ABSTRACT
In this prospective, observational study we describe the incidence and characteristics of out of hospital cardiac arrest (OHCA) cases who received mechanical CPR, after the implementation of a mechanical CPR device (LUCAS 2; Physio Control, Redmond, WA, USA) in a physician staffed helicopter emergency medical service (HEMS) in South Tyrol, Italy. During the study period (06/2013-04/2016), 525 OHCA cases were registered by the dispatch centre, 271 (51.6%) were assisted by HEMS. LUCAS 2 was applied in 18 (6.6%) of all HEMS-assisted OHCA patients; ten were treated with LUCAS 2 at the scene only, and eight were transported to hospital with ongoing CPR. Two (11.1%) of the 18 patients survived long term with full neurologic recovery. In seven of eight patients transferred to hospital with ongoing CPR, CPR was ceased in the emergency room without further intervention. Retrospectively, all HEMS-assisted OHCA cases were screened for proposed indication criteria for prolonged CPR. Thirteen patients fulfilled these criteria, but only two of them were transported to hospital. Based on these results, we propose a standard operating procedure for HEMS-assisted patients with refractory OHCA in a region without hospitals with ECLS capacity.
Subject(s)
Aircraft , Cardiopulmonary Resuscitation/instrumentation , Emergency Medical Services , Out-of-Hospital Cardiac Arrest/therapy , Physicians/supply & distribution , Adolescent , Adult , Aged , Female , Humans , Incidence , Italy/epidemiology , Male , Middle Aged , Out-of-Hospital Cardiac Arrest/epidemiology , Prospective Studies , Retrospective Studies , Workforce , Young AdultABSTRACT
BACKGROUND: Climbing is a popular sport in Switzerland, with approximately 100 000 active participants. There is an inherent risk of falls, overuse and stress-related trauma, with a reported injury rate of 4.2 injuries per 1000 climbing hours. OBJECTIVE: Comparison of possible risk factors in patients and noninjured controls. METHODS: A case-control survey was conducted. Climbers admitted to three trauma units between June and October 2008 were surveyed using a questionnaire evaluating nine potential risk factors. The same questionnaire was distributed to noninjured climbers during the same time period. Logistic regression was performed. RESULTS: Fifty patients and 63 controls were included in this survey. Variables significant for patients were: more than 10 years versus less than 1 year of climbing experience (odds ratio: 5.34; confidence interval: 1.16-17.76; P=0.006) and no previous experiences of the climbing route (odds ratio: 2.72; confidence interval: 1.15-6.39; P=0.022). No statistical significance was detected for age, sex, difficulty level of the climbing route, warm-up, readiness for risk and abstinence from alcohol and drugs. CONCLUSION: Climbers with higher experience seem to be more prone to injuries. Larger studies on this subgroup are warranted, to identify typical risk profiles and to develop preventive strategies. Furthermore, climbers should be advised about the increased injury risk when trying new climbing routes and specific information should be given.
