European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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Comparative Study
First-pass intubation success rate during rapid sequence induction of prehospital anaesthesia by physicians versus paramedics.
Endotracheal intubation is a frequently performed procedure for securing the airway in critically injured or ill patients. Performing prehospital intubation may be challenging and intubation skills vary. We reviewed the first-attempt tracheal intubation success rate in a Dutch prehospital setting. ⋯ Prehospital intubations had a significantly higher success rate when performed by helicopter physicians. We promote a low threshold for HEMS deployment in cases of a potentially compromised airway.
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With increasing rates of in-hospital cardiac arrest, improving resuscitation outcomes is essential. Mechanical chest compressors seem to be related to improved outcome in out-of hospital cardiac arrest; however, the literature on its use in in-hospital cardiac arrest is scarce. We used the Medline public database to systematically review patient outcomes considering mechanical cardiopulmonary resuscitation in in-hospital cardiac arrest. ⋯ Two studies did not report survival rates. Especially in patients with in-hospital cardiac arrest because of treatable causes, early start of mechanical chest compressions could improve future patient outcomes because of better (coronary and brain) perfusion during mechanical chest compressions compared with manual chest compressions. However, the current literature is probably influenced by publication bias and more high-quality research is needed.
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Multicenter Study Observational Study
Emergency department procedural sedation: the London experience.
The aim of this study was to develop a procedural sedation guideline and an audit tool to identify the medications chosen, the incidence of predefined adverse events and the factors associated with their occurrence. ⋯ Procedural sedation and analgesia can be safely and effectively performed in the ED by appropriately trained emergency physicians.
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Comparative Study
A description of echocardiography in life support use during cardiac arrest in an Emergency Department before and after a training programme.
To investigate echocardiography in life support (ELS) use in Emergency Department (ED) cardiac arrest patients before and after a training day. ⋯ Use of ELS significantly increased after the training day most commonly supporting a decision to stop resuscitation. This change in practice has been maintained.
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Observational Study
Training paramedics in focussed echo in life support.
The aim of this study was to determine whether paramedics can be trained to perform and interpret focussed Echo in Life Support (ELS) for the assessment of cardiac movement and the recognition of reversible causes of cardiac arrest. ⋯ Paramedics can perform focused ELS, integrate attempts into simulated cardiac arrest scenarios and retain some of this knowledge. Further work is required to assess the feasibility of incorporating this into real-world cardiac arrest management.