ABSTRACT
Consciousness or signs of life may be seen during cardiopulmonary resuscitation (CPR), without return of spontaneous circulation. Such CPR-induced consciousness includes breathing efforts, eye opening, movements of extremities or communication with the rescuers. The consciousness may be CPR-interfering or non-interfering, and typically ends when the resuscitation efforts end. Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a potential adjunct treatment to CPR and may increase the arterial blood pressure. We present a case where REBOA increased the arterial blood pressure to the extent that CPR-induced consciousness was seen.
ABSTRACT
Background: During cardiopulmonary resuscitation (CPR) cerebral blood flow may be sufficient to restore some cerebral function, and CPR-induced consciousness (CPRIC) may occur. CPRIC includes signs of life such as gasping, breathing efforts, eye opening, movements of extremities or communication with the rescuers. There is a lack in evidence for prevalence, experience, and possible treatment strategies for CPRIC. This survey aimed to assess prehospital anaesthesiologists experience with CPRIC in Norway. Methods: A web-based cross-sectional survey. All physicians working at a Norwegian air ambulance, search-and-rescue base or physician-staffed rapid response car were invited to participate. Result: Out of 177 invited, 115 responded. All were anaesthesiologist, with mean 12.7 (SD 7.2) years of prehospital experience, and 25% had attended more than 200 out-of-hospital cardiac arrests (OHCA). CPRIC was known amongst most physicians prior to the survey and experienced by 91%. Mechanical compression device was used in 79% of cases. The CPRIC were CPR-interfering in 31% of cases. Next-of-kin reported the CPRIC as upsetting in 5% of cases. Medication and/or physical restraint were administered in 75% patients. For patients with CPRIC 50% answered that sedation was needed. If sedation should be provided, 62% answered that this should only be performed by a physician, while 25% answered that both ambulance crew and physicians could provide sedation. Fentanyl, ketamine, and midazolam were suggested as the most appropriate sedation agents. Conclusion: This nationwide survey indicates that CPRIC during OHCA are well known amongst prehospital anaesthesiologist in Norway. Most patients with CPRIC were treated with chest compression device. Most physicians recommend sedation of patients with CPRIC during resuscitation.
ABSTRACT
OBJECTIVES: Dispatching helicopter emergency medical services (HEMS) to the patients with the greatest medical or logistical benefit remains challenging. The introduction of video calls (VC) in the emergency medical communication centres (EMCC) could provide additional information for EMCC operators and HEMS physicians when assessing the need for HEMS dispatch. The aim of this study was to evaluate the impact from VC in the EMCC on HEMS dispatch precision. DESIGN: An observational before-after study. SETTING: The regional EMCC and one HEMS base in Mid-Norway. PARTICIPANTS: EMCC operators and HEMS physicians at the EMCC and HEMS base in Trondheim, Norway. INTERVENTION: In January 2022, VC became available in emergency calls in Trondheim EMCC. Data were collected from 2020 2021 (pre-intervention) and 2022 (post-intervention). PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was the proportion of seriously ill or injured HEMS patients, defined as a National Advisory Committee for Aeronautics (NACA) score between 4 and 7. The secondary outcome was the proportion of inappropriate dispatches, defined as missions with neither provision of additional competence nor any logistical contribution based on quality indicators for physician-staffed emergency medical services. RESULTS: 811 and 402 HEMS missions with patient contact were included in the pre- and post-intervention group, respectively. The proportion of missions with NACA 4-7 was not significantly changed after the intervention (OR 1.21, 95% CI 0.92 to 1.61, p=0.17). There was no significant change in HEMS alarm times between the pre- and post-intervention groups (7.6 min vs 6.4 min, p=0.15). The proportion of missions with neither medical nor logistical benefit was significantly lower in the post-intervention group (28.4% vs 40.3%, p=0.007). CONCLUSION: The results from this study indicate that VC is a promising, feasible and safe tool for EMCC operators in the complex HEMS dispatch process.
Subject(s)
Air Ambulances , Emergency Medical Services , Humans , Controlled Before-After Studies , Emergency Medical Services/methods , Aircraft , Norway , Communication , Retrospective StudiesABSTRACT
BACKGROUND: Due to unwanted delays and suboptimal resource control of helicopter emergency medical services (HEMS), regional HEMS coordinators have recently been introduced in Norway. This may represent an unnecessary link in the alarm chain, which could cause delays in HEMS dispatch. Systematic evaluations of this intervention are lacking. We wanted to conduct this study to assess possible changes in HEMS response times, mission distribution patterns and patient characteristics within our region following this intervention. METHODS: We retrospectively collected timeline parameters, patient characteristics and GPS positions from HEMS missions executed by three regional HEMS bases in Mid-Norway during 2017-2018 (preintervention) and 2019 (postintervention). The mean regional response time in HEMS missions was assessed by an interrupted time series analysis (ITS). The geographical mission distribution between regional HEMS resources was assessed by a before-after study with a convex hull-based method. RESULTS: There was no significant change in the level (-0.13 min/month, p = 0.88) or slope (-0.13 min/month, p = 0.30) of the mean regional response time trend line pre- and postintervention. For one HEMS base, the service area was increased, and the median mission distance was significantly longer. For the two other bases, the service areas were reduced. Both the mean NACA score (4.13 ± SD 0.027 vs 3.98 ± SD 0.04, p < 0.01) and the proportion of patients with severe illness or injury (NACA 4-7, 68.2% vs 61.5%, p < 0.001) were higher in the postintervention group. CONCLUSION: The introduction of a regional HEMS coordinator in Mid-Norway did not cause prolonged response times in acute HEMS missions during the first year after implementation. Higher NACA scores in the patients treated postintervention suggest better selection of HEMS use.
Subject(s)
Air Ambulances , Emergency Medical Services , Aircraft , Emergency Medical Services/methods , Humans , Reaction Time , Retrospective StudiesABSTRACT
OBJECTIVE: Efforts to optimize the use, availability, and safety of helicopter emergency medical services (HEMS) is important. A lack of consistent and comprehensive flight dispatch procedures and a lack of use of safety technology are recurring safety problems. Reports after several major incidents pointed toward a possible gain by coordinating Norwegian HEMS from regional emergency medical communication centrals. Our objective was to develop and implement relevant quality indicators before such implementation in central Norway. METHODS: We recruited an expert panel of 24 persons representing Norwegian health authorities, emergency medical communication centrals, and HEMS bases and performed a 3-step e-mail-based Delphi process to develop relevant quality indicators. Each indicator was assessed according to their feasibility, rankability, actionability, and variability. To reach a consensus, a median score of 5 or more on a 6-point Likert scale in step 3 was needed. RESULTS: A total of 61 quality indicators were proposed. Of the 14 indicators that reached a consensus, 12 of these were considered process indicators, and 2 were bordering to outcome indicators. CONCLUSION: We applied a Delphi process method to develop quality indicators for HEMS coordination and flight following. An experienced and heterogeneous expert panel suggested and reached a consensus on which quality indicators should be applied.
