 |
Free Paper presentations
at the November 2007 Scientific Symposium
Abstracts
Contents
intensive care units after cardiac arrest 1996-2006
2. The effect of chest compressions on the time taken
to insert airway devices in a manikin
3. A comparison of the laryngeal mask airway
with facemask and oropharyngeal airway for manual
ventilation by critical care nurses in children
4. Does dual operator CPR help minimize interruptions
in chest compressions?
5. Randomised controlled trial of gel warming mattress
to prevent hypothermia during resuscitation at birth
of premature infants
Trends in outcome for patients admitted to UK
intensive care units after cardiac arrest 1996-2006
Dr Jerry Nolan
Consultant in Anaesthesia and Intensive Care Medicine
Royal United Hospital, Bath
Other authors:
S Laver, C Welch, D Harrison, K Rowan ABSTRACT:
The abstract for this open paper will be available shortly.
to insert airway devices in a manikin
Dr Matthew Thomas
Specialist Registrar
Royal United Hospital, Bath
Other authors:
J Gatward, J Nolan, T Cook
ABSTRACT:
Aims: To evaluate the speed with which different airway devices could be placed with and without interrupting chest compressions.
Methodology: 40 volunteer doctors involved in cardiopulmonary resuscitation (CPR) were timed inserting four different airway devices (tracheal tube (TT), LMA™ Classic (cLMA), LMA™ ProSeal (PLMA) and iGEL™) into a manikin, both with and without chest compressions being undertaken.
Results: Chest compressions were associated with a delay in the placement of the TT only (3.3 seconds, p<0.0001). Comparison of the speed of insertion of the different airway devices during CPR allowed ranking of the devices: iGEL (fastest), PLMA (second), TT and cLMA (slowest). The iGEL was inserted approximately 50% faster than the other devices. Experienced intubators were significantly faster at intubating the trachea, but no faster at inserting SADs.
Conclusion: Our results show that continuing chest compressions has a minor effect on time for tracheal intubation and until clear human data are available the recommendation to intubate without interrupting CPR is therefore justified. The PLMA and iGEL (SADs with a gastric drain tube) were both faster to insert than the cLMA and offer additional benefits. They should be considered for use in CPR.
A comparison of the laryngeal mask airway with facemask and oropharyngeal airway for manual ventilation
by critical care nurses in children
Dr Jennie Rechner
SpR Anaesthesia
John Radcliffe Hospital, Oxford
Other authors:
VJ Loach, MT Ali, VS Barber, JD Young, DG Mason ABSTRACT:
Aims: The European Resuscitation Council recommends the laryngeal mask airway (LMA) with self-inflating bag in adult resuscitation. It is unclear whether this technique is suitable in children requiring resuscitation by first responders.
Methodology: We trained 19 critical care nurses with experience of facemask ventilation to place the LMA in children using manikins. Using sixty anaesthetised children (prior to elective surgery), we compared ventilation achieved by these nurses using both techniques in random order. Chest expansion (measured with a novel ultrasound device) achieved by a consultant anaesthetist using facemask ventilation was used as the gold standard. Successful ventilation by the nurse using either airway device was defined as 60% or more of the gold standard.
Results: Using the LMA the nurses achieved successful ventilation in 78% of children compared with 71% using facemask ventilation (p=0.39). The LMA was successful on the first attempt in 60%, second attempt in 11% and third attempt in 6% of children. Median time to first breath was 38 seconds for LMA ventilation and 24 seconds for facemask ventilation (p<0.001).
Conclusion: Critical care nurses can be trained to provide successful ventilation in slightly more children using the LMA but it takes longer than facemask ventilation.
Does dual operator CPR help minimize interruptionsin chest compressions?
Brendan Spooner
Medical Student
University of Birmingham
Other authors:
J Fallaha, G Perkins
ABSTRACT:
Aims: Guidelines 2005 emphasize the importance of reducing interruptions in chest compressions (no-flow duration). Dual operator CPR (where one rescuer does ventilations and one chest compressions) could potentially minimize no-flow duration compared to currently recommended single operator CPR. This study aims to determine if dual operator CPR reduces no flow time compared to single operator CPR.
Method: This was a prospective randomised controlled crossover trial. BLS instructors were randomised into ‘Single Operator’ and ‘Dual Operator’ groups. Both groups performed 4 minutes of CPR according to their group allocation before crossing over one week later. Data on CPR performance were downloaded from a Laerdal Skillmeter manikin.
Results: Fifty participants were recruited. Dual Operator CPR achieved slightly lower no-flow times (28.53% versus 31.62%, P = 0.004) than the Single Operator CPR. Dual Operator CPR also achieved more rescue breaths per minute (4.88 versus 4.52, P= 0.018). There was no difference in compression depth, compression rate, duty cycle, rescue breath flow rate or rescue breath volume.
Conclusion: Dual Operator CPR provides marginal improvement in no-flow duration but CPR quality is otherwise equivalent to Single Operator CPR. There seems little advantage to adding teaching on Dual Operator CPR to layperson CPR programs.
Randomised controlled trial of gel warming mattress to prevent hypothermia during resuscitation at birth of premature infants
Dr Andrew Leslie
BLISS Research Fellow in Neonatal Nursing
and Neonatal Nurse Practitioner
NPEU, University of Oxford and Nottingham Neonatal Service
Other authors:
P Brocklehurst, S Wardle, H Budge, N Marlow ABSTRACT:
Aims: To investigate whether use of a gel warming mattress (Transwarmer, Prism Technologies) in addition to routine thermal care during resuscitation at birth increases temperature on admission to NICU of infants less than 29 weeks.
Methodology: Infants all received standard thermal care at birth including radiant warmer, plastic bag and hat. A study pack opened at delivery determined whether infants received a study mattress. Temperature was measured on admission to NICU. Written informed parental consent was obtained for all infants.
Results: Forty-seven infants were recruited. There are no differences between the groups for median (range) birthweight (control 805g (560g – 1320g), mattress 840g (530g – 1240g)) or gestation at birth (control 26 weeks (23 - 28), mattress 26 weeks (23 - 28)).
The mean (95% CI) admission temperature in the control group was 36.7°C (36.2 – 37.1) and in the mattress group was 37°C (36.5 – 37.4). There were no significant differences when infants <=26 weeks and >26 weeks were analysed.
Conclusion: The addition of a gel warming mattress to standard thermal care does not result in a significant improvement in temperature on admission. In this study 19% of infants had admission temperature <36.5°C. Further research is required to improve this aspect of care.
 |
 |
 |
 |
 |
 |
 |
 |
|
|||||||
|
© Resuscitation Council (UK) 2007  This page last updated: 26 November 2007 |
 |
|||||