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Fibrinolysis: A needed check up
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Abstracts / Resuscitation 118S (2017) e43–e90
scientific impact and animal welfare at the same time. Currently it’s limited to animal studies on medical technology. http://dx.doi.org/10.1016/j.resuscitation.2017.08.147 AP047 A shocking picture: Automated external defibrillators are poorly signposted in the community David B. Sidebottom 1,∗ , Ryan Potter 1 , Gillian Hodgett 2 , Charles D. Deakin 3 1
Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK 2 South Central Ambulance Service NHS Trust, Bicester, UK 3 NIHR Southampton Respiratory Biomedical Research Unit, University of Southampton, Southampton, UK Background: Early defibrillation as part of basic life support is a critical link in the chain of survival. Public access defibrillation (PAD) programmes utilising automated external defibrillators (AEDs) decrease the time to first shock, with demonstrable mortality benefits for out-of-hospital cardiac arrest (OHCA). Effective use of PADs requires rapid location of the device, facilitated by adequate signage. We aimed to assess the proportion of registered PADs with external signage visible within a 300 m radius (considered by the Resuscitation Council (UK) as the useable range). Method: We surveyed rural and urban community PADs available for public use on the ‘Save a Life’ AED locator mobile application near Southampton, UK. External signage effectiveness was evaluated according to appropriateness of design, visibility, and any visual obstruction. We also measured the distance from the furthest sign to the device using a laser rangefinder, and collected location and device affiliation descriptives. Results: Researchers evaluated 103 PADs during May 2017. All devices were included in the final analysis. 68.0% of devices had no external signage located. Of devices with external signage, 60.6% used 2008 ILCOR signage and 30.3% used 2006 Resuscitation Council (UK) signage. The mean distance from the furthest visible sign to the device was 1.9m. Mean signage size was 16.7 cm by 15.5 cm. No GP surgery used external signage or an external PAD 24/7 access box. Conclusions: Current signage of PADs is very poor and will limit their effectiveness by impeding awareness of nearby devices, and hindering rapid location of a device when needed. Benefits of signage in raising public awareness of PADs are also lost. Recommendations are required to ensure that every PAD has visible signage within its operational radius.
Fig. 1. Time of CPR after the administration of fibrinolytics in patients without ROSC.
(OHCA). To determine the conditions of its use, to check compliance with ERC Guidelines and to compare results with those from our previous series. Materials and methods: Descriptive, retrospective, observational study of the OHCA assisted by SAMU-Asturias. Study period: July 1st 2013 to December 31st 2016. Inclusion criteria: Patients that received fibrinolytics during ACLS provided by EMS. Patients with suspected acute pulmonary embolism (APE) OHCA, with or without use of fibrinolytics. Data collected from clinical reports and Utstein based OHCA registry. Data analysed with SPSS Statistics 21 software. Results: Out of 2251 PC registered, 31 (1.37%) received fibrinolytics during ACLS: 16 before 2016, and 15 in 2016. The increase is statistically significant (p = 0.021). 23 patients (74.2%) male: average age, 56.5 years (s = 15.3). Table 1 shows the epidemiological variables studied related to these events. 9 (29.0%) survived events, all in 2016: 6 with suspected cardiac etiology, 3 with suspected APE. Average time of return of spontaneous circulation (ROSC) after administration of fibrinolytics: 20.2 min (s = 16.7) [2–53]. Discharge with CPC 1–2 in 3 cases (9.7%), witnessed CA of cardiac etiology with initial shockable rhythm. Fig. 1 shows CPR times after fibrinolysis in patients without ROSC. Table 2 shows the management of suspected APE.
Table 1 OHCA with use of fibrinolytics epidemiologic variables.
http://dx.doi.org/10.1016/j.resuscitation.2017.08.148 AP048 Fibrinolysis: A needed check up Maria Eugenia Diaz Fernandez, Jose Manuel Cuervo Menendez, Juan Jose Garcia Garcia, Maria Garcia Alonso, Marta Martinez del Valle, César L. Roza-Alonso ∗ SAMU-Asturias, Asturias, Spain Purpose of the study: Utstein based OHCA registry shows an increase, during 2016, of the use of fibrinolytics in cardiac arrests
Table 2 Management of OHCA with suspected APE.
Abstracts / Resuscitation 118S (2017) e43–e90
Conclusions: -
There is a higher use of fibrinolytics in OHCA in 2016. Higher use does not reflect in survival rate. Most of fibrinolytics were used in non suspected APE OHCA. Recommended CPR time after administration of fibrinolytics is not accomplished. - There seems to be a contagion effect on treatment in OHCA due to suspected APE and OHCA of cardiac etiology, which according to literature is contraindicated. http://dx.doi.org/10.1016/j.resuscitation.2017.08.149 AP049 How do nurses interpret low voltage ventricular fibrillation during simulated cardiopulmonary resuscitation? Are they as good as we think? Lukasz Czyzewski 1,∗ , Lukasz Szarpak 1 , Jerzy Ladny 2 , Jacek Smereka 3 1
Medical University of Warsaw, Warsaw, Poland Medical University Bialystok, Bialystok, Poland 3 Wroclaw Medical University, Wroclaw, Poland 2
Purpose of the study: The ability to interpret electrocardiographic (ECG) rhythms associated with cardiac arrest in a necessary skill, having a direct impact on the quality of advanced life support (ALS) and the patient survival. The aim of the study was to evaluate the ability to recognize low voltage ventricular fibrillation (LvVF) during simulated cardiopulmonary resuscitation (CPR) performed by nurses. Materials and methods: The study, conducted during ALS workshops, involved 42 nurses working in emergency units or anesthesiology and intensive care units. The nurses performed CPR according to the European Resuscitation Council (ERC) guidelines. During the exercise resuscitation, the team consisted of 2 independent instructors and a nurse acting as team leader. The resuscitation team leader was required to interpret the ECG rhythm and administer the appropriate treatment, including drugs and defibrillation. CPR was applied in a MegaCode Kelly manikin (Laerdal, Stavanger, Norway) with the use of a LIFEPACK 15 manual defibrillator (Physio-Control, the Netherlands). During the 10-min scenario, the ECG rhythms were randomly altered, always including the occurrence of LvVF. Results: The median age of participants was 31 (interquartile range, IQR, 26–44) years, and work experience – 6.5 (IQR; 3–8) years. LvVF was recognized only by 17 nurses (40.5%) In the case of LvVF occurrence, only 33.3% participants increased the ECG amplitude and changed the ECG lead. Among the 16 nurses who recognized LvVF, 15 performed defibrillation, and 2 followed the guidelines for non-shockable rhythms. Conclusions: There is a need to introduce compulsory periodic training for the nursing staff to focus on recognizing rhythms associated with cardiac arrest and implementing procedures based on the 2015 ERC guidelines. http://dx.doi.org/10.1016/j.resuscitation.2017.08.150
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AP050 A statistics based teaching intervention to aid foundation doctors when discussing cardiopulmonary resuscitation (CPR) Mayurun Ramadas ∗ , Lubna Ghani, Ben Clark Imperial College School of Medicine, London, UK Purpose: The United Kingdom Foundation Programme (UKFPO) syllabus states a foundation doctor should be able to discuss why CPR is not appropriate [1]). Discussions and questions pertaining to CPR success rate and complications are an often challenging yet a vital part of medical practice [2]. We implemented a teaching intervention that aimed to equip Foundation doctors’ with key National Cardiac Arrest Audit (NCAA) statistical data [3] to help them field such questions. Materials and method: Prior to the teaching a survey was given to foundation doctors (n = 36). Subsequently, a mandatory teaching session was delivered for them. The session identified key cardiac arrest demographics, success rate and complications based on the latest resus council NCAA data and how to express this appropriately. This was followed up by an immediate evaluation survey. A three month follow up survey evaluated whether the workshop resulted in self-rated behaviour change and long term impact. It was emphasised in the session that a statistics approach to CPR discussions was optional and one out of a variety of approaches that could be used if doctors felt confident discussing the statistics involved. Results: Qualitative pre-session data clearly highlighted that foundation doctors face challenging questions and statements from patients and family about ‘CPR prognosis/statistics’. Immediate post-session evaluation revealed foundation doctors found the teaching to be relevant, interactive and helpful to their training using a 5-point Likert scale (mean = 4.6). The three month postsession questionnaire showed that 69% of foundation doctors used the NCAA statistics provided in the workshop in their clinical practice when discussing why CPR was not appropriate. The same proportion felt the workshop had increased their confidence when discussing why CPR is not appropriate. Conclusion: Our results show many foundation doctors are fielding challenging questions and statements from patients and relatives about CPR. A useful approach to answering such questions is by using evidence based statistical data based on national cardiac arrest data (NCAA). The teaching session equipped them with statistical data and communication strategies which they found relevant and helpful to their training. Moreover, long term impact and behavioural change was noted as the majority of foundation doctors were using the statistics provided to them in their clinical practice three months post session to help them explain with confidence why CPR was not appropriate. References [1].UKFPO. Foundation Programme Syllabus; 2017. Available at: http://www. foundationprogramme.nhs.uk/curriculum/Syllabus; Clinical care; End of Life. [2].Etheridge Z, Gatland E. When and how to discuss “do not resuscitate” decisions with patients. BMJ (Clin Res ed) 2015;350:h2640. [3].National Cardiac Arrest Audit (NCAA) 2015/2016, Resuscitation council UK.
http://dx.doi.org/10.1016/j.resuscitation.2017.08.151
Abstracts / Resuscitation 118S (2017) e43–e90
scientific impact and animal welfare at the same time. Currently it’s limited to animal studies on medical technology. http://dx.doi.org/10.1016/j.resuscitation.2017.08.147 AP047 A shocking picture: Automated external defibrillators are poorly signposted in the community David B. Sidebottom 1,∗ , Ryan Potter 1 , Gillian Hodgett 2 , Charles D. Deakin 3 1
Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK 2 South Central Ambulance Service NHS Trust, Bicester, UK 3 NIHR Southampton Respiratory Biomedical Research Unit, University of Southampton, Southampton, UK Background: Early defibrillation as part of basic life support is a critical link in the chain of survival. Public access defibrillation (PAD) programmes utilising automated external defibrillators (AEDs) decrease the time to first shock, with demonstrable mortality benefits for out-of-hospital cardiac arrest (OHCA). Effective use of PADs requires rapid location of the device, facilitated by adequate signage. We aimed to assess the proportion of registered PADs with external signage visible within a 300 m radius (considered by the Resuscitation Council (UK) as the useable range). Method: We surveyed rural and urban community PADs available for public use on the ‘Save a Life’ AED locator mobile application near Southampton, UK. External signage effectiveness was evaluated according to appropriateness of design, visibility, and any visual obstruction. We also measured the distance from the furthest sign to the device using a laser rangefinder, and collected location and device affiliation descriptives. Results: Researchers evaluated 103 PADs during May 2017. All devices were included in the final analysis. 68.0% of devices had no external signage located. Of devices with external signage, 60.6% used 2008 ILCOR signage and 30.3% used 2006 Resuscitation Council (UK) signage. The mean distance from the furthest visible sign to the device was 1.9m. Mean signage size was 16.7 cm by 15.5 cm. No GP surgery used external signage or an external PAD 24/7 access box. Conclusions: Current signage of PADs is very poor and will limit their effectiveness by impeding awareness of nearby devices, and hindering rapid location of a device when needed. Benefits of signage in raising public awareness of PADs are also lost. Recommendations are required to ensure that every PAD has visible signage within its operational radius.
Fig. 1. Time of CPR after the administration of fibrinolytics in patients without ROSC.
(OHCA). To determine the conditions of its use, to check compliance with ERC Guidelines and to compare results with those from our previous series. Materials and methods: Descriptive, retrospective, observational study of the OHCA assisted by SAMU-Asturias. Study period: July 1st 2013 to December 31st 2016. Inclusion criteria: Patients that received fibrinolytics during ACLS provided by EMS. Patients with suspected acute pulmonary embolism (APE) OHCA, with or without use of fibrinolytics. Data collected from clinical reports and Utstein based OHCA registry. Data analysed with SPSS Statistics 21 software. Results: Out of 2251 PC registered, 31 (1.37%) received fibrinolytics during ACLS: 16 before 2016, and 15 in 2016. The increase is statistically significant (p = 0.021). 23 patients (74.2%) male: average age, 56.5 years (s = 15.3). Table 1 shows the epidemiological variables studied related to these events. 9 (29.0%) survived events, all in 2016: 6 with suspected cardiac etiology, 3 with suspected APE. Average time of return of spontaneous circulation (ROSC) after administration of fibrinolytics: 20.2 min (s = 16.7) [2–53]. Discharge with CPC 1–2 in 3 cases (9.7%), witnessed CA of cardiac etiology with initial shockable rhythm. Fig. 1 shows CPR times after fibrinolysis in patients without ROSC. Table 2 shows the management of suspected APE.
Table 1 OHCA with use of fibrinolytics epidemiologic variables.
http://dx.doi.org/10.1016/j.resuscitation.2017.08.148 AP048 Fibrinolysis: A needed check up Maria Eugenia Diaz Fernandez, Jose Manuel Cuervo Menendez, Juan Jose Garcia Garcia, Maria Garcia Alonso, Marta Martinez del Valle, César L. Roza-Alonso ∗ SAMU-Asturias, Asturias, Spain Purpose of the study: Utstein based OHCA registry shows an increase, during 2016, of the use of fibrinolytics in cardiac arrests
Table 2 Management of OHCA with suspected APE.
Abstracts / Resuscitation 118S (2017) e43–e90
Conclusions: -
There is a higher use of fibrinolytics in OHCA in 2016. Higher use does not reflect in survival rate. Most of fibrinolytics were used in non suspected APE OHCA. Recommended CPR time after administration of fibrinolytics is not accomplished. - There seems to be a contagion effect on treatment in OHCA due to suspected APE and OHCA of cardiac etiology, which according to literature is contraindicated. http://dx.doi.org/10.1016/j.resuscitation.2017.08.149 AP049 How do nurses interpret low voltage ventricular fibrillation during simulated cardiopulmonary resuscitation? Are they as good as we think? Lukasz Czyzewski 1,∗ , Lukasz Szarpak 1 , Jerzy Ladny 2 , Jacek Smereka 3 1
Medical University of Warsaw, Warsaw, Poland Medical University Bialystok, Bialystok, Poland 3 Wroclaw Medical University, Wroclaw, Poland 2
Purpose of the study: The ability to interpret electrocardiographic (ECG) rhythms associated with cardiac arrest in a necessary skill, having a direct impact on the quality of advanced life support (ALS) and the patient survival. The aim of the study was to evaluate the ability to recognize low voltage ventricular fibrillation (LvVF) during simulated cardiopulmonary resuscitation (CPR) performed by nurses. Materials and methods: The study, conducted during ALS workshops, involved 42 nurses working in emergency units or anesthesiology and intensive care units. The nurses performed CPR according to the European Resuscitation Council (ERC) guidelines. During the exercise resuscitation, the team consisted of 2 independent instructors and a nurse acting as team leader. The resuscitation team leader was required to interpret the ECG rhythm and administer the appropriate treatment, including drugs and defibrillation. CPR was applied in a MegaCode Kelly manikin (Laerdal, Stavanger, Norway) with the use of a LIFEPACK 15 manual defibrillator (Physio-Control, the Netherlands). During the 10-min scenario, the ECG rhythms were randomly altered, always including the occurrence of LvVF. Results: The median age of participants was 31 (interquartile range, IQR, 26–44) years, and work experience – 6.5 (IQR; 3–8) years. LvVF was recognized only by 17 nurses (40.5%) In the case of LvVF occurrence, only 33.3% participants increased the ECG amplitude and changed the ECG lead. Among the 16 nurses who recognized LvVF, 15 performed defibrillation, and 2 followed the guidelines for non-shockable rhythms. Conclusions: There is a need to introduce compulsory periodic training for the nursing staff to focus on recognizing rhythms associated with cardiac arrest and implementing procedures based on the 2015 ERC guidelines. http://dx.doi.org/10.1016/j.resuscitation.2017.08.150
e61
AP050 A statistics based teaching intervention to aid foundation doctors when discussing cardiopulmonary resuscitation (CPR) Mayurun Ramadas ∗ , Lubna Ghani, Ben Clark Imperial College School of Medicine, London, UK Purpose: The United Kingdom Foundation Programme (UKFPO) syllabus states a foundation doctor should be able to discuss why CPR is not appropriate [1]). Discussions and questions pertaining to CPR success rate and complications are an often challenging yet a vital part of medical practice [2]. We implemented a teaching intervention that aimed to equip Foundation doctors’ with key National Cardiac Arrest Audit (NCAA) statistical data [3] to help them field such questions. Materials and method: Prior to the teaching a survey was given to foundation doctors (n = 36). Subsequently, a mandatory teaching session was delivered for them. The session identified key cardiac arrest demographics, success rate and complications based on the latest resus council NCAA data and how to express this appropriately. This was followed up by an immediate evaluation survey. A three month follow up survey evaluated whether the workshop resulted in self-rated behaviour change and long term impact. It was emphasised in the session that a statistics approach to CPR discussions was optional and one out of a variety of approaches that could be used if doctors felt confident discussing the statistics involved. Results: Qualitative pre-session data clearly highlighted that foundation doctors face challenging questions and statements from patients and family about ‘CPR prognosis/statistics’. Immediate post-session evaluation revealed foundation doctors found the teaching to be relevant, interactive and helpful to their training using a 5-point Likert scale (mean = 4.6). The three month postsession questionnaire showed that 69% of foundation doctors used the NCAA statistics provided in the workshop in their clinical practice when discussing why CPR was not appropriate. The same proportion felt the workshop had increased their confidence when discussing why CPR is not appropriate. Conclusion: Our results show many foundation doctors are fielding challenging questions and statements from patients and relatives about CPR. A useful approach to answering such questions is by using evidence based statistical data based on national cardiac arrest data (NCAA). The teaching session equipped them with statistical data and communication strategies which they found relevant and helpful to their training. Moreover, long term impact and behavioural change was noted as the majority of foundation doctors were using the statistics provided to them in their clinical practice three months post session to help them explain with confidence why CPR was not appropriate. References [1].UKFPO. Foundation Programme Syllabus; 2017. Available at: http://www. foundationprogramme.nhs.uk/curriculum/Syllabus; Clinical care; End of Life. [2].Etheridge Z, Gatland E. When and how to discuss “do not resuscitate” decisions with patients. BMJ (Clin Res ed) 2015;350:h2640. [3].National Cardiac Arrest Audit (NCAA) 2015/2016, Resuscitation council UK.
http://dx.doi.org/10.1016/j.resuscitation.2017.08.151