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Free Paper presentations
at the September 2009 Scientific Symposium
Abstracts
Contents
2. Evaluation of telephone cardiopulmonary resuscitation
advice for paediatric cardiac arrest
3. Does an Advanced Life Support (ALS) course
give adequate skills to manage an airway?
4. Randomised controlled trial comparing two techniques
for locating chest compression hand position in
adult Basic Life Support (BLS)
5. Inclusion of pulse oximetry as a component of an early
warning score improves its ability to predict mortality
following a cardiac arrest call or unplanned ICU admission
The use of i-gels at cardiac arrest
Dr Rachel Dancer
Senior House Officer
Royal United Hospital, Bath
Other authors:
J Nolan, H Winslow, E Zasada
ABSTRACT:
Aims: Recent changes in the skill mix of resident ICU doctors in the UK have made it difficult to ensure that at least one cardiac arrest team member is skilled in tracheal intubation. The i-gel supraglottic airway device (SAD) can be inserted with a high rate of first-time success even by novices and may enable ventilation during CPR. In our centre, the majority of ICU residents cannot intubate but they are trained to insert SADs. We undertook an audit to determine which airway devices our ICU residents were using at cardiac arrests and to determine the success rates for ventilation with these devices.
Methodology: We collected data on cardiac arrest patients requiring ventilator support during March to December 2008.
Results: In 56 (71%) of 79 cardiac arrests the responder was not trained in intubation. An i-gel was inserted in 31 cases. Ventilation via the i-gel was definitely successful in 21 (67%), uncertain in two, and unsuccessful in eight (seven of these were associated with a major air leak) necessitating an alternative technique.
Conclusion: During in-hospital cardiopulmonary resuscitation, in the absence of someone skilled in intubation, the i-gel enables effective ventilation in about two-thirds of cases.
Evaluation of telephone cardiopulmonary resuscitation advice for paediatric cardiac arrest
Sian Evans
Medical Student
South Central Ambulance Service, Otterbourne, Winchester
Other authors:
C Deakin ABSTRACT:
Aims: Telephone cardiopulmonary resuscitation (CPR) advice aims to increase the quality and quantity of bystander CPR; one of the few interventions shown to improve outcome in cardiac arrest. We evaluated a current paediatric telephone protocol (AMPDS v11.1) to assess the effectiveness of verbal CPR instructions in paediatric cardiac arrest.
Methodology: Consecutive emergency calls classified by the AMPDS as cardiac arrests in children <8 years old, over an 11 month period, were compared with their corresponding Patient Report Forms (PRF) to confirm the diagnosis. Audio recordings and PRFs were then evaluated to assess whether bystander CPR was given, and when it was, the time taken to perform CPR interventions, before paramedic arrival.
Results: Of the 42 calls reviewed, 18 (43%) were confirmed as cardiac arrests. CPR was already underway in 2 cases (11%). Eleven callers (61%) agreed to attempt T-CPR, resulting in an overall bystander CPR rate of 61%. The median time and range to open the airway was 126s (62-236s, n=11), deliver the first ventilation was 180s (135-360s, n=11), perform the first chest compression was 280s (164-420s, n=9).
Conclusion: Although current telephone-CPR instructions improve the numbers of children in whom bystander CPR is attempted, effectiveness is likely to be limited by the significant delays in actually delivering basic life support.
Does an Advanced Life Support (ALS) course give adequate skills to manage an airway?
David Murphy
Medical Student
Southampton University
Other authors:
M Couzins, C Deakin
ABSTRACT:
Aims: Traditionally, anaesthetists have provided airway management skills on resuscitation teams. ALS courses now teach the full range of airway interventions to all doctors. Are non-anaesthetic doctors meeting the required ALS standard? If so, are anaesthetists now surplus to requirements on resuscitation teams?
Method: We recruited adult surgical patients receiving a general anaesthetic and LMA airway as part of their care. Patients were randomly assigned to airway management by a junior doctor; either an ALS-qualified anaesthetist or an ALS-qualified non-anaesthetist. After induction of anaesthesia, a doctor delivered 5 ventilations via a bag-valve-mask system (BVM) before inserting an LMA. We recorded the quality of manual ventilation using the BVM system (adequate, partially adequate or inadequate), the time to LMA insertion, and any complications.
Results: Twenty anaesthetists and 16 non-anaesthetist ALS graduates participated. Of the anaesthetists, 18 (90%) demonstrated adequate and 2 (10%) demonstrated partially adequate manual ventilation skills; compared with non-anaesthetists of whom 5 (31.25%) demonstrated adequate, 5 (31.25%) demonstrated partially adequate, and 6 (37.5%) demonstrated inadequate manual ventilation skills (p=0.0008). Eighteen anaesthetists (90%) and 4 non-anaesthetists (25%) met the ALS LMA guideline time of 30 -seconds (p<0.0001). Median time for LMA insertion by anaesthetists and non-anaesthetists was 20.5s (range 16-40s, n=20) and 35.0s (range 18-168, n=10) respectively (p<0.05). Six of the non-anaesthetists failed to insert the LMA. There were 4 (25%) complications (laryngospasm, vomiting, SaO2 <90%) in the non-anaesthetic group, compared with 0 in the anaesthetic group (p=0.01).
Conclusion: While doctors are achieving the ALS standards in training, this does not transfer to real patients. Therefore, we must conclude that anaesthetists are still essential members of the resuscitation team. We suggest further examination of the ALS course, specifically looking at ways to improve the transfer of airway skills from training to practice.
A randomised controlled trial comparing two techniques for locating chest compression hand position in adult
Basic Life Support (BLS)
Dr Andrew Owen
Foundation Year 2 Doctor
University of Birmingham
Other authors:
P Harvey, J Hulme, L Kocierz, A Lewis, J Walters ABSTRACT:
Aims: Chest compressions can increase survival after cardiac arrest. European Resuscitation Council (ERC) 2005 guidelines simplified the hand position technique aiming to increase effective compressions. This randomised controlled trial compares chest compression efficacy using the 2005 guidelines, with and without, additional landmark teaching.
Methodology: 82 first-year healthcare students at the University of Birmingham, UK, were randomised to ‘control’ (41) or ‘intervention’ (41) groups after passing an ERC BLS assessment. The intervention group received additional landmark training as per the 2005 ERC guidelines, using the costal margin and midline to locate the correct hand position, but emphasising minimal delay in chest compressions. Both groups then performed 2 minutes of BLS on skill-reporter manikins with additional subjective assessment by experienced instructors.
Results: Control and intervention average compression rates were 103 and 105 per minute respectively (p=0.29). The average number of incorrect hand placements, assessed by the skill-reporter manikin, were 24 and 8.9 respectively (p=0.03). There were no significant differences in compression depth or duty cycle from manikin recordings or incorrect hand placements judged by instructors.
Conclusion: Using simplified hand positioning instructions with additional teaching of a rapid landmark technique for chest compressions improves hand positioning without reducing the number of effective chest compressions performed during BLS.
The inclusion of pulse oximetry as a component of an early warningscore improves its ability to predict mortality following a cardiac arrest
call or unplanned ICU admission
Mrs Sarah Owen
Resuscitation Officer
Wythenshawe Hospital, Sale, Cheshire
Other authors:
P Alexander, S Clark ABSTRACT:
Aims: It is well recognised that ward based early warning score systems can be used to predict outcome. In 2007 the UK’s National Institute for Health and Clinical Excellence recommended that physiological scoring systems should include the following variables: HR, BP, RR, T, AVPU and SpO2.
Methodology: For a period of 3 months from January to April 2008 physiological data were collected for all unplanned ICU admissions and cardiac arrest calls in our institution. Up to 24 hours of physiological parameters prior to the event and the documented MEWS were documented. The maximum pre-event value for each patient was then compared with corrected MEWS (recalculated from documented physiology), PMEWS (HR, BP, RR, T, AVPU, SpO2), NMEWS (HR, BP, RR, T, AVPU, SpO2, FiO2) and SEWS (HR, BP, RR, T, AVPU, SpO2, UO).
Results: Hospital discharge data were available on 86 patients (overall mortality, 45.3%) with 44 CA calls (mortality 54.5%) and 42 uICU admissions (mortality 38.5%). Results are reported as median (IQR) and P values from Mann Whitney test. Receiver Operating Characteristic (ROC) curve areas were different among the scoring systems with the best prediction being those containing an SpO2 score.
| Alive | Death | P | ROC Area | 95% C.I. | |
| Documented MEWS | 4 (2-6) | 4.5 (2-8) | 0.094 | 0.62 | 0.49 to 0.74 |
| Corrected MEWS | 3 (1-5) | 4 (2-6) | 0.175 | 0.60 | 0.46 to 0.73 |
| PMEWS | 3 (2-6) | 6 (3-7.5) | 0.003 | 0.71 | 0.59 to 0.83 |
| NMEWS | 5 (2-7) | 6.5 (4-9) | 0.022 | 0.66 | 0.53 to 0.79 |
| SEWS | 3 (1-4.5) | 5 (2.5-7) | 0.008 | 0.69 | 0.56 to 0.81 |
Conclusion: The addition of SpO2 to early warning score systems improves their ability to predict hospital discharge mortality following a cardiac arrest call or unplanned ICU admission.
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© Resuscitation Council (UK) 2009  This page last updated: 27 October 2009 |
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