Recent discussions
-
Виктория Антонова
Thank you for this interesting and important review. Please take this response on behalf of the British Red Cross. With increasing pressure on emergency services, changes to how people learn, and the emerging models for community resilience which include preparedness and skills to respond, exploration of this topic indicates significant gaps in research and insight. The outcomes you were looking for were inevitably limited. By not including social/ethical/environmental outcomes either because the studies did not report them, or because they could not be directly linked to patient outcomes seems a significant limitation. Outcomes not included here such as community resilience, learner confidence/intention/likelihood/willingness to act, empowerment of lay responders, interdependence between lay and professional responders created as a result of community education would be interesting and important to explore in this context. It appears that ‘bystander CPR rate’ has possibly been used as a proxy for all these more nuanced outcomes, and in doing so the review misses an opportunity to recognise the wider benefits of community education. ‘Bundled initiatives’ is not a term we were familiar with, although having read the review we understand it to be a set of clinically focused education interventions grouped together. From an educational perspective this also seems limiting. Blended learning is not mentioned in this review, although it could have similar benefits for the learner. Perhaps an additional gap to note might be to find the optimal mix of both topics and educational approaches to achieve identified outcomes. -
Lloyd Jensen
Great discussion of a very important point. Agree that for those in the Delivery Room with experience and equipment, the UVC is a simple , fast and reliable method. As long as it is only placed in 2 to 4 cm, there is no need for radio-graphic confirmation during an emergency. Agree completely with Scott De Boer regarding situations outside of the DR.- ie the responder/provider in the ED, in the field, in facilities without experience in UVC placement, or where you did not get the emergent UVC, or the neonate with a dried cord. The skill to place a IO can be life saving. This skill has to be practiced. The task training to place an IO is a critical skill for those responding to emergencies. If one does not have a "drill" or a "manual" IO devise a larger spinal needle could be used- 13, 18. (or 20 gauge) .The problem is the length of those needles. My opinion is that it is a skill that should be included in neonatal resuscitation training-especially for non NICU/DR providers. -
Виктория Антонова
In the prehospital ED adult cardiac arrest the IO is faster with better flow than a peripheral IV (if humeral) and is not "traumatic" as someone above said. I would hate to see people pushing IV with often significant delays with multiple attempts at a peripheral IV. -
Виктория Антонова
I am conducting an intervention study related to neonatal resuscitation in one of the poorest regions of Brazil. In this region, there are no doctors specializing in neonatology, the structure is very precarious and about 7000 newborns are born per year. I believe that IO training for this population would be more feasible given the difficulty of a practitioner with poor CUV practice succeeding in advanced resuscitation. -
Виктория Антонова
Agree. UVC is the preferred route but if it can't be placed (i.e. week old infant) and peripheral access is not easily obtained an IO is the only other option. -
Виктория Антонова
Acho o cateterismo umbilical mais seguro para acesso vascular no momento da reanimação neonatal O acesso IO requer prática e principalmente material próprio para evitar complicações óssea no RN -
Виктория Антонова
I totally agree with Scott (not surprising) but in the prehospital/ED world IO is often a much more available/usable option and given the lack of any good evidence should not be treated as a "bad" choice -
Виктория Антонова
As mentioned by Scott DeBoer in an earlier comment, there are few if any EMS agencies in the U.S. that perform UVC. The recommendation language should be worded differently for pre-hospital vs. in-hospital personnel. This recommendation will be disregarded by most of us in EMS based on the current wording mainly due to impracticality. Furthermore, we have moved to the distal femur for IO placement in pediatric arrest with good success. We do agree that the proximal tibia IO site is fraught with difficulties and complications. -
Виктория Антонова
Thank you for this review. We welcome the positive acknowledgement of efficiency that stroke recognition tools can have for the lay public and positive outcomes. The discussion in your justification narrative rightly defers to those providing local guidelines for responders regarding the use of glucose which, from an educational perspective is perhaps better suited to the trained first responder. Perhaps an additional gap in existing knowledge is the ability of a lay responder to make the decision to take the test, their ability to do so, and the pathway for decision-making beyond the test. -
Виктория Антонова
I agree with the treatment recommendations.