methods: (A) All media reports on assumed severe fire smoke exposures in Germany listed in “Google News Deutschland” were analysed daily over two years (2009-01 to 2010-12). (B) Additional Information in detail was requested by questionnaire from the local Emergency Medical Service in all cases with emergency medical treatment (2009-04 to 2011-05). Results: (A) In 151 of 364 Cases resuscitation attempts were reported, succeeding in 54 patients (36%). 28 of these died later in hospital (survival rate after CPR 17%). (B)
Objectives: 1. To develop a nurse initiated defibrillation programme for the high risk patients in the hospital. 2. To eliminate the time delay for the arrival of doctors before initiation of defibrillation. 3. To improve the outcome of patients who develop cardiac arrest. Methodology: 1. To identify the high risk area for resuscitation in hospital. 2. To develop a nurse initiated defibrillation protocol. 3. To install the equipments necessary for defibrillation with proper maintenance. 4. To provide theoretical and practical training for the nurses. Results: 1. Three high risk areas, ventilatory ward, neurosurgical high dependence unit (HDU), cardiothoracic HDU were identified for promulgation of nurse initiated defibrillation programme. Patients in such areas are at high risk of development of cardiac arrest but on-call doctors cannot attend the patients as promptly as in ICU and CCU.
AP041 Joining the EuReCA – The Romanian Registry on Cardiac arrest – a year later Horea Sabau 1 , Oana Tudorache 2 , Horea Pop 4 , Valentin Georgescu 3 , Victor Strambu 5 , Ioana Dimitriu 3 , Mirela Sorina Nicolau 6 , Diana Cimpoesu 8 , Hadrian Borcea 9 , Alice Branzea 7
S19
In 44 cases out-of-hospital resuscitation was documented, succeeding in 16 patients (36%). 11 of these died later in hospital (survival rate after CPR 11%). 29 of the patients (66%) had no severe burns, 8 had more than 10% of the body surface burnt. Cyanide antidotes were available in 37 cases, administered in 2 cases. Reported CO-Hb-Levels, detected before as well as after hospital admission, predominantly ranged below 40%. Conclusions: Cardiac Arrest following severe smoke inhalation is quite common, even without concomitant severe burns. Attention should be paid to the out-of hospital treatment, where most deaths occur. The use of cyanide antidotes is rare, although largely available and recommended by the ERC Guidelines. Low CO-Hb-levels may suggest an additive cyanide intoxication, but the observed survival was not worse than in patients receiving an antidote.[1 Recently started investigations will provide further evidence of the role of cyanide intoxication in severe smoke inhalation. References: 1. Fortin JL, et al. Prehospital Administration of Hydroxocobalamin for Smoke Inhalation-Associated Cyanide Poisoning. Clin Toxicol 2006;44:37–44.
1
CNRR, Cluj- Napoca, Romania Department of Emergency Medicine, “Saint Pantelimon” Emergency Hospital, Bucharest, Romania 3 Department of Anesthetics and Intensive Care, “Saint Pantelimon” Emergency Hospital, Bucharest, Romania 4 Faculty of Mathematics and Computer Science, University “Babes Bolyai”, Cluj- Napoca, Romania 5 Department of Surgery, “Saint Pantelimon” Emergency Hospital, Bucharest, Romania 6 Department of Anesthetics and Intensive Care, “Saints Cozma and Damian” Hospital, Bucharest, Romania 7 National Institute of Geriatrics “Ana Aslan”, Bucharest, Romania 8 Department of Emergency Medicine, “Saint Spiridon” Emergency Hospital, Iasi, Romania 9 Department of Emergency Medicine, County Emergency Hospital, Oradea, Romania 2
Background: The Romanian Registry on Cardiac Arrest (RRCA) is a database designed to analyze information regarding cardio respiratory arrests gathered through a specific reporting chart based on the Utstein reporting system. The initiative started an year ago, being given a boost by the EuReCA Project. Materials and Methods: After one year of experience with the RRCA, we decided to extend the survey to several Pre-hospital emergency services. We added a number of 9 emergency services and compared the results of the resuscitation teams. Results: As the RRSC reveals, in our country, there is a maximum of cardio respiratory arrest risk in the 7th decade of life, as about 25% of the registered cases show so. Regarding the DNAR cases, over 95% haven’t had any precise indication and resuscitation was attempted in all this cases. More than 90% of the registered cases were witnessed by lay persons, but most of them did not perform BLS before EMS arrival. The emergency call-EMS arrival time is shorter then years before implementing the actual pre hospital EMS and so does the cardiac arrest-BLS time. Regarding the response time and the quality of medical response, the smaller cities afford including a doctor in the EMS team providing ALS on the scene. Conclusions: Dramatic events occur at an early age in Romania, so recommendations regarding the screening and prophylaxis of heart-threatening conditions should be done. There is a great need for education in resuscitation addressed to laypersons and for the implementation and use of Public Access Defibrillators (PAD), supported by the local communities. There is need for a more precise legislation regarding DNAR criteria, and the Registry can prove it. Every emergency team which consents to apply this feed-back method has the possibility to increase performances.
AP043 Can More Accurate Measurement of Chest Compression Depth Help Nurses do Better CPR on Soft Surfaces? Isabelle Banville, Lizabeth Rose, Patty O’Hearn, Timothy Campbell, Richard Nova, Fred Chapman Physio-Control, Redmond, WA, USA Background: Quality of CPR performed on soft surfaces is often poor, even with real-time feedback. Current feedback devices cannot distinguish between compression of the chest and deflection of the underlying surface, and therefore can give erroneous guidance. A novel device more accurately estimates compression depth by measuring changes in magnetic field strength between a backpad and a chestpad. We tested whether performing CPR on a mattress with real-time feedback from that device, or simply training with it, improved CPR quality. Materials and Methods: Critical care nurses performed two 2-minutes sets of continuous chest compressions on a weighted manikin placed on a backboard on a hospital bed with foam mattress. Participants performed a baseline set of compressions without feedback, followed by 10 minutes of rest, training and practice with the novel Guidelines 2010-compliant feedback device. Then a second set of compressions was performed immediately with (FB) or without (NoFB) real-time feedback, as randomized. Results: The 20 participants (1 male) weighed 68.6±11 kg (mean±SD) and were 165.3±6 cm tall. At baseline for all nurses, the chest compression depth was 36.8±8.8 mm with a rate of 109±18/min. Six nurses had incomplete release in >10% of compressions. For the second set, done after training with the feedback device, compression depth increased to 49±9 mm when feedback was used (n=11) and to 40±9 mm without feedback (n=9), results which differed significantly (p=0.03). There was no difference in compression rate (94±9 vs 103±12, p=0.08), or incomplete release (3/9 vs 2/11 nurses, p=NS) between FB and NoFB. Compared to baseline, training with and using feedback significantly improved depth (p<0.02 (95% CI: [2.5, 17.3 mm]) and training alone trended toward improved depth (p=0.06 (95% CI: [-0.4, 11.5 mm]). Conclusions: In a realistic simulation on a hospital bed, feedback from a novel device improved nurses compression depth, and simply training with the device may provide some improvement.
AP044 Development of nurse initiated defibrillation programme to improve the clinical outcome of patients with cardiac arrest
AP042
K.W. Lam, K.W. Au Yeung, K.Y. Lai
Resuscitation following cardiac arrest in special circumstances: Fire smoke poisoning
Queen Elizabeth Hospital, Hong Kong, Hong Kong
Guido Kaiser 1 , Markus Roessler 2 1
GIZ-Nord Poisons Centre, University Medical Center, Göttingen, Germany Department of Anaesthesiology, Emergency and Intensive Care Medicine, University Medical Center, Göttingen, Germany 2
Background: Poisoning rarely causes cardiac arrest, but sometimes is a “reversible cause” necessitating special treatment beyond standard ALS procedures. Among accidental poisonings, fire smoke inhalation is a frequent cause of death, but little is reported about incidence, conditions and outcome of corresponding CPR situations. Materials and Methods: (A) All media reports on assumed severe fire smoke exposures in Germany listed in “Google News Deutschland” were analysed daily over two years (2009-01 to 2010-12). (B) Additional Information in detail was requested by questionnaire from the local Emergency Medical Service in all cases with emergency medical treatment (2009-04 to 2011-05). Results: (A) In 151 of 364 Cases resuscitation attempts were reported, succeeding in 54 patients (36%). 28 of these died later in hospital (survival rate after CPR 17%). (B)
Objectives: 1. To develop a nurse initiated defibrillation programme for the high risk patients in the hospital. 2. To eliminate the time delay for the arrival of doctors before initiation of defibrillation. 3. To improve the outcome of patients who develop cardiac arrest. Methodology: 1. To identify the high risk area for resuscitation in hospital. 2. To develop a nurse initiated defibrillation protocol. 3. To install the equipments necessary for defibrillation with proper maintenance. 4. To provide theoretical and practical training for the nurses. Results: 1. Three high risk areas, ventilatory ward, neurosurgical high dependence unit (HDU), cardiothoracic HDU were identified for promulgation of nurse initiated defibrillation programme. Patients in such areas are at high risk of development of cardiac arrest but on-call doctors cannot attend the patients as promptly as in ICU and CCU.