Seite 1 von 25 182/001: In -flight Cardiopulmonary ... · Seite 2 von 25 182/001: In -flight...

Seite 1 von 25 182/001: In-flight Cardiopulmonary Resuscitation

Reference 12

Study design

Participants

Drop out rate

Intervention

Control

Primary endpoint

Main result

Comment

Brown A, Rittenberger J, Ammon C, Harrington S, Guyette F. In-flight automated external defibrillator use and consultation patterns. Prehosp Emerg Care. 2010;14(2):235-239.

Retrospective analysis of data

Data from a total of 169 AED applications with 40 cardiac arrests.

N/A

N/A

N/A

Use of AED during flight

Use of AEDs resulted in 50% survival among those with VF/VT in flight and 15% overall survival for cardiac arrest.

Limitations: serious Inconsistency: Non-serious Indirectness: Non-serious Imprecision: Non-serious Evidence: low

Conclusion: Use of AEDs resulted in 50% survival among those with VF/VT in flight and 15% overall survival for cardiac arrest.


Reference 25

Study design

Participants

Drop out rate

Intervention

Control

Primary endpoint

Main result

Comment

Mahony P, Griffiths R, Larsen P, Powell D. Retention of knowledge and skills in first aid and resuscitation by airline cabin crew. Resuscitation. 2008;76(3):413-418

Prospective observational study

35 cabin crew

N/A

use the bag-mask correctly, perform CPR, and place AED

N/A

Correct use of the bag-mask, perform CPR, and place AED

The results of this study indicate that cabin crew may not have sufficiently high levels of skill to manage a cardiac arrest adequately

Limitations: Serious Inconsistency: none Indirectness: none Imprecision: none Evidence: moderate

Conclusion: While theoretical first aid knowledge was high, the participants held low levels of self-confidence in their CPR and AED skills. The results of this study indicate that cabin crew may not have sufficiently high levels of skill to manage a cardiac arrest adequately.


Reference 26

Study design

Participants

Drop out rate

Intervention

Control

Primary endpoint

Main result

Comment

Bolle SR, Johnsen E, Gilbert M. Video calls for dispatcher-assisted cardiopulmonary resuscitation can improve the confidence of lay rescuers--surveys after simulated cardiac arrest. J Telemed Telecare.17(2):88-92

RCT

180 High school students

N/A

Showing video file

audio instruction

Confidence for CPR

visual contact and supervision through video calls improved rescuers' confidence in stressful emergencies

Limitations: serious Inconsistency: none Indirectness: serious Imprecision: none Evidence: low

Conclusion: visual contact and supervision through video calls improved rescuers' confidence in stressful emergencies; good and important study, but can hardly transferred to the aviation field


Reference 28

Study design

Participants

Drop out rate

Intervention

Control

Primary endpoint

Main result

Comment

Spelten O, Warnecke T, Wetsch WA, Schier R, Bottiger BW, Hinkelbein J. Dispatcher-assisted compression-only cardiopulmonary resuscitation provides best quality cardiopulmonary resuscitation by laypersons: A randomised controlled single-blinded manikin trial. Eur J Anaesthesiol.33(8):575-580

Randomised controlled single-blinded manikin trial

60 lay persons

2/60 Dispatcher-assisted CPR Unassisted

CPR and dispatcher-assisted compression-only

Quality of CPR

Initial no-flow-time was lowest in the dispatcher-assisted compression only-CPR group (mean 21.3 ± 14.4%), followed by dispatcher-assisted full CPR (mean 49.1 ± 8.5%) and by unassisted CPR (mean 55.0 ± 12.9%).

Limitations: none Inconsistency: none Indirectness: serious Imprecision: none Evidence: moderate

Conclusion: Best quality of CPR was achieved by dispatcher-assisted compression only -CPR because of superior compression frequencies and reduced NFT. good and important study, but can hardly transferred tot he aviation field


Reference 39

Study design

Participants

Drop out rate

Intervention

Control

Primary endpoint

Main result

Comment

Page R, Joglar J, Kowal R, Zagrodzky J, Nelson L, Ramaswamy K, Barbera S, Hamdan M, McKenas D. Use of automated external defibrillators by a U.S. airline. N Engl J Med. 2000;343(1210-1216)

Retrospective analysis

Data of 200 patients

N/A

N/A

N/A

Use of an AED

The rate of survival to discharge from the hospital after shock with the automated external defibrillator was 40 percent

Limitations: serious Inconsistency: none Indirectness: none Imprecision: none Evidence: low

Conclusion: The use of the automated external defibrillator aboard commercial aircraft is effective, with an excellent rate of survival to discharge from the hospital after conversion of ventricular fibrillation.


Reference 42

Study design

Participants

Drop out rate

Intervention

Control

Primary endpoint

Main result

Comment

Pedersen T, Moller A, Pedersen B. Pulse oximetry for perioperative monitoring: systematic review of randomized, controlled trials. Anesth Analg. 2003;96:426–431.

Systematic review

Studies of 21,773 patients

N/A

10,312 with pulse oximeter

10,490 without P.O.

effect of perioperative monitoring with pulse oximetry

Hypoxemia was reduced in the pulse oximetry group both in the operating room and in the recovery room.

Limitations: none Inconsistency: none Indirectness: Very serious Imprecision: none Evidence: moderate

Conclusion: The studies confirmed that pulse oximetry could detect hypoxemia and related events.


Reference 44

Study design

Participants

Drop out rate

Intervention

Control

Primary endpoint

Main result

Comment

Havel C, Schreiber W, Riedmuller W, Haugk M, Richling N, Trimmel H, Malzer R, Sterz F, Herkner H. Quality of closed chest compression in ambulance vehicles, flying helicopters and at the scene. Resuscitation. 2007;73:264—270

randomised cross-over trial

11 European Resuscitation Council (ERC) approved health care professionals

N/A

Interventions during resuscitation: (a) in a moving ambulance, (b) in a flying helicopter, were compared to those staying at the (c) scene (control).

N/A

Direct comparison of the quality of resuscitation at the scene, during a helicopter flight and in a moving ambulance

Compared to resuscitation at the scene, efficiency of chest compressions during a helicopter flight was 86% and 95% in the moving ambulance 95%.

Limitations: none Inconsistency: none Indirectness: none Imprecision: none

Evidence: high

Conclusion: Resuscitation during transport is feasible and relatively efficient. There is some difference between the environments, but there is no relevant difference between helicopters and ambulances regarding the effectiveness of CPR.


Reference 45

Study design

Participants

Drop out rate

Intervention

Control

Primary endpoint

Main result

Comment

Thomas S, Stone C, Bryan-Berge D. The ability to perform closed chest compressions in helicopters. Am J Emerg Med. 1994;12(3):296-298

Prospective, observational

manikin model

N/A N/A N/A Quality of chest compressions

Chest c compressions performed in the BK-117 helicopter were as effective as those performed in the control environment, but compressions performed in the BO-105 were significantly less effective than controls. 77.2% control and 6.0/17.3% in BO-105 correct compressions

Limitations: none Inconsistency: none Indirectness: none Imprecision: none Evidence: High *

Conclusion: in a manikin model, chest compressions are substandard in the BO-105 helicopter because of the limited space available in the aircraft. * Rating up because of large effect


Reference 46

Study design

Participants

Drop out rate

Intervention

Control

Primary endpoint

Main result

Comment

Handley A, Handley J. Performing chest compressions in a confined space. Resuscitation. 2004;61:55-61

Prospective observational study

Nineteen airline employees

N/A

one-person over-the-head

two-person straddle

Quality of CPR

There were no statistically significant differences between the one-person methods of chest compression (St-1 and OTH) for the average compression rate, the number of chest compressions achieved in a minute, or the average hands-off time per cycle

Limitations: none Inconsistency: none Indirectness: none Imprecision: none Evidence: low

Conclusion: in this study, hand placement during chest compression was poor, and additional training may be necessary before it can be considered a safe technique.


Reference 47

Study design

Participants

Drop out rate

Intervention

Control

Primary endpoint

Main result

Comment

Perkins G, Stephenson B, Smith C, Gao F. A comparison between over-the-head and standard cardiopulmonary resuscitation. Resuscitation. 2004;61(2):155-161

RCT

Twenty volunteers

N/A

OTH CPR

Standard CPR

Quality of CPR

Chest compression depth and ventilation volume declined over time (0-3 min P < 0.001). There was no difference in compression rate, depth, duty cycle or ventilation rate, inflation rate and ventilation volume between techniques

Limitations: none Inconsistency: none Indirectness: none Imprecision: none Evidence: high

Conclusion: OTH CPR appears equally effective as standard CPR with some marginal advantages in correct hand placement.


Reference 48

Study design

Participants

Drop out rate

Intervention

Control

Primary endpoint

Main result

Comment

McIntosh S, Swanson E, McKeone A, Barton E. Location of airway management in air medical transport. Prehosp Emerg Care. 2008;12(4):438-442

Retrospective analysis

Patient records of nine hundred thirty-eight patients

N/A

N/A

N/A

Success rate of airway management

Airway management was performed with a high success rate in a variety of locations and patient characteristics by our air medical crew.

Limitations: serious Inconsistency: none Indirectness: none Imprecision: none Evidence: low

Conclusion: Caution should be used, however, when considering intubating in-flight because of slightly lower success rates.


Reference 50

Study design

Participants

Drop out rate

Intervention

Control

Primary endpoint

Main result

Comment

Bernhard M, Mohr S, Weigand M, Martin E, Walther A. Developing the skill of endotracheal intubation: implication for emergency medicine. Acta Anaesthesiol Scand. 2012;56(2):164-171

prospective single centre observational study

21 residents

N/A

ETI procedures

N/A

Success rate

The ETI success rate after the first 25 ETIs increased steadily to the results after 200 ETIs

Limitations: none Inconsistency: none Indirectness: serious Imprecision: none Evidence: low

Conclusion: The increasing rate of relative ETI success and the decreasing rate of necessary attempts for successful airway management suggest a steadily increasing gain in ETI experience; good and important study, but can hardly transferred to the aviation field.


Reference 51

Study design

Participants

Drop out rate

Intervention

Control

Primary endpoint

Main result

Comment

Mohr S, Weigand M, Hofer S, Martin E, Gries A, Walther A, Bernhard M. Developing the skill of laryngeal mask insertion. Anaesthesist. 2013;62:447-452

This prospective single center observational study

10 anesthesiology resident physicians

N/A

Success rate

N/A

Success rate

The LMI success rate after the first 5 LMIs increased steadily up to the results after 40 LMIs per resident


Conclusion: The increasing LMI success rate and the decreasing rate of LMI attempts for successful airway management correlated to a learning curve and development of LMI dexterity over time; good and important study, but can hardly transferred to the aviation field.


Reference 52

Study design

Participants

Drop out rate

Intervention

Control

Primary endpoint

Main result

Comment

Berden H, Bierens J, Willems F, Hendrick J, Pijls N, Knape J. Resuscitation skills of lay public after recent training. Ann Intern Med. 1994;23(5):1003-1008

Cross-sectional assessment of practical CPR skills

151 laypeople who were trained twice in the preceding 20 to 24 months

N/A

CPR

N/A

six primary recorded variables that describe the quality of CPR techniques in a training situation

Thirty-three percent of the participants were able to perform adequate CPR. The compression:relaxation ratio, the breathing volume, and the breathing interval were points of concern

Limitations: severe Inconsistency: none Indirectness: none Imprecision: none Evidence: low

Conclusion: Practical skills in basic CPR after a 12-month training interval, though better in this study than in many previous studies, are insufficient in the majority of laypeople.


Reference 53

Study design

Participants

Drop out rate

Intervention

Control

Primary endpoint

Main result

Comment

Abella B, Sandbro N, Vassilatos P, et a. Chest compression rates during cardiopulmonary resuscitation are suboptimal — a prospective study during in-hospital cardiac arrest. Circulation. 2005;111(428-434)

prospective observational study

various

N/A

N/A

N/A

CPR quality

In 36.9% of the total number of segments, compression rates were <80 compressions per minute (cpm), and 21.7% had rates <70 cpm.

Limitations: None Inconsistency: none Indirectness: Very serious Imprecision: none Evidence: Very low

Conclusion: In-hospital chest compression rates were below published resuscitation recommendations, and suboptimal compression rates in our study correlated with poor return of spontaneous circulation. good and important study, but can hardly transferred to the aviation field.


Reference 55

Study design

Participants

Drop out rate

Intervention

Control

Primary endpoint

Main result

Comment

Parnell M, Larsen P. Poor quality teaching in lay person CPR courses. Resuscitation.73:271-278

Prospective observational

14 CPR courses complying with New Zealand Qualifications Authority standards

N/A

N/A

N/A

CPR quality

Importantly, in the majority of courses (71%), certification was granted when the CPR technique was performed incorrectly, with both compression depth and compression place being corrected only 57% of the time.

Limitations: none Inconsistency: none Indirectness: serious Imprecision: serious Evidence: Very low

Conclusion: In light of these observations it is suggested that the current style of teaching is unlikely to result in students being able to perform adequate CPR if required in the community. good and important study, but can hardly transferred to the aviation field.


Reference 56

Study design

Participants

Drop out rate

Intervention

Control

Primary endpoint

Main result

Comment

Kaye W, Wynne G, Marteau T, et a. An advanced resuscitation course for pre-registration house officers. J R Coll Phys Lond. 1990;24(1):51-54

two consecutive groups

Fifty-nine newly qualified doctors

N/A

N/A

N/A

Quality of CPR

The knowledge and skills of both groups immediately after training were significantly improved and at 5 months skills were subject to modest decay only

Limitations: None Inconsistency: none Indirectness: Very serious Imprecision: none Evidence: Very low

Conclusion: Experience of managing cardiac arrests was not a substitute for formal practical training. This study can hardly transferred to the aviation field.


Reference 58

Study design

Participants

Drop out rate

Intervention

Control

Primary endpoint

Main result

Comment

Nishiyama C, Iwami T, Murakami Y, Kitamura T, Okamoto Y, Marukawa S, Sakamoto T, Kawamura T. Effectiveness of simplified 15-min refresher BLS training program: A randomized controlled trial. Resuscitation. 2015;90:56-60

Prospective cohort study

140 participants

28/140

71 with refresher training

69 without training

CPR quality

The number of appropriate chest compressions performed during the 2-min test period was significantly greater in the refresher training group (68.9±72.3) than in the control group (36.3±50.8, p=0.009).


Conclusion: A short-time refresher BLS training program 6 months after the initial training can help trainees retain chest compression skills for up to 1 year.


Reference 59

Study design

Participants

Drop out rate

Intervention

Control

Primary endpoint

Main result

Comment

Rössler B, Ziegler M, Hüpfl M, Fleischhackl R, Krychtiuk K, Schebesta K. Can a flowchart improve the quality of bystander cardiopulmonary resuscitation? Resuscitation. 2013;84(7):982-986

RCT

83 medically untrained laypersons

N/A

With flowchart: n=42

Without flow-chart: n=41

hands-off time (HOT).

Overall HOT was 147±30 s (flowchart) vs. 169±55 s (non-flowchart), p=0.024.

Limitations: none Inconsistency: none Indirectness: none Imprecision: none Evidence: high

Conclusion: A chart provided at the beginning of resuscitation attempts improves quality of CPR significantly by decreasing HOT and increasing the participants' confidence when performing CPR


Reference 64

Study design

Participants

Drop out rate

Intervention

Control

Primary endpoint

Main result

Comment

Kilgannon J, Jones A, Parrillo J, Dellinger R, Milcarek B, Hunter K, Shapiro N, Trzeciak S. Relationship Between Supranormal Oxygen Tension and Outcome After Resuscitation From Cardiac Arrest. Circulation. 2011;123:2717-2722

multicenter retrospective cohort study

IMPACT database, 4459 patients

N/A

4459 patients

N/A

in-hospital mortality

Over ascending ranges of oxygen tension, we found significant linear trends of increasing in-hospital mortality and decreasing survival as functionally independent.


Conclusion: In this large sample of postresuscitation patients, we found a dose-dependent association between supranormal oxygen tension and risk of in-hospital death. good and important study, but can hardly transferred to the aviation field.


Reference 65

Study design

Participants

Drop out rate

Intervention

Control

Primary endpoint

Main result

Comment

Kilgannon J, Jones A, Shapiro N, Angelos M, Milcarek B, Hunter K, Parrillo J, Trzeciak S. Association Between Arterial Hyperoxia Following Resuscitation From Cardiac Arrest and In-Hospital Mortality. J Am Med Assoc. 2010;303(21):2165-2171

Multicenter retrospective cohort study

6326 patients in IMPACT critical care database

N/A

6326 patients

N/A

In-hospital mortality

The hyperoxia group had significantly higher in-hospital mortality (732/1156 [63%; 95% confidence interval {CI}, 60%-66%]) compared with the normoxia group (532/1171 [45%; 95% CI, 43%-48%]; proportion difference, 18% [95% CI, 14%-22%]) and the hypoxia group (2297/3999 [57%; 95% CI, 56%-59%]; proportion difference, 6% [95% CI, 3%-9%]).


Conclusion: Among patients admitted to the ICU following resuscitation from cardiac arrest, arterial hyperoxia was independently associated with increased in-hospital mortality compared with either hypoxia or normoxia. good and important study, but can hardly transferred to the aviation field.


Reference 68

Study design

Participants

Drop out rate

Intervention

Control

Primary endpoint

Main result

Comment

Hinkelbein J, Glaser E, Doerrstein J, Genzwuerker H. Oxygen delivery comparison of two constant-flow masks during flight to 6863 m. Aviat Space Environ Med. 2006;77(5):540-544

RCT

parachutists (n=31)

8/31

HiOx mask (TST) n=17

Basic mask (BAS) n=14

oxygen saturation (SpO2)

Above 3965 m (13,000 ft) the TST required significantly less oxygen flow than the BAS to maintain the target SpO2. At 6863 m (22,500 ft), mean oxygen flow was 5.5 +/- 3.5 L x min(-1) for the BAS vs. 3.4 +/- 2.3 L x min(-1) for the TST (p = 0.029).


Conclusion: The TST required significantly less oxygen flow compared with the BAS at high altitudes and may, therefore, reduce total oxygen use, resulting in reduced costs and longer oxygen availability during a flight


Reference 70

Study design

Participants

Drop out rate

Intervention

Control

Primary endpoint

Main result

Comment

Nielsen N, Wetterslev J, Cronberg T, Erlinge D, Gasche Y, Hassager C, Horn J, Hovdenes J, Kjaergaard J, Kuiper M, Pellis T, Stammet P, Wanscher M, Wise M, Åneman A, Al-Subaie N, Boesgaard S, Bro-Jeppesen J, Brunetti I, Bugge J, Hingston C, Juffermans N, Koopmans M, Køber L, Langørgen J, Lilja G, Møller J, Rundgren M, Rylander C, Smid O, Werer C, Winkel P, Friberg H, Investigators. TT. Targeted temperature management at 33°C versus 36°C after cardiac arrest. N Engl J Med. 2013

International RCT

950 unconscious adults

11/950

TTM 33°C, n=473

36°C, n=466

all-cause mortality

At the end of the trial, 50% of the patients in the 33°C group (235 of 473 patients) had died, as compared with 48% of the patients in the 36°C group (225 of 466 patients) (hazard ratio with a temperature of 33°C, 1.06; 95% confidence interval [CI], 0.89 to 1.28; P=0.51).


Conclusion: In unconscious survivors of out-of-hospital cardiac arrest of presumed cardiac cause, hypothermia at a targeted temperature of 33°C did not confer a benefit as compared with a targeted temperature of 36°C. good and important study, but can hardly transferred to the aviation field.


Reference 71

Study design

Participants

Drop out rate

Intervention

Control

Primary endpoint

Main result

Comment

Bro-Jeppesen J, Hassager C, Wanscher M, et al. Post-hypothermia fever is associated with increased mortality after out-of-hospital cardiac arrest. Resuscitation. 2013;84(1734-1740)

consecutive cohort of comatose survivors

270 patients resuscitated after OHCA

N/A

Cooling, no PHF, n=134

No cooling, PHF, n=136

30-days mortality

PHF (≥38.5°C) was associated with a 36% 30-days mortality rate compared to 22% in patients without PHF, plog-rank=0.02, corresponding to an adjusted hazard rate (HR) of 1.8 (95% CI: 1.1-2.7), p=0.02).


Conclusion: Post-hypothermia fever ≥38.5°C is associated with increased 30-days mortality, even after controlling for potential confounding factors. Avoidance of PHF as a therapeutic target should be evaluated in prospective randomized trials. good and important study, but can hardly transferred to the aviation field.


Reference 72

Study design

Participants

Drop out rate

Intervention

Control

Primary endpoint

Main result

Comment

Kim F, Nichol G, Maynard C, Hallstrom A, Kudenchuk P, Rea T, Copass M, Carlbom D, Deem S, Longstreth JW, Olsufka M, Cobb L. Effect of prehospital induction of mild hypothermia on survival and neurological status among adults with cardiac arrest: a randomized clinical trial. J Am Med Assoc. 2014;311(1):45-52

randomized clinical trial

1359 patients

N/A

prehospital cardiac arrest to standard care with prehospital cooling, n=686

prehospital cardiac arrest to standard care without prehospital cooling, n=671

survival to hospital discharge and neurological status at discharge

However, survival to hospital discharge was similar among the intervention and control groups among patients with VF (62.7% [95% CI, 57.0%-68.0%] vs 64.3% [95% CI, 58.6%-69.5%], respectively; P = .69) and among patients without VF (19.2% [95% CI, 15.6%-23.4%] vs 16.3% [95% CI, 12.9%-20.4%], respectively; P = .30).


Conclusion: Although use of prehospital cooling reduced core temperature by hospital arrival and reduced the time to reach a temperature of 34°C, it did not improve survival or neurological status among patients resuscitated from prehospital VF or those without VF. good and important study, but can hardly transferred to the aviation field.

Seite 1 von 25 182/001: In -flight Cardiopulmonary ... · Seite 2 von 25 182/001: In -flight...

Documents

Transcript of Seite 1 von 25 182/001: In -flight Cardiopulmonary ... · Seite 2 von 25 182/001: In -flight...