The resource-limiting environment of the pre-hospital setting necessitates the continuous development of tools and interventions that maximise the capabilities of emergency medical services (EMS) municipalities. One such product developed by Zoll, the ResQCPR system, attempts to enhance the effectiveness of prehospital cardiopulmonary resuscitation (CPR). The ResQCPR system is comprised of the ResQPOD, which is an impedance threshold device (ITD), and the ResQPUMP, which is an assisted compression-decompression (ACD) device. Limited data exists regarding Zoll’s specific apparatuses as well as similar such devices. This systematic analysis comprehensively summarises a number of related studies. Their methods, limitations, results, and other aspects are outlined in the respective sections. Conclusion: This review concludes by determining that the effectiveness of the ResQPUMP, in particular (and ACD devices in general), is promising while the ResQPOD’s is uncertain. Future studies are needed to determine whether the effectiveness of the ResQPUMP markedly diminishes when used independently of the ResQPOD. This is an important feature for fire departments and other EMS municipalities because outfitting all appropriate units with both devices can be quite costly. Further studies are also needed to demonstrate reproducibility in humans (because 2 of the studies used pigs as test subjects) and with a greater amount of test subjects.
BackgroundDespite advances in resuscitation science and public health, out-of-hospital cardiac arrest (OOHCA) has an average survival rate of only 12% nationwide, compared to 24.8% of patients who suffer from cardiac arrest while in hospital. Additionally, gender is an important element of human health, and there is a clear pattern for gender-specific survivability in cardiac arrest. This study examined differences in presentations, treatment, management, and outcomes.AimThe primary focus of this study was to shed light on differences in presentations, treatments, and outcomes between men and women suffering from an out-of-hospital cardiac arrest and the accompanying contributing factors.MethodsAll emergency medical services-related data, including age, date, initial rhythm, chemical interventions (i.e., epinephrine, dextrose), blood glucose levels, defibrillations, endotracheal tube (ETT) attempts, final airway management, achievement of return of spontaneous circulation (ROSC), and the conclusion of the case up to the emergency department, were recorded using a standardized emergency medical services (EMS) charting record by the highest-ranking EMS provider on the ambulance. The reports were retrospectively collected and analyzed.ConclusionThe study examined demographics, treatments rendered, and outcomes in OOHCA cases that occurred in a major United States (US) city in 2016. Several significant differences in care were noted between men and women. In general, women received less respiratory, chemical, and electrical interventions than men; however, statistically significant differences were only observed in the number of attempts of endotracheal intubations, number of doses of epinephrine per encounter, and number of defibrillations per encounter. In spite of generally receiving less care, women appeared to respond more favorably to cardiac arrest interventions, as demonstrated by higher rates of ROSC. Despite this, women were also found to be eight years older at the time of arrest. Future studies are needed to determine causality in discrepancies between the genders in addition to investigating differences in treatment in other areas of the United States.
BackgroundDespite advances in resuscitation science and public health, out-of-hospital cardiac arrest (OOHCA) cases have an average survival rate of only 12% nationwide, compared to 24.8% of cases occurring in hospital. Many factors, including resuscitation interventions, contribute to positive patient outcomes and have, therefore, been studied in attempts to optimize emergency medical services (EMS) protocols to achieve higher rates of return of spontaneous circulation (ROSC) in the field. However, no consensus has been met regarding the appropriate amount of time for EMS to spend on scene.AimA favorable outcome is defined as patients that achieved the combination of ROSC and a final disposition of “ongoing resuscitation in the emergency department (ED).” The primary purpose of this preliminary study was to determine the scene time interval (STI) in which American urban EMS systems achieved the highest rates of favorable outcomes in non-traumatic OOHCAs.MethodsAll EMS-related data, including demographics, presenting rhythm, airway management, chemical interventions, and ROSC were recorded using a standardized EMS charting system by the highest-ranking EMS provider on the ambulance. The reports were retrospectively collected and analyzed.ConclusionOur data suggest that the optimal 20-minute STI for OOHCA patients in an urban EMS system is between 41 and 60 minutes. Interestingly, the 10-minute interval within the 41-60 minute cohort that provided the highest rate of ROSC was between 41 and 50 minutes. Generally, the longer the STI, the greater the percentage of favorable outcomes up to the 50-minute mark. Once past 50 minutes, a phenomenon of diminishing return was observed and the rates of favorable outcomes sharply declined. This suggests a possible “sweet spot” that may exist regarding the optimal scene time in a cardiac arrest encounter. Significant differences between the average number of interventions per patient were found, however, many confounding factors and the limited data set make the results difficult to generalize.
Leriche syndrome, a rare and critical complication of peripheral arterial disease (PAD), affects the distal abdominal aorta (infrarenal) and, similar to PAD, is a result of plaque buildup in the arterial lumen. The Leriche syndrome triad includes claudication in the proximal lower extremity, decreased or absent femoral pulses, and, in some cases, impotence. This article presents a patient with an atypical presentation of foot pain who was subsequently found to have Leriche syndrome. The patient was a 59-year-old female, a former smoker, who presented to the emergency department (ED) with atraumatic, acute right foot pain. All right lower extremity pulses were faintly audible on bedside Doppler. Computed tomography with angiography of the abdominal aorta revealed a Leriche-type occlusion of the infrarenal abdominal aorta and left common iliac and a 10 cm right popliteal arterial occlusion. Pharmacological anticoagulation was initiated by the ED. Definitive treatment in this patient included catheter-directed tissue plasminogen activator lysis to the thrombus on the right and placement of kissing stents in the distal aorta without complication. The patient made an excellent recovery and had a complete resolution of her symptoms. PAD is an omnipresent condition and, when untreated, can result in a myriad of high mortality and morbidity conditions such as Leriche syndrome. Collateral vessel formation can make the symptoms of Leriche syndrome vague and inconsistent, often making early recognition difficult. Optimal outcomes hinge on the clinician’s ability to efficiently recognize, diagnose, stabilize, and coordinate multidisciplinary involvement of vascular and interventional radiology specialties. Case reports such as this one help to illuminate some of the more infrequent presentations of Leriche syndrome.
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