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Cardiac arrest transport

Joseph K Maddry, Eric M Ball, Daniel B Cox, Kathleen M Flarity, Vikhyat S Bebarta
Introduction: The U.S. Air Force utilizes specialized Critical Care Air Transport Teams (CCATT) for transporting "stabilized" patients. Given the drawdown of military forces from various areas of operation, recent CCATT operations have increasingly involved the evacuation of unstable and incompletely resuscitated patients from far forward, austere locations. This brief report describes unique cases representative of the evolving CCATT mission and provides future direction for changes in doctrine and educational requirements in preparation for en route combat casualty care...
December 7, 2018: Military Medicine
Demis Lipe, Al Giwa, Nicholas D Caputo, Nachiketa Gupta, Joseph Addison, Alexis Cournoyer
Background Patients suffering from an out-of-hospital cardiac arrest are often transported to the closest hospital. Although it has been suggested that these patients be transported to cardiac resuscitation centers, few jurisdictions have acted on this recommendation. To better evaluate the evidence on this subject, a systematic review and meta-analysis of the currently available literature evaluating the association between the destination hospital's capability (cardiac resuscitation center or not) and resuscitation outcomes for adult patients suffering from an out-of-hospital cardiac arrest was performed...
December 4, 2018: Journal of the American Heart Association
Peter Paal, Hermann Brugger, Giacomo Strapazzon
Accidental hypothermia causes profound changes to the body's physiology. After an initial burst of agitation (e.g., 36-37°C), vital functions will slow down with further cooling, until they vanish (e.g. <20-25°C). Thus, a deeply hypothermic person may appear dead, but may still be able to be resuscitated if treated correctly. The hospital use of minimally invasive rewarming for nonarrested, otherwise healthy patients with primary hypothermia and stable vital signs has the potential to substantially decrease morbidity and mortality for these patients...
2018: Handbook of Clinical Neurology
Ikuto Takeuchi, Hiroki Nagasawa, Kei Jitsuiki, Akihiko Kondo, Hiromichi Ohsaka, Youichi Yanagawa
Context/Aims: We retrospectively analyzed the characteristics of prehospital care for cardiopulmonary arrest (CPA) to identify the predictors of a good recovery (GR) among the recent changes in the management of Japanese prehospital care. Settings and Design: This study was a retrospective medical chart review. Subjects and Methods: We reviewed the transportation records written by emergency medical technicians and the characteristics of prehospital management of out-of-hospital (oh) CPA described by the Sunto-Izu Fire Department from April 2016 to March 2017...
July 2018: Journal of Emergencies, Trauma, and Shock
John Freese, Charles B Hall, Elizabeth A Lancet, Rachel Zeig-Owens, Mark Menegus, Norma Keller, Jeffrey Rabrich, Todd L Slesinger, Robert A Silverman, David J Prezant
Therapeutic hypothermia, the standard for post-resuscitation care of out-of-hospital sudden cardiac arrest (SCA), is an area that the most recent resuscitation guidelines note "has not been studied adequately." We conducted a two-phase study examining the role of intra-arrest hypothermia for out-of-hospital SCA, first standardizing the resuscitation and transport of patients to resuscitation centers where post-resuscitation hypothermia was required and then initiating hypothermia during out-of-hospital resuscitation efforts...
November 14, 2018: Therapeutic Hypothermia and Temperature Management
Paul R Banerjee, Latha Ganti, Paul E Pepe, Amninder Singh, Abhishek Roka, Raf A Vittone
AIM: To evaluate the frequency of neurologically-intact survival (SURV) following pediatric out-of-hospital cardiac arrest (POHCA) when comparing traditional early evacuation strategies to those emphasizing resuscitation efforts being performed on-scene. METHODS: Before 2014, emergency medical services (EMS) crews in a county-wide EMS agency provided limited treatment for POHCA on-scene and rapidly transported patients to appropriate hospitals. After 2014, training strongly enhanced EMS provider comfort levels with on-scene resuscitation efforts including methods to expedite protocols on-site and control positive-pressure ventilation...
November 6, 2018: Resuscitation
Jason M Hardwick, Sean D Murnan, Daphne P Morrison-Ponce, John J Devlin
IntroductionEmergency physicians are using bolus-dose vasopressors to temporize hypotensive patients until more definitive blood pressure support can be established. Despite a paucity of clinical outcome data, emergency department applications are expanding into the prehospital setting. This series presents two cases of field expedient vasopressor use by emergency medicine providers for preflight stabilization during aeromedical evacuation to a hospital ship as part of the United States Navy disaster response in Puerto Rico...
November 9, 2018: Prehospital and Disaster Medicine
Marion Moseby-Knappe, Niklas Mattsson, Niklas Nielsen, Henrik Zetterberg, Kaj Blennow, Josef Dankiewicz, Irina Dragancea, Hans Friberg, Gisela Lilja, Philip S Insel, Christian Rylander, Erik Westhall, Jesper Kjaergaard, Matt P Wise, Christian Hassager, Michael A Kuiper, Pascal Stammet, Michael C Jaeger Wanscher, Jørn Wetterslev, David Erlinge, Janneke Horn, Tommaso Pellis, Tobias Cronberg
Importance: Prognostication of neurologic outcome after cardiac arrest is an important but challenging aspect of patient therapy management in critical care units. Objective: To determine whether serum neurofilament light chain (NFL) levels can be used for prognostication of neurologic outcome after cardiac arrest. Design, Setting and Participants: Prospective clinical biobank study of data from the randomized Target Temperature Management After Cardiac Arrest trial, an international, multicenter study with 29 participating sites...
October 29, 2018: JAMA Neurology
Sergei Valkov, Rizwan Mohyuddin, Jan Harald Nilsen, Torstein Schanche, Timofey Kondratiev, Gary C Sieck, Torkjel Tveita
NEW FINDINGS: What is the central question of this study? Absence of hypothermia-induced cardiac arrest is a strong predictor for a favorable outcome after rewarming. Nevertheless, detailed knowledge of preferences in organ blood flow during rewarming with spontaneous circulation is largely unknown. What is the main finding and its importance? In a porcine model of accidental hypothermia, we find, despite a significantly reduced cardiac output during rewarming, normal blood flow and O2 supply in vital organs due to patency of adequate physiologic compensatory responses...
October 29, 2018: Experimental Physiology
Sriram Ramgopal, Sylvia Owusu-Ansah, Christian Martin-Gill
BACKGROUND: Pediatric patients attended to by emergency medical services (EMS) but not transported to the hospital are an at-risk population. We aimed to evaluate risk factors associated with nontransport by EMS in pediatric patients. METHODS: We reviewed medical records of 24 agencies in a regional EMS system in Southwestern Pennsylvania between January 1, 2014, and December 31, 2017. We abstracted demographics (age, sex, medical complaint, median household income by zip code, race, ethnicity), clinical characteristics (abnormal vital signs by age, procedures done), and transport characteristics...
October 29, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Nicolas Danchin, Etienne Puymirat, Guillaume Cayla, Yves Cottin, Pierre Coste, Martine Gilard, Patrick Goldstein, François Braun, Loic Belle, Gilles Montalescot, Jean Ferrières, François Schiele, Tabassome Simon
Background The optimal timing of administration of dual antiplatelet therapy (DAPT) in acute ST-segment-elevation myocardial infarction patients is debated. Clinical trials have failed to demonstrate the superiority of pretreatment with P2Y12 inhibitors in ST-segment-elevation myocardial infarction, but they were not designed to assess hard clinical end points. We used data from the FAST-MI (French Registry on Acute ST-Segment-Elevation or Non-ST-Segment-Elevation Myocardial Infarction) cohorts to determine 1-year survival and in-hospital outcomes in patients receiving DAPT, comparing prehospital versus in-hospital administration...
September 2018: Circulation. Cardiovascular Interventions
Hiromichi Ohsaka, Youichi Yanagawa, Hiroki Nagasawa, Ikuto Takeuchi, Kei Jitsuiki, Shunsuke Madokoro, Akihiko Kondo, Kouhei Ishikawa, Kazuhiko Omori
OBJECTIVE: In Japan, the main helicopters that transport patients are physician-staffed helicopters (known as doctor helicopters [DHs]) and firefighter/rescue helicopters (F/RHs). We report the collaboration between F/RHs and DHs in eastern Shizuoka Prefecture. METHODS: We retrospectively investigated all of the patients who were transported by F/RHs in Shizuoka Prefecture between January 2015 and April 2018. RESULTS: Nine cases were defined as subjects...
September 2018: Air Medical Journal
Mark Froats, Andrew Reed, Richard Dionne, Justin Maloney, Susan Duncan, Rob Burns, Julie Sinclair, Michael Austin
BACKGROUND: Most patients transferred from a non-percutaneous coronary intervention (PCI) facility for primary PCI do not meet target reperfusion times. Direct transportation of patients with ST-elevation myocardial infarction (STEMI) from the scene by advanced life support (ALS) paramedics has been shown to improve reperfusion times and outcomes. OBJECTIVE: The aim of this study was to determine whether it is safe to bypass the closest hospital and transport by basic life support (BLS) provider to a PCI facility...
October 9, 2018: Journal of Emergency Medicine
Kylie Dyson, Dion Stub, Stephen Bernard, Karen Smith
High-quality cardiopulmonary resuscitation, in particular chest compressions, is a key aspect of out-of-hospital cardiac arrest (OHCA) resuscitation. Manual chest compressions remain the standard of care; however, the extrication and transport of patients with OHCA undermine the quality of manual chest compressions and risk the safety of paramedics. Therefore, in circumstances whereby high-quality manual chest compressions are difficult or unsafe, paramedics should consider using a mechanical device. By combining high-quality manual chest compressions and judicious application of mechanical chest compressions, emergency medical service agencies can optimize paramedic safety and patient outcomes...
August 2018: Cardiology Clinics
J Nas, J Thannhauser, J J Herrmann, K van der Wulp, P M van Grunsven, N van Royen, M J de Boer, J L Bonnes, M A Brouwer
PURPOSE: Out-of-hospital cardiac arrests (OHCAs) are a major healthcare problem. Over the years, several initiatives have contributed to more lay volunteers providing cardiopulmonary resuscitation (CPR) and increased use of automated external defibrillators (AEDs) in the Netherlands. As part of a quality and outcomes program, we registered bystander CPR, AED use and outcome in the Nijmegen area. METHODS: Prospective resuscitation registry with a study cohort of non-traumatic OHCA cases from 2013-2016 and historical controls from 2008-2011...
October 2, 2018: Netherlands Heart Journal
Kyung Hune Cho, Jong-Hak Park, Sung Woo Moon, Seong-Keun Yun, Jin-Young Kim
OBJECTIVE: In South Korea, the Gyeonggi Fire Services introduced a multi-tiered dispatch system for out-of-hospital cardiac arrest (OHCA) cases in July 2015. In this study, we investigated whether the multi-tiered dispatch system improved the pre-hospital return of the spontaneous circulation (ROSC) rate. METHODS: All non-traumatic adult OHCAs treated and transported by the 119 emergency medical system from July 2015 to December 2015 were included in the study. Demographic and pre-hospital Utstein element-data were collected from the emergency medical system OHCA database...
September 2018: Clinical and Experimental Emergency Medicine
Emilie Gregers, Jesper Kjærgaard, Freddy Lippert, Jakob H Thomsen, Lars Køber, Michael Wanscher, Christian Hassager, Helle Søholm
BACKGROUND: The prognosis in refractory out-of-hospital cardiac arrest (OHCA) with ongoing cardiopulmonary resuscitation (CPR) at hospital arrival is often considered dismal. The use of extracorporeal cardiopulmonary resuscitation (eCPR) for perfusion enhancement during resuscitation has shown variable results. We aimed to investigate outcome in refractory OHCA patients managed conservatively without use of eCPR. METHODS: We included consecutive OHCA patients with refractory arrest or prehospital return of spontaneous circulation (ROSC) in the Copenhagen area in 2002-2011...
September 29, 2018: Critical Care: the Official Journal of the Critical Care Forum
R M Carrillo-Larco, M Moscoso-Porras, A Taype-Rondan, A Ruiz-Alejos, A Bernabe-Ortiz
Background: Unmanned aircraft vehicles (UAVs) have had a rapid escalation in manageability and affordability, which can be exploited in healthcare. We conducted a systematic review examining the use of drones for health-related purposes. Methods: A search was conducted in Medline, Embase, Global Health, Scopus, CINAHL and SciELO. Experimental studies were selected if the population included human subjects, the intervention was the use of UAVs and there was a health-related outcome...
2018: Global health, epidemiology and genomics
James Vassallo, Melanie Webster, Edward B G Barnard, Mark D Lyttle, Jason E Smith
OBJECTIVE: To describe the epidemiology and aetiology of paediatric traumatic cardiac arrest (TCA) in England and Wales. DESIGN: Population-based analysis of the UK Trauma Audit and Research Network (TARN) database. PATIENTS AND SETTING: All paediatric and adolescent patients with TCA recorded on the TARN database for a 10-year period (2006-2015). MEASURES: Patient demographics, Injury Severity Score (ISS), location of TCA ('prehospital only', 'in-hospital only' or 'both'), interventions performed and outcome...
September 27, 2018: Archives of Disease in Childhood
Jay S Shavadia, Matthew T Roe, Anita Y Chen, Joseph Lucas, Alexander C Fanaroff, Ajar Kochar, Christopher B Fordyce, James G Jollis, Jacqueline Tamis-Holland, Timothy D Henry, Akshay Bagai, Michael C Kontos, Christopher B Granger, Tracy Y Wang
OBJECTIVES: The aim of this study was to describe the prevalence of pre-hospital cardiac catheterization laboratory activation and its association with reperfusion timeliness and in-hospital mortality. BACKGROUND: For patients with ST-segment elevation myocardial infarction diagnosed in the field, catheterization laboratory pre-activation may lead to more timely reperfusion and improved outcomes. METHODS: A total of 27,840 patients with ST-segment elevation myocardial infarction transported via emergency medical services to 744 percutaneous coronary intervention-capable hospitals in the ACTION Registry from January 2015 to March 2017 were evaluated, excluding patients with cardiac arrest or requiring pre-percutaneous coronary intervention intubation...
September 24, 2018: JACC. Cardiovascular Interventions
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