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71.
E. John Gallagher MD Gary Lombardi MD Paul Gennis MD Marsha Treiber MA 《Academic emergency medicine》1994,1(5):423-429
Objective: To identify variation in outcome predictor documentation in out-of-hospital cardiac arrest associated with two different methods of data collection: concurrent questioning of personnel following a resuscitation attempt and archival report review.
Methods: All patients ≤ 18 years old who had had out-of-hospital cardiac arrests, verified using the New York City 911 telephone system, between October 1, 1990, and April 1, 1991, were eligible for inclusion. The authors reviewed the first 200 cases of presumed primary cardiac arrest involving a resuscitation attempt from among 3,243 consecutive ambulance call reports for cardiac arrest occurring during the study period. This archival data set was compared with data for the same 200 cases gathered through direct interview of field personnel by trained paramedics. The two data sets had been compiled independently by different individuals, using the same data collection instrument, which conformed to the Utstein template.
Results: Comparison of the data obtained from ambulance records with the data obtained from interviews of prehospital personnel revealed several areas of variance. Of note was a significantly lower proportion of bystander-witnessed ventricular fibrillation (VF) in the data set gathered from written reports (7% vs 18%; 95% CI for the difference 4–18%; p = 0.001).
Conclusion: Differences in methods of collection of out-of-hospital cardiac arrest data are associated with a more than twofold variation in the reported incidences of witnessed cardiac arrests manifesting as VF. Methodology-dependent variation in this important "denominator" may produce substantially different estimates of survival within the same cohort of patients. 相似文献
Methods: All patients ≤ 18 years old who had had out-of-hospital cardiac arrests, verified using the New York City 911 telephone system, between October 1, 1990, and April 1, 1991, were eligible for inclusion. The authors reviewed the first 200 cases of presumed primary cardiac arrest involving a resuscitation attempt from among 3,243 consecutive ambulance call reports for cardiac arrest occurring during the study period. This archival data set was compared with data for the same 200 cases gathered through direct interview of field personnel by trained paramedics. The two data sets had been compiled independently by different individuals, using the same data collection instrument, which conformed to the Utstein template.
Results: Comparison of the data obtained from ambulance records with the data obtained from interviews of prehospital personnel revealed several areas of variance. Of note was a significantly lower proportion of bystander-witnessed ventricular fibrillation (VF) in the data set gathered from written reports (7% vs 18%; 95% CI for the difference 4–18%; p = 0.001).
Conclusion: Differences in methods of collection of out-of-hospital cardiac arrest data are associated with a more than twofold variation in the reported incidences of witnessed cardiac arrests manifesting as VF. Methodology-dependent variation in this important "denominator" may produce substantially different estimates of survival within the same cohort of patients. 相似文献
72.
Objective
The objective of this study is to compare the skill retention of two groups of lay persons, six months after their last CPR training. The intervention group was provided with animation-assisted CPRII (AA-CPRII) instruction on their cellular phones, and the control group had nothing but what they learned from their previous training.Methods
This study was a single blind randomized controlled trial. The participants’ last CPR trainings were held at least six months ago. We revised our CPR animation for on-site CPR instruction content emphasizing importance of chest compression. Participants were randomized into two groups, the AA-CPRII group (n = 42) and the control group (n = 38). Both groups performed three cycles of CPR and their performances were video recorded. These video clips were assessed by three evaluators using a checklist. The psychomotor skills were evaluated using the Resusci®Anne SkillReporter™.Results
Using the 30-point scoring checklist, the AA-CPRII group had a significantly better score compared to the control group (p < 0.001). Psychomotor skills evaluated with the AA-CPRII group demonstrated better performance in hand positioning (p = 0.025), compression depth (p = 0.035) and compression rate (p < 0.001) than the control group.Conclusion
The AA-CPRII group resulted in better checklist scores, including chest compression rate, depth and hand positioning. Animation-assisted CPR could be used as a reminder tool in achieving effective one-person-CPR performance. By installing the CPR instruction on cellular phones and having taught them CPR with it during the training enabled participants to perform better CPR. 相似文献73.
OBJECTIVE: To describe emergency medical service providers' experiences with family member presence during resuscitation, and to determine whether those experiences are similar within urban and suburban settings. METHODS: We conducted a personally distributed survey of a convenience sample of urban and suburban emergency medical service (EMS) providers presenting to two Midwestern Emergency Departments. Providers were questioned as to their experiences with resuscitating patients in the presence of family members. RESULTS: There were 128 respondents to the survey (59 urban and 69 suburban), of which 70.1% were EMT-Paramedics. No provider who was approached refused participation. Nearly all (122) had performed CPR in the presence of family members, with most (77%) performing greater than 20. Subjects averaged 12.3 years of experience. The majority of urban and suburban providers felt it was inappropriate for family to witness resuscitations (75.9% versus 60.3%, respectively; p=0.068). Many providers reported feeling uncomfortable with family presence (31.5% urban versus 44.8% suburban; p=0.136), and few preferred that family witness the resuscitation (13.2% urban versus 15.4 suburban; p=0.738). A minority of providers believed that family were better prepared to accept the death of the patient (37.0% urban versus 37.6% suburban; p=0.939). Approximately half felt comfortable providing emotional support (66.0% urban versus 53.7% suburban; p=0.173). Many felt that family caused a negative impact during resuscitation (53.7% urban and 36.8% suburban; p=0.061). Urban providers more often reported feeling threatened by family members during resuscitation (66.7% versus 39.7%; p=0.003), and felt that family often interfered with their ability to perform resuscitations (35.6% versus 16.4%, p=0.014). CONCLUSIONS: EMS providers have substantial experience with family witnessed resuscitations, are uncomfortable about their presence, and often must provide support for families. While urban providers tended to report more negative experiences and perceptions, there were minimal differences between the two groups. 相似文献
74.
Recai Dagli Mehmet Canturk Fatma Celik Zeynel Abidin Erbesler Meryem Gurler 《Brazilian Journal of Anesthesiology》2018,68(5):447-454
Background
Macintosh laryngoscopes are widely used for endotracheal intubation training of medical students and paramedics whereas there are studies in the literature that supports videolaryngoscopes are superior in endotracheal intubation training. Our aim is to compare the endotracheal intubation time and success rates of videolaryngoscopes and Macintosh laryngoscopes during endotracheal intubation training and to determine the endotracheal intubation performance of the students when they have to use an endotracheal intubation device other than they have used during their education.Methods
Endotracheal intubation was performed on a human manikin owing a standard respiratory tract by Macintosh laryngoscopes and C-MAC® videolaryngoscope (Karl Storz, Tuttligen, Germany). Eighty paramedic students were randomly allocated to four groups. At the first week of the study 10 endotracheal intubation trials were performed where, Group‐MM and Group‐MV used Macintosh laryngoscopes; Group‐VV and Group‐VM used videolaryngoscopes. Four weeks later all groups performed another 10 endotracheal intubation trial where Macintosh laryngoscopes was used in Group‐MM and Group‐VM and videolaryngoscopes used in Group‐VV and Group‐MV.Results
Success rates increased in the last 10 endotracheal intubation attempt in groups MM, VV and MV (p = 0.011; p = 0.021, p = 0.290 respectively) whereas a decrease was observed in group‐VM (p = 0.008).Conclusions
The success rate of endotracheal intubation decreases in paramedic students who used VL during endotracheal intubation education and had to use Macintosh laryngoscopes later. Therefore we believe that solely videolaryngoscopes is not enough in endotracheal intubation training programs. 相似文献75.
76.
Managing Traps and Pitfalls During Initial Steps of an ECMO Retrieval Program Using a Miniaturized Portable System: What Have We Learned From the First Two Years? 下载免费PDF全文
Anton Sabashnikov Ilja Djordjevic Antje‐Christin Deppe Elmar W. Kuhn Julia Merkle Carolyn Weber Dirk Sindhu Kaveh Eghbalzadeh Mohamed Zeriouh Oliver J. Liakopoulos Parwis B. Rahmanian Ferdinand Kuhn‐Régnier Yeong‐Hoon Choi Navid Madershahian Thorsten Wahlers 《Artificial organs》2018,42(5):484-492
The aim of this study was to provide early and mid‐term results of the newly established extracorporeal membrane oxygenation (ECMO) retrieval service in a tertiary cardiothoracic center using the miniaturized portable Cardiohelp System (Maquet, Rastatt, Germany). A particular attention was paid to organizational and logistic specifics as well as challenges and pitfalls associated with initial phase of the program. From January 2015 until January 2017 a heterogenic group of 28 consecutive patients underwent ECMO implantation in distant hospitals for acute cardiac, pulmonary or combined failure as a bridge‐to‐decision and were subsequently transported to our institution. Each cannulation was performed bedside on intensive care units (ICU) using the Seldinger's technique. Early outcomes and mid‐term overall survival with up to two‐year follow‐up along with the impact of ongoing cardiopulmonary resuscitation (CPR) on outcome were presented. Also, changes in hemodynamics and tissue perfusion factors 24 h after ECMO implantation were evaluated. ECMO implantations were performed in 15 distant departments with the median distance of 23(10;40) (maximum 60) km. A total of 15 patients (54%) were cannulated under CPR with the median duration of 30(20;110) (maximum 180) min. After 24 h of support there were significant improvements in SvO2 (P = 0.021), mean arterial pressure (P = 0.027), FiO2 (P = 0.001), lactate (P = 0.001), and pH (P < 0.001). The mean ECMO support duration was 96 ± 100 (maximum 384) hours, whereas 11 patients (40%) were weaned off support and discharged from hospital. Overall cumulative survival in patients without the need for CPR was 61.5% at one week and 38.5% at 1 month, 6 month, and 1 year, whereas patients requiring CPR survived in 40% at one week, and 33.3% at 1 month, 6 month, and 1 year (Log‐Rank (Mantel‐Cox) P = 0.374, Breslow (Generalized Wilcoxon) P = 0.162). Our initial experience shows that launching new ECMO retrieval programs in centers with sufficient ICU capacities and local ECMO experience can be feasible and associated with acceptable “real world” results despite the initial learning curve. Rapid logistical organization and team flexibility are the key points to ensure comparable survival of patients requiring prolonged CPR. 相似文献
77.
Intravenous fluid therapy is the most commonly prescribed inpatient medication in hospitals around the world. Intravenous fluids are drugs and have an indication, a dose, and expected and unintended effects. The type and amount of fluid given to patients are both important, and can either hasten or slow recovery depending on how they are administered. This narrative review provides a brief summary of the effect of intravenous fluid administration on kidney function and on renal outcome measures of relevance to both patients and clinicians. Several large clinical trials of fluid therapy are currently underway, the results of which are likely to change clinical practice. 相似文献
78.
79.
David Fernández-Ayuso Cristino del Campo Cazallas Rosa María Fernández Ayuso José Luís Pérez Olmo Javier Morillo Rodríguez Borja Matías Pompa 《Educación Médica》2018,19(6):320-326
Objective
To determine if there is a correlation between self-perception and self- efficacy in the development of learning abilities associated with the care of the critically ill patient in a Clinical Environment of High Fidelity Simulation, as part of the training for nursing students in the field of Life Support.Method
Quasi-experimental study carried out in academic year 2014-2015 with two groups of Nursing Degree students, and applying pre/post measurement tests. The students were subjected to the same simulation experience, that of a critical patient with a possible progression to cardiac arrest. Simulation training, self-perception, and self-efficacy were used as theoretical framework, as well as the latest recommendations by European Resuscitation Council.Results
A significant increase in self-perception for the development of competences associated with a critical situation was observed in both groups. As for self-perception and self-efficacy, some variations were found between the groups.Conclusions
The results found allow us to recommend clinical simulation for the training of students in critically ill patients, since there is a significant increase in the level of self-perception for the development of competences associated with critical care. Likewise, clinical simulation provides a positive link between self-perception and self-confidence in the students. 相似文献80.
目的 探讨情景模拟联合实训口诀法在ICU护生心肺复苏培训的效果。方法 将80名护生随机分为对照组与观察组各40名。对照组采用常规教学方法;观察组采用情景模拟联合实训口诀法进行心肺复苏培训。比较两组培训前后的理论、操作成绩,操作失误率,抢救时各项操作落实时间及观察组对教学方法的评价。结果 培训后观察组心肺复苏理论及操作考核成绩显著高于对照组,环境评估和顺序颠倒失误率显著低于对照组,各项抢救落实措施显著短于对照组(均P<0.01),观察组对此教学方法的满意度为100%。结论 情景模拟联合实训口诀法培训有助于提高心肺复苏培训效果,提高护生满意度。 相似文献