EMS World

OCT 2018

EMS World Magazine is the most authoritative source in the world for clinical and educational material designed to improve the delivery of prehospital emergency medical care.

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EMSWORLD.com | OCTOBER 2018 71 OCTOBER 29 - NOVEMBER 2, 2018 NASHVILLE, TENNESSEE Conclusion—No significant relationship existed between the operational order of first-line treatment and ROSC. A higher- than-expected proportion of patients in the sample received vasopressors as first-line treatment despite best practice-based protocols as determined by the American Heart Association. Impedance Threshold Devices and Mechanical CPR in Out-of-Hospital Cardiac Arrest: Does Any Combination Increase ROSC? Author: Ginny Renkiewicz, PhD(c), MHS, Paramedic Associate authors: Jared S. Moore, EMT, Emma L. Hand, EMT, Emily A. Burchette, BS, NRP, Stephen E. Taylor, MHS, CCEMT-P Introduction—Impedance threshold devices (ITDs) have been used in the treatment of out-of-hospital cardiac arrest (OHCA) by increasing circulation through negative pressurization during CPR. Mechanical CPR (mCPR) devices have also seen increased usage, despite questionable utility. Few studies have examined the concurrent use of both adjuncts in OHCA. Objective—To determine whether the use of an ITD coupled with either mechanical or manual CPR during the management of an OHCA increases the probability of return of spontaneous circulation (ROSC). Methods—A retrospective analysis of OHCA patients from July 2012 to June 2014 was conducted using data from the North Car- olina Prehospital Medical Information System (PreMIS). Patients greater than 18 years old who suffered an OHCA before or after EMS arrival were included. Descriptive statistics were used to analyze the overall sample, while logistic regression was used to analyze the relationship between ROSC and combinations of receipt of an ITD and type of CPR (mechanical vs. manual), while controlling for potential confounders. Results—A total of 15,395 patients met inclusion criteria, of which 9,241 (60.03%) were male; 10,507 (68.24%) were Cauca- sian; 5,947 (38.62%) received bystander CPR; 2,802 (18.2%) had a shockable presenting rhythm; and 5,832 (37.88%) achieved ROSC. ROSC was three times more likely in patients with shock- able presenting rhythms (OR 3.00, p<0.001) and 2.17 times more likely with the receipt of lay person and/or first responder CPR (OR 2.17, p<0.001). The odds of ROSC were 19% less likely with males (OR 0.81, p<0.001) and 35% and 29% less likely with the provision of mCPR with (OR 0.65, p<0.001) or without (OR 0.71, p=0.007) the use of an ITD respectively. Patient age and use of standard CPR in conjunction with an ITD were not statistically significant in this cohort. Conclusion—The achievement of ROSC was shown to be less likely in patients who received mCPR with or without the use of an ITD. As has been seen in previous studies, patients in this cohort directly benefited from the provision of lay person and/ or first responder CPR and were twice as likely to achieve ROSC when presenting in an initially shockable rhythm. These results might be useful for EMS resource allocation. Eect of Time of Day and EMS Performance Criteria on the Odds of Return of Spontaneous Circulation for Out-of-Hospital Cardiac Arrest Author: Ginny Renkiewicz, PhD(c), MHS, Paramedic Associate authors: N. Beiter, EM, Gregory B. Carr, Paramedic, Wills Dean, BS, NRP, David Newton, DrPH(c), MPH, NRP, A. Pyatt, EMT, Jenna Tuttle, MHS, NRP Introduction—Time of day might affect the expediency with which out-of-hospital cardiac arrest (OHCA) patients receive critical interventions. EMS professionals working extended shifts might be less likely to perform skills in a timely manner, and this delay in treatment might reduce the odds of achieving return of spontaneous circulation (ROSC) in the prehospital setting. Objective—To analyze time-of-day variation in the likelihood of attaining ROSC. Methods—A retrospective analysis of cardiac arrest patient records in the North Carolina Prehospital Medical Information System (PreMIS) database was conducted. Included were OHCAs occurring in adults between Jan. 1, 2012, and June 30, 2014. Excluded were traumatic arrests, unwitnessed arrests, arrests with on-scene termination of efforts, and records missing demographic or treatment variables. Time of day was stratified into morning (0700–1459), afternoon (1500–2259), and night (2300–0659) shifts. A logistic regression model for ROSC was fitted using time of day (referent=morning), demographic, and treatment variables as predictors. Results—This study analyzed a total of 8,779 cardiac arrest patients, of whom 2,889 (32.9%) achieved ROSC in the field. The proportions of patients attaining ROSC were 33.8%, 35.2%, and 27.6% for morning, afternoon, and night respectively. In com- parison to patients experiencing cardiac arrest during the morn- ing hours, patients arresting at night were less likely to attain ROSC (OR 0.804, p=0.00) while arrests occurring during the afternoon were not statistically different from morning arrests (OR 0.939, p=0.26). Females (OR 1.33, p=0.00), patients with shockable presenting rhythms (OR 2.64, p=0.00), and patients receiving bystander CPR (OR 1.90, p=0.00) were more likely to attain ROSC. Each additional year of age (OR 0.996, p=0.00), unwitnessed arrests (OR 0.313, p=0.00), and each additional minute of EMS response time (OR 0.964, p=0.00) reduced the likelihood of ROSC. Conclusion—Within the limitations of the study design, patients experiencing cardiac arrest at night were 20% less likely to attain ROSC after controlling for other confounding variables.

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