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Severe underuse of dispatch life support in traumatic cardiac arrest
Abstracts / Resuscitation 118S (2017) e5–e42
AS079 Lifesavers in the kindergarten – Long term effects of a 3-day first aid programme for 5–6 years old children Balint Banfai 1,∗ , Henrietta Csonka 2 , Attila Pandur 1 , Emese Pek 1 , Jozsef Betlehem 1 1 University of Pécs Faculty of Health Sciences Institute of Emergency Care and Health Pedagogy, Pécs, Hungary 2 University of Pécs, Department of Emergency Medicine, Pécs, Hungary
Purpose of the study: In life-threatening situations quick first aid can save lives. Sometimes children witness accidents first. Our aim was to investigate the effectiveness of a 3-day first aid programme for kindergarten children. Material and methods: 58 kindergarten children at the age of 5–6 years were involved in the study, 32 girls and 26 boys. Training consisted of three sessions with theoretical and practical skills about first aid. The most important and urgent situations were involved in our study: basic life support (BLS), using an AED, handling an unconscious patient, managing bleeding and calling the ambulance. Data collection was made with a self-made questionnaire and observation. The children were tested before, immediately after, four months after and 15 months after training. For analysis descriptive statistics, Chi-square- test, t-test, ANOVA and correlation analysis were used. Results were considered significant in case of p < 0.05. Results: In the pre-test none of the children knew the correct emergency phone number. Immediately after training 75.9%, four months later 55.2%, 15 months later 36.2% of the children knew it. Before training more than half, after training (in all measurements) more than three-quarter of the children could decide, is calling the ambulance service necessary or not. Before training none of the children, immediately after and four months after training two-third and one-third, 15 months later one tenth of the children knew the correct assessment of breathing. Knowledge retention after 15 months was similar for boys and girls in BLS, bleeding and unconsciousness. Conclusions: 5–6 years old children are able to perform basic life saving skills. Knowledge retention is acceptable in skills four months after training, but low 15 months later, so regular repetition is required. http://dx.doi.org/10.1016/j.resuscitation.2017.08.087 AS080 Analysis of the implantation of an immediate life support program Jose Gomez Tarradas ∗ , Marta Magaldi, Jaime Fontanals, Angel Caballero, Mireia Chanza, Antonio Lopez Hernandez Hospital Clínico de Barcelona, Barcelona, Spain Purpose of the study: The immediate life support (ILS) courses aim training the ABCDE approach as a method that allows the early recognition of the critical patient (CP), the appropriate activation of the emergency team and the appropriate immediate treatment. In 2011, training in ILS was started in our hospital. The objective of our study is to verify the effect of the implantation of the ILS program in CP during his stay in conventional wards.
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Material and methods: This is a retrospective study in which all the calls to the intrahospital outreach team during the period 1992-2015 are analysed. Calls are divided into two groups: G1: 1992–2010 and G2: 2011–2015. We compare: annual incidence of calls, total incidence of cardio-pulmonary arrests (CPA), total incidence of CP attendance in the ward, incidence of calls not indicated, initial survival and survival at hospital discharge. Results were analysed with SPSS (® ) v. 20 predictive analytics software. Results: During the period 1992–2015 the number of calls was 2656. G1 = 2231 (117 calls/year). G2 = 425 (106 calls/year). Of all calls, the incidence of CPA was G1 = 51.9% and G2 = 30.4%; The incidence of CP without CPA was G1 = 43.3% and G2 = 67.7%; The incidence of call not indicated G1 = 4.8% and G2 = 1.9%. The initial survival was in G1 = 71.1% and in G2 = 86.5%; Survival at hospital discharge was G1 = 39.4% and G2 = 56.2% Conclusions: The establishment of an ILS program has not modified the number of calls to the outreach team, although its shown a reduction in the incidence of in-hospital CPR with an increase in CP calls (pre-CPR). All this involves an increase in initial and postdischarge survival after the introduction of this program. To be able to affirm these conclusions, works including longer period of time are required. http://dx.doi.org/10.1016/j.resuscitation.2017.08.088 AS081 Severe underuse of dispatch life support in traumatic cardiac arrest Hartwig Marung 1 , Barbara Jakisch 1 , Jan-Thorsten Gräsner 1 , Matthias Fischer 2 , Andreas Bohn 3 , Tanja Jantzen 4 , Sigrid Brenner 5 , Stephan Seewald 1 , Jan Wnent 1,∗ 1
Schleswig-Holstein University Hospital, Institute of Emergency Medicine, Kiel, Germany 2 Department of Anaesthesiology, Alb-Fils-Kliniken, Goeppingen, Germany 3 Emergency Medical Director, Muenster Fire Department, Muenster, Germany 4 German Red Cross Interhospital Transfer, Mecklenburg-Vorpommern, Germany 5 Dresden University Hospital, Dresden, Germany Purpose of the study: Dispatcher Assisted CPR or dispatch life support (DLS) is strongly recommended by 2010 and even more so 2015 ERC Guidelines [1,2]. Its implementation is heterogeneous all over Europe [3]. To this date, no studies exist analyzing the effects of DLS in the specific event of traumatic cardiac arrest. Materials and methods: Retrospective data analysis from the German Resuscitation Registry (GRR) covering the period from January 1, 2011 to December 31, 2016. Results: 56,002 cases of out-of-hospital resuscitation were available for examination. Overall use of DLS in German dispatch agencies increased from 2.3% at the beginning to 16.5% at the end of the study period (mean 9.0%). Traumatic OHCA accounted for 1,471 (2.6%) of all cases. Use of DLS after trauma was 0.9% in 2011 and 2.1% (17/353) in 2016 (mean 1.7%). Overall ROSC after dispatch assisted CPR was 43.4% (n = 2.583). ROSC after traumatic OHCA was 27.4 (17/62) with and 27.8% (410/1471) without DLS, respectively. Conclusions: Dispatch Life Support has not been established comprehensively in Germany during the last six years. As shown here for the first time, this holds even more true for traumatic OHCA. ROSC rates after traumatic CPR show no difference between DLS- and none DLS-groups. The rate of bystander assistance in
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Abstracts / Resuscitation 118S (2017) e5–e42
traumatic arrest is remarkably low considering its high priority in current ERC guidelines. These initial findings may result from complex dispatch requirements in trauma cases, adverse patients’ conditions or presumed poor outcome and deserve further investigation. References [1].Resuscitation 2010:1219–76. [2].Resuscitation 2015:81–99. [3].Resuscitation 2016:188–95.
http://dx.doi.org/10.1016/j.resuscitation.2017.08.089 AS082 Do novice physicians know how to act in cases of torsade de pointes during simulated cardiopulmonary resuscitation? Preliminary data Lukasz Szarpak 1,∗ , Marcin Madziala 1 , Zenon Truszewski 1 , Jacek Smereka 2 , Marek Dabrowski 3 1
Department of Emergency Medicine, Medical University of Warsaw, Warsaw, Poland 2 Department of Emergency Medical Service, Wroclaw Medical University, Wroclaw, Poland 3 Department of Rescue and Disaster Medicine, Poznan University of Medical Sciences, Poznan, Poland Purpose: The ability to recognize torsade de pointes (TDP) is very important in clinical settings. The diagnosis requires special treatment in order to reverse the rhythm abnormalities. The aim of the study was to determine novice physicians’ skills to interpret TDP and their ability to implement adequate management in accordance with the 2015 European Resuscitation Council guidelines. Methods: The study participants were randomly selected from novice physicians taking part in the obligatory training on emergency medicine organized by the Department of Emergency Medicine at the Medical University of Warsaw, Poland. After the presentation of the study subjective, 45 novice physicians voluntary participated in this trial. Prior to the course, the participants were asked to perform a 10-min advanced life support (ALS) scenario. Cardiopulmonary resuscitation was applied in a MegaCode Kelly manikin (Laerdal, Stavanger, Norway) and the electrocardiographic (ECG) rhythm was monitored with the use of a LIFEPACK 15 manual defibrillator (Physio-Control, the Netherlands). TDP was programmed with the frequency of 150 min−1 . The study participants had no contact with one another during the trial, and thus communication regarding the cardiac arrest scenario was eliminated. Results: The total of 38 participants (84.4%) interpreted the rhythm as TDP. The other physicians recognized the rhythm as ventricular fibrillation. Among those who established a correct TDP diagnosis, 44.7% ordered immediate intravascular access and the administration of 2 g of magnesium sulfate; 13.1% ordered magnesium sulfate administration after the 3rd unsuccessful defibrillation attempt, while 42.2% did not order magnesium sulfate administration during the entire 10-min ALS scenario. Conclusions: The ECG interpretation and management in TDP during simulated cardiopulmonary resuscitation is poor. It is necessary to evaluate training in the interpretation and management of TDP. http://dx.doi.org/10.1016/j.resuscitation.2017.08.090
AS083 Simulation platform facilitates systematic performance assessment of algorithm for pulse detection during cardiopulmonary resuscitation Ralph Wijshoff ∗ , Jakob Van de Laar, Jens Muehlsteff Philips Research, Eindhoven, The Netherlands Introduction: The performance of algorithms for pulse detection during cardiopulmonary resuscitation (CPR) is typically assessed on clinical data. Acquired clinical data often does not cover all ranges of, e.g., spontaneous pulse rates (PRs) and signal-to-noise ratios (SNRs), and its annotation is challenging. This complicates systematic assessment of algorithm performance. To complement clinical data and facilitate systematic performance assessment, we developed a simulation platform which can generate signals covering the parameter range of interest and provides annotations by design. Via the platform we assessed an algorithm that detects pulse by quantifying the periodicity of a photoplethysmography (PPG) signal, previously evaluated on pre-clinical data [1]. Methods: We simulated PPG signals for PRs between 30 and 300 min−1 and added white noise (uniform power-distribution over frequencies) to obtain SNRs between 0.3 and 100. The algorithm indicated pulse presence on a continuous scale from 0 to 1 by evaluating 5 s windows. Algorithm performance was evaluated for all combinations of PRs and SNRs. We investigated SNR requirements by evaluating the mean algorithm output for windows fully containing pulse signal. We investigated the detection delay by determining the duration of pulse signal required in the 5 s window to have the algorithm output exceed 0.5. Results: Fig. 1a shows the mean algorithm output and indicates a mean output larger than 0.9 for SNRs over 5 and PRs over 60 min−1 . Fig. 1b shows the detection delay and indicates a PR dependency, revealing that detection requires at least two pulse periods.
Fig. 1. Systematic performance assessment. (a) Algorithm output. (b) Detection delay.
Conclusions: The simulation platform can complement clinical data by facilitating systematic assessment of algorithm performance. The platform can provide information about SNR requirements and expected detection delays, and can show PR dependencies. Reference [1].Wijshoff R, et al. Poster 2016;318. ReSS.
http://dx.doi.org/10.1016/j.resuscitation.2017.08.091
AS079 Lifesavers in the kindergarten – Long term effects of a 3-day first aid programme for 5–6 years old children Balint Banfai 1,∗ , Henrietta Csonka 2 , Attila Pandur 1 , Emese Pek 1 , Jozsef Betlehem 1 1 University of Pécs Faculty of Health Sciences Institute of Emergency Care and Health Pedagogy, Pécs, Hungary 2 University of Pécs, Department of Emergency Medicine, Pécs, Hungary
Purpose of the study: In life-threatening situations quick first aid can save lives. Sometimes children witness accidents first. Our aim was to investigate the effectiveness of a 3-day first aid programme for kindergarten children. Material and methods: 58 kindergarten children at the age of 5–6 years were involved in the study, 32 girls and 26 boys. Training consisted of three sessions with theoretical and practical skills about first aid. The most important and urgent situations were involved in our study: basic life support (BLS), using an AED, handling an unconscious patient, managing bleeding and calling the ambulance. Data collection was made with a self-made questionnaire and observation. The children were tested before, immediately after, four months after and 15 months after training. For analysis descriptive statistics, Chi-square- test, t-test, ANOVA and correlation analysis were used. Results were considered significant in case of p < 0.05. Results: In the pre-test none of the children knew the correct emergency phone number. Immediately after training 75.9%, four months later 55.2%, 15 months later 36.2% of the children knew it. Before training more than half, after training (in all measurements) more than three-quarter of the children could decide, is calling the ambulance service necessary or not. Before training none of the children, immediately after and four months after training two-third and one-third, 15 months later one tenth of the children knew the correct assessment of breathing. Knowledge retention after 15 months was similar for boys and girls in BLS, bleeding and unconsciousness. Conclusions: 5–6 years old children are able to perform basic life saving skills. Knowledge retention is acceptable in skills four months after training, but low 15 months later, so regular repetition is required. http://dx.doi.org/10.1016/j.resuscitation.2017.08.087 AS080 Analysis of the implantation of an immediate life support program Jose Gomez Tarradas ∗ , Marta Magaldi, Jaime Fontanals, Angel Caballero, Mireia Chanza, Antonio Lopez Hernandez Hospital Clínico de Barcelona, Barcelona, Spain Purpose of the study: The immediate life support (ILS) courses aim training the ABCDE approach as a method that allows the early recognition of the critical patient (CP), the appropriate activation of the emergency team and the appropriate immediate treatment. In 2011, training in ILS was started in our hospital. The objective of our study is to verify the effect of the implantation of the ILS program in CP during his stay in conventional wards.
e33
Material and methods: This is a retrospective study in which all the calls to the intrahospital outreach team during the period 1992-2015 are analysed. Calls are divided into two groups: G1: 1992–2010 and G2: 2011–2015. We compare: annual incidence of calls, total incidence of cardio-pulmonary arrests (CPA), total incidence of CP attendance in the ward, incidence of calls not indicated, initial survival and survival at hospital discharge. Results were analysed with SPSS (® ) v. 20 predictive analytics software. Results: During the period 1992–2015 the number of calls was 2656. G1 = 2231 (117 calls/year). G2 = 425 (106 calls/year). Of all calls, the incidence of CPA was G1 = 51.9% and G2 = 30.4%; The incidence of CP without CPA was G1 = 43.3% and G2 = 67.7%; The incidence of call not indicated G1 = 4.8% and G2 = 1.9%. The initial survival was in G1 = 71.1% and in G2 = 86.5%; Survival at hospital discharge was G1 = 39.4% and G2 = 56.2% Conclusions: The establishment of an ILS program has not modified the number of calls to the outreach team, although its shown a reduction in the incidence of in-hospital CPR with an increase in CP calls (pre-CPR). All this involves an increase in initial and postdischarge survival after the introduction of this program. To be able to affirm these conclusions, works including longer period of time are required. http://dx.doi.org/10.1016/j.resuscitation.2017.08.088 AS081 Severe underuse of dispatch life support in traumatic cardiac arrest Hartwig Marung 1 , Barbara Jakisch 1 , Jan-Thorsten Gräsner 1 , Matthias Fischer 2 , Andreas Bohn 3 , Tanja Jantzen 4 , Sigrid Brenner 5 , Stephan Seewald 1 , Jan Wnent 1,∗ 1
Schleswig-Holstein University Hospital, Institute of Emergency Medicine, Kiel, Germany 2 Department of Anaesthesiology, Alb-Fils-Kliniken, Goeppingen, Germany 3 Emergency Medical Director, Muenster Fire Department, Muenster, Germany 4 German Red Cross Interhospital Transfer, Mecklenburg-Vorpommern, Germany 5 Dresden University Hospital, Dresden, Germany Purpose of the study: Dispatcher Assisted CPR or dispatch life support (DLS) is strongly recommended by 2010 and even more so 2015 ERC Guidelines [1,2]. Its implementation is heterogeneous all over Europe [3]. To this date, no studies exist analyzing the effects of DLS in the specific event of traumatic cardiac arrest. Materials and methods: Retrospective data analysis from the German Resuscitation Registry (GRR) covering the period from January 1, 2011 to December 31, 2016. Results: 56,002 cases of out-of-hospital resuscitation were available for examination. Overall use of DLS in German dispatch agencies increased from 2.3% at the beginning to 16.5% at the end of the study period (mean 9.0%). Traumatic OHCA accounted for 1,471 (2.6%) of all cases. Use of DLS after trauma was 0.9% in 2011 and 2.1% (17/353) in 2016 (mean 1.7%). Overall ROSC after dispatch assisted CPR was 43.4% (n = 2.583). ROSC after traumatic OHCA was 27.4 (17/62) with and 27.8% (410/1471) without DLS, respectively. Conclusions: Dispatch Life Support has not been established comprehensively in Germany during the last six years. As shown here for the first time, this holds even more true for traumatic OHCA. ROSC rates after traumatic CPR show no difference between DLS- and none DLS-groups. The rate of bystander assistance in
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Abstracts / Resuscitation 118S (2017) e5–e42
traumatic arrest is remarkably low considering its high priority in current ERC guidelines. These initial findings may result from complex dispatch requirements in trauma cases, adverse patients’ conditions or presumed poor outcome and deserve further investigation. References [1].Resuscitation 2010:1219–76. [2].Resuscitation 2015:81–99. [3].Resuscitation 2016:188–95.
http://dx.doi.org/10.1016/j.resuscitation.2017.08.089 AS082 Do novice physicians know how to act in cases of torsade de pointes during simulated cardiopulmonary resuscitation? Preliminary data Lukasz Szarpak 1,∗ , Marcin Madziala 1 , Zenon Truszewski 1 , Jacek Smereka 2 , Marek Dabrowski 3 1
Department of Emergency Medicine, Medical University of Warsaw, Warsaw, Poland 2 Department of Emergency Medical Service, Wroclaw Medical University, Wroclaw, Poland 3 Department of Rescue and Disaster Medicine, Poznan University of Medical Sciences, Poznan, Poland Purpose: The ability to recognize torsade de pointes (TDP) is very important in clinical settings. The diagnosis requires special treatment in order to reverse the rhythm abnormalities. The aim of the study was to determine novice physicians’ skills to interpret TDP and their ability to implement adequate management in accordance with the 2015 European Resuscitation Council guidelines. Methods: The study participants were randomly selected from novice physicians taking part in the obligatory training on emergency medicine organized by the Department of Emergency Medicine at the Medical University of Warsaw, Poland. After the presentation of the study subjective, 45 novice physicians voluntary participated in this trial. Prior to the course, the participants were asked to perform a 10-min advanced life support (ALS) scenario. Cardiopulmonary resuscitation was applied in a MegaCode Kelly manikin (Laerdal, Stavanger, Norway) and the electrocardiographic (ECG) rhythm was monitored with the use of a LIFEPACK 15 manual defibrillator (Physio-Control, the Netherlands). TDP was programmed with the frequency of 150 min−1 . The study participants had no contact with one another during the trial, and thus communication regarding the cardiac arrest scenario was eliminated. Results: The total of 38 participants (84.4%) interpreted the rhythm as TDP. The other physicians recognized the rhythm as ventricular fibrillation. Among those who established a correct TDP diagnosis, 44.7% ordered immediate intravascular access and the administration of 2 g of magnesium sulfate; 13.1% ordered magnesium sulfate administration after the 3rd unsuccessful defibrillation attempt, while 42.2% did not order magnesium sulfate administration during the entire 10-min ALS scenario. Conclusions: The ECG interpretation and management in TDP during simulated cardiopulmonary resuscitation is poor. It is necessary to evaluate training in the interpretation and management of TDP. http://dx.doi.org/10.1016/j.resuscitation.2017.08.090
AS083 Simulation platform facilitates systematic performance assessment of algorithm for pulse detection during cardiopulmonary resuscitation Ralph Wijshoff ∗ , Jakob Van de Laar, Jens Muehlsteff Philips Research, Eindhoven, The Netherlands Introduction: The performance of algorithms for pulse detection during cardiopulmonary resuscitation (CPR) is typically assessed on clinical data. Acquired clinical data often does not cover all ranges of, e.g., spontaneous pulse rates (PRs) and signal-to-noise ratios (SNRs), and its annotation is challenging. This complicates systematic assessment of algorithm performance. To complement clinical data and facilitate systematic performance assessment, we developed a simulation platform which can generate signals covering the parameter range of interest and provides annotations by design. Via the platform we assessed an algorithm that detects pulse by quantifying the periodicity of a photoplethysmography (PPG) signal, previously evaluated on pre-clinical data [1]. Methods: We simulated PPG signals for PRs between 30 and 300 min−1 and added white noise (uniform power-distribution over frequencies) to obtain SNRs between 0.3 and 100. The algorithm indicated pulse presence on a continuous scale from 0 to 1 by evaluating 5 s windows. Algorithm performance was evaluated for all combinations of PRs and SNRs. We investigated SNR requirements by evaluating the mean algorithm output for windows fully containing pulse signal. We investigated the detection delay by determining the duration of pulse signal required in the 5 s window to have the algorithm output exceed 0.5. Results: Fig. 1a shows the mean algorithm output and indicates a mean output larger than 0.9 for SNRs over 5 and PRs over 60 min−1 . Fig. 1b shows the detection delay and indicates a PR dependency, revealing that detection requires at least two pulse periods.
Fig. 1. Systematic performance assessment. (a) Algorithm output. (b) Detection delay.
Conclusions: The simulation platform can complement clinical data by facilitating systematic assessment of algorithm performance. The platform can provide information about SNR requirements and expected detection delays, and can show PR dependencies. Reference [1].Wijshoff R, et al. Poster 2016;318. ReSS.
http://dx.doi.org/10.1016/j.resuscitation.2017.08.091