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By Terren Trott
Graham Nichol, Brian Leroux, Henry Wang, Clifton W Callaway, George Sopko, Myron Weisfeldt, Ian Stiell, Laurie J Morrison, Tom P Aufderheide, Sheldon Cheskes, Jim Christenson, Peter Kudenchuk, Christian Vaillancourt, Thomas D Rea, Ahamed H Idris, Riccardo Colella, Marshal Isaacs, Ron Straight, Shannon Stephens, Joe Richardson, Joe Condle, Robert H Schmicker, Debra Egan, Susanne May, Joseph P Ornato
BACKGROUND: During cardiopulmonary resuscitation (CPR) in patients with out-of-hospital cardiac arrest, the interruption of manual chest compressions for rescue breathing reduces blood flow and possibly survival. We assessed whether outcomes after continuous compressions with positive-pressure ventilation differed from those after compressions that were interrupted for ventilations at a ratio of 30 compressions to two ventilations. METHODS: This cluster-randomized trial with crossover included 114 emergency medical service (EMS) agencies...
December 3, 2015: New England Journal of Medicine
Akihiro Kobayashi, Naoki Misumida, Shunsuke Aoi, Eric Steinberg, Kathleen Kearney, John T Fox, Yumiko Kanei
BACKGROUND: Emergency medical services (EMS) transportation is associated with shorter door-to-balloon (DTB) time in patients with ST-segment elevation myocardial infarction (STEMI). In addition to EMS transportation, prehospital notification of STEMI by EMS to receiving hospital might be able to further shorten DTB time. We evaluated the impact of STEMI notification on DTB time as well as infarct size. METHODS: We performed a retrospective analysis of consecutive patients with anterior wall STEMI who underwent emergent coronary angiography...
August 2016: American Journal of Emergency Medicine
Judith L Bonnes, Marc A Brouwer, Eliano P Navarese, Dominique V M Verhaert, Freek W A Verheugt, Joep L R M Smeets, Menko-Jan de Boer
STUDY OBJECTIVE: Mechanical chest compression devices have been developed to facilitate continuous delivery of high-quality cardiopulmonary resuscitation (CPR). Despite promising hemodynamic data, evidence on clinical outcomes remains inconclusive. With the completion of 3 randomized controlled trials, we conduct a meta-analysis on the effect of in-field mechanical versus manual CPR on clinical outcomes after out-of-hospital cardiac arrest. METHODS: With a systematic search (PubMed, Web of Science, EMBASE, and the Cochrane Libraries), we identified all eligible studies (randomized controlled trials and nonrandomized studies) that compared a CPR strategy including an automated mechanical chest compression device with a strategy of manual CPR only...
March 2016: Annals of Emergency Medicine
Mark Dixon, Joseph O'Halloran, Ailish Hannigan, Scott Keenan, Niamh M Cummins
BACKGROUND: Spinal immobilisation during extrication of patients in road traffic collisions is routinely used despite the lack of evidence for this practice. In a previous proof of concept study (n=1), we recorded up to four times more cervical spine movement during extrication using conventional techniques than self-controlled extrication. OBJECTIVE: The objective of this study was to establish, using biomechanical analysis which technique provides the minimal deviation of the cervical spine from the neutral in-line position during extrication from a vehicle in a larger sample of variable age, height and mass...
December 2015: Emergency Medicine Journal: EMJ
Priyamvada Paudyal, Jason Smith, Maria Robinson, Adrian South, Ian Higginson, Adam Reuben, Julian Shaffee, Sarah Black, Stuart Logan
OBJECTIVE: To carry out a prospective evaluation of tranexamic acid (TXA) use in trauma patients. PATIENTS AND METHODS: TXA was introduced to all emergency ambulances and emergency departments in the South West, UK, on 1 December 2011. We carried out a prospective evaluation of TXA use in trauma patients in the South West Peninsula between December 2011 and December 2012. We collected prehospital and hospital data on TXA administration using the Trauma Audit Research Network database...
February 2017: European Journal of Emergency Medicine: Official Journal of the European Society for Emergency Medicine
Craig Goolsby, Andrew Branting, Elizabeth Chen, Erin Mack, Cara Olsen
OBJECTIVES: The objective was to determine whether just-in-time (JiT) instructions increase successful tourniquet application by laypersons. METHODS: This was a randomized pilot study conducted in August 2014. The study occurred at the Uniformed Services University campus in Bethesda, Maryland. A total of 194 volunteers without prior military service or medical training completed the study. The participant stood in front of a waist-down mannequin that had an exposed leg...
September 2015: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Christian Martin-Gill, Max Wayne, Francis X Guyette, Oladipupo Olafiranye, Catalin Toma
Remote ischemic peri-conditioning (RIPC) has gained interest as a means of reducing ischemic injury in patients with acute ST-elevation myocardial infarction (STEMI) who are undergoing emergent primary percutaneous coronary intervention (pPCI). We aimed to evaluate the feasibility, process, and patient-related factors related to the delivery of RIPC during air medical transport of STEMI patients to tertiary pPCI centers. We performed a retrospective review of procedural outcomes of a cohort of STEMI patients who received RIPC as part of a clinical protocol in a multi-state air medical service over 16 months (March 2013 to June 2014)...
2016: Prehospital Emergency Care
John H Chi, M Margaret Knudson, Mary J Vassar, Mary C McCarthy, Michael B Shapiro, Susan Mallet, John J Holcroft, Hugh Moncrief, Jennifer Noble, David Wisner, Krista L Kaups, Lynn D Bennick, Geoffrey T Manley
BACKGROUND: The goals of this study were to determine the incidence and duration of hypotension and hypoxia in the prehospital setting in patients with potentially survivable brain injuries, and to prospectively examine the association of these secondary insults with mortality and disability at hospital discharge. METHODS: Trauma patients with suspected brain injuries underwent continuous blood pressure and pulse oximetry monitoring during helicopter transport. Postadmission inclusion criteria were (1) diagnosis of acute traumatic brain injury (TBI) confirmed by computed tomography (CT) scan, operative findings, or autopsy findings; and (2) Head Abbreviated Injury Scale (AIS) score of > or = 3 or Glasgow Coma Scale (GCS) score of < or = 12 within the first 24 hours of admission...
November 2006: Journal of Trauma
G Franschman, S M Peerdeman, S Greuters, J Vieveen, A C M Brinkman, H M T Christiaans, E J Toor, G N Jukema, S A Loer, C Boer
The international Brain Trauma Foundation guidelines recommend prehospital endotracheal intubation in all patients with traumatic brain injury (TBI) and a Glasgow Coma Scale (GCS)< or =8. Close adherence to these guidelines is associated with improved outcome, but not all severely injured TBI patients receive adequate prehospital airway support. Here we hypothesized that guideline adherence varies when skills are involved that rely on training and expertise, such as endotracheal intubation. We retrospectively studied the medical records of CT-confirmed TBI patients with a GCS< or =8 who were referred to a level 1 trauma centre in Amsterdam (n=127)...
October 2009: Resuscitation
Sten Rubertsson, Erik Lindgren, David Smekal, Ollie Östlund, Johan Silfverstolpe, Robert A Lichtveld, Rene Boomars, Björn Ahlstedt, Gunnar Skoog, Robert Kastberg, David Halliwell, Martyn Box, Johan Herlitz, Rolf Karlsten
IMPORTANCE: A strategy using mechanical chest compressions might improve the poor outcome in out-of-hospital cardiac arrest, but such a strategy has not been tested in large clinical trials. OBJECTIVE: To determine whether administering mechanical chest compressions with defibrillation during ongoing compressions (mechanical CPR), compared with manual cardiopulmonary resuscitation (manual CPR), according to guidelines, would improve 4-hour survival. DESIGN, SETTING, AND PARTICIPANTS: Multicenter randomized clinical trial of 2589 patients with out-of-hospital cardiac arrest conducted between January 2008 and February 2013 in 4 Swedish, 1 British, and 1 Dutch ambulance services and their referring hospitals...
January 1, 2014: JAMA: the Journal of the American Medical Association
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