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  1. Article ; Online: Evaluation of Physiologic Alterations during Prehospital Paramedic-Performed Rapid Sequence Intubation.

    Walker, Robert G / White, Lynn J / Whitmore, Geneva N / Esibov, Alexander / Levy, Michael K / Cover, Gregory C / Edminster, Joel D / Nania, James M

    Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors

    2018  Volume 22, Issue 3, Page(s) 300–311

    Abstract: Objective: Physiologic alterations during rapid sequence intubation (RSI) have been studied in several emergency airway management settings, but few data exist to describe physiologic alterations during prehospital RSI performed by ground-based ... ...

    Abstract Objective: Physiologic alterations during rapid sequence intubation (RSI) have been studied in several emergency airway management settings, but few data exist to describe physiologic alterations during prehospital RSI performed by ground-based paramedics. To address this evidence gap and provide guidance for future quality improvement initiatives in our EMS system, we collected electronic monitoring data to evaluate peri-intubation vital signs changes occurring during prehospital RSI.
    Methods: Electronic patient monitor data files from cases in which paramedic RSI was attempted were prospectively collected over a 15-month study period to supplement the standard EMS patient care documentation. Cases were analyzed to identify peri-intubation changes in oxygen saturation, heart rate, and blood pressure.
    Results: Data from 134 RSI cases were available for analysis. Paramedic-assigned prehospital diagnostic impression categories included neurologic (42%), respiratory (26%), toxicologic (22%), trauma (9%), and cardiac (1%). The overall intubation success rate (95%) and first-attempt success rate (82%) did not differ across diagnostic impression categories. Peri-intubation desaturation (SpO
    Conclusions: In this study, the majority of peri-intubation physiologic alterations occurred on first-attempt success, highlighting that first-attempt success is an incomplete and potentially deceptive measure of intubation quality. Supplementing the standard patient care documentation with electronic monitoring data can identify unrecognized physiologic instability during prehospital RSI and provide valuable guidance for quality improvement interventions.
    MeSH term(s) Adult ; Aged ; Clinical Competence ; Emergency Medical Services ; Emergency Medical Technicians ; Female ; Heart Rate/physiology ; Humans ; Intubation, Intratracheal ; Male ; Middle Aged ; Monitoring, Physiologic ; Oxygen Consumption/physiology ; Prospective Studies ; Respiration ; Toxicology
    Language English
    Publishing date 2018-01-03
    Publishing country England
    Document type Journal Article
    ZDB-ID 1461751-1
    ISSN 1545-0066 ; 1090-3127
    ISSN (online) 1545-0066
    ISSN 1090-3127
    DOI 10.1080/10903127.2017.1380095
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Optimizing neurologically intact survival from sudden cardiac arrest: a call to action.

    Goodloe, Jeffrey M / Wayne, Marvin / Proehl, Jean / Levy, Michael K / Yannopoulos, Demetris / Thigpen, Ken / O'Connor, Robert E

    The western journal of emergency medicine

    2014  Volume 15, Issue 7, Page(s) 803–807

    Abstract: The U.S. national out-of-hospital and in-hospital cardiac arrest survival rates, although improving recently, have remained suboptimal despite the collective efforts of individuals, communities, and professional societies. Only until very recently, and ... ...

    Abstract The U.S. national out-of-hospital and in-hospital cardiac arrest survival rates, although improving recently, have remained suboptimal despite the collective efforts of individuals, communities, and professional societies. Only until very recently, and still with inconsistency, has focus been placed specifically on survival with pre-arrest neurologic function. The reality of current approaches to sudden cardiac arrest is that they are often lacking an integrative, multi-disciplinary approach, and without deserved funding and outcome analysis. In this manuscript, a multidisciplinary group of authors propose practice, process, technology, and policy initiatives to improve cardiac arrest survival with a focus on neurologic function.
    MeSH term(s) Cardiopulmonary Resuscitation/methods ; Clinical Protocols ; Cognition Disorders/etiology ; Cognition Disorders/physiopathology ; Cognition Disorders/prevention & control ; Death, Sudden, Cardiac/prevention & control ; Electroencephalography ; Emergency Medical Services ; Heart Arrest/complications ; Heart Arrest/physiopathology ; Heart Arrest/therapy ; Humans ; Nervous System Diseases/etiology ; Nervous System Diseases/physiopathology ; Nervous System Diseases/prevention & control ; Policy Making ; Practice Guidelines as Topic ; Prognosis ; Randomized Controlled Trials as Topic ; Survival Analysis ; United States
    Language English
    Publishing date 2014-11
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ISSN 1936-9018
    ISSN (online) 1936-9018
    DOI 10.5811/westjem.2014.6.21832
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Rationale and Strategies for Development of an Optimal Bundle of Management for Cardiac Arrest.

    Pepe, Paul E / Aufderheide, Tom P / Lamhaut, Lionel / Davis, Daniel P / Lick, Charles J / Polderman, Kees H / Scheppke, Kenneth A / Deakin, Charles D / O'Neil, Brian J / van Schuppen, Hans / Levy, Michael K / Wayne, Marvin A / Youngquist, Scott T / Moore, Johanna C / Lurie, Keith G / Bartos, Jason A / Bachista, Kerry M / Jacobs, Michael J / Rojas-Salvador, Carolina /
    Grayson, Sean T / Manning, James E / Kurz, Michael C / Debaty, Guillaume / Segal, Nicolas / Antevy, Peter M / Miramontes, David A / Cheskes, Sheldon / Holley, Joseph E / Frascone, Ralph J / Fowler, Raymond L / Yannopoulos, Demetris

    Critical care explorations

    2020  Volume 2, Issue 10, Page(s) e0214

    Abstract: Objectives: To construct a highly detailed yet practical, attainable roadmap for enhancing the likelihood of neurologically intact survival following sudden cardiac arrest.: Design setting and patients: Population-based outcomes following out-of- ... ...

    Abstract Objectives: To construct a highly detailed yet practical, attainable roadmap for enhancing the likelihood of neurologically intact survival following sudden cardiac arrest.
    Design setting and patients: Population-based outcomes following out-of-hospital cardiac arrest were collated for 10 U.S. counties in Alaska, California, Florida, Ohio, Minnesota, Utah, and Washington. The 10 identified emergency medical services systems were those that had recently reported significant improvements in neurologically intact survival after introducing a more comprehensive approach involving citizens, hospitals, and evolving strategies for incorporating technology-based, highly choreographed care and training. Detailed inventories of in-common elements were collated from the ten 9-1-1 agencies and assimilated. For reference, combined averaged outcomes for out-of-hospital cardiac arrest occurring January 1, 2017, to February 28, 2018, were compared with concurrent U.S. outcomes reported by the well-established Cardiac Arrest Registry to Enhance Survival.
    Interventions: Most commonly, interventions and components from the ten 9-1-1 systems consistently included extensive public cardiopulmonary resuscitation training, 9-1-1 system-connected smart phone applications, expedited dispatcher procedures, cardiopulmonary resuscitation quality monitoring, mechanical cardiopulmonary resuscitation, devices for enhancing negative intrathoracic pressure regulation, extracorporeal membrane oxygenation protocols, body temperature management procedures, rapid cardiac angiography, and intensive involvement of medical directors, operational and quality assurance officers, and training staff.
    Measurements and main results: Compared with Cardiac Arrest Registry to Enhance Survival (
    Conclusions: The likelihood of neurologically favorable survival following out-of-hospital cardiac arrest can improve substantially in communities that conscientiously and meticulously introduce a well-sequenced, highly choreographed, system-wide portfolio of both traditional and nonconventional approaches to training, technologies, and physiologic management. The commonalities found in the analyzed systems create a compelling case that other communities can also improve out-of-hospital cardiac arrest outcomes significantly by conscientiously exploring and adopting similar bundles of system organization and care.
    Language English
    Publishing date 2020-10-15
    Publishing country United States
    Document type Journal Article
    ISSN 2639-8028
    ISSN (online) 2639-8028
    DOI 10.1097/CCE.0000000000000214
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: One-year outcomes of out-of-hospital administration of intravenous glucose, insulin, and potassium (GIK) in patients with suspected acute coronary syndromes (from the IMMEDIATE [Immediate Myocardial Metabolic Enhancement During Initial Assessment and Treatment in Emergency Care] Trial).

    Selker, Harry P / Udelson, James E / Massaro, Joseph M / Ruthazer, Robin / D'Agostino, Ralph B / Griffith, John L / Sheehan, Patricia R / Desvigne-Nickens, Patrice / Rosenberg, Yves / Tian, Xin / Vickery, Ellen M / Atkins, James M / Aufderheide, Tom P / Sayah, Assaad J / Pirrallo, Ronald G / Levy, Michael K / Richards, Michael E / Braude, Darren A / Doyle, Delanor D /
    Frascone, Ralph J / Kosiak, Donald J / Leaming, James M / Van Gelder, Carin M / Walter, Gert-Paul / Wayne, Marvin A / Woolard, Robert H / Beshansky, Joni R

    The American journal of cardiology

    2014  Volume 113, Issue 10, Page(s) 1599–1605

    Abstract: The Immediate Myocardial Metabolic Enhancement During Initial Assessment and Treatment in Emergency care Trial of very early intravenous glucose-insulin-potassium (GIK) for acute coronary syndromes (ACS) in out-of-hospital emergency medical service (EMS) ...

    Abstract The Immediate Myocardial Metabolic Enhancement During Initial Assessment and Treatment in Emergency care Trial of very early intravenous glucose-insulin-potassium (GIK) for acute coronary syndromes (ACS) in out-of-hospital emergency medical service (EMS) settings showed 80% reduction in infarct size at 30 days, suggesting potential longer-term benefits. Here we report 1-year outcomes. Prespecified 1-year end points of this randomized, placebo-controlled, double-blind, effectiveness trial included all-cause mortality and composites including cardiac arrest, mortality, or hospitalization for heart failure (HF). Of 871 participants randomized to GIK versus placebo, death occurred within 1 year in 11.6% versus 13.5%, respectively (unadjusted hazard ratio [HR] 0.83, 95% confidence interval [CI] 0.57 to 1.23, p = 0.36). The composite of cardiac arrest or 1-year mortality was 12.8% versus 17.0% (HR 0.71, 95% CI 0.50 to 1.02, p = 0.06). The composite of hospitalization for HF or mortality within 1 year was 17.2% versus 17.2% (HR 0.98, 95% CI 0.70 to 1.37, p = 0.92). The composite of mortality, cardiac arrest, or HF hospitalization within 1 year was 18.1% versus 20.4% (HR 0.85, 95% CI 0.62 to 1.16, p = 0.30). In patients presenting with suspected ST elevation myocardial infarction, HRs for 1-year mortality and the 3 composites were, respectively, 0.65 (95% CI 0.33 to 1.27, p = 0.21), 0.52 (95% CI 0.30 to 0.92, p = 0.03), 0.63 (95% CI 0.35 to 1.16, p = 0.14), and 0.51 (95% CI 0.30 to 0.87, p = 0.01). In patients with suspected acute coronary syndromes, serious end points generally were lower with GIK than placebo, but the differences were not statistically significant. However, in those with ST elevation myocardial infarction, the composites of cardiac arrest or 1-year mortality, and of cardiac arrest, mortality, or HF hospitalization within 1 year, were significantly reduced.
    MeSH term(s) Acute Coronary Syndrome/diagnosis ; Acute Coronary Syndrome/drug therapy ; Acute Coronary Syndrome/mortality ; Adult ; After-Hours Care/methods ; Cardioplegic Solutions ; Cause of Death/trends ; Double-Blind Method ; Electrocardiography ; Female ; Follow-Up Studies ; Glucose/administration & dosage ; Heart Arrest/mortality ; Heart Arrest/prevention & control ; Humans ; Infusions, Intravenous ; Insulin/administration & dosage ; Male ; Middle Aged ; Myocardium/metabolism ; Outpatients ; Potassium/administration & dosage ; Retrospective Studies ; Survival Rate/trends ; Time Factors ; Treatment Outcome ; United States/epidemiology
    Chemical Substances Cardioplegic Solutions ; Insulin ; glucose-insulin-potassium cardioplegic solution ; Glucose (IY9XDZ35W2) ; Potassium (RWP5GA015D)
    Language English
    Publishing date 2014-03-01
    Publishing country United States
    Document type Journal Article ; Multicenter Study ; Randomized Controlled Trial ; Research Support, N.I.H., Extramural
    ZDB-ID 80014-4
    ISSN 1879-1913 ; 0002-9149
    ISSN (online) 1879-1913
    ISSN 0002-9149
    DOI 10.1016/j.amjcard.2014.02.010
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Out-of-hospital administration of intravenous glucose-insulin-potassium in patients with suspected acute coronary syndromes: the IMMEDIATE randomized controlled trial.

    Selker, Harry P / Beshansky, Joni R / Sheehan, Patricia R / Massaro, Joseph M / Griffith, John L / D'Agostino, Ralph B / Ruthazer, Robin / Atkins, James M / Sayah, Assaad J / Levy, Michael K / Richards, Michael E / Aufderheide, Tom P / Braude, Darren A / Pirrallo, Ronald G / Doyle, Delanor D / Frascone, Ralph J / Kosiak, Donald J / Leaming, James M / Van Gelder, Carin M /
    Walter, Gert-Paul / Wayne, Marvin A / Woolard, Robert H / Opie, Lionel H / Rackley, Charles E / Apstein, Carl S / Udelson, James E

    JAMA

    2012  Volume 307, Issue 18, Page(s) 1925–1933

    Abstract: Context: Laboratory studies suggest that in the setting of cardiac ischemia, immediate intravenous glucose-insulin-potassium (GIK) reduces ischemia-related arrhythmias and myocardial injury. Clinical trials have not consistently shown these benefits, ... ...

    Abstract Context: Laboratory studies suggest that in the setting of cardiac ischemia, immediate intravenous glucose-insulin-potassium (GIK) reduces ischemia-related arrhythmias and myocardial injury. Clinical trials have not consistently shown these benefits, possibly due to delayed administration.
    Objective: To test out-of hospital emergency medical service (EMS) administration of GIK in the first hours of suspected acute coronary syndromes (ACS).
    Design, setting, and participants: Randomized, placebo-controlled, double-blind effectiveness trial in 13 US cities (36 EMS agencies), from December 2006 through July 31, 2011, in which paramedics, aided by electrocardiograph (ECG)-based decision support, randomized 911 (871 enrolled) patients (mean age, 63.6 years; 71.0% men) with high probability of ACS.
    Intervention: Intravenous GIK solution (n = 411) or identical-appearing 5% glucose placebo (n = 460) administered by paramedics in the out-of-hospital setting and continued for 12 hours.
    Main outcome measures: The prespecified primary end point was progression of ACS to myocardial infarction (MI) within 24 hours, as assessed by biomarkers and ECG evidence. Prespecified secondary end points included survival at 30 days and a composite of prehospital or in-hospital cardiac arrest or in-hospital mortality, analyzed by intent-to-treat and by presentation with ST-segment elevation.
    Results: There was no significant difference in the rate of progression to MI among patients who received GIK (n = 200; 48.7%) vs those who received placebo (n = 242; 52.6%) (odds ratio [OR], 0.88; 95% CI, 0.66-1.13; P = .28). Thirty-day mortality was 4.4% with GIK vs 6.1% with placebo (hazard ratio [HR], 0.72; 95% CI, 0.40-1.29; P = .27). The composite of cardiac arrest or in-hospital mortality occurred in 4.4% with GIK vs 8.7% with placebo (OR, 0.48; 95% CI, 0.27-0.85; P = .01). Among patients with ST-segment elevation (163 with GIK and 194 with placebo), progression to MI was 85.3% with GIK vs 88.7% with placebo (OR, 0.74; 95% CI, 0.40-1.38; P = .34); 30-day mortality was 4.9% with GIK vs 7.7% with placebo (HR, 0.63; 95% CI, 0.27-1.49; P = .29). The composite outcome of cardiac arrest or in-hospital mortality was 6.1% with GIK vs 14.4% with placebo (OR, 0.39; 95% CI, 0.18-0.82; P = .01). Serious adverse events occurred in 6.8% (n = 28) with GIK vs 8.9% (n = 41) with placebo (P = .26).
    Conclusions: Among patients with suspected ACS, out-of-hospital administration of intravenous GIK, compared with glucose placebo, did not reduce progression to MI. Compared with placebo, GIK administration was not associated with improvement in 30-day survival but was associated with lower rates of the composite outcome of cardiac arrest or in-hospital mortality.
    Trial registration: clinicaltrials.gov Identifier: NCT00091507.
    MeSH term(s) Acute Coronary Syndrome/drug therapy ; Acute Coronary Syndrome/mortality ; Aged ; Allied Health Personnel ; Angina, Unstable/complications ; Angina, Unstable/drug therapy ; Cardioplegic Solutions/therapeutic use ; Decision Support Techniques ; Double-Blind Method ; Electrocardiography ; Emergency Medical Services ; Female ; Glucose/therapeutic use ; Heart Arrest/prevention & control ; Hospital Mortality ; Humans ; Insulin/therapeutic use ; Male ; Middle Aged ; Myocardial Infarction/etiology ; Myocardial Infarction/prevention & control ; Odds Ratio ; Potassium/therapeutic use ; Survival Analysis ; Treatment Outcome
    Chemical Substances Cardioplegic Solutions ; Insulin ; glucose-insulin-potassium cardioplegic solution ; Glucose (IY9XDZ35W2) ; Potassium (RWP5GA015D)
    Language English
    Publishing date 2012-03-27
    Publishing country United States
    Document type Clinical Trial ; Journal Article ; Multicenter Study ; Randomized Controlled Trial ; Research Support, N.I.H., Extramural
    ZDB-ID 2958-0
    ISSN 1538-3598 ; 0254-9077 ; 0002-9955 ; 0098-7484
    ISSN (online) 1538-3598
    ISSN 0254-9077 ; 0002-9955 ; 0098-7484
    DOI 10.1001/jama.2012.426
    Database MEDical Literature Analysis and Retrieval System OnLINE

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