The results of EuReCa ONE highlight that OHCA is still a major public health problem accounting for a substantial number of deaths in Europe. EuReCa ONE very clearly demonstrates marked differences in the processes for data collection and reported outcomes following OHCA all over Europe. Using these data and analyses, different countries, regions, systems, and concepts can benchmark themselves and may learn from each other to further improve survival following one of our major health care events.
SummaryIn a randomised, non-crossover study, we tested the hypothesis that the ease of insertion using a duodenal tube guided insertion technique and the oropharyngeal leak pressure differ between the LMA ProSeal TM and the i-gel TM in non-paralysed, anesthetised female subjects. One hundred and fifty-two females aged 19-70 years were studied. Insertion success rate, insertion time and oropharyngeal leak pressure were measured. First attempt and overall insertion success were similar (LMA ProSeal, 75 ⁄ 76 (99%) and 76 ⁄ 76 (100%); i-gel 73 ⁄ 75 (97%) and 75 (100%), respectively). Mean (SD) insertion times were similar (LMA ProSeal, 40 (16) s; i-gel 43 (21) s). Mean oropharyngeal leak pressure was 7 cmH 2 O higher with the LMA ProSeal (p < 0.0001). Insertion of the LMA ProSeal and i-gel is similarly easy using a duodenal tube guided technique, but the LMA ProSeal forms a more effective seal for ventilation. . In the following randomised, non-crossover study, we tested the hypothesis that the ease of guided insertion and the oropharyngeal leak pressure differ between the LMA ProSeal and the i-gel in non-paralysed, anaesthetised females.
MethodsEthical Committee approval and written informed consent were obtained. One hundred and fifty-two consecutive female patients (ASA physical status grade 1-2, aged 19-70 years) undergoing elective gynaecological or orthopaedic surgery in the supine position were studied. Patients were randomly assigned to have either the LMA ProSeal (n = 76) or i-gel (n = 76) for airway management. Randomisation was by thoroughly mixing 152 opaque sealed envelopes, each containing the name of a device on an identical sheet of inwardly folded paper. The device was assigned by opening a randomly selected envelope. Patients were excluded if they were < 19 years old, had a known or predicted difficult airway, a body mass index > 35 kg.m )2 , or were at risk of aspiration. All cases were conducted by one of five anaesthetists with substantial experience of both devices using non-guided techniques (75-500 uses) but limited experience of using a guided technique (5-10 uses).
SummaryThe i-gel TM and LMA Supreme TM are extraglottic airway devices with non-inflatable and inflatable cuffs, respectively.We hypothesised that directly measured mucosal pressures would differ between these devices in anesthetised paralysed patients. Thirty patients were randomly allocated to receive one of these two devices. Four pressure sensors were attached to all airway devices used to measure mucosal pressure at the base of the tongue, the distal oropharynx, the hypopharynx and the pyriform fossa. At these four places, median ( There were no pressure differences between the locations for the i-gel.
For the HEMS in this study, there has been an increasing number of calls for help from persons involved in outdoor leisure activities. As the number of life-threatening injuries declines, HEMSs more frequently serve as means of rescue rather than as providers of emergency treatment.
We investigated the hypothesis that the oropharyngeal leak pressure would differ between the GuardianCPV TM and the LMA Supreme TM in anaesthetised patients. We randomly assigned 120 patients to receive either the GuardianCPV or the LMA Supreme for airway management. Oropharyngeal leak pressure was measured during cuff inflation from 0 to 40 ml in 10-ml steps. In addition, intracuff pressure, fibreoptic position of the airway and drain tube, device insertion success, ventilation success, blood staining and airway morbidity were determined. Mean (SD) oropharyngeal leak pressures for clinically acceptable cuff volumes of 20-40 ml were 31 (7) cmH 2 O for the GuardianCPV and 27 (7) cmH 2 O for the LMA Supreme (p < 0.0001); mean (SD) intracuff pressures were 68 (33) cmH 2 O and 88 (43) cmH 2 O (p < 0.0001), respectively. We found no differences in device insertion success, ventilation success, fibreoptic position of the airway and drain tube, blood staining or airway morbidity. We conclude that the oropharyngeal leak pressure is better for the GuardianCPV than for the LMA Supreme in anaesthetised patients.
BackgroundAlthough the number of lung transplantations (LTx) performed worldwide for COVID-19 induced acute respiratory distress syndrome (ARDS) is still low, there is general agreement that this treatment can save a subgroup of most severly ill patients with irreversible lung damage. However, the true proportion of patients eligible for LTx, the overall outcome and the impact of LTx to the pandemic are unknown.MethodsA retrospective analysis was performed using a nationwide registry of hospitalised patients with confirmed severe acute respiratory syndrome coronavirus type 2 (SARS-Cov-2) infection admitted between January 1, 2020 and May 30, 2021 in Austria. Patients referred to one of the two Austrian LTx centers were analyzed and grouped into patients accepted and rejected for LTx. Detailed outcome analysis was performed for all patients who received a LTx for post-COVID-19 ARDS and compared to patients who underwent LTx for other indications.ResultsBetween January 1, 2020 and May 30, 2021, 39.485 patients were hospitalised for COVID-19 in Austria. 2323 required mechanical ventilation, 183 received extra-corporeal membrane oxygenation (ECMO) support. 106 patients with severe COVID-19 ARDS were referred for LTx. Of these, 19 (18%) underwent LTx. 30-day mortality after LTx was 0% for COVID-19 ARDS transplant recipients. With a median follow-up of 134 (47–450) days, 14/19 patients are alive.ConclusionsEarly referral of ECMO patients to a LTx center is pivotal in order to select patients eligible for LTx. Transplantation offers excellent midterm outcomes and should be incorporated in the treatment algorithm of post-COVID-19 ARDS.
Rapid procedures are preferred to sustained on-scene treatment, particularly when surrounding conditions are hostile. HEMS emergency physicians attempt to keep on-site intervals short and treatment and monitoring to the essential to minimize delay in rescue.
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