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Book: Prehospital care of neurologic emergencies

Crocco, Todd J. / Sayre, Michael R.

2014

Author's details	ed. by Todd J. Crocco ; Michael R. Sayre
Keywords	Nervous System Diseases ; Emergency Medical Services
Language	English
Size	XII, 199 S.
Publisher	Cambridge Univ. Press
Publishing place	Cambridge
Publishing country	Great Britain
Document type	Book
Note	Includes bibliographical references and index
HBZ-ID	HT018378926
ISBN	978-1-107-67832-3 ; 1-107-67832-3
Database	Catalogue ZB MED Medicine, Health

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2014 A 3378	available for loan (reading room)	Lesesaal EG

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Article ; Online: "Head Up CPR" Is Not Ready for Widespread Adoption.

Jarvis, Jeffrey L / Sayre, Michael R / Crowe, Remle P / Menegazzi, James J / Wang, Henry E

Prehospital emergency care

2024 , Page(s) 1–3

Language	English
Publishing date	2024-02-28
Publishing country	England
Document type	Editorial
ZDB-ID	1461751-1
ISSN	1545-0066 ; 1090-3127
ISSN (online)	1545-0066
ISSN	1090-3127
DOI	10.1080/10903127.2024.2319697
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Article: REVISING PROTOCOLS. A back-to-basics training approach to comply with the AHA Guidelines Update.

Sayre, Michael R

JEMS : a journal of emergency medical services

2016 Volume 41, Issue 3, Page(s) 46–47

MeSH term(s)	American Heart Association ; Emergency Medical Technicians/education ; Guidelines as Topic ; Humans ; United States
Language	English
Publishing date	2016-03
Publishing country	United States
Document type	Journal Article
ZDB-ID	1292428-3
ISSN	0197-2510
ISSN	0197-2510
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Article ; Online: Wolf Creek XVII part 3: Automated cardiac arrest diagnosis.

van den Beuken, Wisse M F / Sayre, Michael R / Olasveengen, Theresa M / Sunshine, Jacob E

Resuscitation plus

2023 Volume 16, Page(s) 100499

Abstract: Introduction: Automated cardiac arrest diagnosis offers the possibility to significantly shorten the interval between onset of out-of-hospital cardiac arrest (OHCA) and notification of EMS, providing the opportunity for earlier resuscitation and ... ...

Abstract	Introduction: Automated cardiac arrest diagnosis offers the possibility to significantly shorten the interval between onset of out-of-hospital cardiac arrest (OHCA) and notification of EMS, providing the opportunity for earlier resuscitation and possibly increased survival. Methods: Automated cardiac arrest diagnosis was one of six focus topics for the Wolf Creek XVII Conference held on June 14-17 2023 in Ann Arbor, Michigan, USA. Conference invitees included international thought leaders and scientists in the field of cardiac arrest resuscitation from academia and industry. Participants submitted via online survey knowledge gaps, barriers to translation and research priorities for each focus topic. Expert panels used the survey results and their own perspectives and insights to create and present a preliminary unranked list for each category that was debated, revised and ranked by all attendees to identify the top 5 for each category. Results: Top knowledge gaps include the accuracy of automated OHCA detection technologies and the feasibility and reliability of automated EMS activation. The main barriers to translation are the risk of false positives potentially overburdening EMS, development and application costs of technology and the challenge of integrating new technology in EMS IT systems. The top research priorities are large-scale evaluation studies to measure real world performance and user research regarding the willingness to adopt these technologies. Conclusion: Automated cardiac arrest diagnosis has the potential to significantly impact time to resuscitation and survival of OHCA because it could convert unwitnessed events into witnessed events. Validation and feasibility studies are needed. The specificity of the technology must be high not to overburden limited EMS resources. If adequate event classification is achieved, future research could shift toward event prediction, focusing on identifying potential digital biomarkers and signatures of imminent cardiac arrest. Implementation could be challenging due to high costs of development, regulatory considerations and instantiation logistics.
Language	English
Publishing date	2023-11-20
Publishing country	Netherlands
Document type	Journal Article ; Review
ISSN	2666-5204
ISSN (online)	2666-5204
DOI	10.1016/j.resplu.2023.100499
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Metronome use improves achievement of a target compression rate in out-of-hospital cardiac arrest: A retrospective analysis.

Kennedy, Jacob / Machado, Kimberly / Maynard, Charles / Walker, Robert G / Sayre, Michael R / Counts, Catherine R

Resuscitation plus

2023 Volume 15, Page(s) 100417

Abstract: Aim: The aim of this study was to evaluate chest compression rates (CCR) with and without the use of a metronome during treatment of out-of-hospital cardiac arrest (OHCA).: Methods: We performed a retrospective cohort investigation of non-traumatic ... ...

Abstract	Aim: The aim of this study was to evaluate chest compression rates (CCR) with and without the use of a metronome during treatment of out-of-hospital cardiac arrest (OHCA). Methods: We performed a retrospective cohort investigation of non-traumatic OHCA cases treated by Seattle Fire Department from January 1, 2013, to December 31, 2019. The exposure was a metronome running during CPR at a rate of 110 beats per minute. The primary outcome was the median CCR for all periods of CPR with a metronome compared to periods without a metronome. Results: We included 2,132 OHCA cases with 32,776 minutes of CPR data; 15,667 (48%) minutes had no metronome use, and 17,109 (52%) minutes had a metronome used. Without a metronome, the median CCR was 112.8 per minute with an interquartile range of 108.4 - 119.1, and 27% of minutes were above 120 or less than 100. With a metronome, the median CCR was 110.5 per minute with an interquartile range of 110.0-112.0, and less than 4% of minutes were above 120 or less than 100. The compression rate was 109, 110, or 111 in 62% of minutes with a metronome compared to 18% of minutes with no metronome. Conclusion: The use of a metronome during CPR resulted in increased compliance to a predetermined compression rate. Metronomes are a simple tool that improves achievement of a target compression rate with little variance from that target.
Language	English
Publishing date	2023-06-23
Publishing country	Netherlands
Document type	Journal Article
ISSN	2666-5204
ISSN (online)	2666-5204
DOI	10.1016/j.resplu.2023.100417
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Response to Letter to the Editor from Fu-Shan Xue et al Concerning "Routine Use of a Bougie Improves First-Attempt Intubation Success in the Out-of-Hospital Setting".

Latimer, Andrew J / Counts, Catherine R / Sayre, Michael R / Maynard, Charles

Annals of emergency medicine

2021 Volume 78, Issue 3, Page(s) 458–459

MeSH term(s)	Emergency Service, Hospital ; Hospitals ; Humans ; Intubation, Intratracheal
Language	English
Publishing date	2021-09-06
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	603080-4
ISSN	1097-6760 ; 0196-0644
ISSN (online)	1097-6760
ISSN	0196-0644
DOI	10.1016/j.annemergmed.2021.04.029
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Article ; Online: A retrospective study on machine learning-assisted stroke recognition for medical helpline calls.

Wenstrup, Jonathan / Havtorn, Jakob Drachmann / Borgholt, Lasse / Blomberg, Stig Nikolaj / Maaloe, Lars / Sayre, Michael R / Christensen, Hanne / Kruuse, Christina / Christensen, Helle Collatz

NPJ digital medicine

2023 Volume 6, Issue 1, Page(s) 235

Abstract: Advanced stroke treatment is time-dependent and, therefore, relies on recognition by call-takers at prehospital telehealth services to ensure fast hospitalisation. This study aims to develop and assess the potential of machine learning in improving ... ...

Abstract	Advanced stroke treatment is time-dependent and, therefore, relies on recognition by call-takers at prehospital telehealth services to ensure fast hospitalisation. This study aims to develop and assess the potential of machine learning in improving prehospital stroke recognition during medical helpline calls. We used calls from 1 January 2015 to 31 December 2020 in Copenhagen to develop a machine learning-based classification pipeline. Calls from 2021 are used for testing. Calls are first transcribed using an automatic speech recognition model and then categorised as stroke or non-stroke using a text classification model. Call-takers achieve a sensitivity of 52.7% (95% confidence interval 49.2-56.4%) with a positive predictive value (PPV) of 17.1% (15.5-18.6%). The machine learning framework performs significantly better (p < 0.0001) with a sensitivity of 63.0% (62.0-64.1%) and a PPV of 24.9% (24.3-25.5%). Thus, a machine learning framework for recognising stroke in prehospital medical helpline calls may become a supportive tool for call-takers, aiding in early and accurate stroke recognition.
Language	English
Publishing date	2023-12-19
Publishing country	England
Document type	Journal Article
ISSN	2398-6352
ISSN (online)	2398-6352
DOI	10.1038/s41746-023-00980-y
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Article ; Online: Prehospital Administration of Norepinephrine and Epinephrine for Shock after Resuscitation from Cardiac Arrest.

Wender, Emma R / Counts, Catherine R / Van Dyke, Molly / Sayre, Michael R / Maynard, Charles / Johnson, Nicholas J

Prehospital emergency care

2023 Volume 28, Issue 3, Page(s) 453–458

Abstract: Introduction: Shock after resuscitation from out-of-hospital cardiac arrest (OHCA) is often treated with vasopressors. We examined whether infusion of epinephrine versus norepinephrine was associated with prehospital rearrest and neurologically ... ...

Abstract	Introduction: Shock after resuscitation from out-of-hospital cardiac arrest (OHCA) is often treated with vasopressors. We examined whether infusion of epinephrine versus norepinephrine was associated with prehospital rearrest and neurologically favorable survival among OHCA patients. Methods: This retrospective study included OHCA cases in Seattle, Washington from 2014-2021 who had return of spontaneous circulation (ROSC) followed by vasopressor infusion. Our primary exposure was infusion of epinephrine or norepinephrine. Our primary outcome was prehospital rearrest. Secondary outcomes included survival and neurologically favorable outcome (Cerebral Performance Category score of 1 or 2). We used multivariable logistic regression to test associations between exposures and outcomes adjusting for key covariates. Results: Of 451 OHCA patients with ROSC followed by vasopressor infusion, 253 (56%) received norepinephrine and 198 (44%) received epinephrine infusions. Those who received epinephrine were older (median 66 [interquartile ranges {IQR} 53-79] vs 63 [IQR 47-75] years), but otherwise had similar baseline characteristics. Patients who received epinephrine were twice as likely to rearrest (55% vs 25%). After adjustment, the difference in rearrest rates between epinephrine and norepinephrine persisted (OR 3.28, 95%CI 2.25-5.08), and the odds of pulses at hospital arrival were lower in the epinephrine group (OR 0.52 95%CI 0.32-0.83). After adjustment, there was no difference in neurologically favorable survival, survival to hospital admission, or survival to discharge. Conclusion: Patients who received epinephrine infusions after ROSC suffered prehospital rearrest more frequently than those who received norepinephrine. Survival and neurological status at hospital discharge were similar. Future trials should examine the optimal approach to hemodynamic management for post-OHCA shock.
MeSH term(s)	Humans ; Norepinephrine/therapeutic use ; Retrospective Studies ; Cardiopulmonary Resuscitation ; Emergency Medical Services ; Epinephrine/therapeutic use ; Vasoconstrictor Agents/therapeutic use ; Out-of-Hospital Cardiac Arrest/drug therapy ; Shock
Chemical Substances	Norepinephrine (X4W3ENH1CV) ; Epinephrine (YKH834O4BH) ; Vasoconstrictor Agents
Language	English
Publishing date	2023-09-14
Publishing country	England
Document type	Journal Article
ZDB-ID	1461751-1
ISSN	1545-0066 ; 1090-3127
ISSN (online)	1545-0066
ISSN	1090-3127
DOI	10.1080/10903127.2023.2252500
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Comparison of Intubating Conditions with Succinylcholine Versus Rocuronium in the Prehospital Setting.

Ramsey, J T / Pache, Killian M / Sayre, Michael R / Maynard, Charles / Johnson, Nicholas J / Counts, Catherine R

Prehospital emergency care

2023 Volume 28, Issue 4, Page(s) 537–544

Abstract: Objective: Rapid sequence intubation (RSI) is frequently performed by emergency medical services (EMS). We investigated the relationship between succinylcholine and rocuronium use and time until first laryngoscopy attempt, first-pass success, and ... ...

Abstract	Objective: Rapid sequence intubation (RSI) is frequently performed by emergency medical services (EMS). We investigated the relationship between succinylcholine and rocuronium use and time until first laryngoscopy attempt, first-pass success, and Cormack-Lehane (CL) grades. Methods: We included adult patients for whom prehospital RSI was attempted from July 2015 through June 2022 in a retrospective, observational study with pre-post analysis. Timing was verified using recorded defibrillator audio in addition to review of continuous ECG, pulse oximetry, and end-tidal carbon dioxide waveforms. Our primary exposure was neuromuscular blocking agent (NMBA) used, either rocuronium or succinylcholine. Our prespecified primary outcome was the first attempt Cormack-Lehane view. Key secondary outcomes were first laryngoscopy attempt success rate, timing from NMBA administration to first attempt, number of attempts, and hypoxemic events. Results: Of 5,179 patients in the EMS airway registry, 1,475 adults received an NMBA while not in cardiac arrest. Cormack-Lehane grades for succinylcholine and rocuronium were similar: grade I (64%, 59% [95% CI 0.64-1.09]), grade II (16%, 21%), grade III (18%, 16%), grade IV (3%, 3%). The median interval from NMBA administration to start of the first attempt was 57 s for succinylcholine and 83 s for rocuronium (mean difference 28 [95% CI 20-36] seconds). First attempt success was 84% for succinylcholine and 83% for rocuronium. Hypoxemic events were present in 25% of succinylcholine cases and 23% of rocuronium cases. Conclusions: Prehospital use of either rocuronium or succinylcholine is associated with similar Cormack-Lehane grades, first-pass success rates, and rates of peri-intubation hypoxemia.
MeSH term(s)	Humans ; Succinylcholine/administration & dosage ; Rocuronium/administration & dosage ; Female ; Male ; Retrospective Studies ; Emergency Medical Services/methods ; Middle Aged ; Aged ; Rapid Sequence Induction and Intubation/methods ; Intubation, Intratracheal/methods ; Neuromuscular Nondepolarizing Agents/administration & dosage ; Adult ; Neuromuscular Depolarizing Agents/administration & dosage
Chemical Substances	Succinylcholine (J2R869A8YF) ; Rocuronium (WRE554RFEZ) ; Neuromuscular Nondepolarizing Agents ; Neuromuscular Depolarizing Agents
Language	English
Publishing date	2023-12-22
Publishing country	England
Document type	Journal Article ; Observational Study ; Comparative Study
ZDB-ID	1461751-1
ISSN	1545-0066 ; 1090-3127
ISSN (online)	1545-0066
ISSN	1090-3127
DOI	10.1080/10903127.2023.2285399
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Article ; Online: Pediatric Out-of-Hospital Cardiac Arrest: The Role of the Telecommunicator in Recognition of Cardiac Arrest and Delivery of Bystander Cardiopulmonary Resuscitation.

Lewis, Miranda M / Pache, Killian / Guan, Sally / Shin, Jenny / Parayil, Megin / Counts, Catherine R / Drucker, Chris / Sayre, Michael R / Kudenchuk, Peter J / Eisenberg, Mickey / Rea, Thomas D

Journal of the American Heart Association

2024 Volume 13, Issue 2, Page(s) e031740

Abstract: Background: Telecommunicator CPR (T-CPR), whereby emergency dispatch facilitates cardiac arrest recognition and coaches CPR over the telephone, is an important strategy to increase early recognition and bystander CPR in adult out-of-hospital cardiac ... ...

Abstract	Background: Telecommunicator CPR (T-CPR), whereby emergency dispatch facilitates cardiac arrest recognition and coaches CPR over the telephone, is an important strategy to increase early recognition and bystander CPR in adult out-of-hospital cardiac arrest (OHCA). Little is known about this treatment strategy in the pediatric population. We investigated the role of T-CPR and related performance among pediatric OHCA. Methods and results: This study was a retrospective cohort investigation of OHCA among individuals <18 years in King County, Washington, from April 1, 2013, to December 31, 2019. We reviewed the 911 audio recordings to determine if and how bystander CPR was delivered (unassisted or T-CPR), key time intervals in recognition of arrest, and key components of T-CPR delivery. Of the 185 eligible pediatric OHCAs, 23% (n=43) had bystander CPR initiated unassisted, 59% (n=109) required T-CPR, and 18% (n=33) did not receive CPR before emergency medical services arrival. Among all cases, cardiac arrest was recognized by the telecommunicator in 89% (n=165). Among those receiving T-CPR, the median (interquartile range) interval from start of call to OHCA recognition was 59 seconds (38-87) and first CPR intervention was 115 seconds (94-162). When stratified by age (≤8 versus >8), the older age group was less likely to receive CPR before emergency medical services arrival (88% versus 69%, Conclusions: T-CPR is an important strategy to increase early recognition and early CPR among pediatric OHCA.
MeSH term(s)	Child ; Humans ; Cardiopulmonary Resuscitation/methods ; Emergency Medical Services ; Out-of-Hospital Cardiac Arrest/diagnosis ; Out-of-Hospital Cardiac Arrest/therapy ; Retrospective Studies ; Washington
Language	English
Publishing date	2024-01-12
Publishing country	England
Document type	Journal Article
ZDB-ID	2653953-6
ISSN	2047-9980 ; 2047-9980
ISSN (online)	2047-9980
ISSN	2047-9980
DOI	10.1161/JAHA.123.031740
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