Tracheal intubation by paramedics under limited indication criteria may improve the short-term outcome of out-of-hospital cardiac arrests with noncardiac origin

Takei, Yutaka; Enami, Miki; Yachida, Takahiro; Ohta, Keisuke; Inaba, Hideo

doi:10.1007/s00540-010-0974-6

Cited by 27 publications

(17 citation statements)

References 23 publications

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“…4) Because tracheal intubation and adrenaline administration have been shown to affect the outcomes of OHCAs [16,[20][21][22][23], we analysed the effect of the project on the outcomes of OHCAs managed prior to hospital arrival without tracheal intubation or adrenalin administration. As shown in Fig.…”

Section: Resultsmentioning

confidence: 99%

“…2). In this term, we had a larger number of OHCAs, and the interval between the call and the arrival on the scene was significantly prolonged, presumably due to unusually heavy snowfall in this winter.The use of ACLS, including tracheal intubation and adrenaline administration, has been shown to affect the outcome of OHCAs [16,[20][21][22][23]. We compared the outcomes between the two time periods for OHCAs managed prior to hospital arrival without prehospital ACLS procedures because the incidence of ACLS was higher after the project.…”

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confidence: 99%

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The continuous quality improvement project for telephone-assisted instruction of cardiopulmonary resuscitation increased the incidence of bystander CPR and improved the outcomes of out-of-hospital cardiac arrests

et al. 2012

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(CQI) project for telephone-assisted cardiopulmonary resuscitation (telephone-CPR), which included instruction on chest-compression-only CPR, education on how to recognise out-of-hospital cardiac arrests (OHCAs) with agonal breathing, emesis and convulsion, recommendations for on-line or redialling instructions, and feedback from emergency physicians. This study aimed to investigate the effect of this project on the incidence of bystander CPR and the outcomes of OHCAs.Materials and Methods: The baseline data were prospectively collected on 4995 resuscitation-attempted OHCAs, which were recognised or witnessed by citizens rather than emergency medical technicians during the period of February 2004 to March 2010. The incidence of telephone-CPR and bystander CPR, as well as the outcomes of the OHCAs, were compared before and after the project.Results: The incidence of telephone-CPR and bystander CPR significantly increased after the project (from 42% to 62% and from 41% to 56%, respectively). The incidence of failed telephone-CPR due to human factors significantly decreased from 30% to 16%. The outcomes of OHCAs significantly improved after the projects. A multiple logistic regression analysis revealed that the CQI project is one of independent factors associated with one-year (1-Y) survival with favourable neurological outcomes (odds ratio = 1.81, 95% confidence interval = 1.20-2.76).Conclusions: The CQI project for telephone-CPR increased the incidence of bystander CPR and improved the outcome of OHCAs. A CQI project appeared to be essential to augment the effects of telephone-CPR.Keywords: Telephone-CPR; Continuous quality improvement; Cardiopulmonary resuscitation; Dispatcher; Emergency medical service; Out-of-hospital cardiac arrest INTRODUCTION Currently, medical control (MC) for the emergency medical service system (EMS) is active in Japan.However, MC, including education, is mainly targeted to emergency medical technicians (EMTs) and is rarely targeted to dispatchers in Japan. Since February 2004, the Ishikawa MC Council has requested that fire departments collect the reasons why dispatchers failed to provide telephone-assisted instruction on cardiopulmonary resuscitation (telephone-CPR). Telephone-CPR has been shown to increase the incidence of bystander CPR and is expected to improve the outcomes of out-of-hospital cardiac arrests (OHCAs) [1][2][3][4][5].There are no special qualifications or authorisations required for fire department staff to be dispatchers in Japan. Some dispatchers have no experience as EMTs. An educational program for dispatchers has not been established. In some fire departments, the actual condition of the OHCA patient, discovered by EMTs during a post-arrival interview, is not relayed back to the dispatchers.In March of 2007, the Ishikawa MC Council initiated the Continuous Quality Improvement (CQI) project for telephone-CPR. The project included the following: 1) a standardized manual for instruction on chest-compression-only CPR (CC-only CPR), 2) education on how to recognise OH...

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Section: Resultsmentioning

confidence: 99%

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confidence: 99%

The continuous quality improvement project for telephone-assisted instruction of cardiopulmonary resuscitation increased the incidence of bystander CPR and improved the outcomes of out-of-hospital cardiac arrests

et al. 2012

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“…Since July 2004, specially trained paramedics have been permitted to insert tracheal tubes under a limited indication criteria [14], and since April 2006, they have been permitted to administer intravenous adrenaline. In all fire departments, each ambulance is usually boarded with three or more EMTs including at least one paramedic.…”

Section: Populations and Settingmentioning

confidence: 99%

Does the number of rescuers affect the survival rate from out-of-hospital cardiac arrests? Two or more rescuers are not always better than one

et al. 2013

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Review: An increased number of rescuers may improve the survival rate from out-of-hospital cardiac arrests (OHCAs). The majority of OHCAs occur at home and are handled by family members.Materials and Methods: Data from 5,078 OHCAs that were witnessed by citizens and unwitnessed by citizens or emergency medical technicians from January 2004 to March 2010 were prospectively collected. The number of rescuers was identified in 4,338OHCAs and was classified into two (single rescuer (N=2,468) and multiple rescuers (N=1870)) or three (single rescuer, two rescuers (N=887) and three or more rescuers (N=983)) groups. The backgrounds, characteristics and outcomes of OHCAs were compared between the two groups and among the three groups.Results: When all OHCAs were collectively analysed, an increased number of rescuers was associated with better outcomes (one-year survival and one-year survival with favourable neurological outcomes were 3.1% and 1.9% for single rescuers, 4.1% and 2.0% for two rescuers, and 6.0% and 4.6% for three or more rescuers, respectively, (p=0.0006 and p<0.0001)). A multiple logistic regression analysis showed that the presence of multiple rescuers is an independent factor that is associated with one-year survival (odds ratio (95% confidence interval): 1.539 (1.088-2.183)). When only OHCAs that occurred at home were analysed (N=2902), the OHCAs that were handled by multiple rescuers were associated with higher incidences of bystander CPR but were not associated with better outcomes.Conclusions: In summary, an increased number of rescuers improves the outcomes of OHCAs. However, this beneficial effect is absent in OHCAs that occur at home. Word count 250

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“…Although there have been no studies directly comparing fractions of inspired oxygen delivered during resuscitation with survival, indirect studies have found that patients with higher PaO 2 levels during resuscitation were more likely to achieve ROSC. (23) From the currently available literature, it is recommended that 100% oxygen or the highest available oxygen concentrations be used during cardiac arrest resuscitation.…”

Section: Oxygen Therapy In Cardiac Arrestmentioning

confidence: 99%

Advanced Cardiac Life Support: 2016 Singapore Guidelines

Ching

Leong

Chua

et al. 2017

smedj

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Public access defibrillation PAD is another key intervention to improve the time to defi brillation for shockable rhythms in OHCA, through increasing the availability of automated external defi brillators (AEDs) in public places. Patients with shockable rhythms who received bystander defibrillation had 5.8 times the odds of survival compared to those who did not. Emergency ambulance response Prehospital emergency medical services should optimise the rapid dispatch of fi rst-responders who are trained in Basic Cardiac Life Support (BCLS) and AED use, as well as paramedics trained in advanced life support protocols, to the scene within eight minutes. This can be achieved through strategic preplacement of ambulances and related vehicular assets, as well as stratifi ed levels of responses for calls of different priority levels.Survival in OHCA is critically dependent on prompt institution of the fi rst three links of the chain of survival. Prehospital factors, including witnessed arrests, initial shockable rhythms, bystander defi brillation and emergency ambulance response times within eight minutes of collapse, have been ABSTRACT The main areas of emphasis in the Advanced Cardiac Life Support (ACLS) guidelines are: early recognition of cardiac arrest and call for help; good-quality chest compressions; early defi brillation when applicable; early administration of drugs; appropriate airway management ensuring normoventilation; and delivery of appropriate post-resuscitation care to enhance survival. Of note, it is important to monitor the quality of the various care procedures. The resuscitation team needs to reduce unnecessary interruptions to chest compressions in order to maintain adequate coronary perfusion pressure during the ACLS drill. In addition, the team needs to continually look out for reversible causes of the cardiac arrest.

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Tracheal intubation by paramedics under limited indication criteria may improve the short-term outcome of out-of-hospital cardiac arrests with noncardiac origin

Cited by 27 publications

References 23 publications

The continuous quality improvement project for telephone-assisted instruction of cardiopulmonary resuscitation increased the incidence of bystander CPR and improved the outcomes of out-of-hospital cardiac arrests

The continuous quality improvement project for telephone-assisted instruction of cardiopulmonary resuscitation increased the incidence of bystander CPR and improved the outcomes of out-of-hospital cardiac arrests

Does the number of rescuers affect the survival rate from out-of-hospital cardiac arrests? Two or more rescuers are not always better than one

Advanced Cardiac Life Support: 2016 Singapore Guidelines

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