The impact of introducing real time feedback on ventilation rate and tidal volume by ambulance clinicians in the North East in cardiac arrest simulations.

BACKGROUND: Research suggests rescuers deliver ventilations outside of recommendations during out of hospital cardiac arrest (OHCA), which can be deleterious to survival. We aimed to determine if ambulance clinician compliance with ventilation recommendations could be improved using the Zoll Accuvent real time ventilation feedback device (VFD). METHODS: Participants simulated a two-minute cardiac arrest scenario using a mannequin and defibrillator without ventilation feedback. Eligible for inclusion were all clinicians aged ≥18 years who perform cardiopulmonary resuscitation (CPR) as part of their role, who had completed an internal advanced life support (ALS) refresher. Following familiarisation of a few minutes with the VFD, participants repeated the two-minute scenario with ventilation feedback. Ventilation rate and volume and CPR quality were recorded. Primary outcome was % difference in ventilation compliance with and without feedback. Secondary outcomes were differences between paramedic and non-paramedic clinicians and compliance with chest compression guidelines. RESULTS: One hundred and six participants completed the study. Median ventilation rate without feedback was 10 (IQR 8-14, range 4-30) compared to 9 (IQR 9-9, range 6-17) with feedback; median tidal volume without feedback was 630 mls (IQR 518-725, range 201-1114) compared to 546 mls (IQR 531-560, range 490-750) with feedback. Proportion of clinicians ≥50% compliant with European Resuscitation Council ventilation recommendations were significantly greater with ventilation feedback compared to without, 91% vs. 9%, (McNemars test p = <0.0001). Paramedics out performed non-paramedic clinicians with and without feedback and compression quality was not compromised by using the VFD. CONCLUSIONS: Ambulance clinician baseline ventilation quality was frequently outside of recommendations, but a VFD can ensure treatment is within evidence-based recommendations. Further research is required to validate the use of the VFD in true clinical practice and to evaluate the relationship between improved ventilation quality during OHCA and patient outcomes.

Call to hospital times for suspected stroke patients in the North East of England: a service evaluation.

INTRODUCTION: Stroke is a leading cause of mortality and morbidity. The role of the ambulance service in acute stroke care focuses on recognition followed by rapid transport to specialist care. The treatment options for acute ischaemic strokes are time dependent, so minimising the pre-hospital phase of care is important. The aim of this service evaluation was to report historical pre-hospital times for suspected stroke patients transported by the North East Ambulance Service NHS Foundation Trust (NEAS) and identify areas for improvement. METHODS: This was a retrospective service evaluation using routinely collected data. Data on overall call to hospital times, call to arrival times, on scene times and leave scene to hospital are reported. RESULTS: Data on 24,070 patients with an impression of stroke transported by NEAS between 1 April 2011 and 31 May 2018 are reported. The median call to hospital time increased from 41 to 68 minutes, call to arrival from 7 to 17 minutes, on scene from 20 to 30 minutes and leave to hospital from 12 to 15 minutes. CONCLUSION: The pre-hospital call to hospital time for stroke patients increased between 2011 and 2018. The call to arrival phase saw a sharp increase between 2015 and 2017, whereas on scene and leave scene to hospital saw steadier increases. Increasing demand on the ambulance service, reorganisation of regional stroke services and other factors may have contributed to the increase in times. Reducing the on scene phase of pre-hospital stroke care would lead to patient benefits and is the area where ambulance clinicians have the most influence.

Tetranuclear group 7/8 mixed-metal and open trinuclear group 7 metal carbonyl clusters bearing bridging 2-mercapto-1-methylimidazole ligands.

The reactivity of group 7 metal dinuclear carbonyl complexes [M(2)(CO)(6)(mu-SN(2)C(4)H(5))(2)] (1, M = Re; 2, M = Mn) toward group 8 metal trinuclear carbonyl clusters were examined. Reactions of 1 and 2 with [Os(3)(CO)(10)(NCMe)(2)] in refluxing benzene furnished the tetranuclear mixed-metal clusters [Os(3)Re(CO)(13)(mu(3)-SN(2)C(4)H(5))] (3) and [Os(3)Mn(CO)(13)(mu(3)-SN(2)C(4)H(5))] (4), respectively. Similar treatment of 1 and 2 with Ru(3)(CO)(12) yielded the ruthenium analogs [Ru(3)Re(CO)(13)(mu(3)-SN(2)C(4)H(5))] (5), and [Ru(3)Mn(CO)(13)(mu(3)-SN(2)C(4)H(5))] (6), but in the case of 2 a secondary product [Mn(3)(CO)(10)(mu-Cl)(mu(3)-SN(2)C(4)H(5))(2)] (7) was also formed. Compounds have a butterfly core of four metal atoms with the M (Mn or Re) at a wingtip of the butterfly and containing a noncrystallographic mirror plane of symmetry. This result provides a potential method for the synthesis of a series of new group 7/8 mixed metal complexes containing a bifunctional heterocyclic ligand. Compound 7 is a unique example of a 54-electron trimanganese complex having bridging 2-mercapto-1-methylimidazolate and chloride ligands. Interestingly, the reaction of 1 with Fe(3)(CO)(12) at 70-75 degrees C furnished the tri- and dirhenium complexes [Re(3)(CO)(10)(mu-H)(mu(3)-SN(2)C(4)H(5))(2)] (8) and [Re(2)(CO)(6)(N(2)C(4)H(5))(mu-SN(2)C(4)H(5))(2)] (9), respectively instead of the expected formation of the mixed-metal clusters. The former is an interesting example of a 52-electron trirhenium-hydridic complex containing bridging 2-mercapto-1-methylimidazolate ligand, while the latter can be viewed as a 1-methylimidazole adduct of 1 . No mixed Fe-Re complexes were produced in this reaction. The molecular structures of the new compounds and were established by single-crystal X-ray diffraction analyses and the DFT studies of compounds , and are reported.