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Henry E Wang - One of the best experts on this subject based on the ideXlab platform.
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interruptions in cardiopulmonary resuscitation from paramedic Endotracheal Intubation
Annals of Emergency Medicine, 2009Co-Authors: Henry E Wang, Scott Simeone, Matthew D Weaver, Clifton W CallawayAbstract:Study objective Emergency cardiac care guidelines emphasize treatment of cardiopulmonary arrest with continuous uninterrupted cardiopulmonary resuscitation (CPR) chest compressions. Paramedics in the United States perform Endotracheal Intubation on nearly all victims of out-of-hospital cardiopulmonary arrest. We quantified the frequency and duration of CPR chest compression interruptions associated with paramedic Endotracheal Intubation efforts during out-of-hospital cardiopulmonary arrest. Methods We studied adult out-of-hospital cardiopulmonary arrest treated by an urban and a rural emergency medical services agency from the Resuscitation Outcomes Consortium during November 2006 to June 2007. Cardiac monitors with compression sensors continuously recorded rescuer CPR chest compressions. A digital audio channel recorded all resuscitation events. We identified CPR interruptions related to Endotracheal Intubation efforts, including airway suctioning, laryngoscopy, Endotracheal tube placement, confirmation and adjustment, securing the tube in place, bag-valve-mask ventilation between Intubation attempts, and alternate airway insertion. We identified the number and duration of CPR interruptions associated with Endotracheal Intubation efforts. Results We included 100 of 182 out-of-hospital cardiopulmonary arrests in the analysis. The median number of Endotracheal Intubation–associated CPR interruption was 2 (interquartile range [IQR] 1 to 3; range 1 to 9). The median duration of the first Endotracheal Intubation–associated CPR interruption was 46.5 seconds (IQR 23.5 to 73 seconds; range 7 to 221 seconds); almost one third exceeded 1 minute. The median total duration of all Endotracheal Intubation–associated CPR interruptions was 109.5 seconds (IQR 54 to 198 seconds; range 13 to 446 seconds); one fourth exceeded 3 minutes. Endotracheal Intubation–associated CPR pauses composed approximately 22.8% (IQR 12.6-36.5%; range 1.0% to 93.4%) of all CPR interruptions. Conclusion In this series, paramedic out-of-hospital Endotracheal Intubation efforts were associated with multiple and prolonged CPR interruptions.
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out of hospital Endotracheal Intubation where are we
Annals of Emergency Medicine, 2006Co-Authors: Henry E Wang, Donald M. YealyAbstract:While remaining prominent in paramedic care and beneficial to some patients, out-of-hospital Endotracheal Intubation has not clearly improved survival or reduced morbidity from critical illness or injury when studied more broadly. Recent studies identify equivocal or unfavorable clinical effects, adverse events and errors, interaction with other important resuscitation interventions, and challenges in providing and maintaining procedural skill. We provide an overview of current data evaluating the overall effectiveness, safety, and feasibility of paramedic out-of-hospital Endotracheal Intubation. These studies highlight our limited understanding of out-of-hospital Endotracheal Intubation and the need for new strategies to improve airway support in the out-of-hospital setting.
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Out-of-hospital Endotracheal Intubation: where are we?
Annals of emergency medicine, 2006Co-Authors: Henry E Wang, Donald M. YealyAbstract:While remaining prominent in paramedic care and beneficial to some patients, out-of-hospital Endotracheal Intubation has not clearly improved survival or reduced morbidity from critical illness or injury when studied more broadly. Recent studies identify equivocal or unfavorable clinical effects, adverse events and errors, interaction with other important resuscitation interventions, and challenges in providing and maintaining procedural skill. We provide an overview of current data evaluating the overall effectiveness, safety, and feasibility of paramedic out-of-hospital Endotracheal Intubation. These studies highlight our limited understanding of out-of-hospital Endotracheal Intubation and the need for new strategies to improve airway support in the out-of-hospital setting.
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Out-of-hospital Endotracheal Intubation and outcome after traumatic brain injury
Annals of emergency medicine, 2004Co-Authors: Henry E Wang, Andrew B. Peitzman, Laura D. Cassidy, P. David Adelson, Donald M. YealyAbstract:Study objective: Previous studies disagree about the effect of out-of-hospital Endotracheal Intubation on traumatic brain injury. This study compares the effects of out-of-hospital Endotracheal Intubation versus emergency department (ED) Endotracheal Intubation on mortality and neurologic and functional outcome after severe traumatic brain injury. Methods: From the 2000 to 2002 Pennsylvania Trauma Outcome Study (a registry of all patients treated at traumacenters inthe Commonwealth of Pennsylvania), adult patients with head/neck Abbreviated Injury Scale score of 3 or greater and undergoing outof-hospital Endotracheal Intubation or ED Endotracheal Intubation were included. Transferred patients were excluded. The primary outcome was death (on hospital discharge). The secondary outcomes were neurologic (good versus poor, inferred from discharge to home versus long-term care facility) and functional outcome (determined from a Functional Impairment Score). The key exposure was Endotracheal Intubation (out-of-hospital Endotracheal Intubation versus ED Endotracheal Intubation). Using multivariate logistic regression, odds estimates for out-of-hospital Endotracheal Intubation were adjusted using age, sex, head/neck Abbreviated Injury Scale score, Injury Severity Score, mechanism of injury (penetrating versus blunt), admission systolic bloodpressure,modeoftransport(groundonlyversushelicopterorhelicopter + ground), and the use of out-of-hospital neuromuscular blocking agents. A propensity score adjustment accounted for the potential effects of preexisting conditions, inhospital complications, and social factors (drug and alcohol use, race, and insurance coverage). Results: There were 4,098 patients with head/neck Abbreviated Injury Scale score of 3 or greater who received either out-of-hospital Endotracheal Intubation (n=1,797, 43.9%) or ED Endotracheal Intubation (n=2,301, 56.1%). Adjusted odds of death were higher for out-of-hospital Endotracheal Intubation than ED Endotracheal Intubation (odds ratio [OR] 3.99; 95% confidence interval [CI] 3.21 to 4.93). Out-of-hospital Endotracheal Intubation was associated with anincreasedadjusted oddsof poorneurologic outcome (OR 1.61; 95% CI 1.15 to 2.26), moderate or severe functional impairment (Functional ImpairmentScore6to15;OR1.92;95%CI1.40to2.64), andsevere functionalimpairment (Functional Impairment Score 11 to 15; OR 1.80; 95% CI 1.29 to 2.52). Conclusion: Out-of-hospital Endotracheal Intubation was associated with adverse outcomes after severe traumatic brain injury. The implications for current clinical care remain undefined.
Donald M. Yealy - One of the best experts on this subject based on the ideXlab platform.
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out of hospital Endotracheal Intubation where are we
Annals of Emergency Medicine, 2006Co-Authors: Henry E Wang, Donald M. YealyAbstract:While remaining prominent in paramedic care and beneficial to some patients, out-of-hospital Endotracheal Intubation has not clearly improved survival or reduced morbidity from critical illness or injury when studied more broadly. Recent studies identify equivocal or unfavorable clinical effects, adverse events and errors, interaction with other important resuscitation interventions, and challenges in providing and maintaining procedural skill. We provide an overview of current data evaluating the overall effectiveness, safety, and feasibility of paramedic out-of-hospital Endotracheal Intubation. These studies highlight our limited understanding of out-of-hospital Endotracheal Intubation and the need for new strategies to improve airway support in the out-of-hospital setting.
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Out-of-hospital Endotracheal Intubation: where are we?
Annals of emergency medicine, 2006Co-Authors: Henry E Wang, Donald M. YealyAbstract:While remaining prominent in paramedic care and beneficial to some patients, out-of-hospital Endotracheal Intubation has not clearly improved survival or reduced morbidity from critical illness or injury when studied more broadly. Recent studies identify equivocal or unfavorable clinical effects, adverse events and errors, interaction with other important resuscitation interventions, and challenges in providing and maintaining procedural skill. We provide an overview of current data evaluating the overall effectiveness, safety, and feasibility of paramedic out-of-hospital Endotracheal Intubation. These studies highlight our limited understanding of out-of-hospital Endotracheal Intubation and the need for new strategies to improve airway support in the out-of-hospital setting.
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Out-of-hospital Endotracheal Intubation and outcome after traumatic brain injury
Annals of emergency medicine, 2004Co-Authors: Henry E Wang, Andrew B. Peitzman, Laura D. Cassidy, P. David Adelson, Donald M. YealyAbstract:Study objective: Previous studies disagree about the effect of out-of-hospital Endotracheal Intubation on traumatic brain injury. This study compares the effects of out-of-hospital Endotracheal Intubation versus emergency department (ED) Endotracheal Intubation on mortality and neurologic and functional outcome after severe traumatic brain injury. Methods: From the 2000 to 2002 Pennsylvania Trauma Outcome Study (a registry of all patients treated at traumacenters inthe Commonwealth of Pennsylvania), adult patients with head/neck Abbreviated Injury Scale score of 3 or greater and undergoing outof-hospital Endotracheal Intubation or ED Endotracheal Intubation were included. Transferred patients were excluded. The primary outcome was death (on hospital discharge). The secondary outcomes were neurologic (good versus poor, inferred from discharge to home versus long-term care facility) and functional outcome (determined from a Functional Impairment Score). The key exposure was Endotracheal Intubation (out-of-hospital Endotracheal Intubation versus ED Endotracheal Intubation). Using multivariate logistic regression, odds estimates for out-of-hospital Endotracheal Intubation were adjusted using age, sex, head/neck Abbreviated Injury Scale score, Injury Severity Score, mechanism of injury (penetrating versus blunt), admission systolic bloodpressure,modeoftransport(groundonlyversushelicopterorhelicopter + ground), and the use of out-of-hospital neuromuscular blocking agents. A propensity score adjustment accounted for the potential effects of preexisting conditions, inhospital complications, and social factors (drug and alcohol use, race, and insurance coverage). Results: There were 4,098 patients with head/neck Abbreviated Injury Scale score of 3 or greater who received either out-of-hospital Endotracheal Intubation (n=1,797, 43.9%) or ED Endotracheal Intubation (n=2,301, 56.1%). Adjusted odds of death were higher for out-of-hospital Endotracheal Intubation than ED Endotracheal Intubation (odds ratio [OR] 3.99; 95% confidence interval [CI] 3.21 to 4.93). Out-of-hospital Endotracheal Intubation was associated with anincreasedadjusted oddsof poorneurologic outcome (OR 1.61; 95% CI 1.15 to 2.26), moderate or severe functional impairment (Functional ImpairmentScore6to15;OR1.92;95%CI1.40to2.64), andsevere functionalimpairment (Functional Impairment Score 11 to 15; OR 1.80; 95% CI 1.29 to 2.52). Conclusion: Out-of-hospital Endotracheal Intubation was associated with adverse outcomes after severe traumatic brain injury. The implications for current clinical care remain undefined.
Clifton W Callaway - One of the best experts on this subject based on the ideXlab platform.
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interruptions in cardiopulmonary resuscitation from paramedic Endotracheal Intubation
Annals of Emergency Medicine, 2009Co-Authors: Henry E Wang, Scott Simeone, Matthew D Weaver, Clifton W CallawayAbstract:Study objective Emergency cardiac care guidelines emphasize treatment of cardiopulmonary arrest with continuous uninterrupted cardiopulmonary resuscitation (CPR) chest compressions. Paramedics in the United States perform Endotracheal Intubation on nearly all victims of out-of-hospital cardiopulmonary arrest. We quantified the frequency and duration of CPR chest compression interruptions associated with paramedic Endotracheal Intubation efforts during out-of-hospital cardiopulmonary arrest. Methods We studied adult out-of-hospital cardiopulmonary arrest treated by an urban and a rural emergency medical services agency from the Resuscitation Outcomes Consortium during November 2006 to June 2007. Cardiac monitors with compression sensors continuously recorded rescuer CPR chest compressions. A digital audio channel recorded all resuscitation events. We identified CPR interruptions related to Endotracheal Intubation efforts, including airway suctioning, laryngoscopy, Endotracheal tube placement, confirmation and adjustment, securing the tube in place, bag-valve-mask ventilation between Intubation attempts, and alternate airway insertion. We identified the number and duration of CPR interruptions associated with Endotracheal Intubation efforts. Results We included 100 of 182 out-of-hospital cardiopulmonary arrests in the analysis. The median number of Endotracheal Intubation–associated CPR interruption was 2 (interquartile range [IQR] 1 to 3; range 1 to 9). The median duration of the first Endotracheal Intubation–associated CPR interruption was 46.5 seconds (IQR 23.5 to 73 seconds; range 7 to 221 seconds); almost one third exceeded 1 minute. The median total duration of all Endotracheal Intubation–associated CPR interruptions was 109.5 seconds (IQR 54 to 198 seconds; range 13 to 446 seconds); one fourth exceeded 3 minutes. Endotracheal Intubation–associated CPR pauses composed approximately 22.8% (IQR 12.6-36.5%; range 1.0% to 93.4%) of all CPR interruptions. Conclusion In this series, paramedic out-of-hospital Endotracheal Intubation efforts were associated with multiple and prolonged CPR interruptions.
Ana Cristina Simões E Silva - One of the best experts on this subject based on the ideXlab platform.
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Is remifentanil an option for premedication for neonatal Endotracheal Intubation
Archives of disease in childhood. Fetal and neonatal edition, 2010Co-Authors: Yerkes Pereira Silva, Juliana De Oliveira Marcatto, Rosilu Ferreira Barbosa, Ana Cristina Simões E SilvaAbstract:It was with great interest that we read the article by Choong et al , ‘Remifentanil for Endotracheal Intubation in neonates: a randomised controlled trial’.1 First of all, we would like to congratulate the authors on their randomised controlled trial (RCT). However, there are some issues that should be raised. The premedication protocol for Endotracheal Intubation in this study includes many classes of drugs besides opioids that might interfere with physiological responses. For instance, the administration of …
Li Yu-jie - One of the best experts on this subject based on the ideXlab platform.
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Survey on the Endotracheal Intubation skills in pre-hospital emergency personnel in Guangzhou.
Journal of Tropical Medicine, 2009Co-Authors: Wang Xifu, Zhan Hong, Wei Hongyan, Hu Chunlin, Xiong Yan, Li Yu-jieAbstract:Objective To explore the Endotracheal Intubation Skills of Pre-hospital Emergency Personnel in Guangzhou. Method Survey the Endotracheal Intubation Skills of 216 individuals who participate standardized training of pre-hospital emergency from March to June in Guangzhou. Results The rate of managed the Endotracheal Intubation skills of Pre-hospital Emergency Personnel was lower(51.9%) than that of doctors 74.1% (P0.001). However, the rate of managed tracheal Intubation skill of nurses was 29.6%. The rate of managed the Endotracheal Intubation skills of pre-hospital emergency doctors from level 3 hospitals was significantly higher than that of pre-hospital emergency doctors from level 2 hospitals(88.2% vs 50%, P0.001). In some hospitals, tracheal Intubation was practiced mainly by anesthesia doctors. 98.1% of hospital emergency vehicle was not equipped with else advanced airway devices, such as laryngeal mask, esophageal-tracheal combitube. Conclusion The rate of managed the Endotracheal Intubation skills of pre-hospital emergency personnel was low. There was a big difference in managed the Endotracheal Intubation skill between the pre-hospital emergency doctors from hospital of different levels. In order to truly improve the overall level of pre-hospital emergency service of Guangzhou city, unify and standardize the Endotracheal Intubation skills training in pre-hospital emergency personnel is urgently needed.