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Factors associated with the Return of Spontaneous Circulation (ROSC) outcome in cardiopulmonary resuscitated patients
S20
Abstracts / Resuscitation 85S (2014) S15–S121
AP011 A comparison of intravenous and intraosseous vascular access during simulated cardiac arrest on an Advanced Life Support course M. Ibrahim 1,2,∗ , K. Cairney 1,2 1 2
Barts Health NHS Trust, London, UK Croydon University Hospital NHS Trust, London, UK
Purpose: Vascular access during a cardiac arrest is a significant challenge faced by responding healthcare professionals. It has been suggested that as many as 40% of intravenous attempts during cardiac arrest are unsuccessful and that the time taken to achieve access can be up to thirty minutes (Lapostelle et al., 2007). The purpose of this study was to compare the time taken and number of attempts taken to achieve intravenous access compared to intraosseous access during a simulated cardiac arrest on a Resuscitation Council (UK) Advanced Life Support course. Methods: The design was a prospective randomised controlled cross over. During the ALS course, study participants completed a vascular access skills station. Participants were then randomly allocated to either attempt IV access or IO access during a simulated PEA cardiac arrest. The simulation involved trained ALS faculty performing compressions and airway management. The time taken and number of attempts to obtain access was recorded. The participants then repeated the simulation but with the other vascular access method. Participants were also asked to complete a pre and post IO access station qualitative questionnaire. Results: Thirty three candidates consented to participate in the study. Successful IV access was obtained at first attempt 70% of the time, compared to 100% for IO access. There was no statistically significant difference in time taken to obtain access between the two devices. There was a significant increase in participants confidence and awareness of the IO route, from a VAS of 22–65, demonstrating an almost 300% increase in confidence. Conclusion: This study concludes that successful humeral IO access can be achieved following a short education input. The implications for clinical and educational practice is wide-reaching and it is hoped that a follow up study looking at skill retention will add to the findings from this study. http://dx.doi.org/10.1016/j.resuscitation.2014.03.060 AP012 Factors associated with the Return of Spontaneous Circulation (ROSC) outcome in cardiopulmonary resuscitated patients Antoniu Petris, Irina Costache, Ovidiu Popa, Ovidiu Petris, Didona Ungureanu, Diana Cimpoesu ∗ UMF Gr. T. Popa, Iasi, Romania Objectives: The recent studies proved poor outcome after cardiac arrest (CA) despite of the 2010 ERC Guidelines implementation. Nevertheless, in various European centers, examples of excellent practice could be mentioned. Improving outcome requires better knowledge about CA mechanism, about patients and process of cardiopulmonary resuscitation. Our study about including patients with out-of-hospital and in-hospital CA try to demonstrate what is different inside the survival group compared with non-survival patients and what is the role of the focused echocardiography during resuscitation for recognition and treatment of reversible causes of the cardiac arrest.
Methods: We prospectively analyzed a group of 109 patients with cardiac arrest (CA) admitted consecutively in the Cardiology Clinic of an academic hospital for adults in Iasi, Romania. Results: The study did not show a significant difference in the ejection fraction in patients with ROSC subgroup (39.28 ± 11.11) than the subgroup without ROSC (38.88 ± 14.28), but significant differences between the two subgroups were identified regarding to the collapse/small size of the inferior vena cava (hypovolemic status marker) (p < 0.005). We find also statistically significant differences between patients with/without ROSC regarding the association of acute heart failure manifestations, the CA-CPR times, CPR duration, initiation of CPR by witnesses, the place of the CA (OHCA vs. IHCA), GCS and SaO2 score, the use of clopidogrel, heparin, amiodarone and vasopressors (positive inotropic) as preexisting medication. Conclusion: The study showed statistically significant differences between patients with/without ROSC regarding the hypertension history, the association of acute heart failure manifestations and hypovolemic status. When hypovolemia was identified by using ultrasonography and treated by aggressively fluid replacement in the ALS algorithm, ROSC and survival is observed to be more frequent. Keywords: Cardiac arrest outcome; Reversible causes of cardiac arrest; Focused echocardiography; Resuscitation http://dx.doi.org/10.1016/j.resuscitation.2014.03.061 AP013 Clinicians’ views on the effectiveness of adrenaline to treat cardiac arrest Mike smyth 1,∗ , Tom Quinn 2 , Jerry Nolan 3 , Simon Gates 1 , Gavin Perkins 1 1
Warwick Clinical Trials Unit, University of Warwick, Coventry, UK 2 University of Surrey, Surrey, UK 3 Royal United Hospital, Bath, Bath, UK Purpose of the study: Recent evidence has cast doubt on the safety and effectiveness of adrenaline as a treatment for cardiac arrest.1,2 The purpose of this study was to obtain the views of UK clinicians on the effects of adrenaline on outcomes from cardiac arrest and whether a randomized controlled trial is needed. Materials and methods: We distributed questionnaires to participants at the Resuscitation Council (UK) Annual Scientific Conference held in September 2012. Participants were asked to rate their views using a 7-point Likert scale (1 strongly disagree to 7 strongly agree) on the effect of adrenaline on short- and long-term survival, long-term patient focused outcomes (e.g. neurocognitive function) and whether the risks of adrenaline outweighed the benefit. In addition we sought views on an appropriate comparator agent and setting for a randomized controlled trial. Data shown are median and [interquartile range] for Likert responses. Results: Completed questionnaires were received from 216 delegates. Respondents agreed that adrenaline improved short-term survival (median 6 [6–7]) but disagreed that it improved longterm survival (2 [1–3]) or patient focused long-term outcomes (2 [1–3]). Respondents’ views about whether the risk of adrenaline outweighs the benefit are shown in the figure. 95% of respondents agreed with a need for a large randomized controlled trial including standard dose adrenaline (72% strongly agreed, 2% disagreed). The majority (58%) felt the comparator in a trial should be placebo, 14% low-dose adrenaline and 26% adrenaline as a continuous infusion.
Abstracts / Resuscitation 85S (2014) S15–S121
AP011 A comparison of intravenous and intraosseous vascular access during simulated cardiac arrest on an Advanced Life Support course M. Ibrahim 1,2,∗ , K. Cairney 1,2 1 2
Barts Health NHS Trust, London, UK Croydon University Hospital NHS Trust, London, UK
Purpose: Vascular access during a cardiac arrest is a significant challenge faced by responding healthcare professionals. It has been suggested that as many as 40% of intravenous attempts during cardiac arrest are unsuccessful and that the time taken to achieve access can be up to thirty minutes (Lapostelle et al., 2007). The purpose of this study was to compare the time taken and number of attempts taken to achieve intravenous access compared to intraosseous access during a simulated cardiac arrest on a Resuscitation Council (UK) Advanced Life Support course. Methods: The design was a prospective randomised controlled cross over. During the ALS course, study participants completed a vascular access skills station. Participants were then randomly allocated to either attempt IV access or IO access during a simulated PEA cardiac arrest. The simulation involved trained ALS faculty performing compressions and airway management. The time taken and number of attempts to obtain access was recorded. The participants then repeated the simulation but with the other vascular access method. Participants were also asked to complete a pre and post IO access station qualitative questionnaire. Results: Thirty three candidates consented to participate in the study. Successful IV access was obtained at first attempt 70% of the time, compared to 100% for IO access. There was no statistically significant difference in time taken to obtain access between the two devices. There was a significant increase in participants confidence and awareness of the IO route, from a VAS of 22–65, demonstrating an almost 300% increase in confidence. Conclusion: This study concludes that successful humeral IO access can be achieved following a short education input. The implications for clinical and educational practice is wide-reaching and it is hoped that a follow up study looking at skill retention will add to the findings from this study. http://dx.doi.org/10.1016/j.resuscitation.2014.03.060 AP012 Factors associated with the Return of Spontaneous Circulation (ROSC) outcome in cardiopulmonary resuscitated patients Antoniu Petris, Irina Costache, Ovidiu Popa, Ovidiu Petris, Didona Ungureanu, Diana Cimpoesu ∗ UMF Gr. T. Popa, Iasi, Romania Objectives: The recent studies proved poor outcome after cardiac arrest (CA) despite of the 2010 ERC Guidelines implementation. Nevertheless, in various European centers, examples of excellent practice could be mentioned. Improving outcome requires better knowledge about CA mechanism, about patients and process of cardiopulmonary resuscitation. Our study about including patients with out-of-hospital and in-hospital CA try to demonstrate what is different inside the survival group compared with non-survival patients and what is the role of the focused echocardiography during resuscitation for recognition and treatment of reversible causes of the cardiac arrest.
Methods: We prospectively analyzed a group of 109 patients with cardiac arrest (CA) admitted consecutively in the Cardiology Clinic of an academic hospital for adults in Iasi, Romania. Results: The study did not show a significant difference in the ejection fraction in patients with ROSC subgroup (39.28 ± 11.11) than the subgroup without ROSC (38.88 ± 14.28), but significant differences between the two subgroups were identified regarding to the collapse/small size of the inferior vena cava (hypovolemic status marker) (p < 0.005). We find also statistically significant differences between patients with/without ROSC regarding the association of acute heart failure manifestations, the CA-CPR times, CPR duration, initiation of CPR by witnesses, the place of the CA (OHCA vs. IHCA), GCS and SaO2 score, the use of clopidogrel, heparin, amiodarone and vasopressors (positive inotropic) as preexisting medication. Conclusion: The study showed statistically significant differences between patients with/without ROSC regarding the hypertension history, the association of acute heart failure manifestations and hypovolemic status. When hypovolemia was identified by using ultrasonography and treated by aggressively fluid replacement in the ALS algorithm, ROSC and survival is observed to be more frequent. Keywords: Cardiac arrest outcome; Reversible causes of cardiac arrest; Focused echocardiography; Resuscitation http://dx.doi.org/10.1016/j.resuscitation.2014.03.061 AP013 Clinicians’ views on the effectiveness of adrenaline to treat cardiac arrest Mike smyth 1,∗ , Tom Quinn 2 , Jerry Nolan 3 , Simon Gates 1 , Gavin Perkins 1 1
Warwick Clinical Trials Unit, University of Warwick, Coventry, UK 2 University of Surrey, Surrey, UK 3 Royal United Hospital, Bath, Bath, UK Purpose of the study: Recent evidence has cast doubt on the safety and effectiveness of adrenaline as a treatment for cardiac arrest.1,2 The purpose of this study was to obtain the views of UK clinicians on the effects of adrenaline on outcomes from cardiac arrest and whether a randomized controlled trial is needed. Materials and methods: We distributed questionnaires to participants at the Resuscitation Council (UK) Annual Scientific Conference held in September 2012. Participants were asked to rate their views using a 7-point Likert scale (1 strongly disagree to 7 strongly agree) on the effect of adrenaline on short- and long-term survival, long-term patient focused outcomes (e.g. neurocognitive function) and whether the risks of adrenaline outweighed the benefit. In addition we sought views on an appropriate comparator agent and setting for a randomized controlled trial. Data shown are median and [interquartile range] for Likert responses. Results: Completed questionnaires were received from 216 delegates. Respondents agreed that adrenaline improved short-term survival (median 6 [6–7]) but disagreed that it improved longterm survival (2 [1–3]) or patient focused long-term outcomes (2 [1–3]). Respondents’ views about whether the risk of adrenaline outweighs the benefit are shown in the figure. 95% of respondents agreed with a need for a large randomized controlled trial including standard dose adrenaline (72% strongly agreed, 2% disagreed). The majority (58%) felt the comparator in a trial should be placebo, 14% low-dose adrenaline and 26% adrenaline as a continuous infusion.