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Signa Vitae

Journal of Intensive Care and Emergency Medicine

Most frequent interventions involving children in prehospital emergency medicine

Abstract

A retrospective study of interventions involving children in the period from 2011 to 2015 was conducted at the Teaching Institute for Emergency Medicine of Zagreb. During this period a total of 18,356 interventions involving children occurred in the field. From 2011 to 2013, 11,576 interventions occurred, which makes up 4.56 % of all interventions in that period. During 2014 and 2015 there were 6,780 interventions which make up 3.69 % of all interventions in the field during that period. There was a 20 % reduction in the number of emergency interventions involving children in the last two years of the study in comparison to the previous period. The greatest number of these emergency interventions is due to injury. From 2011 to 2013, the total number of interventions involving injured children was 24.59 % as opposed to 19.94 % from 2014 to 2015. There is a statistically significant decrease in the number of occurring injuries by 19%, whereas the number of head injuries went down from 12.48 % to 10.01 %. That marks a decrease of 20 % in the second part of the studied period. This is most probably a result of better injury prevention as a result of education programs in preschools, schools, media campaigns, and the use of protective equipment (protective helmets for cyclist, skaters, skiers etc.)

Key words: children, trauma, emergency medical service

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Dose pre-hospital laryngeal mask airway use has a survival benefit in non-shockable cardiac arrest?

Abstract

Background. Whether pre-hospital laryngeal mask airway (LMA) use poses a survival benefit and should be approved as routine airway management in non-shockable cardiac arrest is of major concern. The present study examined the effectiveness of LMA, in comparison to other pre-hospital airway management on individuals who have experienced non-shockable cardiac arrest.

Methods. Adult patients who experienced non-shockable cardiac arrest with activation of the emergency medical service (EMS) made up our study cohort in Taoyuan, Taiwan. The data were abstracted from EMS records and cardiac arrest registration protocols.

Results. Among the 1912 enrolled patients, most received LMA insertion (72.4%), 108 (5.6%) bag-valve-mask (BVM) ventilation, 376 (19.7%) high-flow oxygen non-rebreather facemask, and only 44 (2.3%) received endotracheal tube intubation (ETI). With regard to survival to discharge, no significant differences in prevalence were evident among the groups: 2.8% of oxygen facial mask, 1.1% of BVM, 2.1% of LMA, and 4.5% of the ETI group survived to discharge (p = 0.314). In comparison to oxygen facial mask use, different types of airway management remained unassociated with survival to discharge after adjusting for variables by logistic regression analysis (BVM: 95% confidence interval [CI], 0.079 – 1.639 [p = 0.186]; LMA: 95% CI, 0.220–2.487 [p = 0.627]; ETI: 95% CI, 0.325–17.820 [p = 0.390]). The results of Hosmer-Lemeshow goodness-of-fit test of logistic regression model revealed good calibration.

Conclusions. Pre-hospital LMA use was not associated with additional survival to discharge compared with facial oxygen mask, BVM, or ETI following non-shockable cardiac arrest.

Key words: emergency medical service, out-of-hospital cardiac arrest, laryngeal mask airway, ventilation, cardiopulmonary resuscitation

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