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Thermistor probe for measurement of tympanic temperature: Influence of ambient temperature
Poster Presentations / Resuscitation 84S (2013) S8–S98
AP210
AP211
Thermistor probe for measurement of tympanic temperature: Influence of ambient temperature
Care related in hospital cardiac arrest (CR-IHCA)—Incidence and outcome—A single center report
Giacomo Strapazzon 1,∗ , Emily Procter 1 , Giovanni Avancini 1 , Norbert Überbacher 2 , Gabriel Putzer 3 , Georg Hofer 4 , Bernhard Rainer 5 , Tomas Dal Cappello 1 , Xavier Ledoux 6 , Hermann Brugger 1 1
EURAC Institute of Mountain Emergency Medicine, Bolzano, Italy 2 Department of Otolaryngology, Hospital of Bressanone, Bressanone, Italy 3 Department of Anesthesiology and Critical Care Medicine, Innsbruck Medical University, Innsbruck, Italy 4 Department of Anesthesiology, Hospital of Silandro, Silandro, Italy 5 Department of Anesthesiology, Casa di Cura Santa Maria, Bolzano, Italy 6 Department of Anesthesiology, Centre Hospitalier de Saint Martin, Saint Martin, Martinique
Purpose of the study: Temperature of the tympanic membrane correlates well with brain and oesophageal temperature independent from environmental temperature. However, because customary thermistor or thermocouple sensors are designed for placement in the ear canal distant from the tympanic membrane, the influence of ambient temperature on recorded measurements in the field cannot be excluded. The purpose of this study was to determine the influence of low ambient temperature on measurements in the ear canal using a customary thermistor sensor. Materials and methods: Using a randomized cross-over design oesphageal (Toe ) and epitympanic (Tty ) temperatures were consecutively measured for 10 min each in 32 healthy and normothermic volunteers (mean 38.3 ± 11.5 yr) using a customary thermistor tympanic probe (M1024233, GE Healthcare Finland Oy) at normal (23.2 ± 0.4 ◦ C) and low ambient temperature (−18.7 ± 1.0 ◦ C). In ten of the participants, epitympanic temperature was recorded with an ear protector over the ear for insulation (Tty-p ). Results: The overall concordance correlation coefficient between Toe and Tty was <0.01 (95% confidence interval −0.01 to 0.01) for all measurements without the ear protector. Tty decreased significantly from 32.5 ± 1.6 ◦ C to 28.5 ± 2.0 ◦ C (Tty0–10 = 4.0 ◦ C), whereas Toe and Tty-p remained stable over the whole test duration (Toe0–10 and Tty-p0–10 < 0.5 ◦ C). Accordingly, with insulation of the ear the decrement of Tty-p was significantly lower than Tty (p < 0.05). Conclusions: In healthy, normothermic subjects Tty decreased significantly during exposure to low ambient temperature using a customary thermistor tympanic probe. The influence of cold environmental conditions can be attenuated with additional insulation of the ear. http://dx.doi.org/10.1016/j.resuscitation.2013.08.236
S93
Philippe Burtin ∗ , Charlotte Vannucci, Anais Marie, Jean Yves Bigeon, Constantin Halchini, Anne Granier, Patrick Courant Clinique du Millénaire, Montpellier, France Introduction: Due to the considerable work of analysis of the National Registry of Cardiopulmonary resuscitation, knowledge about incidence and prognosis of In Hospital Cardiac Arrest (IHCA) has evolved recently.1–3 Institution resources devoted to reduce IHCA mortality are increasing worldwide. Most strategies focus on either emergency team performance or pre-IHCA deterioration detection. While differences in outcome between care units and in-hospital location of IHCA is almost universally recognized,4 incidence and prognosis of CR-IHCA remains an undisclosed issue. We analyzed our internal IHCA database to determine the incidence and outcome of CR-IHCA. Patients and methods: Retrospective analysis was performed on all IHCAs prospectively recorded from 01/01/2009 to 12/31/2012. Dedicated IHCA follow-up form allows recording of: demographic data, location of occurrence, time to rescue unit call, initial cardiac rhythm, first treatment attempt, time to and duration of chest compression, number of electric shocks, type of IV treatment, IGS II score at ICU admission, duration of ICU stay, immediate and hospital discharge survival. CR-IHCA is defined as IHCA occurring during current medical or surgical care or immediately after percutaneous or IV line injection. Comparisons between non-carerelated IHCA (NCR-IHCA) and CR-IHCA were made by Khi 2 and Fisher t tests. Results: 229 IHCA were analyzed. 35 were CR-IHCA (15.3%) and 194 were NCR-IHCA (84.7%). All CR-IHCA were witnessed and 94.3% of patients were monitored at occurrence. Cases occurred for 37% during percutaneous coronary intervention, 23% during anesthesia/surgery and 17% were caused by severe anaphylaxis. CR-IHCA had significantly lower rate of comorbidities than NCR-IHCA (COPD 8.5% vs 17.6%; CRF 8.5% vs 22%; Cancer 8.5% vs 16%; diabetes 25.7% vs 83.5% (p < 0.05)), except for ischemic and non-ischemic cardiomyopathy (74.3% vs 70% and 25.7% vs 34.5% (NS)). CR-IHCAs had significantly lower time to first response (0.5 vs 1.38 min), duration of RCP (12 vs 17.2 min), IGS II score (46.3 vs 56) and duration of mechanical ventilation (2 vs 3.5 days) (p < 0.05); ICU stay was not different. Incidence of VT/VF as initial rhythm during CR-IHCA was significantly higher than in NCR-IHCA (60% vs 38.7%, p < 0.05). Outcome was better in CR-IHCA (immediate survival: 77.1% vs 60.8% (NS); hospital discharge survival: 68.6% vs 38% (p < 0.05). Discussion: This is the first report addressing the incidence and outcome of care-related IHCAs. Incidence appears high (1 IHCA out of 6 or 7 cases). As CR-IHCA has never been described, the incidence can only be approached by re-analysis of previous reports. Incidence could vary from 16.8%4 to 23.7%5 . Actual incidence should be confirmed by larger studies. CR-IHCA is a subgroup of patients with considerably better outcome than NCR-IHCA. In our cohort, CR-IHCA have a significantly better prognosis due to the shorter time to chest compression, the higher ratio of VT/VF as initial cardiac rhythm, and the lower incidence of significant comorbidities. The characteristics of CR-IHCA warrant implementation of specific intervention procedures, focused on staff members capabilities, in order to further increase survival in these patients.
AP210
AP211
Thermistor probe for measurement of tympanic temperature: Influence of ambient temperature
Care related in hospital cardiac arrest (CR-IHCA)—Incidence and outcome—A single center report
Giacomo Strapazzon 1,∗ , Emily Procter 1 , Giovanni Avancini 1 , Norbert Überbacher 2 , Gabriel Putzer 3 , Georg Hofer 4 , Bernhard Rainer 5 , Tomas Dal Cappello 1 , Xavier Ledoux 6 , Hermann Brugger 1 1
EURAC Institute of Mountain Emergency Medicine, Bolzano, Italy 2 Department of Otolaryngology, Hospital of Bressanone, Bressanone, Italy 3 Department of Anesthesiology and Critical Care Medicine, Innsbruck Medical University, Innsbruck, Italy 4 Department of Anesthesiology, Hospital of Silandro, Silandro, Italy 5 Department of Anesthesiology, Casa di Cura Santa Maria, Bolzano, Italy 6 Department of Anesthesiology, Centre Hospitalier de Saint Martin, Saint Martin, Martinique
Purpose of the study: Temperature of the tympanic membrane correlates well with brain and oesophageal temperature independent from environmental temperature. However, because customary thermistor or thermocouple sensors are designed for placement in the ear canal distant from the tympanic membrane, the influence of ambient temperature on recorded measurements in the field cannot be excluded. The purpose of this study was to determine the influence of low ambient temperature on measurements in the ear canal using a customary thermistor sensor. Materials and methods: Using a randomized cross-over design oesphageal (Toe ) and epitympanic (Tty ) temperatures were consecutively measured for 10 min each in 32 healthy and normothermic volunteers (mean 38.3 ± 11.5 yr) using a customary thermistor tympanic probe (M1024233, GE Healthcare Finland Oy) at normal (23.2 ± 0.4 ◦ C) and low ambient temperature (−18.7 ± 1.0 ◦ C). In ten of the participants, epitympanic temperature was recorded with an ear protector over the ear for insulation (Tty-p ). Results: The overall concordance correlation coefficient between Toe and Tty was <0.01 (95% confidence interval −0.01 to 0.01) for all measurements without the ear protector. Tty decreased significantly from 32.5 ± 1.6 ◦ C to 28.5 ± 2.0 ◦ C (Tty0–10 = 4.0 ◦ C), whereas Toe and Tty-p remained stable over the whole test duration (Toe0–10 and Tty-p0–10 < 0.5 ◦ C). Accordingly, with insulation of the ear the decrement of Tty-p was significantly lower than Tty (p < 0.05). Conclusions: In healthy, normothermic subjects Tty decreased significantly during exposure to low ambient temperature using a customary thermistor tympanic probe. The influence of cold environmental conditions can be attenuated with additional insulation of the ear. http://dx.doi.org/10.1016/j.resuscitation.2013.08.236
S93
Philippe Burtin ∗ , Charlotte Vannucci, Anais Marie, Jean Yves Bigeon, Constantin Halchini, Anne Granier, Patrick Courant Clinique du Millénaire, Montpellier, France Introduction: Due to the considerable work of analysis of the National Registry of Cardiopulmonary resuscitation, knowledge about incidence and prognosis of In Hospital Cardiac Arrest (IHCA) has evolved recently.1–3 Institution resources devoted to reduce IHCA mortality are increasing worldwide. Most strategies focus on either emergency team performance or pre-IHCA deterioration detection. While differences in outcome between care units and in-hospital location of IHCA is almost universally recognized,4 incidence and prognosis of CR-IHCA remains an undisclosed issue. We analyzed our internal IHCA database to determine the incidence and outcome of CR-IHCA. Patients and methods: Retrospective analysis was performed on all IHCAs prospectively recorded from 01/01/2009 to 12/31/2012. Dedicated IHCA follow-up form allows recording of: demographic data, location of occurrence, time to rescue unit call, initial cardiac rhythm, first treatment attempt, time to and duration of chest compression, number of electric shocks, type of IV treatment, IGS II score at ICU admission, duration of ICU stay, immediate and hospital discharge survival. CR-IHCA is defined as IHCA occurring during current medical or surgical care or immediately after percutaneous or IV line injection. Comparisons between non-carerelated IHCA (NCR-IHCA) and CR-IHCA were made by Khi 2 and Fisher t tests. Results: 229 IHCA were analyzed. 35 were CR-IHCA (15.3%) and 194 were NCR-IHCA (84.7%). All CR-IHCA were witnessed and 94.3% of patients were monitored at occurrence. Cases occurred for 37% during percutaneous coronary intervention, 23% during anesthesia/surgery and 17% were caused by severe anaphylaxis. CR-IHCA had significantly lower rate of comorbidities than NCR-IHCA (COPD 8.5% vs 17.6%; CRF 8.5% vs 22%; Cancer 8.5% vs 16%; diabetes 25.7% vs 83.5% (p < 0.05)), except for ischemic and non-ischemic cardiomyopathy (74.3% vs 70% and 25.7% vs 34.5% (NS)). CR-IHCAs had significantly lower time to first response (0.5 vs 1.38 min), duration of RCP (12 vs 17.2 min), IGS II score (46.3 vs 56) and duration of mechanical ventilation (2 vs 3.5 days) (p < 0.05); ICU stay was not different. Incidence of VT/VF as initial rhythm during CR-IHCA was significantly higher than in NCR-IHCA (60% vs 38.7%, p < 0.05). Outcome was better in CR-IHCA (immediate survival: 77.1% vs 60.8% (NS); hospital discharge survival: 68.6% vs 38% (p < 0.05). Discussion: This is the first report addressing the incidence and outcome of care-related IHCAs. Incidence appears high (1 IHCA out of 6 or 7 cases). As CR-IHCA has never been described, the incidence can only be approached by re-analysis of previous reports. Incidence could vary from 16.8%4 to 23.7%5 . Actual incidence should be confirmed by larger studies. CR-IHCA is a subgroup of patients with considerably better outcome than NCR-IHCA. In our cohort, CR-IHCA have a significantly better prognosis due to the shorter time to chest compression, the higher ratio of VT/VF as initial cardiac rhythm, and the lower incidence of significant comorbidities. The characteristics of CR-IHCA warrant implementation of specific intervention procedures, focused on staff members capabilities, in order to further increase survival in these patients.