Epinephrine or Airway First in OHCA?
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In adults presenting to EMS after OHCA, those receiving epinephrine prior to advanced airway management (AAM = supraglottic airway, SGA, or endotracheal tube) experienced better outcomes and prehospital ROSC than those receiving AAM before epinephrine. This was true for both shockable and non-shockable initial rhythms.
Source
Sequence of Epinephrine and Advanced Airway Placement After Out-of-Hospital Cardiac Arrest. JAMA Netw Open. 2024 Feb 5;7(2):e2356863. doi: 10.1001/jamanetworkopen.2023.56863.
Ketamine vs Etomidate in TBI – Prehospital Version
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Patients with TBI who were intubated in the prehospital setting had no difference in 30-day mortality when comparing induction with ketamine versus etomidate.
Source
Etomidate versus Ketamine as prehospital induction agent in patients with suspected severe traumatic brain injury. Anesthesiology. 2024. Jan 8. Doi: 10.1097/ALN.0000000000004894. Online ahead of print.
Guidelines for Prehospital Airway Management
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A panel of experts appraising a systematic review on prehospital airway management created 22 recommendations relating to ventilation (BVM vs SGA vs ETI), video laryngoscopy (VL), and drug-assisted airway management.
Source
Evidence-Based Guideline for Prehospital Airway Management. Prehosp Emerg Care. 2023. Dec 22. Doi: 10.1080/10903127.2023.2281363. Online ahead of print.
Bigger Bag, Higher ROSC? Impact of BVM Size on OHCA
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Tidal volume (TV) delivered is hard to control during cardiac arrest, and evidence has shown that over-ventilation can be detrimental in physiological parameters integral to cardiac arrest survival. Small bags were thus integrated into a single EMS system to help combat over-ventilation. Paradoxically, large bags had a greater likelihood of return of spontaneous circulation (ROSC) in out of hospital cardiac arrests (OHCA).
Source
Association of small adult ventilation bags with return of spontaneous circulation in out of hospital cardiac arrest. Resuscitation. 2023 Dec:193:109991. doi: 10.1016/j.resuscitation.2023.109991. Epub 2023 Oct 5.
Good Bagging in CPR Saves Lives?
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For the majority of out-of-hospital cardiac arrest (OHCA) patients undergoing standard (30:2 compressions:breaths) cardiopulmonary resuscitation (CPR) prior to definitive airway placement, bag-valve mask (BVM) ventilations did not achieve adequate lung volumes most of the time. Receiving adequate BVM ventilations >50% of the time was associated with significantly higher rates of return of spontaneous circulation (ROSC) and survival.
Source
Bag-Valve-Mask Ventilation and Survival from Out-of-Hospital Cardiac Arrest: A Multicenter Study. Circulation. 2023 Nov 12. doi: 10.1161/CIRCULATIONAHA.123.065561. Epub ahead of print.
How to Manage Blast Injuries
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Blast injuries combine common polytrauma mechanisms - blunt, penetrating, burns - with the unique pathophysiology of blast wave injuries, and mass casualty scenarios. While rare, these patients are resource-intensive, prone to delayed yet rapid clinical deterioration, and carry high morbidity and mortality.
Source
High risk and low prevalence diseases: Blast injuries. Am J Emerg Med. 2023 Aug;70:46-56. doi: 10.1016/j.ajem.2023.05.003. Epub 2023 May 5.
Handy EMS OHCA Handoff Checklist
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In this video review, information contained in out-of-hospital cardiac arrest (OHCA) patient handoffs was highly variable, which is an area for quality improvement and standardization. Try this checklist!
Source
Emergency Medical Services handoff of patients in cardiac arrest in the Emergency Department: A retrospective video review study of duration and details of handoff. Resuscitation. 2023 Aug;189:109834. doi: 10.1016/j.resuscitation.2023.109834. Epub 2023 May 16.
PATCH-Trauma RCT – Does Prehospital TXA Improve Outcomes in Severe Trauma?
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Prehospital administration of tranexamic acid (TXA) did not result in greater functional survival in patients with major trauma and suspected trauma-induced coagulopathy.
Source
Prehospital Tranexamic Acid for Severe Trauma. N Engl J Med. 2023 Jun 14. doi: 10.1056/NEJMoa2215457. Epub ahead of print.
CPR is Tired Work, But Best Not Done in Bed
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CPR performed by laymen benefits from being done on a hard surface rather than on a mattress, though neither group met the AHA recommended depth of 5cm.
Source
Effectiveness of Lay Bystander Hands-Only Cardiopulmonary Resuscitation on a Mattress versus the Floor: A Randomized Cross-Over Trial. Ann Emerg Med. 2023 Feb 23;S0196-0644(23)00026-4. doi: 10.1016/j.annemergmed.2023.01.012. Online ahead of print.
Amiodarone or Lidocaine for Early Shockable OHCA?
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In this secondary analysis of the ALPS trial (Amiodarone, Lidocaine, or Placebo Study), researchers found that early administration of amiodarone (within 8 minutes) is associated with greater functional survival in OHCA with initial shockable rhythm when compared to placebo.
Source
Survival by Time-to-Administration of Amiodarone, Lidocaine, or Placebo in Shock-Refractory Out-of-Hospital Cardiac Arrest. Acad Emerg Med. 2023 Mar 4. doi: 10.1111/acem.14716. Epub ahead of print.