First-attempt Success Rate Research Articles

ECG-guided PICC insertion using a new silicon catheter with a conductive tip: A retrospective clinical study.

Safety and efficacy of ECG-guided PICC insertion using a new silicon catheter with a conductive tip was evaluated in daily practice. A retrospective study was conducted on 1659 patients who accepted successful tip-conductive PICC placement and clinically followed-up until the catheter removal between January 2018 and April 2019. Baseline of patient characteristics, catheter placement characteristics, date of dressing changes as well as records of catheter-related complications were extracted from a special designed mobile APP. The first-attempt success (success of placing catheter tip to the ideal position by primary indwelling operation) rate of PICC placement was 99.3%. The average duration of PICC placement was 128.7 ± 39.5 days and 1535 patients (92.5%) reached the therapy end-point without any complications and removed the catheter normally. The cumulative rates of total complications were 7.5%, including exit site infection (2.5%), phlebitis (0.9%), DVT (1.0%), catheter malposition (1.1%), catheter breakage (0.1%), and liquid extravasation (1.8%). In multivariable logistic regression analyses, hyperlipidemia, diabetes mellitus, lung cancer, stomach cancer, and lymphoma were significantly associated with increased risk of complications, as the independent risk factors. This retrospective clinical study demonstrates that ECG-guided insertion of a new tip-conductive PICC is associated with a high rate of first-attempt success and low rate of catheter related complications.

Practice and outcomes of airway management in patients with cervical orthoses

Increasing evidence indicates an association of video laryngoscopy with the success rate of airway management in patients with neck immobilization. Nevertheless, clinical practice protocols for tracheal intubation in patients immobilized using various types of cervical orthoses and the outcomes remain unclear. We retrospectively assessed the tracheal intubation techniques selected for patients immobilized using cervical orthoses from 2015 to 2018. The endpoints were the intubation outcomes of the different techniques and the factors associated with the selection of the technique. We included 218 patients, 118 of whom wore halo vest braces (halo vest group) and 100 wore cervical collars (collar group). GlideScope video laryngoscopy (GVL) and fiberoptic bronchoscopy (FOB) were the initial intubation methods in 98 and 120 patients, respectively. GVL had a higher first-attempt success rate than did FOB in the collar group (p=0.002) but not in the halo vest group (p=0.522). GVL was associated with a lower risk of episodes of SaO2< 90% (adjusted relative risk [aRR], 0.11; 95% CI, 0.02-0.67; p=0.016) and shorter intubation time (aRR, -3.52; 95% CI, -4.79∼-2.25; p<0.001) in the collar group. However, in the halo vest group, more frequent requirement of a rescue technique (p=0.002) and necessity of patient awakening (p=0.001) was noted when GVL was used. Use of the halo vest brace and noting of severe cord compression were independent predictors of the initial selection of FOB. Caution should be exercised when using GVL for tracheal intubation in patients immobilized using halo vest braces.

First-Attempt Success Rate of Ultrasound-Guided Peripheral IV Access using a Handheld Ultrasound Machine in a Simulation Model

Background: Although peripheral Intravenous (IV) cannulation is a routine procedure performed by nurses, IV access can be difficult to achieve, particularly in emergency patients who have critical illnesses. Ultrasound is used in this procedure to increase the success rate in novice practitioners. Objective: We aimed to determine the first-attempt success rate of ultrasound-guided peripheral IV (USGPIV) performed by emergency nurses in simulation model after having undergone training in the procedure. Materials and Methods: This was prospective descriptive study. The participants consisted of 61 emergency nurses at Srinagarind Hospital Emergency Department from January to April 2020. USGPIV cannulation training was provided by an emergency physician who is also a specialist in emergency ultrasound. After training, we calculated the number of attempts and time required to successfully complete USGPIV in a simulation model. Following this, participants responded to a questionnaire to evaluate their confidence in performing the procedure, as well as its feasibility and practical application. Data were analyzed using a Kolmogorov-Smirnov test, and p&lt;0.05 was considered to be significant. Results: Sixty-one emergency nurses were included. The first-attempt success rate of USGPIV was 85.25% (95% CI 0.761, 0.944), and the mean time required was 47.33+4.89 sec. (95% CI 37.547, 57.103). Fifty-nine participants (96.72%) completed the questionnaire. All items had a mean score of greater than 3 points, with confidence score being the highest. Conclusion: Emergency nurses with no previous experience with USGPIV were able to perform a simulated version of the procedure with a high first-attempt success rate after a short training session. Further studies should be conducted to evaluate nurses’ USGPIV competency in real patients. Keywords: Ultrasound, Peripheral IV cannulation, Emergency medicine, Emergency nurse

Prospective observational study evaluating the C-MAC Video Stylet for awake tracheal intubation: a single-center study.

The gold standard for management of known or predicted difficult airways is awake tracheal intubation. The newly developed C-MAC Video Stylet promises to combine the advantages of rigid stylets and flexible optical scopes. We therefore evaluated the feasibility of awake orotracheal intubations with this device. In this prospective observational study, three anesthesiologists experienced in advanced airway management performed each 12 awake oral intubations with this device on adult patients with known or predicted intubation difficulties. The primary outcome was overall intubation success. Secondary outcomes were total attempts, successful time, first postoperative day sequelae, and subjective intubation difficulty rated on a visual analogue scale (1, very easy; 10, extremely difficult). Thirty-six patients (10 females), aged 64±13 years, with BMI 26±5 kg/m2, were enrolled in the study. ASA status II, III, IV were eight (22%), 23 (64%), and five (14%), respectively. Indications for awake oral intubation were: oropharyngeal tumor 20 (56%), cervical-spine fracture eight (22%), previously known difficult airway four (11%), spinal canal stenosis three (8%), and bilateral peritonsillar abscess one (3%). Overall, 97% were successfully intubated in 45 s (31-88). First-attempt success rate was 80% in 37 s (29-54); 92% of patients would choose the same procedure again. On the first postoperative day, 11 (31%) patients complained of sore throat; five (14%) had minor injuries. Ease of intubation was rated as median VAS 3 (IQR: 1-7). The new C-MAC Video Stylet has the potential to serve as a suitable device for visualized oral awake intubation in difficult airway situations.

Effect of wrist dorsiflexion on ultrasound-guided radial artery catheterisation using dynamic needle tip positioning technique in adult patients: a randomised controlled clinical trial

BackgroundIt is generally recommended to keep the wrist joint mildly dorsiflexed during radial artery catheterisation. However, wrist dorsiflexion might decrease the success rate of radial artery catheterisation with dynamic needle...

First-Attempt Endotracheal Intubation Success Rate Using A Telescoping Steel Bougie

Background There has been a renewed interest in using the plastic intubation bougie to facilitate first-attempt endotracheal intubation success. The sterile single-use telescopic steel bougie (AIROD) was invented to overcome the limitations of the plastic bougie which is easily deformed during storage. Methods This is a retrospective study involving critically ill patients who were intubated with the AIROD in the intensive care unit at a single institution. The purpose of this case series is to compare the success rate of the AIROD to the generally accepted success rate for the traditional plastic bougie of 96%. Results A total of 54 patients were enrolled at a single ICU over a 10 months period. All patients were critically ill with 76% having a difficult airway, Cormack-Lehane grade view 2 or greater in 60%, and ARDS secondary to COVID-19 in 54%. The primary outcome of first-attempt intubation success in critically ill patients intubated in the ICU with the AIROD was 97% with a 95% confidence interval of 0.89 to 0.99. The average time for intubation of all airway classifications was 15 seconds. Conclusion The AIROD first-attempt intubation success rate was found to be similar to the rate for the traditional plastic bougie.

Characteristics, physiology and mortality of intubated patients in an emergency care population in sub-Saharan Africa: a prospective cohort study from Kigali, Rwanda

BackgroundFormalised emergency departments (ED) are in early development in sub-Saharan Africa and there are limited data on emergency airway management in those settings. This study evaluates characteristics and outcomes of...

Comparison of videolaryngoscopy and direct laryngoscopy for tracheal intubation in obstetrics: a mixed-methods systematic review and meta-analysis.

The incidence of difficult and failed intubation is higher in obstetrical patients than in the general population because of anatomic and physiologic changes in pregnancy. Videolaryngoscopy improves the success rate of intubation and reduces complications whencompared with direct laryngoscopy in adults; however, it is not known whether this extends to obstetrical surgery. The aim of this study was to examine the efficacy, efficiency, and safety of videolaryngoscopy compared with direct laryngoscopy in obstetrics. Central, CINAHL, Embase, MEDLINE and Web of Science databases were searched from inception to 27 May 2020 with no restrictions. Inclusion criteria included randomized-controlled trials (RCTs), observational studies, case series, and case reports that reported the application of videolaryngoscopy to intubate the trachea in pregnant patients having general anesthesia. Overall, four RCTs with 428 participants, nine observational studies, and 35 case reports/series with 100 participants were included. On meta-analysis of three trials, the co-primary outcomes of first-attempt success rate (risk ratio, 1.02; 95% confidence intervals [CI], 0.98 to 1.06; P = 0.29; I2 = 0%) and time to tracheal intubation (mean difference, 1.20 sec; 95% CI, -6.63 to 9.04; P = 0.76; I2 = 95%) demonstrated no difference between videolaryngoscopy and direct laryngoscopy in parturients without difficult airways. Observational studies and case reports underline the role of videolaryngoscopy as a primary choice when difficulty with tracheal intubation is expected or as a rescue modality in difficult or failed intubations. Evidence for the utility of videolaryngoscopy continues to evolve but supports its increased adoption in obstetrics where videolaryngoscopes should be immediately available for use as a first-line device. PROSPERO (CRD42020189521); registered 6 July 2020.

Awake fiberoptic orotracheal intubation: a protocol feasibility study.

ObjectiveTo assess the feasibility of an awake fiberoptic intubation (AFOI) protocol.MethodsWe enrolled 40 patients with simulated difficult intubation. The protocol consisted of conscious sedation (midazolam, 0.03 mg/kg and sufentanil, 0.1 µg/kg), regional anesthesia, and intubation. The time, first-attempt intubation success rate, hemodynamic parameters, blood oxygen saturation (SpO2), intubation amnesia rate, patient satisfaction, and relative complications were recorded.ResultsAFOI was completed in all patients. The average total AFOI time was 14.17 ± 1.47 minutes, and the time to placing the landmark-guided bilateral superior laryngeal nerve block was 1.24 ± 0.42 minutes. The first-attempt intubation success rate was 97.5%, and patient satisfaction was 90%. Blood pressure changed (<20%) briefly after administering conscious sedation. Heart rates did not change significantly, and SpO2 remained stable and ≥95%. Three patients had a sore throat, which resolved on postoperative day 1 without other complications. On postoperative day 1, 82.5% (33/40) of the patients had no recall of AFOI, and 17.5% (7/40) had only an indistinct memory.ConclusionsThe protocol was feasible with a high first-attempt intubation success rate and low complications rate. Hemodynamic parameters and respiration remained stable, with high patient satisfaction and effective amnesia.

Effect of the use of an endotracheal tube and stylet versus an endotracheal tube alone on first-attempt intubation success: a multicentre, randomised clinical trial in 999 patients.

PurposeThe effect of the routine use of a stylet during tracheal intubation on first-attempt intubation success is unclear. We hypothesised that the first-attempt intubation success rate would be higher with tracheal tube + stylet than with tracheal tube alone.MethodsIn this multicentre randomised controlled trial, conducted in 32 intensive care units, we randomly assigned patients to tracheal tube + stylet or tracheal tube alone (i.e. without stylet). The primary outcome was the proportion of patients with first-attempt intubation success. The secondary outcome was the proportion of patients with complications related to tracheal intubation. Serious adverse events, i.e., traumatic injuries related to tracheal intubation, were evaluated.ResultsA total of 999 patients were included in the modified intention-to-treat analysis: 501 (50%) to tracheal tube + stylet and 498 (50%) to tracheal tube alone. First-attempt intubation success occurred in 392 patients (78.2%) in the tracheal tube + stylet group and in 356 (71.5%) in the tracheal tube alone group (absolute risk difference, 6.7; 95%CI 1.4–12.1; relative risk, 1.10; 95%CI 1.02–1.18; P = 0.01). A total of 194 patients (38.7%) in the tracheal tube + stylet group had complications related to tracheal intubation, as compared with 200 patients (40.2%) in the tracheal tube alone group (absolute risk difference, − 1.5; 95%CI − 7.5 to 4.6; relative risk, 0.96; 95%CI 0.83–1.12; P = 0.64). The incidence of serious adverse events was 4.0% and 3.6%, respectively (absolute risk difference, 0.4; 95%CI, − 2.0 to 2.8; relative risk, 1.10; 95%CI 0.59–2.06. P = 0.76).ConclusionsAmong critically ill adults undergoing tracheal intubation, using a stylet improves first-attempt intubation success.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00134-021-06417-y.

Short-axis/out-of-plane versus long-axis/in-plane ultrasound-guided central venous catheter placement by inexperienced trainees: randomized trial

Background Ultrasound (US) guidance for central venous catheter (CVC) placement is considered gold standard in localization and cannulation, making the procedure safer with less complications. Objective To compare the short-axis/out-of-plane (SAX) with the long-axis/in-plane (LAX) technique for US-guided CVC insertion in internal jugular vein in intensive care practice regarding safety and efficacy. Patients and methods A prospective randomized trial was conducted in Zagazig University Hospitals, from October 2017 to October 2018. All were randomized into one of two groups according to US guidance technique: SAX technique (group S), including 116 patients, and the LAX technique (group L), including 116 patients, for US-guided CVC insertion in internal jugular vein. The primary outcome was first-attempt success rate of both the SAX and LAX approaches for US-guided vascular catheterization. The secondary outcomes were total success rate, which was defined as successful venous cannulation without complication; cannulation times calculated in seconds; the number of attempts; and complications (hematoma and arterial puncture). Results US-guided venous cannulation was successful without complications in 115 (99.14%) patients. Venous access time, catheterization time, and US imaging time were significantly lower in the group S than in the group L (P

Routine Use of a Bougie Improves First-Attempt Intubation Success in the Out-of-Hospital Setting

The bougie is typically treated as a rescue device for difficult airways. We evaluate whether first-attempt success rate during paramedic intubation in the out-of-hospital setting changed with routine use of a bougie. A prospective, observational, pre-post study design was used to compare first-attempt success rate during out-of-hospital intubation with direct laryngoscopy for patients intubated 18 months before and 18 months after a protocol change that directed the use of the bougie on the first intubation attempt. We included all patients with a paramedic-performed intubation attempt. Logistic regression was used to examine the association between routine bougie use and first-attempt success rate. Paramedics attempted intubation in 823 patients during the control period and 771 during the bougie period. The first-attempt success rate increased from 70% to 77% (difference 7.0% [95% confidence interval 3% to 11%]). Higher first-attempt success rate was observed during the bougie period across Cormack-Lehane grades, with rates of 91%, 60%, 27%, and 6% for Cormack-Lehane grade 1, 2, 3, and 4 views, respectively, during the control period and 96%, 85%, 50%, and 14%, respectively, during the bougie period. Intubation during the bougie period was independently associated with higher first-attempt success rate (adjusted odds ratio 2.82 [95% confidence interval 1.96 to 4.01]). Routine out-of-hospital use of the bougie during direct laryngoscopy was associated with increased first-attempt intubation success rate.

Comparison of dynamic needle tip positioning versus conventional long-axis in-plane techniques for ultrasound-guided internal jugular venous catheterization: a randomized controlled trial.

Continuous visualization of the needle tip is essential for successful ultrasound-guided central venous catheterization, and the dynamic needle tip positioning (DNTP) technique enables it. The aim of this randomized, dual-center trial was to compare the first-attempt success rate of ultrasound-guided internal jugular catheterization between the DNTP and conventional long-axis in-plane (LAX-IP) techniques. Patients undergoing cardiac surgery at two tertiary teaching hospitals were randomly allocated to either the DNTP or LAX-IP group. Internal jugular venous catheterization was performed by four anesthesiologists. The primary outcome was the first-attempt success rate of central venous catheterization. Procedural time and complications related to catheterization were compared as secondary outcomes. In total, 142 patients were analysed. The first-attempt success rate was significantly higher in the DNTP group (59/72, 81.9%) than in the LAX-IP group (46/70, 65.7%; odds ratio, 2.37; 95% confidence interval 1.09-5.15; P=0.028). In addition, the needle was redirected less frequently in the DNTP group than the LAX-IP group (P=0.026). Procedural time was comparable between the groups. No significant differences were observed in complications related to catheterization, including posterior wall puncture, carotid artery puncture, or hematoma. The DNTP technique resulted in a significantly higher success rate on the first attempt at internal jugular venous catheterization and required less frequent redirection of the needle during the procedure than the conventional LAX-IP technique.

First-attempt success rate of video laryngoscopy in small infants (VISI): a multicentre, randomised controlled trial

Orotracheal intubation of infants using direct laryngoscopy can be challenging. We aimed to investigate whether video laryngoscopy with a standard blade done by anaesthesia clinicians improves the first-attempt success rate of orotracheal intubation and reduces the risk of complications when compared with direct laryngoscopy. We hypothesised that the first-attempt success rate would be higher with video laryngoscopy than with direct laryngoscopy. In this multicentre, parallel group, randomised controlled trial, we recruited infants without difficult airways abnormalities requiring orotracheal intubation in operating theatres at four quaternary children's hospitals in the USA and one in Australia. We randomly assigned patients (1:1) to video laryngoscopy or direct laryngoscopy using random permuted blocks of size 2, 4, and 6, and stratified by site and clinician role. Guardians were masked to group assignment. The primary outcome was the proportion of infants with a successful first attempt at orotracheal intubation. Analysis (modified intention-to-treat [mITT] and per-protocol) used a generalised estimating equation model to account for clustering of patients treated by the same clinician and institution, and adjusted for gestational age, American Society of Anesthesiologists physical status, weight, clinician role, and institution. The trial is registered at ClinicalTrials.gov, NCT03396432. Between June 4, 2018, and Aug 19, 2019, 564 infants were randomly assigned: 282 (50%) to video laryngoscopy and 282 (50%) to direct laryngoscopy. The mean age of infants was 5·5 months (SD 3·3). 274 infants in the video laryngoscopy group and 278 infants in the direct laryngoscopy group were included in the mITT analysis. In the video laryngoscopy group, 254 (93%) infants were successfully intubated on the first attempt compared with 244 (88%) in the direct laryngoscopy group (adjusted absolute risk difference 5·5% [95% CI 0·7 to 10·3]; p=0·024). Severe complications occurred in four (2%) infants in the video laryngoscopy group compared with 15 (5%) in the direct laryngoscopy group (-3·7% [-6·5 to -0·9]; p=0·0087). Fewer oesophageal intubations occurred in the video laryngoscopy group (n=1 [<1%]) compared with in the direct laryngoscopy group (n=7 [3%]; -2·3 [-4·3 to -0·3]; p=0·028). Among anaesthetised infants, using video laryngoscopy with a standard blade improves the first-attempt success rate and reduces complications. Anaesthesia Patient Safety Foundation, Society for Airway Management, and Karl Storz Endoscopy.

Combined short- and long-axis method for internal jugular vein catheterization in premature newborns: A randomized controlled trial.

Rapid central venous catheterization is critical for the rescue and perioperative management of premature infants requiring surgery. Ultrasound-guided dynamic needle tip positioning (DNTP) has been widely used as a very effective technique, especially in paediatric vascular puncture and catheterization. However, for low-weight premature newborns, central vein catheterization still poses greater difficulties for paediatricians and paediatric anaesthesiologists. This prospective randomized control study aimed to evaluate the efficacy of combined short- and long-axis (CSLA) internal jugular vein catheterization for premature newborns in comparison with the DNTP technique. A total of 90 premature newborns (gestational age <37weeks and <28days after birth) who were scheduled for surgery were included in this study. All enrolled premature newborns were randomly divided into two groups (n=45): the CSLA group and the DNTP group. We compared the first-puncture success rate, total success rate, procedure time, number of needle passes, occurrence of complications and other outcome measures between the two groups. The two groups (n=45 per group) were similar in sex, gestational age, weight, mean arterial blood pressure, and vein-related measurements of the internal jugular vein. Total success was achieved in 43 (95.6%) and 36 (80.0%) patients in the CSLA and DNTP groups respectively. Compared with the DNTP group, the CSLA group showed a significantly higher first-attempt success rate (71.1% vs 46.7%, χ2 =5.5533, P=.0184) and significantly fewer needle passes (1.0[1.0-2.0] vs 2.0[1.0-3.0], χ2 =-2.6094, P=.0091). There was no significant difference between the groups in the procedure time (368[304-573] vs 478[324-79]s, Z=-1.7690, P=.0769). Complications occurred in both groups, but the incidence was significantly lower in the CSLA group than in the DNTP group (6.7% vs 22.2%, χ2 =4.4056, P=.0358). Ultrasound-guided internal jugular vein catheterization by the CSLA method is effective and safe. The CSLA method may be superior to the DNTP technique in premature newborns.

Comparison of external jugular vein-based surface landmark approach and ultrasound-guided approach for internal jugular venous cannulation: A randomised crossover clinical trial.

Historically, landmark techniques for central venous access through the internal jugular vein (IJV) have yielded a lesser success rate and higher complication rate than the ultrasound (US)-guided approach. The purpose of this study is to assess the success and safety of a novel external jugular vein (EJV)-based landmark (EJV-LM) approach compared with the real-time US-guided approach for central venous access through the IJV. This was a prospective, randomised, crossover trial performed in patients during elective cardiac and non-cardiac surgery. Each resident randomly inserted a central venous catheter using EJV-LM approach and real-time US-guided approach. The primary outcome was first-attempt success. Secondary outcomes included overall success rate, number of puncture attempts, cannulation time, haematoma and mechanical complications. A total of 188 patients were randomly assigned to the EJV-LM and US groups. The demographic characteristics of the groups were comparable. The first-attempt success was not different between EJV-LM and US-guided techniques (79.8%; [95% CI: 70.2-87.4] vs 89.4% [95% CI 81.3-94.8]; P=.06). The overall success rate was 100% with both techniques. There were no differences in the number of puncture attempts with introducer needle (1[1-3] vs 1[1-2]; P=.07). Cannulation time was longer in the EJV-LM group compared with the US group (58.11±6.6 vs 44.27±5.28seconds; P=.0001). EJV-LM technique was associated with a higher occurrence of overall complications compared with the US technique (12.8% [95% CI: 6.7- 21.2] vs 4.2% [95% CI: 1.1-10.5]; P=.03). No major mechanical complications were observed with either techniques. In patients with non-distorted neck anatomy and a visible EJV, IJV catheterisation using the EJV-based LM approach and standard US-guided technique yielded similar first-attempt and overall success rates. Cannulation time was longer and complications occurred more frequently in the EJV-based LM compared with the standard US-guided technique.

Incidence of postoperative sore throat after using a new technique of insertion of a second generation Laryngeal Mask Airway: A randomised controlled trial.

BACKGROUNDSore throat is a common complication after Laryngeal Mask Airway Supreme (SLMA) insertion.OBJECTIVEThe aim of this study was to determine whether a new SLMA insertion technique (not removing the pilot tube blocker before insertion) lowers the incidence of sore throat in the postanaesthesia care unit (PACU).DESIGNA prospective, single-centre, parallel randomised controlled trial.SETTINGOperating room and PACU at a hospital in China from June to September 2019.PATIENTSFour hundred and eight patients aged 18 to 65 years with American Society of Anaesthesiologists physical status class I or II who were scheduled for elective surgery requiring anaesthesia and SLMA insertion.INTERVENTIONSLeaving the blocker at the end of the pilot tube in situ (this blocker keeps the valve open and the balloon remains partially inflated but will deflate with pressure) or removing the blocker and actively deflating the cuff before SLMA insertion.MAIN OUTCOME MEASURESThe primary outcome was the incidence of postoperative sore throat in the PACU. The secondary outcomes included sore throat severity (Prince Henry Hospital Pain Score), first-attempt success rate, ease of insertion, time to successful SLMA insertion, oropharyngeal leak pressure, grade of view on fibreoptic bronchoscopy (indicating the accuracy of SLMA positioning) and adverse events.RESULTSThe incidence of sore throat was 33/204 (16.2%) in the nonremoval group, and 65/204 (31.9%) in the removal group (P < 0.001). The first-attempt success rate was 174/204 (85.3%) in the nonremoval group and 150/204 (73.76%) in the removal group (P = 0.003; relative risk 1.160, 95% CI 1.049 to 1.282). The Kaplan--Meier curves showed that the insertion time in the nonremoval group was shorter (log-rank P = 0.01).CONCLUSIONThe new insertion technique, leaving the blocker attached to the end of the pilot balloon, resulted in a reduced incidence and severity of postoperative sore throat in the PACU, and an improved first-attempt success rate and the accuracy of SLMA positioning.TRIAL REGISTRATIONChinese Clinical Trial Registry identifier: ChiCTR1900023022

Underlying causes of pulled elbow in children: Could there be a physiopathology similar to transient synovitis of the hip?

Objective: Partial dislocation of radius head (pulled elbow) is the most common trauma observed in out-patient orthopedic treatment of children. The typical mechanism of this trauma includes exertion of longitudinal force along the forearm in a pronation position, causing partial dislocation of the radius head. Methods: This Retrospective descriptive and cross-sectional study was undertaken on patients referring to the emergency ward of Imam Reza hospital of Mashhad with typical history of partial dislocation of radius head (pulled elbow). The present study was conducted between March 20, 2018 and March 20, 2019. Based on the number of patients at the emergency ward, the sample size was determined to be 80. Descriptive statistics such as mean and standard deviation were used to describe the collected data. Results: From among 80 children diagnosed with partial radius bone dislocation, 66.23% were girls and 33.77% were boys. The age range of patients was 28.08 months for girls and 31.04 months for boys. Findings also showed that 32 patients had a history of recent respiratory infection within 1 week before the pulled elbow incident. Conclusion: Findings revealed that, similar to previous studies, the pulled elbow injury was more common in girls than in boys. Successful reduction in first and second attempts, notwithstanding the maneuvers used indicated that the success rate of first attempts at reduction was 93%. The history of recent respiratory infections during 1 week before the injury was taken into account, where 40% of the children had some history of such respiratory infections.

Part 1: Executive Summary: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.

Part 1: Executive Summary: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.

Impact of aerosol enclosure barrier to videolaryngoscopic oro-tracheal intubation: A pilot manikin study

Background: Personal protective equipment used for protection of healthcare workers in the combat against Severe Acute Respiratory Syndrome Coronavirus 2 pandemic is in limited supply worldwide at present – 2020. Use of barrier enclosure during endotracheal intubation can potentially act as a cost-effective adjunct to minimize risks of transmitting the infection to healthcare workers. However, there is concern that the enclosure itself will act as a barrier to the intubation procedure in the emergency settings. Objective: To evaluate the negative effect of barrier enclosure (an aerosol box) on the performance of video-assisted intubation in a manikin Methods: A total of 41 Emergency Department doctors from a local hospital were recruited to perform intubation in a manikin simulating normal and more difficult airways (Cormack-Lehane grades I and IIb) with and without the box. The primary outcome was time of successful intubation. The secondary outcomes were first-attempt success rate, number of successful attempts, need of adjuncts, dental injury and ease of intubation as perceived by the participants. Results: The aerosol box had no significant negative effect on the time of successful intubation (p = 0.630 (Grade I airway) and p = 0.436 (Grade IIb airway)), first-attempt success rate, number of successful attempts, need of adjuncts or dental injury. Participants subjectively reported extra yet minor challenges during intubation in the presence of the box. Conclusion: Within limits of the pilot study, the aerosol box had no statistical significant difference but an increasing trend of prolonged endotracheal intubation interval in the Grade IIb airway and negative impact on first-pass success, and could potentially be used to protect healthcare workers during the aerosol-generating intubation procedure.