Minutes Of Chest Compressions Research Articles

The Effect of Step Stool Use on Chest Compression Quality During CPR in Young Children: Findings From the Videography in Pediatric Emergency Research (VIPER) Collaborative.

This study aimed to determine the effect of stepstool use on chest compression (CC) quality during cardiopulmonary resuscitation (CPR) in young children. We conducted a prospective observational study of children <8 years of age who received CC for >2 minutes in the emergency department. Data were collected through CC monitor device and video review. Data were analyzed in "CC segments" (periods of CC by individual providers). CC segments were coded "yes" or "no" for stepstool use based on video review. Univariate analyses of CC rate and depth between stepstool use and hand positions were performed through nonparametric testing, stratified by age category. Forty-two patients received 566 minutes of CC. Overall, American Heart Association (AHA)-compliant (rate and depth) CPR was achieved in 10% of CC segments for children <1 year and only 6% in children >1 year. A stepstool was used in 73% of CC segments in children <1 year and 88% in children >1 year. In children >1 year, stepstool use was associated with deeper CCs (P < 0.001) and a more compliant CC rate (P < 0.01). In children >1 year, 7% of those with a stepstool in use achieved AHA compliance, compared to those without a stepstool, where none achieved AHA compliance. In children >1 year, stepstool use resulted in greater CC depth and more AHA-compliant CC rate. No CC segments in children >1 year achieved AHA compliance without a stepstool. These data support uniform stepstool use during pediatric CPR in children >1 year of age.

Cardiac Arrest During a Ferric Derisomaltose Infusion Followed by Complete Heart Block: A Case Report.

Ferric derisomaltose is the newest available parenteral iron formulation. Studies have demonstrated a good safety profile with improved tolerability compared to alternative parenteral iron formulations. To date there have been no reported acute, life-threatening cardiac events associated with ferric derisomaltose. An 86-year-old male who had previously tolerated routine iron infusions received a first dose of ferric derisomaltose at an outpatient infusion clinic. Six minutes into the infusion the patient became unresponsive with no palpable pulse. Return of spontaneous circulation was achieved after two minutes of chest compressions. Electrocardiogram showed complete heart block requiring transcutaneous pacing and vasopressor administration. The patient was transferred to the emergency department for stabilization and then admitted to the cardiac intensive care unit. During admission, the patient received a dual-chamber, permanent pacemaker without complication and was ultimately discharged. It may be reasonable to consider parenteral iron as a toxicological etiology for patients presenting with complete heart block temporally associated with parenteral iron administration, particularly in patients with underlying conduction abnormalities.

Abstract 382: The Effect of Stepstool Use on Chest Compression Quality During CPR in Young Children: Findings From the Videography in Pediatric Emergency Research (VIPER) Collaborative

Background: Delivering chest compressions (CC) of adequate depth and rate during pediatric cardiopulmonary resuscitation (CPR) has known beneficial hemodynamic consequences; however, chest compression quality in this population is often suboptimal. While common, the benefit of stepstool use during pediatric CPR has not been studied. Objective: To analyze the effect of step stool use on chest compression quality (depth, rate) in a pediatric emergency department (ED). Methods: We conducted a prospective observational cohort study involving patients &lt;8 years of age receiving chest compressions in an ED for &gt;2 minutes. Data was collecting via structured video review and from a CC monitoring device. Analysis was by compressor segment. We compared CC rate and depth by step stool use in each of 3 age groups: &lt; 1 year, 1-8 years, 9-18 years. We also examined step stool and CC quality by compressor hand position: 1) two thumbs, hands encircling chest (2T), 2) two fingers, 2 nd and 3 rd digits, pressing on anterior sternum (2F), 3) one hand (1H), and4) two hands (2H). Results: 46 patients received 390 CC segments (565 total minutes of CC). In patient &lt;1 year and 1-8years of age, the majority of compressors utilized a step stool (73% &lt;1 year; 83.3% 1-8 years). For &lt;1year, there was no difference in mean CC rate or depth with or without step stool use. In children &gt;1year of age, a step stool was associated with deeper chest compressions [3.63cm (IQR 3.07 - 4.17)versus 2.74 cm (IQR 2.39 - 3.24) without, p=0.000] and a mean CC rate more consistent with AHA guidelines [115 compressions per minute (IQR 115 - 128) versus 125 (IQR 110 - 121) without p=0.0037]. Stratified by hand placement technique, 1H compressions with a step stool achieved greater depth in children &gt;1 years (p&lt;0.01); 2H compressions with a step stool achieved a more compliant CC rate in children &gt;1 years (p&lt;0.05). Conclusions: CPR depth failed to reliably meet AHA guidelines regardless of stepstool use across all age categories. However, in children between 1 - 8 years of age, step stool use was significantly associated with higher quality chest compressions. Our findings of better CC depth and rate with one and two hand compressions should prompt further investigation and evaluation of CC technique in the pediatric population.

Quality of chest compressions performed by anaesthetic trainees with and without audiovisual feedback

Introduction: The use of audiovisual feedback devices on chest compression (CC) metrics such as the rate and depth has been proven to improve resuscitation quality. This study compared the quality of CC performed by anaesthetic trainees on manikins with audiovisual feedback and subsequent skill retention without the feedback. Methods: CC metrics measured were the compression rate and depth recorded and reviewed by RescueNet® Code Review software, which recorded compressions in target. Fifty participants performed 2 minutes of CC without audiovisual feedback (CC1), followed by another 2 minutes of CC with audiovisual feedback (CC2), separated by 5 minutes of rest. Those who achieved at least 70% of compressions in target during CC2 performed another 2 minutes of CC without audiovisual feedback at 30 minutes (CC3) and 5–7 days (CC4) later. Results: The baseline compressions in target during CC1 was 14.43 ± 20.18%, improving significantly to 81.80 ± 7.61% (p &lt; 0.001) with audiovisual feedback (CC2). Forty-five (90%) participants achieved compressions in target of at least 70% during CC2. However, without the feedback, compressions in target decreased significantly to 56.33 ± 27.02% (p &lt; 0.001) and 49.32 ± 33.86% (p &lt; 0.001) at 30 minutes (CC3) and 5–7 days (CC4) later, respectively. The overall effect size for the compressions in target was 0.625. Conclusion: Audiovisual feedback device usage significantly improves CC performance, but improved skills were not fully retained when CC was performed without the device afterwards. Therefore, real-time audiovisual feedback may ensure better CC, a component of cardiopulmonary resuscitation.

The effect of hand position on chest compression quality during CPR in young children: Findings from the Videography in Pediatric Resuscitation (VIPER) collaborative

ObjectiveTo determine the effect of hand position on chest compression (CC) quality during CPR in young children. MethodsProspective observational exploratory study. Patients < 8 years receiving CC for > 2 minutes were enrolled. Data was collected from video review and CC monitor device and analyzed in ‘CC segments’ (periods of CC by individual providers). Four techniques were compared: two thumbs (2 T), hands encircling the chest; two fingers (2F) on the sternum; one hand on sternum (1H); two hands on sternum (2H). Univariate analysis of CC rate and depth between hand positions was performed through nonparametric testing, stratified by age category. Results47 patients received 824 minutes of CC. Among 270 CC segments in infants < 1 yo, 2 T was used in 27%; 2F 3%; 1H 18%; 2H 26%. Among 189 CC segments in children aged 1 to 8 yo, 1H was used in 26%; 2H 74%. Across all segments, median CC rate was 117 cpm (IQR 110–125). Median depth was 2.92 cm (IQR 2.44 – 4.04) in infants < 1 yo, 3.56 cm (IQR 2.92 – 4.14) in children 1 to 8 yo. 1H achieved greater depth than 2 T in infants (p < 0.01), and 2H achieved greater depth than 1H in children > 1 (p < 0.001). ConclusionsIn infants, 1H resulted in greater CC depth than 2 T. In children 1 to 8 yo, 2H resulted in greater depth than 1H.. These data suggest that different hand position during CPR in young children from what is currently recommended may result in better CPR quality.

Abstract 307: Kids Save Hearts Project: Hands-only Cardiopulmonary Resuscitation Training For Schoolchildren

Introduction: As part of a global initiative, several countries already provide cardiopulmonary resuscitation (CPR) training to children in school environments. This training is not a part of the Brazilian school curriculum, but it is necessary since cardiorespiratory arrest events are frequently fatal. Objective: This study investigates the effectiveness of hands-only cardiopulmonary resuscitation among different age groups of schoolchildren. Methods: The institution's research ethics committee previously approved the study. Prior to training, both parents and participants signed a consent form. This study was conducted in three (public and private) schools using a quasi-experimental intervention with two age groups: 7 to 11 (group I) and 12 to 17 (group II). The 90-minute training module consisted of short practice videos while watching a song dedicated to "hands-only CPR." Students were then individually evaluated for their skills and knowledge using Skill Reporter Software Laerdal Medical during one minute of chest compressions on a manikin and a dedicated game. Results: The total of 102 schoolchildren (54 females and 48 males) (table1) were trained and evaluated for demographic variables (rate, depth, recoil) and chest compression quality according to international guidelines 2020. There were differences in the physical characteristics of participants (p&lt;0.05) and significant statistical difference related to depth in CPR (median 66 mm; p: 0,01) in group II. Conclusion: It was concluded that schoolchildren performing hands-only cardiopulmonary resuscitation were adequate, and those future efforts are required to implement and expand training in low-income regions of Brazil.

USE OF POINT-OF-CARE ULTRASONOGRAPHY (POCUS) TO PREVENT DILTIAZEM-INDUCED CARDIOGENIC SHOCK

USE OF POINT-OF-CARE ULTRASONOGRAPHY (POCUS) TO PREVENT DILTIAZEM-INDUCED CARDIOGENIC SHOCK

Rescuers’ characteristics associated with the correct chest compression during cardiopulmonary resuscitation

AimTo analyse the caregivers’ physical, anthropometrical and educational characteristics associated with adequate chest compression and full chest recoil during cardiopulmonary resuscitation (CPR). MethodsAn observational prospective research study was conducted. Emergency and critical care health professionals and students performed two minutes of chest compressions on a dummy. Depth and residual leaning after the compressions were assessed and their association with several variables (physical, anthropometrical, and educational) was analysed using logistic regression models. ResultsTwo hundred thirty-eight volunteers participated. Previous experience of the rescuer in less than six CPRs (OR = 3.03; 95% CI 1.2–7.63) was related to a higher probability of not achieving an adequate depth of compressions. Greater height (OR: .93; 95% CI .87–.99) and grip strength (OR: .94; 95% CI .89–.99) were associated with correct performance of chest compression. We did not find any characteristic related to chest recoil. ConclusionsThe caregiver’s previous experience with CPR was the strongest factor associated with adequate performance of chest compressions. To a lesser extent, the professional’s height and upper body muscle strength also have an influence. No factors associated with the adequacy of full chest recoil were identified.

Post-cardiac arrest physiology and management in the neonatal intensive care unit

AimThe importance of high-quality post-cardiac arrest care is well-described in adult and paediatric populations, but data are lacking to inform post-cardiac arrest care in the neonatal intensive care unit (NICU). The objective of this study was to describe post-cardiac arrest physiology and management in a quaternary NICU. MethodsRetrospective descriptive study of post-cardiac arrest physiology and management. Data were abstracted from electronic medical records and an institutional resuscitation database. A cardiac arrest was defined as ≥1 minute of chest compressions. Only index arrests were analysed. Descriptive statistics were used to report patient, intra-arrest, and post-arrest characteristics. ResultsThere were 110 index cardiac arrests during the 5-year study period from 1/2017–2/2021. The majority (69%) were acute respiratory compromise leading to cardiopulmonary arrest (ARC-CPA) and 26% were primary cardiopulmonary arrests (CPA). Vital sign monitoring within 24 hours post-arrest was variable, especially non-invasive blood pressure frequency (median 5, range 1–44 measurements). There was a high prevalence of hypothermia (73% of arrest survivors). There was substantial variability in laboratory frequency within 24 hours post-arrest. Patients with primary CPA received significantly more lab testing and had a higher prevalence of acidosis (pH < 7.2) than those with ARC-CPA. ConclusionsWe identified significant variation in post-arrest management and a high prevalence of hypothermia. These data highlight the need for post-arrest management guidelines specific to neonatal physiology, as well as opportunities for quality improvement initiatives. Further research is needed to ascertain the impact of neonatal post-arrest management on long-term outcomes and survival.

Assessment of the Quality of Chest Compressions Performed by Health-Care Workers Under Simulated Conditions

Aim of the study: to investigate chest compression parameters by city hospital staff under simulated conditions with and without the use of a sensor device for quality control of chest compressions.Materials and Methods. The study was conducted in Moscow's multidisciplinary hospitals. The study included 359 medical staff members. The participants were divided into 4 groups: physicians (n=97) and nurses (n=82) from intensive care units (ICU) and physicians (n=92) and nurses (n=88) from specialized departments. Participants performed 2 minutes of chest compressions without a chest compressions quality control (CCQC) sensor, followed by 2 minutes of chest compressions using a defibrillator sensor with audiovisual prompts from the device turned on. The percentage of target compressions, rate and depth of compressions were analyzed.Results. Compression parameters in the group of ICU doctors were outside the reference range (% target compression — 0.5 (0.0; 14.5)%, rate 124.1±17.8 per minute, depth 5.6±1.1 cm), in the group of ICU nurses, the percentage of target compressions was 0.0 (0.0; 3.5)%, rate — 123.6±23.7 per minute, depth — 5.3±1.2 cm, in the group of specialist doctors the percentage of target compressions was 0.0 (0.0; 1.2) %, rate — 123.8±23.2 per minute, depth — 5.8±1.2 cm, in specialized nurses group the percentage of target compressions was 0.0 (0.0; 6.1)%, rate — 119.7±29.5 per minute, depth — 5.6±1.2 cm. There was a significant improvement in compression performance in all groups when the sensor device was used: in ICU physicians the percentage of target compressions was 81.6 (64.80; 87.90)%, rate — 124.1±17.8 per minute, depth — 5.5±0.2 cm; in ICU nurses the percentage of target compressions was 69.1 (47.4; 80.6), rate — 123.6±23.7 per minute, depth — 5.3±0.3 cm, in specialist doctors the percentage of target compressions was 69.30 (50.50; 78.70), rate — 123.8±23.2 per minute, depth — 5.4±0.3 cm, in specialized nurses the percentage of target compressions reached 63.70 (42.90; 75.80), rate — 119.7±29.5 per minute, depth — 5.4±0.3 cm. There were no differences in analysed compression parameters between staff in different departments or positions.Conclusion. Compression parameters (percentage of target compressions, rate, depth) were not influenced by the department where the staff member worked and the position held (doctor or nurse). The use of a compression quality sensor device has improved compression parameters by reducing rate and normalizing depth. The use of the sensor does not increase the percentage of target compressions to the maximum values, indicating the need for training by an instructor.

Características de los reanimadores asociadas a la correcta compresión torácica durante la reanimación cardiopulmonar

AimTo analyse the caregivers’ physical, anthropometrical and educational characteristics associated with adequate chest compression and full chest recoil during cardiopulmonary resuscitation (CPR). MethodsAn observational prospective research study was conducted. Emergency and critical care health professionals and students performed two minutes of chest compressions on a dummy. Depth and residual leaning after the compressions were assessed and their association with several variables (physical, anthropometrical, and educational) was analysed using logistic regression models. ResultsTwo hundred thirty-eight volunteers participated. Previous experience of the rescuer in less than six CPRs (OR: 3.03; CI 95%: 1.2-7.63) was related to a higher probability of not achieving an adequate depth of compressions. Greater height (OR: .93; 95% CI: .87-.99) and grip strength (OR: .94; 95% CI: .89-.99) were associated with correct performance of chest compression. We did not find any characteristic related to chest recoil. ConclusionsThe caregiver's previous experience with CPR was the strongest factor associated with adequate performance of chest compressions. To a lesser extent, the professional's height and upper body muscle strength also have an influence. No factors associated with the adequacy of full chest recoil were identified.

Cardiopulmonary Resuscitation Retinopathy in an Adult

A man developed vision loss and bilateral subhyaloid, outer plexiform, and subretinal hemorrhages after 2 minutes of chest compressions. Several potential mechanisms, including venous transmission of pressure and elevated intracranial pressure (ICP), could explain these findings.

CPR Compression Rotation Every One Minute Versus Two Minutes: A Randomized Cross-Over Manikin Study

Background The current basic life support guidelines recommend two-minute shifts for providing chest compressions when two rescuers are performing cardiopulmonary resuscitation. However, various studies have found that rescuer fatigue can occur within one minute, coupled with a decay in the quality of chest compressions. Our aim was to compare chest compression quality metrics and rescuer fatigue between alternating rescuers in performing one- and two-minute chest compressions. Methods This prospective randomized cross-over study was conducted at Songklanagarind Hospital, Hat Yai, Songkhla, Thailand. We enrolled sixth-year medical students and residents and randomly grouped them into pairs to perform 8 minutes of chest compression, utilizing both the one-minute and two-minute scenarios on a manikin. The primary end points were chest compression depth and rate. The secondary end points included rescuers' fatigue, respiratory rate, and heart rate. Results One hundred four participants were recruited. Compared with participants in the two-minute group, participants in the one-minute group had significantly higher mean (standard deviation, SD) compression depth (mm) (45.8 (7.2) vs. 44.5 (7.1), P=0.01) but there was no difference in the mean (SD) rate (compressions per min) (116.1 (12.5) vs. 117.8 (12.4), P=0.08), respectively. The rescuers in the one-minute group had significantly less fatigue (P < 0.001) and change in respiratory rate (P < 0.001), but there was no difference in the change of heart rate (P=0.59) between the two groups. Conclusion There were a significantly higher compression depth and lower rescuer fatigue in the 1-minute chest compression group compared with the 2-minute group. This trial is registered with TCTR20170823001.

Chest compression effectiveness with vs without feedback

The objective of this experiment is to assess clinician perceived versus actual compression quality, and to evaluate the impact of using feedback from the Laerdal CPRMeter2 on compression quality. In our setup, we have a total of eighty four participants (43 from the Royal Alex and 41 from the Misericordia hospital). We monitored CPR quality based on the guidelines by Heart and Stroke, which breaks down chest compression effectiveness into three areas- Release, Depth and Rate. Proper Guidelines: Compress the chest at least 5cm (2inches); Compress at a rate of 100 to 120 beats per minute; Allow the chest to recoil completely after each compression. Clinical Setup: A convenience sample of participants performed two minutes of uninterrupted chest compressions on a Laerdal Resusci Anne with a CPRmeter2 on top without feedback, followed by a two minute rest period to fill out a Q.I tracking form. They later repeated the two minutes of chest compressions with the display of the CPRmeter uncovered, with the feedback visible. The chest compression metrics from the trials were compared using a data tracking form. From the data collected, enough evidence shows that the CPRmeter2 is able to improve release, rate and overall CPR quality. After filling out the survey, all of the nurses agree that the device is very useful in giving feedback and should be used in future CPR classes. Furthermore, data collected from the Q.I tracking forms indicates that nurses and other health clinicians are inadequate in predicting their own CPR abilities. Often times, nurses would either overpredict or underpredict their scores on the CPR meter. From the data gathered, the CPRmeter2 is going to be used for training in future CPR classes. Just recently, the device has been incorporated into code calls in the emergency department at the Misericordia. A T-test was done on the findings from the experiment to test if the means of two sets of data are significantly different from each other. Based on our findings, the t-test values for rate, release, and overall quality are statistically significant, meaning that the null hypothesis is rejected.&#x0D;

Abstract 107: The Effects of Hand Placement on Chest Compression Quality in the Pediatric Emergency Department: Findings From the Videography in Pediatric Emergency Research Collaborative

Introduction: Guidelines for infant cardiopulmonary resuscitation (CPR) recommend two finger (2F) technique for one-rescuer chest compressions (CCs) and a two-thumb encircling (2T) for two-rescuers CCs. Pediatric guidelines recommend either a one-handed (1H) or two-handed (2H) technique based on provider judgement. Previous small, single site studies suggest that 2T compressions are more effective for infant CPR than 2F and 1H. Hypothesis: To combine video review and monitor-defibrillator CC analysis to determine the effects of hand placement on CC quality in a pediatric emergency department (PED). Methods: Data was obtained from the Videography in Pediatric Emergency Resuscitation (VIPER) Collaborative, a prospective observational resuscitation database from 3 tertiary PEDs. Participating sites review resuscitations for quality, safety, and research purposes. Rate and depth for continuous CC segments delivered by a single compressor (epoch) were obtained from Zoll R-series monitor-defibrillator, epoch duration and hand position from video, and patient demographics from medical records. Epochs with analyzable video and CC data were eligible for inclusion. Quality of CC rate and depth were evaluated for adherence to 2015 AHA standards. Results: A total of 248 minutes of CCs for 19 patients [14 infants ≤1 year; 5 toddlers 2-4 years] were analyzed. Median CC rates were adherent to AHA standards for toddlers but not infants, where CCs were often too fast (Table 1). CC depth was inadequate in both infant and toddlers. The 2T technique in infants was significantly associated with adherence to AHA standards for rate ( X 2 =4.97; X 2 =3.64) (Table 1). Conclusions: Infant CC rate and depth and toddler CC depth were not adherent to AHA standards. Performing CCs on infants using the 2T technique was most likely to produce CCs at the recommended rate. Further understanding and implementation of techniques to assist with providing high-quality CCs in young patients is needed.

MASSIVE FATAL INTRAPERITONEAL BLEEDING FROM GASTROHEPATIC LIGAMENT FOLLOWING PEG TUBE PLACEMENT: AN EXTREMELY RARE COMPLICATION

SESSION TITLE: Critical Care 1 SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/09/2018 01:15 PM - 02:15 PM INTRODUCTION: Placement of a percutaneous endoscopic gastrostomy (PEG) tube is a common procedure to allow for enteral nutrition in patients with multiple indications. The incidence rates for serious and minor complication have been estimated to be 3 % and 6 %, respectively. Immediate mortality after the procedure appears is less than 1%. Intraperitoneal bleeding is extremely rare and a few cases have been reported associated with hepatic laceration and spleen avulsions. CASE PRESENTATION: 84-year-old male with a past medical history significant for paroxysmal atrial fibrillation and mechanical mitral and aortic valve replacement on Warfarin initially presented with seizure, and diagnosed with coccidioidomycosis pneumonia and started on fluconazole. His long hospital stay was complicated with dysphagia, failed swallow evaluation with sign of aspiration of videofluoroscopic swallow study. Patient family was interested in PEG tube placement for further feeding of the patient. Warfarin was stopped, and started on heparin drip that also was stopped 4 hours pre operative. PEG tube was placed in first attempt without any obvious complication. After 5 hours, the patient was found to be unresponsive and pulseless. Code Blue was called and resuscitation was started following ACLS protocols. Cardiac monitor showed pulseless electrical activity. After 4-5 minutes of chest compression, ROSC was obtained and he was transferred to MICU. Vitals: BP 53/32, HR 63, Temp 98.1. He was given IV fluid and started on levophed and vasopressin. Physical Examination showed abdominal distension with severe abdominal tenderness. Labs showed significant drop in hemoglobin to 6.3 from 10.6. Bedside abdominal ultrasound showed massive fluid in the intraperitoneal cavity. Gastroenterologist was called, and EGD was repeated at bedside with no sign of bleeding in the stomach. The patient was sent to operation room for emergent laparotomy for intraperitoneal bleed. Active bleeding from gastrohepatic ligament was found. About 1400 ml of blood was drained. The source of bleeding was controlled and was sent back to MICU. In spite of multiple blood transfusion with the high dose of norepinephrine and vasopressin infusion, his blood pressure stayed low. The patient could not sustain the acute conditions and expired. DISCUSSION: PEG tube placement is a safe procedure with minor complication. Immediate mortality after PEG placement is very rare, as low as <1%. Massive intraperitoneal bleeding is extremely rare. We report the first case of immediate massive bleeding from gastrohepatic ligament during PEG tube placement.We report the first case of immediate massive bleeding from gastrohepatic ligament during PEG tube placement. Rapid diagnosis and surgical intervention is critical and can prevent an untimely death. CONCLUSIONS: PEG tube placement is a very common procedure, but physicians should be mindful of this uncommon complication. Reference #1: Gauderer MW. Twenty years of percutaneous endoscopic gastrostomy: origin and evolution of a concept and its expanded applications. Gastrointest Endosc. 1999;50:879–883. Reference #2: Gubler C, Wildi M, Bauerfeind P (2005) Liver injury during PEG tube placement: report of two cases. Gastrointest Endosc 61:346–8 Reference #3: Lau G, Lai SH. Fatal retroperitoneal hemorrhage: an unusual complication of percutaneous gastrostomy. Forensic Sci Int 2001;116:69-75. DISCLOSURES: No relevant relationships by Abdul Aleem, source=Web Response no disclosure on file for Nabil Sultani

How Much Cardiopulmonary Resuscitation Does a Pediatric Emergency Provider Perform in 1 Year? A Video-Based Analysis.

We aimed to quantify time performing chest compressions (CCs) per year of individual providers in a pediatric ED and to project a rate of opportunity for CC based on median clinical hours per provider category. This was an observational study of video-recorded resuscitations in a pediatric ED over 1 year. Events where CCs were performed for more than 2 minutes were included. Identification of providers and duration of CCs per provider were determined by video review. Time of CCs was totaled per provider over the study period. Data were expressed as median and interquartile range (IQR). Rate of opportunity for providing CC to a child was calculated by dividing the median clinical hours per year per provider type by the number of CC events per year. Twenty-three CC events totaling 340 minutes of CCs were analyzed. Chest compressions were performed by 6 (13%) of 45 attending physicians, 3 (25%) of 12 fellows, 32 (22%) of 143 nurses, and 19 (59%) of 32 technicians. The median amount of time performing CC was 182 seconds (IQR, 91-396 seconds); by provider category, median amount of time was as follows: attending physicians, 83 seconds (IQR, 64-103 seconds); fellows, 45 seconds (IQR, 6-83 seconds); nurses, 128 seconds (IQR, 93-271 seconds); and technicians, 534 seconds (IQR, 217-793 seconds). The projected hours needed for an opportunity to perform CCs was 730 hours (91 shifts) for attending physicians, 243 hours (30 shifts) for fellows, and 1460 hours (121 shifts) for nurses and technicians. Performing CCs on children in the ED is a rare event, with a median of 3 minutes per provider per year. Future studies should determine training methods to optimize readiness for these rare occurrences.

Atypical Presentation of Lambert Eaton Myasthenic Syndrome

SESSION TITLE: Critical Care 3 SESSION TYPE: Affiliate Case Report Poster PRESENTED ON: Tuesday, October 31, 2017 at 01:30 PM - 02:30 PM INTRODUCTION: Lambert-Eaton Myasthenic Syndrome (LEMS) is a rare disorder in which antibodies against presynaptic voltage-gated calcium channels (VGCC) prevent the flux of calcium into the nerve terminal. This reduces the release of acetylcholine affecting neuromuscular transmission. Here we discuss an atypical presentation of LEMS. CASE PRESENTATION: A 64 year old male was admitted for dysphagia and difficulty ambulating. Chest x-ray showed a mediastinal mass. CT confirmed a 5 x 5 cm anterior mediastinal mass. He had 4/5 strength and 1+ deep tendon reflexes (DTRs) in lower extremities. Sodium was 119 mEq/L. On day 2, the patient had bradycardic arrest. Return of spontaneous circulation was achieved after 3 minutes of chest compressions and he was intubated. During his hospital course, he had tachybradyarrhythmias. Despite immediate recovery to his normal mental status, normal chest x-ray, and arterial blood gas, he continued to fail his spontaneous breathing trials. He had a negative inspiratory force of -6 and vital capacity of 150 mL. Paraneoplastic syndrome was suspected due to neuromuscular respiratory failure, hyponatremia, and mediastinal mass. Intravenous immunoglobulin (IVIG) was given for 5 days. On day 10 of intubation, supraclavicular lymph node biopsy showed small cell lung carcinoma and carboplatin and etoposide was initiated. The patient was extubated on the same day. Serology was positive for P/Q type VGCC antibodies. DISCUSSION: LEMS has a prevalence of 2.3 per million and an incidence of 0.5 per million. There have been 400 reported LEMS cases in the US, of which 17 cases had frank respiratory failure. Sixty percent of LEMS cases are associated with small cell lung cancer. Patients with LEMS have proximal muscle weakness that transiently improves after repetitive exertion, absent DTRs, bulbar dysfunction, and autonomic dysfunction. This patient had dysphagia, a sign of bulbar dysfunction. He ambulated while intubated, which may reflect improvement of weakness after repetitive exertion. If not, this level of weakness is uncommon in LEMS as diaphragmatic weakness often parallels the degree of proximal muscle weakness. In contrast to other cases in which DTRs are absent, this patient had hyporeflexia. Finally, he had dysautonomia manifesting as fluctuating episodes of bradycardia and tachycardia. EMG is used to confirm LEMS, however was not available. CONCLUSIONS: Neuromuscular respiratory failure should lead to evaluation of more common causes of weakness. In patients with malignancy, the possibility of LEMS should be entertained. The early use of IVIG in this patient allowed for earlier extubation. Reference #1: Laghi F, et al. Disorders of the respiratory muscles. Am J Respir Crit Care Med. 2003. 168(1): 10-48. Reference #2: Bekircan-Kurt C, et al. Voltage gated calcium channel antibody-related neurological diseases. World J of Clin Cases: 3.3 (2015): 293. Reference #3: Sanders DB. Lambert-eaton myasthenic syndrome: diagnosis and treatment. Ann NY Acad Sci. 2003. 998: 500-508. DISCLOSURE: The following authors have nothing to disclose: Gauri Behari, Raja Sinha, Vadym Rusnak, Andrea Espinoza, Michael Charlet, Ibrahim El-Abbassi No Product/Research Disclosure Information

早期气管插管对心肺复苏抢救窒息病人的临床意义

目的：探讨早气管插管对提高急诊窒息病人心肺复苏(CPR)成功率的影响。方法：回顾性分析2008年2月到2015年2月两所医院急诊救治的86例因窒息导致心脏骤停患者。其中心脏骤停后胸外按压5分钟内给予气管插管术48例，超过5分钟以上时间给予气管插管术38例。所有病例均施与人工胸外心脏按压，肾上腺素静注，以及在适应症范围内电击复律等抢救措施。结果：因窒息导致的心脏骤停5分钟内给予气管插管术的48例中，32例复苏成功，成功率67%，有效43例(90%)；超过5分钟以上时间给予气管插管术的38例中,抢救成功3例(8%)，有效20例(53%)。结论：因窒息导致心脏骤停的病人早期进行气管插管术配合常规心肺复苏处理提高了心肺复苏的成功率。 Objective: To investigate the success rate of cardiopulmonary resuscitation by early endotracheal intubation for patients with asphyxia in emergency treatment. Methods: Retrospective analysis of clinical data from 86 cardiac arrest patients caused by asphyxia rescued in emergency room in two hospitals during the course from February 2008 to February 2015. Among these patients, 48 patients were treated with endotracheal intubation within 5 minutes of chest compression after heart arrest and 38 patients were given the same treatment after 5 minutes of chest compression. All patients were offered chest compressions, intravenous epinephrine, cardioversion and other life support treatments within indications. Results: 32 of 48 patients were successfully rescued with endotracheal intubation within 5 minutes (67% of successful rate) and 43 of 48 patients were responded by the same treatment (90% of response rate). In contrast, 3 of 38 patients were suc-cessfully rescued with endotracheal intubation after 5 minutes (8% of successful rate) and 20 of 38 patients were responded by the same treatment (53% of response rate). Conclusion: Early phase endotracheal intubation combined with regular cardiopulmonary resuscitation increased the success rate of cardiopulmonary resuscitation for cardiac arrest patients caused by asphyxia.

Development of a standardized in-hospital cardiopulmonary resuscitation set-up

Objective. This study evaluated whether chest compression in a standardized in-hospital cardiopulmonary resuscitation (CPR) set-up can be performed as effec-tively as when the rescuer is kneeling be-side the patient lying on the floor. Specifi-cally, the in-hospital test was standardized according to the rescuers’ average knee height.Methods. Experimental intervention (test 1) was a standardized, in-hospital CPR set-up: first, the bed height was fixed at 70 cm. Second, the height difference between the bed and a step stool was set to the aver-age knee height of the CPR team members (45 cm). Control intervention (test 2) was kneeling on floor. Thirty-eight medical doctors on the CPR team each performed 2 minutes of chest compressions in test 1 and 2 in random order (cross-over trial). A Little Anne was used as a simulated patient who had experienced cardiac arrest. Chest compression parameters, such as average depth and rate, were measured using an ac-celerometer device.Results. In all tests, the average depths were those recommended in the most recent CPR guidelines (50–60 mm); there were no significant differences between Tests 1 and 2 (53.1 ± 4.3 mm vs. 52.6 ± 4.8 mm, respec-tively; p = 0.398). The average rate in Test 2 (119.1 ± 12.4 numbers/min) was slightly faster than that in Test 1 (116.4 ± 10.2 num-bers/min; p = 0.028). No differences were observed in any other parameters. Conclusions. Chest compression quality in our standardized in-hospital CPR set-up was similar with that performed in a kneel-ing position on the floor.Trial Registration: Clinical Research Infor-mation Service: KCT0001599