Survival from Out-of-Hospital Cardiac Arrest - Comparing the Automated LUCAS-2 Device and Manual CPR.

INTRODUCTION: Competency in and understanding of the factors impacting cardiopulmonary resuscitation (CPR) are key to emergency medicine. The purpose of this study was to assess the impact of the automated LUCAS-2 device on survival to emergency department (ED) compared to manual CPR as part of the EMS response using a large data set collected in a mostly rural U.S. state. METHODS: We conducted a retrospective analysis of South Dakota's electronic Patient Care Reports (ePCR) collected from Jan. 1, 2013 through Dec. 31, 2015. The primary outcome measure was survival to ED. RESULTS: A mechanical piston device (LUCAS-2), was utilized in 260 (15 percent) of 1,781 total cases during this period. The odds for survival to ED were calculated and compared between manual and LUCAS-2-assisted CPR. The odds ratio for survival to ED using compressions alone was 3.94 compared to LUCAS-2 and those results persisted after adjusting for significant covariates. DISCUSSION: Despite hemodynamic benefits associated with the LUCAS-2 device in the laboratory and in other settings, this and other studies indicate that compression-only CPR outperforms automation-assisted CPR during OHCA. However, the data also suggest that enhanced training of emergency providers to improve response times and levels of expertise with the equipment may improve the outcomes associated with the LUCAS-2 and it is recommended that further training should be pursued.

Using Data Science to Provide Preliminary Estimates of Out-of-Hospital Cardiac Arrest in Rural South Dakota.

BACKGROUND: Out-of-hospital cardiac arrest (OHCA) is the cessation of electric or mechanical activity of the heart, confirmed by absence of circulation. Survival to hospital dismissal rates have remained low nationwide despite considerable effort to improve treatment. Current initiatives seek systems approaches that optimize care at each point along the "chain of survival." Systems approaches rely on the availability of robust data sets to understand and control variables that can be highly interdependent. The current report seeks to provide a source of reliable data of OHCA for South Dakota. METHODS: Using the "Utstein" guidelines for reviewing and reporting OHCA resuscitations issued by the American Heart Association in 2014, we analyzed the EMS data that were captured by ePCR between January 1, 2013 and December 31, 2015. Inclusion criteria were 911 calls in 2013-2015, where first impression of the call was cardiac arrest. Exclusion criteria were inconsistent and missing data. RESULTS: There were 1,781 OHCA in the ePCR, and 1,280 cases had survival information, with 378 victims surviving to ED. Overall, SD OHCA rates were lower than those reported nationally. Survival was the highest in patients with a shockable rhythm and when victim received bystander CPR. The odds for survival were greater if the arrest took place in an urban setting compared to a rural setting and if the victim received care from an EMS unit that did not have a "hardship" designation. DISCUSSION: Recommendations for future efforts include: (1) Develop and employ quality improvement methodologies for data collection and utilization to minimize the impact of poor or missing data, (2) Assess the educational and training needs of the EMS staff to properly collect, analyze, and develop actionable outputs, (3) Provide public training to include hands-only CPR and PulsePoint.

Conservative Management of Ureteral Injury Caused by a Lumbar Osteophyte.

Background: Osteophytes are bony outgrowths commonly found on lumbar vertebrae. They rarely produce complications with the most common complication being nerve entrapment, but rarer complications including aorta or inferior vena cava rupture, superior mesenteric artery syndrome, compression of the iliopsoas muscle, and cerebrospinal fluid leaks have been described. Rare cases affecting the ureter resulting in ureteral colic or extravasation of urine have been described. Case Presentation: We describe a case in which a lumbar osteophyte bridging the L4 and L5 disks was encircling the ureter and minor trauma caused a ureteral injury, resulting in urine extravasation into the L4 and L5 disks space and the retroperitoneum. Owing to the comorbidities of this patient, this case was treated conservatively with stenting and the patient has suffered no further complications. Conclusion: This is a rare complication of a lumbar osteophyte but should be considered as a potential cause of ureter injury. Treatment should be individualized by patient preference and comorbidities, as some patients would elect to pursue more aggressive therapy whereas others would incline for conservative measures.