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Advanced Life Support

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Gavin D. Perkins – One of the best experts on this subject based on the ideXlab platform.

  • Improving the Efficiency of Advanced Life Support Training
    Annals of Internal Medicine, 2012
    Co-Authors: Gavin D. Perkins, Andrew Lockey, Ian Bullock

    Training health care providers in Advanced Life Support is important but is time- and resource-intensive. This randomized trial compared a conventional 2-day in-person Advanced Life Support course …

  • Improving the efficiency of Advanced Life Support training : a randomized, controlled trial
    Annals of internal medicine, 2012
    Co-Authors: Gavin D. Perkins, Ian Bullock, Andrew Lockey, Robin P. Davies, Peter K. Kimani, Tom Clutton-brock, Mike Gale, Jenny Lam, Nigel Stallard

    BACKGROUND Each year, more than 1.5 million health care professionals receive Advanced Life Support (ALS) training. OBJECTIVE To determine whether a blended approach to ALS training that includes electronic learning (e-learning) produces outcomes similar to those of conventional, instructor-led ALS training. DESIGN Open-label, noninferiority, randomized trial. Randomization, stratified by site, was generated by Sealed Envelope (Sealed Envelope, London, United Kingdom). (International Standardized Randomized Controlled Trial Number Register: ISCRTN86380392) SETTING 31 ALS centers in the United Kingdom and Australia. PARTICIPANTS 3732 health care professionals recruited between December 2008 and October 2010. INTERVENTION A 1-day course supplemented with e-learning versus a conventional 2-day course. MEASUREMENTS The primary outcome was performance in a cardiac arrest simulation test at the end of the course. Secondary outcomes comprised knowledge- and skill-based assessments, repeated assessment after remediation training, and resource use. RESULTS 440 of the 1843 participants randomly assigned to the blended course and 444 of the 1889 participants randomly assigned to conventional training did not attend the courses. Performance in the cardiac arrest simulation test after course attendance was lower in the electronic Advanced Life Support (e-ALS) group compared with the conventional Advanced Life Support (c-ALS) group; 1033 persons (74.5%) in the e-ALS group and 1146 persons (80.2%) in the c-ALS group passed (mean difference, -5.7% [95% CI, -8.8% to -2.7%]). Knowledge- and skill-based assessments were similar between groups, as was the final pass rate after remedial teaching, which was 94.2% in the e-ALS group and 96.7% in the c-ALS group (mean difference, -2.6% [CI, -4.1% to 1.2%]). Faculty, catering, and facility costs were $438 per participant for electronic ALS training and $935 for conventional ALS training. LIMITATIONS Many professionals (24%) did not attend the courses. The effect on patient outcomes was not evaluated. CONCLUSION Compared with conventional ALS training, an approach that included e-learning led to a slightly lower pass rate for cardiac arrest simulation tests, similar scores on a knowledge test, and reduced costs. PRIMARY FUNDING SOURCE National Institute of Health Research and Resuscitation Council (UK).

  • Advanced Life Support update
    British medical bulletin, 2009
    Co-Authors: Natalie Husselbee, Robin P. Davies, Gavin D. Perkins

    Introduction: Cardiac arrest is a common emergency in acute hospitals. The Resuscitation Council (UK) Advanced Life Support Guidelines provide a systematic approach to cardiac arrest recognition, treatment and aftercare. This review provides an update on the current treatment guidelines and identifies areas where these may be strengthened. Methods: The evidence informing the 2005 Resuscitation Guidelines is reviewed. New evidence since the publication of the guidelines was identified by searching Medline (December 2005‐December 2008) with the term heart arrest or Advanced Life Support. Results: Opportunities for strengthening the chain of survival exist for each link. These include better recognition of critically ill patients at risk of cardiac arrest, improved quality of cardiopulmonary resuscitation, defibrillation strategies, which minimize pre- and post-shock pauses and development of postresuscitation care bundles. Conclusion: Emerging evidence suggests opportunities where Resuscitation Guidelines could be strengthened by focusing on specific aspects of the chain of survival.

Daniel W Spaite – One of the best experts on this subject based on the ideXlab platform.

  • The OPALS Major Trauma Study: impact of Advanced LifeSupport on survival and morbidity
    CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 2008
    Co-Authors: Ian G Stiell, Daniel W Spaite, Brian J Field, Lisa Nesbitt, Justin Maloney, William Pickett, Douglas P. Munkley, Jane Banek, Lorraine Luinstra-toohey, Jon Dreyer

    Background: To date, the benefit of prehospital Advanced LifeSupport programs on trauma-related mortality and morbidity has not been established Methods: The Ontario Prehospital Advanced Life Support (OPALS) Major Trauma Study was a before–after systemwide controlled clinical trial conducted in 17 cities. We enrolled adult patients who had experienced major trauma in a basic LifeSupport phase and a subsequent Advanced LifeSupport phase (during which paramedics were able to perform endotracheal intubation and administer fluids and drugs intravenously). The primary outcome was survival to hospital discharge. Results: Among the 2867 patients enrolled in the basic LifeSupport (n = 1373) and Advanced LifeSupport (n = 1494) phases, characteristics were similar, including mean age (44.8 v. 47.5 years), frequency of blunt injury (92.0% v. 91.4%), median injury severity score (24 v. 22) and percentage of patients with Glasgow ComaComale score less than 9 (27.2% v. 22.1%). Survival did not differ overall (81.1% among patients in the Advanced LifeSupport phase v. 81.8% among those in the basic LifeSupport phase; p = 0.65). Among patients with Glasgow ComaComale score less than 9, survival was lower among those in the Advanced LifeSupport phase (50.9% v. 60.0%; p = 0.02). The adjusted odds of death for the Advanced LifeSupport v. basic LifeSupport phases were nonsignificant (1.2, 95% confidence interval 0.9–1.7; p = 0.16). Interpretation: The OPALS Major Trauma Study showed that systemwide implementation of full Advanced LifeSupport programs did not decrease mortality or morbidity for major trauma patients. We also found that during the Advanced LifeSupport phase, mortality was greater among patients with Glasgow ComaComale scores less than 9. We believe that emergency medical services should carefully re-evaluate the indications for and application of prehospital Advanced LifeSupport measures for patients who have experienced major trauma.

  • Advanced Life Support for out of hospital respiratory distress
    The New England Journal of Medicine, 2007
    Co-Authors: Ian G Stiell, Daniel W Spaite, Brian J Field, Lisa Nesbitt, Doug Munkley, Justin Maloney, Jon Dreyer, Lorraine Luinstra Toohey, Tony Campeau, Eugene Dagnone

    The clinical characteristics of the 8138 patients in the two phases of the study were similar. During the first phase, no patients were treated by paramedics trained in Advanced Life Support; during the second phase, 56.6% of patients received this treatment. Endotracheal intubation was performed in 1.4% of the patients, and intravenous drugs were administered to 15.0% during the second phase. This phase of the study was also marked by a substantial increase in the use of nebulized salbutamol and sublingual nitroglycerin for the relief of symptoms. The rate of death among all patients decreased significantly, from 14.3% to 12.4% (absolute difference, 1.9%; 95% confidence interval [CI], 0.4 to 3.4; P = 0.01) from the basic-LifeSupport phase to the AdvancedLifeSupport phase (adjusted odds ratio, 1.3; 95% CI, 1.1 to 1.5). CONCLUSIONS The addition of a specific regimen of out-of-hospital AdvancedLifeSupport interventions to an existing EMS system that provides basic Life Support was associated with a decrease in the rate of death of 1.9 percentage points among patients with respiratory distress.

  • The Ontario Prehospital Advanced Life Support (OPALS) Study: Rationale and Methodology for Cardiac Arrest Patients
    Annals of emergency medicine, 1998
    Co-Authors: Ian G Stiell, Eugene Dagnone, Daniel W Spaite, Brian J Field, Justin Maloney, Douglas P. Munkley, George A. Wells, Marion B Lyver, Gordon R Jones, Lorraine G Luinstra

    The Ontario Prehospital Advanced Life Support Study represents the largest prehospital study yet conducted, worldwide. This study will involve more than 25,000 cardiac arrest, trauma, and critically ill patients over an 8-year period. The study will evaluate the incremental benefit of rapid defibrillation and prehospital Advanced Cardiac Life Support measures for cardiac arrest survival and the benefit of Advanced Life Support for patients with traumatic injuries and other critically ill prehospital patients. This article describes the OPALS study with regard to the rationale and methodology for cardiac arrest patients.

Jodee M. Anderson – One of the best experts on this subject based on the ideXlab platform.

M Dixon – One of the best experts on this subject based on the ideXlab platform.

  • Advanced Life Support Research and Technology Transfer at the University of Guelph
    Open Agriculture, 2017
    Co-Authors: M Dixon, M. Stasiak, T. Rondeau, T. Graham

    AbstractResearch and technology developments surrounding Advanced LifeSupport (ALS) began at the University of Guelph in 1992 as the Space and Advanced Life Support Agriculture (SALSA) program, which now represents Canada’s primary contribution to ALS research. The early focus was on recycling hydroponic nutrient solutions, atmospheric gas analysis and carbon balance, sensor research and development, inner/intra-canopy lighting and biological filtration of air in closed systems. With funding from federal, provincial and industry partners, a new generation of technology emerged to address the challenges of deploying biological systems as fundamental components of LifeSupport infrastructure for long-duration human space exploration. Accompanying these advances were a wide range of technology transfer opportunities in the agri-food and health sectors, including air and water remediation, plant and environment sensors, disinfection technologies, recyclable growth substrates and Advanced light emitting dioddiode (LED) lighting systems. This report traces the evolution of the SALSA program and catalogues the benefits of ALS research for terrestrial and non-terrestrial applications.

  • Canadian Advanced Life Support capacities and future directions
    Advances in Space Research, 2009
    Co-Authors: Matthew Bamsey, T. Graham, Maciej Stasiak, Alain Berinstain, A. Scott, T. Rondeau Vuk, M Dixon

    Canada began research on space-relevant biological Life Support systems in the early 1990s. Since that time Canadian capabilities have grown tremendously, placing Canada among the emerging leaders in biological Life Support systems. The rapid growth of Canadian expertise has been the result of several factors including a large and technically sophisticated greenhouse sector which successfully operates under challenging climatic conditions, well planned technology transfer strategies between the academic and industrial sectors, and a strong emphasis on international research collaborations. Recent activities such as Canada’s contribution of the Higher Plant Compartment of the European Space Agency’s MELiSSA Pilot Plant and the remote operation of the Arthur Clarke Mars Greenhouse in the Canadian High Arctic continue to demonstrate Canadian capabilities with direct applicability to Advanced Life Support systems. There is also a significant latent potential within Canadian institutions and organizations with respect to directly applicable Advanced Life Support technologies. These directly applicable research interests include such areas as horticultural management strategies (for candidate crops), growth media, food processing, water management, atmosphere management, energy management, waste management, imaging, environment sensors, thermal control, lighting systems, robotics, command and data handling, communications systems, structures, in-situ resource utilization, space analogues and mission operations. With this background and in collaboration with the Canadian aerospace industry sector, a roadmap for future Life Support contributions is presented here. This roadmap targets an objective of at least 50% food closure by 2050 (providing greater closure in oxygen, water recycling and carbon dioxide uptake). The Canadian Advanced Life Support community has chosen to focus on lunar surface infrastructure and not low EartEarth orbit or transit systems (i.e. microgravity applications). To advance the technical readiness for the proposed lunar missions, including a lunar plant growth lander, lunar “salad machine” (i.e. small scale plant production unit) and a full scale lunar plant production system, a suite of terrestrial developments and analogue systems are proposed. As has been successfully demonstrated by past Canadian Advanced Life Support activities, terrestrial technology transfer and the development of highly qualified personnel will serve as key outputs for Canadian Advanced Life Support system research programs. This approach is designed to serve the Canadian greenhouse industry by developing compliance measures for mitigating environmental impact, reducing labour and energy costs as well as improving Canadian food security, safety and benefit northern/remote communities. Crown Copyright © 2009.

Kjetil Sunde – One of the best experts on this subject based on the ideXlab platform.