Recent discussions
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Maria Luce Caputo
It is a matter of fact that the technology is more and more improving the lay citizens' knowledge and involvment in the out-of-hospital cardiac arrest care. This review document by ILCOR summarize very well what we know right now about the impact of the mobile phones technology on the critical outcomes of OHCAs. However, more studies are needed to better assess some key points, including the use of the technology to select the person who has to retrieve the Automatic external defibrillator or the development of specific protocols of intervention in case of trauma or intoxication. -
Виктория Антонова
Thank you for taking the time to comment on this CoSTR. We acknowledge that an immediate replantation of an avulsed tooth substantially increases its survival and, hence, healing. However, this procedure may not be possible in the first aid setting due to the patient‘s concomitant injuries (e.g. unconsciousness, bleedings, fractures, …) at the time of accident and lack of knowledge in and willingness to undertake the management of such injuries. The use of a suitable temporary storage solution or technique for an avulsed tooth should not delay efforts at replantation, but it may aid in the survival of the tooth before receiving professional help. -
Виктория Антонова
Concordo -
Виктория Антонова
Just a few small edits with regard to the Saperstein study The citation is Saperstein 2018 216. It is a convenience sample case series describing 10 choking episodes in 8 patients (one unfortunate patient had three episodes). The last three sentences of the first paragraph of the Suction-Based Airway Clearing Devices section don't make sense with a single study. I think you mean to say that the single study had a high risk of bias due to selective reporting (the number of episodes in which the device was used is not stated, and unknowable). For that same reason, I wonder if this case series should be treated as evidence at all - we don't know if it was used successfully in 10/10 attempts, or 10/10,000 (the true rate is likely between these extremes, but there's no way to know where). You don't provide a reference to the Saperstein article in the References. It is: Saperstein DM, Pugliesi PR, Ulteig C, Schreiber N. Successful use of a novel device called the Lifevac to resuscitate choking victims - world-side results. Int J Clin Skills. 2018; 12(3):216-9. -
Виктория Антонова
Our service is in agreement with use of Intraosseous needle in situations where umbilical venous cannulation is unsuccessful. UVC placement should be considered first as it is usually more rapid, and in our service appropriately trained staff are available. We agree with comments already made about prioritising practice and training in UVC technique to ensure familiarity. Intraosseous needles provide rapid access in the emergency department setting, and for general paediatricians, there is usually familiarity with their use. Study will remain difficult due to rarity of use. -
Виктория Антонова
Não tenho experiência com intra óssea na reanimação.. mas acho interessante o treinamento e a abordagem..pois no momento da emergência todos nós temos que estar preparados para um plano B -
Виктория Антонова
I totally agree with Ellen Heimbergs comment. I know very well both sides (AHA and ERC)For the pediatric patients it is important that someone does something as fast as possible, ...and -beside of any not really existing evidence for both pathways- it is at the end simply more realistic and pragmatic to start with CC. ...until REAL evidence tell us what is the best! -
Виктория Антонова
I very much support a change to CAB. The easier the algorithm the better the adherence to it. My experience on the PICU is that with a sudden or unwitnessed onset of cardiac arrest, staff mostly starts with chest compressions while calling for help, although staff is very well trained in ABC. Thus, ABC is not practical for most cardiac carrest cases in a PICU setting. Furthermore, do we really want two different algorithm approaches for BLS on one ward? Let’s make algorithms as simple and intuitive as possible and let’s adjust algorithms for pediatric and adolescent patients. This discussion is not just about a potential delay of ventilation – this is about how we can implement and adhere to algorithms best. -
Виктория Антонова
The blog reveals: The predilection for either the i.o. access or the UVC spreads along the border “neonatologist” vs. “pediatric intensivist/emergency physician”, respectively corresponding nurse specialization. The primary goal must be: be as quick as possible. The European Resuscitation Council Guideline of 2015 clearly demands to have an i.v. access in pediatric emergencies within 1 minute, otherwise to switch to the i.o. access, which obviously means: within 2 or 3 minutes the access to the vascular system must be finished. There is no reason to believe that during newborn resuscitation we have more time! So ask yourself the critical question: with which of the available techniques will I have safe access within 2 or 3 minutes! Having experience with newborn and pediatric resuscitation for more than 35 years and practicing i.o. access as well (also in premature infants below 1.0 kg) I can say: in a newborn with a persisting soft umbilical stump (i.e. in the first 24 hrs) the umbilical access with a blunt hollow cannula is by far faster and more promising than the i.o. access. This also holds true for physicians, who rarely practice this procedure (obstetricians, anesthetists etc.), provided that they were familiarized with the technique. To repeat the comment by Susan Niermeyer (who has been a member of the ILCOR editorial board for a long time) from this blog: “The knowledge gaps are especially important, as they highlight areas in which information/approach could be improved around the predominant technique of UVC access”. 3 further recommendations: (1) Use fresh umbilical cord pieces for dry runs of this procedure at a bench to train this route of access at least twice per year with your whole team; (2) forget the traditional UV catheter and use a plastic blunt hollow cannula of about 70 mm length instead (see for instance www.interlockmed.com and search for “Einmalknopfkanüle”) (should be available from other manufacturers in other countries as well); (3) the emergency procedure should never aim at an anatomically perfect placement with the tip of the cannula or catheter at the entrance to the right atrium, 2-3 cm below the abdominal wall is enough, most often blood can be aspirated. However, this preference for the umbilical route is in contrast to the only study on this issue, that I am aware of, comparing i.o. with umbilical access in a manikin (which might not be a good model) (Schwindt EM et al.. Pediatr Crit Care Med 2018; 19:468–76). We currently run a bench study with medical students to assess different umbilical access routes (lateral incision vs. cross section – UVC vs. cannula) on cut-off specimens of umbilical cords. Preliminary results are expected end of this year. Further literature for the cannula technique - both papers “unfortunately” in German: Hentschel R.; The emergency vascular access in the delivery room. DOI 10.3238/DIVI.2018.0014–0024 with 6 figures and short English abstract (available on request by email to the author) Hopfner RJ et al.; Erstversorgung und Reanimation von Frühgeborenen. DOI 10.1007/s10049-005-0750-6 Notfall + Rettungsmedizin 2005; 8: 334–41 -
Виктория Антонова
Full disclosure I work for PerSys Medical the manufacturer of the NIO IO device. My background is in emergency care, critical care and vascular access. I agree with Scott DeBoer's comments. In emergency medicine and pre-hospital arrests UVC route is often not a skill that is regulary taught or maintained. Many pre-hospital EMS systems do not have UVC in their protocols. This leads to potential failed access or delayed access. I agree with the Infusion Nursing Society INS 2016 Standard 55.1 "In the event of adult or pediatric cardiac arrest, anticipate use of the IO route if intravenous access is not available or cannot be obtained quickly. Pediatric Advanced Life Support (PALS) support guidelines suggest the use of the IO route as the initial vascular access route. (II)" Per the INS 2016 guidelines Umbilical Catheters Standard 30.1 Practice criteria E." Confirm the catheter tip location by radiography, echocardiography, or ultrasonography before catheter use" Confirming catheter UVC tip prior to use outside of hospital is not obtainable in most cases. Many studies support the use of IO as a faster route than the placement of UVC without the increase of complications. Oustide of NICU theater I would highly recommend the use of IO access as the first preferred route.