ABSTRACT
Introduction: The potential utility of apnoeic oxygenation combined with continuous chest compressions during cardiopulmonary resuscitation (CPR) is recognised in ERC Guidelines but is not routinely recommended. Case Presentation: A female 73 years old patient, ASA PS 3, with a recent hospitalization because of COVID 19, was scheduled for lung cancer staging mediastinoscopy. After anesthesia induction, patient exhibited difficult ventilation due to increased airway pressures. Direct bronchoscopy with a fiberoptic bronchoscope was conducted, which revealed trachea compression due to an extra tracheal tumor at the level of the carina. Initially, tumor debulking was attempted with the fiberoptic bronchoscope and, thereafter, with the rigid one. During those attempts, patient suffered a pulseless electrical activity (PEA) cardiac arrest (CA). Immediate CPR with chest compressions was performed. Tracheal occlusion was negotiated with the help of the rigid bronchoscope and apnoeic oxygenation was applied since ventilation with the anesthesia ventilator was not effective (Fig. 1). Chest compressions qualitywas evaluatedby usingdata fromthearterial pressure waveform (Fig. 2). Return of spontaneous circulation (ROSC) was achieved after 10 min CPR and administration of 2 mg of epinephrine. AfterROSC, oral endotracheal intubationwas accomplished and patient was transferred to the ICU (Fig. 3). She remained under sedation for 24hrs and was extubated after 30hrs in good condition. PaCO2 after ROSC was 120mmHg compared to 55 mHg before CA, whereas PaO2 was 230 mmHg compared to 250 mmHg before CA. (Figure Presented) Conclusions: Apnoeic oxygenation is awell-established technique since many years1. It can be combined with several other techniques, can be applied in various clinical settings and is an oxygenation alternative during CPR2
ABSTRACT
Purpose: “KIDS SAVE LIVES” is a suggested training program by European Resuscitation Council (ERC) and aims to educate all children in First Aid. We aimed to present the results of KIDS SAVE LIVES training program for the period 2016–2019. Methods: The Humanitarian Organisation “KIDS SAVE LIVES -Tα Παιδιά Σώζουν Zωέζ” and the Hellenic Society of Emergency Prehospital Care set up a plan for establishing mandatory education of schoolchildren over 10 years old in CPR. Having the approval of Greek Ministry of Education, the aforementioned Organisations implemented CPR training in primary and secondary schools. Results: After 4 years of KIDS SAVE LIVES initiation in Greece, 53,793 schoolchildren ≥10 yrs, teachers, and parents were trained in 559 schools (46,217, 6681 and 895 accordingly). Today, Greece is the country with the youngest certified Instructors in Europe (100 BLS Provider and Instructor courses in schools). 18 victims of OHCA resuscitated by trained bystanders and Nefeli, is the first child that resuscitated an OHCA victim;6 volunteers resuscitated 12 choking victims. Moreover, the program has been achieved the establishment of 140 public AEDs, the creation of an application with the location of 442 AEDs, the national school CPR championship, the Virtual Reality-CPR training, and online lessons of students due to COVID-19 prevention measures. The official law proposal for the establishment of CPR training as a basic school subject has already applied to the Ministry of Education. The pilot phase is expected to begin in September of 2020 with the initiation of CPR lessons by teachers who have been trained by our program. Conclusion: KIDS SAVE LIVES course is a successful method for mass training events. Incorporating training into the mandatory education syllabus, will facilitate the formation of a pool of young promising rescuers and contributing so to the future improvement of survival after OHCA.