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Resuscitation after smoke inhalation with cyanide intoxication: An experimental approach
Abstracts / Resuscitation 106S (2016) e23–e95
Methods: The study included 12 emergency medical service MDTs comprising 4 members each (n = 48). Six MDTs underwent 9 simulations (experimental group) and 6 underwent 3 simulations (control group) over one year. SC was assessed by ELISA the day prior to simulation (T0), before simulation (T1), after simulation (T2), and after debriefing (T3). Variation in SC level over time was analyzed using repeated measures ANOVA. Mann–Whitney U test was used for comparison between the groups at two times, and Kruskal–Wallis test was used to study the stress response in the different status of teams. A p value <0.05 was considered significant. Results: SC increased from 0.16 ± 0.12 (T0) to 0.26 ± 0.14 (T1). SC level continued to increase to 0.39 ± 0.27 at T2 before decreasing to 0.21 ± 0.12 at T3 (p < 0.0001). SC increase was found in all team members with no status effect. SC level was not blunt after repetition of sessions regardless of the frequency of sessions. Conclusion: SC increased during immersive simulation, and this variation was not blunt after repetition of simulation sessions. No status effect was found among the MDTs’ members. Future study should investigate other markers of stress response and correlate them to team performance. http://dx.doi.org/10.1016/j.resuscitation.2016.07.213 AP166 Results of donor after cardiac death circulation activation: Recuperation of spontaneous circulation analysis Alonso Mateos 2,∗ , Elisabeth Coll 4 , Maria Padilla 4 , Alicia Villar 1 , Fernando Caballero 3 , Diana Monge 3 , Lara Picazo 3 , Alberto Blanco 1,2,3,4 1
Summa 112, Madrid, Spain Summa 112, Universidad Francisco de Vitoria, Madrid, Spain 3 Universidad Francisco de Vitoria, Madrid, Spain 4 Organizacion Nacional de Trasplantes, Madrid, Spain 2
Introduction: The activation procedure of a potential donor after cardiac death begins after recognition of a situation in which an unrecovered PCR patient meets the criteria for donor after cardiac death. There are yet a number of medical and logistical conditions to be fulfilled for the potential donor to become an effective donor. The aim of this study is to describe this procedure and know the number of potential donors who can finally become effective donors. Method: The study collected all activations procedure after cardiac death donor HU 12 October for 5 years (2009–2013). Data collection was performed on a website created for this purpose. Results: During the study period, 641 patients who fulfilled criteria for PCR donor after cardiac death were evaluated. Among them, 310 (48.4%) were not transferred, 65.7% were initiated by the hospital and 34.2% were SEM initiative. The reasons for no transfer were most common medical contraindications (51.3%) and excess time criterion (21.6%). In the nontransported cases, the recuperation of spontaneous circulation was observed in 17 patients (5.5%). A total of 331 patients were transferred to the hospital to donate their organs. Of these, the number of donors was 253 (76.4%); of these donors, the kidneys were extracted in 246 cases and the liver in 90 cases. Among the 77 non-donors, most cases were due to family refusal (27 cases, 8.2% of potential donors) or biological causes (16 cases, 4.8% of potential donors). There were 8 cases of recuperation of spontaneous circulation after the activation procedure initiated by the donor. Seven patients died within 24 h primaries and 1 patient was discharged.
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Conclusion: The activation procedure of a donor after cardiac death has an efficiency of approximately 70%. Two of 3 potential donors donate at least one of their organs. Cases of spontaneous recovery pulse are anecdotal, and most often end with the death of the patient due to brain damage. http://dx.doi.org/10.1016/j.resuscitation.2016.07.214 AP167 Resuscitation after smoke inhalation with cyanide intoxication: An experimental approach Jost Beelitz 1 , Clemens Kill 1,∗ , Nina Vogt 2 , Florian Veit 3 , Hinnerk Wulf 1 , Carsten Feldmann 1 , Wolfgang Dersch 1 1
Department of Emergency Medicine, Department of Anesthesia and Critical Care, Philipps-University, Marburg, Germany 2 Department of Neurosurgery, University of Giessen, Giessen, Germany 3 Institute of Legal Medicine, Department of Forensic Toxicology, Justus-Liebig-University Giessen, Giessen, Germany Purpose of the study: Death by fire is mainly caused by toxic smoke inhalation.1 Resuscitation of fire victims may need specific antidote treatment.2 We designed a realistic animal model to investigate the effects of combined inhalation of the important toxic gases carbon monoxide (CO) and hydrogen cyanide (HCN). The objective of this study was to determine the feasibility and safety of this model and the effects of Advanced Life Support on Return of Spontaneous Circulation (ROSC). Materials and methods: After receiving approval from the local authorities, a smoke inhalation model for pigs (25–35 kg) was designed with a closed ventilation circuit. Oxygen, compressed air, compressed air with CO (1500 parts per million (ppm)) and compressed air with HCN (1000 ppm) cylinders were connected together with valves, allowing a multiple mixture of gas concentrations to be supplied to a Siemens Servo300 ventilator. The expiratory outlet leads to a gas suction unit. Room-air concentrations were monitored with gas detection devices for CO and HCN. Twenty-four pigs (mean weight 31 kg) underwent anaesthesia, intubation and instrumentation. Inhalational intoxication was simulated by controlled ventilation with air with CO (1500 ppm) (5 min), followed by air with CO (750 ppm) and HCN (500 ppm) (5 min) and finally HCN (1000 ppm) until cardiac arrest occurred. Resuscitation was started with 100% oxygen and chest compressions (10 min), followed by ALS according to guidelines. Additionally, 5 g hydroxycobalamin or placebo was given. Results: No increase in room air concentration of CO/HCN could be observed. Cardiac arrest occurred in all pigs in a median time of 38 min (25.5/48.5). ROSC was achieved in 14/24 pigs (7 hydroxycobalamin, 7 placebo), and the median time to ROSC was 14 min (13/15.8). Conclusions: This smoke inhalation model was safe and lead to cardiac arrest in all cases. The time to cardiac arrest in this model was much longer than that reported in literature.3 Additional investigations are needed to re-evaluate the toxic effects of combined CO/HCN inhalation and resuscitation outcome. References
1. Postgrad Med 1987;82:63–8. 2. Eur J. Emerg Med 2013;20:2–9. 3. Fire Technol 1972;8:120–30.
http://dx.doi.org/10.1016/j.resuscitation.2016.07.215
Methods: The study included 12 emergency medical service MDTs comprising 4 members each (n = 48). Six MDTs underwent 9 simulations (experimental group) and 6 underwent 3 simulations (control group) over one year. SC was assessed by ELISA the day prior to simulation (T0), before simulation (T1), after simulation (T2), and after debriefing (T3). Variation in SC level over time was analyzed using repeated measures ANOVA. Mann–Whitney U test was used for comparison between the groups at two times, and Kruskal–Wallis test was used to study the stress response in the different status of teams. A p value <0.05 was considered significant. Results: SC increased from 0.16 ± 0.12 (T0) to 0.26 ± 0.14 (T1). SC level continued to increase to 0.39 ± 0.27 at T2 before decreasing to 0.21 ± 0.12 at T3 (p < 0.0001). SC increase was found in all team members with no status effect. SC level was not blunt after repetition of sessions regardless of the frequency of sessions. Conclusion: SC increased during immersive simulation, and this variation was not blunt after repetition of simulation sessions. No status effect was found among the MDTs’ members. Future study should investigate other markers of stress response and correlate them to team performance. http://dx.doi.org/10.1016/j.resuscitation.2016.07.213 AP166 Results of donor after cardiac death circulation activation: Recuperation of spontaneous circulation analysis Alonso Mateos 2,∗ , Elisabeth Coll 4 , Maria Padilla 4 , Alicia Villar 1 , Fernando Caballero 3 , Diana Monge 3 , Lara Picazo 3 , Alberto Blanco 1,2,3,4 1
Summa 112, Madrid, Spain Summa 112, Universidad Francisco de Vitoria, Madrid, Spain 3 Universidad Francisco de Vitoria, Madrid, Spain 4 Organizacion Nacional de Trasplantes, Madrid, Spain 2
Introduction: The activation procedure of a potential donor after cardiac death begins after recognition of a situation in which an unrecovered PCR patient meets the criteria for donor after cardiac death. There are yet a number of medical and logistical conditions to be fulfilled for the potential donor to become an effective donor. The aim of this study is to describe this procedure and know the number of potential donors who can finally become effective donors. Method: The study collected all activations procedure after cardiac death donor HU 12 October for 5 years (2009–2013). Data collection was performed on a website created for this purpose. Results: During the study period, 641 patients who fulfilled criteria for PCR donor after cardiac death were evaluated. Among them, 310 (48.4%) were not transferred, 65.7% were initiated by the hospital and 34.2% were SEM initiative. The reasons for no transfer were most common medical contraindications (51.3%) and excess time criterion (21.6%). In the nontransported cases, the recuperation of spontaneous circulation was observed in 17 patients (5.5%). A total of 331 patients were transferred to the hospital to donate their organs. Of these, the number of donors was 253 (76.4%); of these donors, the kidneys were extracted in 246 cases and the liver in 90 cases. Among the 77 non-donors, most cases were due to family refusal (27 cases, 8.2% of potential donors) or biological causes (16 cases, 4.8% of potential donors). There were 8 cases of recuperation of spontaneous circulation after the activation procedure initiated by the donor. Seven patients died within 24 h primaries and 1 patient was discharged.
e89
Conclusion: The activation procedure of a donor after cardiac death has an efficiency of approximately 70%. Two of 3 potential donors donate at least one of their organs. Cases of spontaneous recovery pulse are anecdotal, and most often end with the death of the patient due to brain damage. http://dx.doi.org/10.1016/j.resuscitation.2016.07.214 AP167 Resuscitation after smoke inhalation with cyanide intoxication: An experimental approach Jost Beelitz 1 , Clemens Kill 1,∗ , Nina Vogt 2 , Florian Veit 3 , Hinnerk Wulf 1 , Carsten Feldmann 1 , Wolfgang Dersch 1 1
Department of Emergency Medicine, Department of Anesthesia and Critical Care, Philipps-University, Marburg, Germany 2 Department of Neurosurgery, University of Giessen, Giessen, Germany 3 Institute of Legal Medicine, Department of Forensic Toxicology, Justus-Liebig-University Giessen, Giessen, Germany Purpose of the study: Death by fire is mainly caused by toxic smoke inhalation.1 Resuscitation of fire victims may need specific antidote treatment.2 We designed a realistic animal model to investigate the effects of combined inhalation of the important toxic gases carbon monoxide (CO) and hydrogen cyanide (HCN). The objective of this study was to determine the feasibility and safety of this model and the effects of Advanced Life Support on Return of Spontaneous Circulation (ROSC). Materials and methods: After receiving approval from the local authorities, a smoke inhalation model for pigs (25–35 kg) was designed with a closed ventilation circuit. Oxygen, compressed air, compressed air with CO (1500 parts per million (ppm)) and compressed air with HCN (1000 ppm) cylinders were connected together with valves, allowing a multiple mixture of gas concentrations to be supplied to a Siemens Servo300 ventilator. The expiratory outlet leads to a gas suction unit. Room-air concentrations were monitored with gas detection devices for CO and HCN. Twenty-four pigs (mean weight 31 kg) underwent anaesthesia, intubation and instrumentation. Inhalational intoxication was simulated by controlled ventilation with air with CO (1500 ppm) (5 min), followed by air with CO (750 ppm) and HCN (500 ppm) (5 min) and finally HCN (1000 ppm) until cardiac arrest occurred. Resuscitation was started with 100% oxygen and chest compressions (10 min), followed by ALS according to guidelines. Additionally, 5 g hydroxycobalamin or placebo was given. Results: No increase in room air concentration of CO/HCN could be observed. Cardiac arrest occurred in all pigs in a median time of 38 min (25.5/48.5). ROSC was achieved in 14/24 pigs (7 hydroxycobalamin, 7 placebo), and the median time to ROSC was 14 min (13/15.8). Conclusions: This smoke inhalation model was safe and lead to cardiac arrest in all cases. The time to cardiac arrest in this model was much longer than that reported in literature.3 Additional investigations are needed to re-evaluate the toxic effects of combined CO/HCN inhalation and resuscitation outcome. References
1. Postgrad Med 1987;82:63–8. 2. Eur J. Emerg Med 2013;20:2–9. 3. Fire Technol 1972;8:120–30.
http://dx.doi.org/10.1016/j.resuscitation.2016.07.215