Category: Emergency Medicine

Categories : Emergency Medicine Injury & TraumaTags :

Intubation Before Hospital Admission for Major Trauma Saves Lives

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Photo by Mikhail Nilov

Trauma patients urgently requiring a breathing tube are more likely to survive if the tube is inserted before arriving at hospital compared to insertion afterwards, suggests a modelling study led by researchers at University College London and the Severn Major Trauma Network.

The researchers found that prehospital emergency intubation of high-risk trauma patients could improve 30-day survival by 10.3%, and could save 170 lives each year in the UK.

The findings of the new artificial intelligence (AI)-supported analysis, published in The Lancet Respiratory Medicine, provide\s the strongest evidence yet that prehospital emergency anaesthesia with intubation saves lives when delivered to those who need it most.

Trauma is a leading cause of death worldwide, with rates in South Africa 5–9 times higher than the global average. But there is a lack of high-quality evidence on the best time to start certain types of care for major trauma patients, such as the insertion of breathing tubes.

Prehospital intubation needs to be administered by an advanced critical care team, specially trained and equipped to administer the anaesthesia required to facilitate the insertion of breathing tubes. In the UK, that is currently provided only by the air ambulance services.

The researchers say their findings could inform policy discussions on funding specialist prehospital critical care teams, which could include public funding for air ambulances or funding additional training for ground ambulance teams, so that more high-risk major trauma patients can have breathing tubes inserted before arrival at hospital.

Joint first author Dr Amy Nelson (UCL Queen Square Institute of Neurology and King’s College London) said: “The airway is a top priority in major trauma, but the question of whether we should intubate before hospital arrival is unsettled because we cannot ethically conduct a randomised trial.

“Emergency care decisions made before hospital admission depend on the combination of many measurements taken under pressure. We used these measurements to answer the question in steps: we first built a machine learning model to identify high-risk patients, then we modelled the impact of early intubation in this group, which showed us that prehospital intubation saves lives.”

For the study, researchers analysed data from 6467 trauma patients treated at Southmead Hospital Major Trauma Centre, Bristol.

The researchers used AI-assisted modelling to predict both who would need intubation and who would likely survive – to isolate the impact that intubation had from other factors such as the injury severity. To facilitate their analysis, they developed a new machine learning model, called ‘Intub-8’, which predicted outcomes based on eight routinely collected prehospital measurements.

The researchers found that among high-risk patients who were identified by the model as needing intubation (229 patients), those who received it before arriving at hospital were 10.3% more likely to survive (within a 30-day period) compared with those who did not.

By scaling up their findings relative to national trauma incidence, the researchers estimate that if every trauma patient who needed prehospital intubation was given it, 170 lives could be saved each year in the UK – roughly one life saved every other day. 

Additionally, they conducted a cost-effectiveness analysis, finding that cost savings would be in the range of £101 million annually for the UK, due to reduced costs of further care and lives saved.

Professor Parashkev Nachev (UCL Queen Square Institute of Neurology), joint senior author, said: “In medicine, action and inaction are not morally asymmetric. When we cannot have randomised controlled trial evidence for an intervention, we must use the best available alternative: causal inference from real-world data, assisted by artificial intelligence, the only technology with the power to address the complexity of biological systems.”

Associate Professor Julian Thompson, joint senior author and Clinical Director of the Severn Major Trauma Network, said: “Until now, advanced air ambulance services across the world who respond to critically injured patients have struggled to conduct studies that assess the benefit and cost effectiveness of their life-saving interventions. The use of AI in this study has allowed us to analyse existing data in a totally new way. This reveals the huge impact that advanced care provides when delivered before arrival in hospital.

“These findings may have a huge impact on how UK and international health services look after the most severely injured patients in our societies.”

The authors note that the findings are specific to a mixed rural-urban UK setting where highly trained physician-paramedic teams perform all prehospital intubation. The survival benefit may differ in other healthcare systems or national contexts, and further research is needed to examine long-term outcomes and potential complications.

Source: University College London

Categories : Emergency MedicineTags :

Potential New Treatment for Sepsis Shows Promise in Trial

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Griffith University researchers may have unlocked the secret to treating sepsis, with a Phase II clinical trial in China successfully concluding with promising results.

Photo by Alex Fedini on Pixabay

Griffith University researchers may have unlocked the secret to treating sepsis, with a Phase II clinical trial in China successfully concluding with promising results. The sepsis drug candidate, a carbohydrate-based drug called STC3141, was co-developed by Distinguished Professor Mark von Itzstein AO and his team from Griffith’s Institute for Biomedicine and Glycomics, and Professor Christopher Parish and his team at The Australian National University.

“The trial met the key endpoints to indicate the drug candidate was successful in reducing sepsis in humans,” Professor von Itzstein said.

STC3141 was administered as an infusion via a cannula and counteracted a significant biological molecule release phenomenon which occurred in the body during the course of sepsis.

The small-molecule experimental drug was a carbohydrate-based molecule and could treat sepsis by reversing organ damage.

Sepsis was known to affect millions of hospitalised patients across the world each year and occurred when the body’s immune response to an infection attacked and injured its own tissues and organs.

“When sepsis is not recognised early and managed promptly, it can lead to septic shock, multiple organ failure and death,” Distinguished Professor von Itzstein said.

The trial, conducted by Grand Pharmaceutical Group Limited (Grand Pharma), involved 180 patients with sepsis, one of the leading causes of death and long-term disability worldwide.

Currently, there is no specific anti-sepsis therapy available, and sepsis is considered a clinical unmet need.

Professor von Itzstein said Grand Pharma would now look to progress to a Phase III trial to continue testing the efficacy of the novel treatment.

“It’s hoped we could see the treatment reach the market in a handful years, potentially saving millions of lives,” he said.

Executive Director of the Institute for Biomedicine and Glycomics, Professor Paul Clarke, said: “I am thrilled to see the results of the trial which ultimately aims to save lives.”

“The Institute and its researchers collectively work on translational research to deliver real and immediate impacts both in Australia, and globally to transform lives.”

Source: Griffith University

Categories : Emergency MedicineTags :

Case Study: Building a Stronger Emergency Response System in Limpopo

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Strengthening Limpopo’s post-crash emergency response has been one of the most powerful achievements of the Limpopo Road Safety Programme (LRSP). Through a combined focus on updated clinical training, advanced rescue skills and improved operational systems, Projects 12 and 12.1 have reshaped how Emergency Medical Services (EMS) teams respond in the critical minutes after a crash – from the first emergency call to hospital handover.

Updating clinical skills to strengthen frontline emergency care

Across South Africa, the Clinical Practice Guidelines (CPGs) for emergency care have been substantially updated, including a major revision in 2018. These updates incorporated new evidence, improved patient outcomes, and standardised practice across the health system, shifting toward more user-friendly formats such as clinical decision-support tools. For Limpopo’s EMS, this presented both an opportunity and a challenge: although the guidelines were available, many personnel had not yet received training to apply them consistently in the realities of roadside emergencies. Project 12 addressed this need directly, rolling out comprehensive CPG training across all five districts. EMS practitioners were equipped with updated algorithms for trauma, medical, paediatric and obstetric emergencies, along with enhanced assessment, triage and stabilisation skills.

This clinical uplift aligned perfectly with major system improvements. In the 2023/2024 financial year, the Limpopo Department of Health procured more than 500 new, modern ambulances, significantly expanding the provincial fleet. The LRSP ensured this investment translated into real-world impact: EMS personnel were trained not only on updated CPGs but also to use the new vehicles and onboard equipment to their full potential; optimising monitoring, patient loading, scene workflow and en-route care. Modern ambulances combined with modern knowledge dramatically strengthened the quality of emergency care.

By 2025, the system advanced even further with the introduction of a Computer-Aided Dispatch (CAD) system, enabling more efficient call-taking, improved dispatch decision-making, clearer communication and better tracking of EMS resources across districts. The CAD system, together with updated CPGs and a modern ambulance fleet, created a tightly integrated platform for faster, smarter and more coordinated EMS response. For the first time, Limpopo could align clinical best practice, operational intelligence and fleet capacity into one cohesive system.

Introducing advanced rescue skills for high-severity crash scenes

Yet, while clinical updates and dispatch improvements strengthened core EMS response, Limpopo still faced a critical need for specialised capacity at high-severity crash scenes, especially those involving vehicle entrapment. Project 12.1 filled this gap by introducing the province’s first Advanced Vehicle Rescue Short Course, delivered by EPIC EM and the University of Johannesburg. Over seven intensive days, participants trained in vehicle stabilisation, extrication techniques, hydraulic tool use, and multi-casualty scene management, blending theory with realistic, high-pressure simulations. Many described the training as transformative, giving them the competence and confidence to manage complex incidents on Limpopo’s regional and mining routes.

Together, these interventions have created a step change in Limpopo’s post-crash care system. Today, EMS teams arrive at crash scenes equipped with modern ambulances, updated clinical guidance, advanced rescue skills and a CAD-supported operational network that ensures faster and more coordinated response. Patients benefit from safer extrication, quicker stabilisation and better continuity of care during the “golden hour”. Beyond improving skills, the programme has strengthened morale, professionalism and a culture of excellence within EMS.

Projects 12 and 12.1 have left a lasting legacy: a provincial emergency response system that is smarter, faster and better prepared to save lives on Limpopo’s roads.

Categories : Emergency MedicineTags :

Is There a Doctor on Board? New Research Reveals the Frequency of In-Flight Medical Emergencies

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The study is the largest global analysis of in-flight medical events

Photo by Daniel Eledut on Unsplash

 With nearly five billion people flying each year, medical emergencies in the air may be more common than most realise and they can be deadly.

A new study led by Duke Health researchers analysed more than 77, 00 in-flight medical events reported to the world’s busiest airline medical support centre. The findings show that while most incidents are minor, thousands of passengers required hospital care after landing, and hundreds died or triggered aircraft diversions.

The study, published in JAMA Network Open, was conducted in partnership with MedAire, an aviation and maritime health and safety solutions company, which also provided the data for analysis. The paper offers a rare look into how airlines respond to medical crises and why some flights are forced to divert.

“This is the largest and most comprehensive study of in-flight medical emergencies ever conducted,” said Alexandre Rotta, MD, senior and corresponding author of the paper and chief of the Division of Pediatric Critical Care Medicine with the Department of Pediatrics at Duke University School of Medicine.

“It gives us a real-world snapshot of what happens when someone gets sick in the sky and how starkly the options differ from those in a hospital,” Rotta said.

Researchers reviewed medical calls from 84 airlines across six continents, covering over 3.1 billion passenger boardings between January 2022 and December 2023.

They found that one in every 212 flights involved a medical emergency. Of those flights, about 8% of passengers were taken to the hospital after landing, and 1.7% of the total medical events were so serious they caused the plane to divert.

The most common reasons for diversion were suspected strokes, seizures, chest pain, and altered mental status. Cardiac arrest occurred in 293 cases, with survival rates far lower than on land.

Medical volunteers (often physicians) assisted in nearly one-third of emergencies. Their involvement was linked to a higher likelihood of diversion, likely because they were called upon during more serious events.

“It’s humbling to practice medicine in the air,” said Rotta, who became interested in the topic after being called upon as medical volunteer during several flights. “You’re working with limited equipment, no lab tests and no backup. Even minor issues can become major challenges.”

Rotta emphasised that airlines are generally well-prepared, especially in the US, where regulations require defibrillators and basic medical kits. However, he noted that not all airlines partner with ground-based medical support centres, an approach he believes is essential.

“Airplanes aren’t hospitals, and we shouldn’t expect them to be,” he said. “But having expert guidance from the ground can make all the difference when someone’s life is at risk.”

The findings could help shape airline policies, improve crew training and inform passengers with chronic conditions about how to prepare for travel.

Source: Duke University

Categories : Cardiovascular Disease Emergency MedicineTags :

Innovative UK Project to Test Drones for Cardiac Arrest Response

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Credit: University of Surrey

A project to test how drones can be integrated into the UK’s 999 emergency response system to rapidly deliver defibrillators to patients experiencing out-of-hospital cardiac arrest (OHCA) has been launched by the University of Surrey, Air Ambulance Charity Kent Surrey Sussex, South East Coast Ambulance Service NHS Foundation Trust. 

With survival rates for OHCA in the UK currently below 10%, a key challenge is the delay in delivering life-saving defibrillation. While public Automated External Defibrillators (AEDs) are widely available, getting them to a patient in time is often difficult. This 16-month project will explore using drones to rapidly deliver AEDs to the scene of an emergency. 

This research is the first step towards integrating drone technology into our emergency response systems. Our ultimate goal is to develop and test the procedures needed to seamlessly introduce drone delivery of AEDs into the 999-emergency system 

Dr Scott Munro, Lecturer in Paramedic Practice at the University of Surrey and co-lead on the project

The initiative, which has been funded by the National Institute for Health and Care Research (NIHR), will be divided into two sections: in the first, researchers will develop and refine the drone delivery process through a series of simulations, coordinating 999 call taking, Air Traffic Control, ambulance dispatch and drone operators.  

In the second part, interviews will be conducted with a diverse group of people -including OHCA survivors, family members, responders and members of the public – to understand the public’s perception of drone technology, including any barriers or concerns, and to ensure ease of use for responders. 

This project is a great example of how NIHR’s RfPB programme supports life-saving innovation. Using drones to deliver defibrillators could help emergency teams reach patients faster, improve survival after cardiac arrest, and bring cutting-edge technology directly to the NHS frontline, while working with the public to ensure it’s used safely and effectively. 

Professor Kevin Munro, Director of the NIHR Research for Patient Benefit (RfPB) Programme

Rapid intervention is vital in managing out-of-hospital cardiac arrests. As demand continues to grow, the opportunity to integrate this technology into future healthcare systems represents real progress in ensuring ambulance services can work with the communities they serve to strengthen the chain of survival and give patients the best chance of a positive outcome Being a partner in this research, we are eager to explore how this new initiative could strengthen our cardiac arrest care pathway. 

Dr Craig Mortimer, Research Manager at South East Coast Ambulance Service NHS Foundation Trust (SECAmb)

Source: University of Surrey

Categories : Emergency Medicine Injury & TraumaTags :

Unlocking Fast, Targeted Treatment for Trauma Injuries

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Photo by Mat Napo on Unsplash

A groundbreaking study by researchers at Rutgers Health has uncovered a way to precisely identify and target trauma sites in the body within minutes of injury. The findings, published in the journal Med (Cell Press), could revolutionise emergency care by enabling real-time diagnostics and site-specific treatments delivered within minutes of injury.

A team of scientists, led by Renata Pasqualini and Wadih Arap at the Rutgers Cancer Institute discovered something new about how the body reacts to injury. When cells are damaged, like in a major bone break, calcium levels shift, which causes certain proteins to change shape. These changed proteins, called the “traumome,” are only found in injured tissues and show up right after an injury happens. This discovery opens up a new way to treat injuries directly, without affecting healthy parts of the body.

“The moment trauma occurs, specific proteins undergo structural changes, creating a molecular footprint of injury,” said Arap. “This opens the door to delivering diagnostics or therapies directly to the site – without affecting healthy tissues.”

This discovery has relevance in emergency treatment because many medicines can affect healthy organs when they’re given too soon. With this new approach, doctors could deliver treatments like imaging agents, clotting factors or antibiotics directly to the injured area, which would help the body heal faster with fewer side effects.    

“Our long-term vision is a simple injection that autonomously finds and treats injury sites,” said Pasqualini. “This could be transformative for battlefield medicine and emergency trauma care, where every second matters.”

The team used advanced testing on a pig model with major injuries to find tiny protein pieces called peptides. These peptides are like guides that can find and stick to the specific proteins altered by injury. One of these peptides stands out because it can attach to a protein that changes shape when calcium levels rise after an injury. This makes it possible to use special scans, like PET or MRI, to see exactly where the injury is in the body.

The trauma-targeting peptide worked the same way in rats, which shows that this injury “signature” is similar in all mammals, including humans.

The work was supported by the Defense Advanced Research Projects Agency (DARPA), an agency of the U.S. Department of Defense, underscoring its strategic value in both civilian and military medical applications. “Non-compressible bleeding remains a leading cause of death among soldiers before they reach a hospital, and localised treatment could dramatically improve survival rates, which was the original impetus of this research,” said Jon Mogford, a study co-author and former DARPA official.

The next phase of research will involve linking therapeutic agents to the trauma site-homing peptides and testing them in animal models before moving to early human clinical trials. The team envisions translational applications ranging from battlefield medicine to civilian trauma response and possibly even sports injuries or surgical recovery.

“We are actively developing peptide-linked drugs and imaging agents based on this discovery,” said Arap. “The traumome concept may also have applications beyond trauma, including in surgery, inflammation and tissue regeneration.”

Source: Rutgers University

Categories : Emergency Medicine Injury & TraumaTags :

Adaptive Spine Board Could Revolutionise ER Transport

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ASB overlay is divided into five distinct sections—head and neck, upper trunk, buttocks and pelvis, thighs, and feet and heels

In combat zones and emergency rescues, rapid evacuation and treatment can mean the difference between life and death. But prolonged immobilisation during transport poses another life-threatening risk: pressure injuries.

A newly developed adaptive spine board (ASB) overlay aims to change that, offering an innovative solution to prevent pressure injuries and dramatically improve patient outcomes. Developed by researchers at The University of Texas at Arlington and UT Southwestern Medical School, the adaptive spine board sits atop a standard stretcher or spine board, using air-cell technology to redistribute pressure more effectively than traditional evacuation surfaces. The team’s newly published study in the Journal of Rehabilitation and Assistive Technologies Engineering shows the ASB outperforms other immobilisation options.

“The ability to dynamically adjust pressure so that no vulnerable body regions experience excessive weight is a breakthrough for medical evacuation,” said Muthu B.J. Wijesundara, principal research scientist at the University of Texas at Arlington Research Institute. “This innovation could set a new standard in casualty transport protocols.”

Also called bedsores or ulcers, pressure injuries result from prolonged pressure on the skin and underlying soft tissue, leading to cell death, tissue breakdown and open wounds. They are a constant risk for trauma patients during long-range transport, which sometimes lasts more than 16 hours. Research shows that more than 50% of casualties transported during the Iraq War developed pressure injuries before reaching a hospital.

While some existing technologies, such as vacuum spine boards, can help redistribute pressure, their effectiveness is limited. Many conventional supports fail to keep pressure below the thresholds recommended to prevent injury. Military stretchers and pads have shown to create high-pressure points on vulnerable areas of the body, including the back of the head, base of the spine, buttocks and heels.

“Beyond military use, the ASB overlay could prove valuable in civilian medical transport, particularly for spinal injury patients who are at high risk for pressure ulcers,” Dr Wijesundara said. “The research also highlights potential applications in other environments where prolonged immobilisation is necessary, such as disaster relief and space exploration.”

The ASB overlay features a multi-segmented air-cell design that target pressure-prone areas more effectively than previous solutions. It is divided into five distinct sections—head and neck, upper trunk, buttocks and pelvis, thighs, and feet and heels—each equipped with sensor-driven pressure modulation for responsive, localised support.

“One key innovation is the system’s ability to autonomously adjust the air-cell pressure to maintain optimal distribution for each patient,” Wijesundara said. “We developed an algorithm that compensates for environmental variables, such as temperature and barometric pressure changes, ensuring consistent performance across varying conditions. Testing showed that the ASB overlay outperformed typical equipment used in casualty transport.”

For critically injured patients, pressure injuries can significantly complicate treatment and recovery, leading to longer hospital stays, higher infection risks and additional surgeries. They’re also costly. The Agency for Healthcare Research and Quality (AHRQ) estimates that pressure injuries in the US can cost up to $151 700 per case, adding $11.6 billion in additional health care expenses annually. Alarmingly, the AHRQ also reports that approximately 60 000 patients die each year because of pressure injuries. The ASB overlay’s advanced pressure modulation could help mitigate these risks—especially for patients who cannot be repositioned during extended transport.

The research team is now planning additional studies to improve the device’s usability in real-world conditions. As the military increasingly relies on prolonged aeromedical evacuation, such advancements are critical for enhancing patient care in conflict zones.

Categories : Emergency MedicineTags :

Statins May Reduce Mortality Risk by 39% for Patients with Septic Shock

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Each year in the US alone, approximately 750 000 patients are hospitalised for sepsis, of which approximately 27% die. In about 15% of cases, sepsis worsens into septic shock, characterised by dangerously low blood pressure and reduced blood flow to tissues. The risk of death from septic shock is even higher, between 30% and 40%.

The earlier patients with sepsis are treated, the better their prospects. Typically, they receive antibiotics, intravenous fluids, and vasopressors to raise blood pressure. But now, a large cohort study in Frontiers in Immunology has shown for the first time that supplementary treatment with statins could boost their chances of survival.

“Our large, matched cohort study found that treatment with statins was associated with a 39% lower death rate for critically ill patients with sepsis, when measured over 28 days after hospital admission,” said Dr Caifeng Li, the study’s corresponding author and an associate professor at Tianjin Medical University General Hospital in China.

Statins are best known as a protective treatment against cardiovascular disease, which function by lowering ‘bad’ LDL cholesterol and triglycerides, and raising ‘good’ HDL cholesterol. But they have been shown to bring a plethora of further benefits, which explains the burgeoning interest in their use as a supplementary therapy for inflammatory disorders, including sepsis.

Not just lowering cholesterol

“Statins have anti-inflammatory, immunomodulatory, antioxidative, and antithrombotic properties. They may help mitigate excessive inflammatory response, restore endothelial function, and show potential antimicrobial activities,” said Li.

The authors sourced their data from the public Medical Information Mart for Intensive Care-IV (MIMIC-IV) database, which holds the anonymised e-health records of 265 000 patients admitted to the emergency department and the intensive care unit of the Beth Israel Deaconess Medical Center of Boston between 2008 and 2019. Only adults with a diagnosis of sepsis hospitalised for longer than 24 hours were included here.

The authors compared outcomes between patients who received or didn’t receive any statins during their stay besides standard of care, regardless of the type of statin. Unlike in randomised clinical trials, the allocation of treatments is not determined by random in observational studies like the present cohort study. This means that it is in principle hard to rule out that an unknown underlying variable affected allocation, for example if physicians unconsciously or on purpose were prone to give statins to those patients most likely to benefit from them.

However, Li and colleagues used a technique called ‘propensity score matching’ to minimize the risk of such bias: they built a statistical model to determine a likelihood score that a given patient would receive statins, based on their medical records, and then found a matching patient with a similar score, but who didn’t receive statins. In the final sample, 6070 critical patients received statins while another 6070 did not.

Source: Frontiers

Categories : Emergency Medicine NeurologyTags :

T Cells could Ease Brain Injury after Cardiac Arrest

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Photo by Mat Napo on Unsplash

Despite improvements in CPR and ambulance response times, only about one in 10 people ultimately survive after out-of-hospital cardiac arrest (OHCA). Most patients hospitalised with OCHA die of brain injury, and no medications are currently available to prevent this outcome. A team led by researchers from Mass General Brigham found that immune cells may play a key role.

Using samples from patients who have had an OHCA, the team uncovered changes in immune cells just six hours after cardiac arrest that can predict brain recovery 30 days later. They pinpointed a particular population of cells that may provide protection against brain injury and a drug that can activate these cells, which they tested in preclinical models. Their results are published in Science Translational Medicine.

“Cardiac arrest outcomes are grim, but I am optimistic about jumping into this field of study because, theoretically, we can treat a patient at the moment injury happens,” said co-senior and corresponding author Edy Kim, MD, PhD, of the Division of Pulmonary and Critical Care Medicine at Brigham and Women’s Hospital. “Immunology is a super powerful way of providing treatment. Our understanding of immunology has revolutionised cancer treatment, and now we have the opportunity to apply the power of immunology to cardiac arrest.”

As a resident physician in the Brigham’s cardiac intensive care unit, Kim noticed that some cardiac arrest patients would have high levels of inflammation on their first night in the hospital and then rapidly improve. Other patients would continue to decline and eventually die. In order to understand why some patients survive and others do not, Kim and colleagues began to build a biobank – a repository of cryopreserved cells donated by patients with consent from their families just hours after their cardiac arrest.

The researchers used a technique known as single-cell transcriptomics to look at the activity of genes in every cell in these samples. They found that one cell population – known as diverse natural killer T (dNKT) cells – increased in patients who would have a favourable outcome and neurological recovery. The cells appeared to be playing a protective role in preventing brain injury.

To further test this, Kim and colleagues used a mouse model, treating mice after cardiac arrest with sulfatide lipid antigen, a drug that activates the protective NKT cells. They observed that the mice had improved neurological outcomes.

The researchers note that there are many limitations to mouse models, but making observations from human samples first could increase the likelihood of successfully translating their findings into intervention that can help patients. Further studies in preclinical models are needed, but their long-term goal is to continue to clinical trials in people to see if the same drug can offer protection against brain injury if given shortly after cardiac arrest.

“This represents a completely new approach, activating T cells to improve neurological outcomes after cardiac arrest,” said Kim. “And a fresh approach could lead to life-changing outcomes for patients.”

Source: Mass General Brigham

Categories : Emergency MedicineTags :

CPR with Breaths Essential for Cardiac Arrest after Drowning

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Photo by Kampus Production

Updated guidance reaffirms the recommendation for cardiopulmonary resuscitation (CPR) and highlights the importance of compressions with rescue breaths as a first step in responding to cardiac arrest following drowning, according to a new, focused update to Special Circumstances Guidelines from the American Heart Association and the American Academy of Pediatrics. The recommendations were published simultaneously in Circulation (focusing on adults) and Pediatrics (focusing on children).

Drowning is the third-leading cause of death from unintentional injury worldwide. The World Health Organization estimates there are about 236 000 deaths due to drowning each year globally. According to the CDC, it’s the number one cause of death for children ages 1-4 years old in the US.

“The focused update on drowning contains the most up-to-date, evidence-based recommendations on how to resuscitate someone who has drowned, offering practical guidance for health care professionals, trained rescuers, caregivers and families,” said writing group Co-Chair Tracy E. McCallin, M.D., FAAP, associate professor of paediatrics in the division of paediatric emergency medicine at Rainbow Babies and Children’s Hospital in Cleveland. “While we work on a daily basis to lower risks of drowning through education and community outreach on drowning prevention, we still need emergency preparedness training that can be used in tragic circumstances if a drowning occurs.”  

Detailed in the new guideline update:

  • Anyone removed from the water without showing signs of normal breathing or consciousness should be presumed to be in cardiac arrest.
  • Rescuers should immediately initiate CPR that includes rescue breathing in addition to chest compressions. Multiple large studies over time show more people with cardiac arrest from non-cardiac causes such as drowning survive when CPR includes rescue breaths compared to Hands-Only CPR (calling 911 [10111 in South Africa] and pushing hard and fast in the centre of the chest).

Drowning generally progresses quickly from initial respiratory arrest (when a person is unable to breathe) to cardiac arrest, meaning that the heart stops beating. As a result, blood cannot circulate properly throughout the body, and it is starved of oxygen.

“CPR for cardiac arrest due to drowning must focus on restoring breathing as well as restoring blood circulation,” said writing group Co-Chair Cameron Dezfulian, MD, FAHA, FAAP, senior faculty in paediatrics and critical care at Baylor College of Medicine in Houston.

“Cardiac arrest following drowning is most often due to severe hypoxia, or low blood oxygen levels,“ Dezfulian said. ”This differs from sudden cardiac arrest from a cardiac cause where the individual generally collapses with fully oxygenated blood.”

The updated guidance advises untrained rescuers and the public to:

  • Provide CPR with breaths and compressions to all people who have a cardiac arrest after drowning. If a person is untrained, unwilling, or unable to give breaths, they can provide chest compressions only until help arrives. 
  • In-water rescue breathing should be given only by rescuers trained in this special skill if it doesn’t compromise their own safety. Trained rescuers should also provide supplemental oxygen if available.
  • The initiation of CPR should always be prioritised and begin as soon as possible as early lay responder CPR has been shown to improve outcomes from drowning.
  • The writing group recommends an automated external defibrillator (AED) should be placed in public facilities where aquatic activities are present such as swimming pools or beaches. They can be used once the person is removed from the water, if available, yet should not delay initiation of CPR. If available, the AED should be connected to the patient to assess for shockable rhythms once CPR is ongoing. Although most cases of cardiac arrest following drowning do not have shockable rhythms, if a primary cardiac event such as a heart attack occurs while in the water, the best outcomes are when defibrillation is done quickly. AED use is safe and feasible in aquatic environments.
  • All individuals requiring any level of resuscitation following drowning, including those who only need rescue breaths, should be transported to a hospital for evaluation, monitoring and treatment.

In addition to the recommendations on drowning resuscitation, the guideline update also highlights the Drowning Chain of Survival, which includes the steps needed to improve chances of survival: prevention, recognition and safe rescue.

Prevention

It has been estimated that more than 90% of all drownings are preventable. Research has found most infants drown in bathtubs, and the majority of preschool-aged children drown in swimming pools. The American Heart Association and the American Academy of Pediatrics recommend being water aware and practicing water safety. See: Prevention of Drowning and other guidelines.  

Recognition

Recognition of drowning may be challenging because someone who is drowning may not be able to verbalise distress or signal for help. Drowning happens quickly. People in distress will rapidly submerge, lose consciousness and may be hidden from anyone not actively seeking them.

Safe Rescue and Removal

The guideline update recommends that appropriately trained rescuers, such as lifeguards, swim instructors or first responders, should provide in-water rescue breathing to an unresponsive person who has drowned if it does not compromise their own safety. Previous studies have proven this leads to more favourable survival outcomes. A drowning person who is unconscious and likely in cardiac arrest should be removed from the water in a near-horizontal position, with the head maintained above body level and airway open. If the drowning individual is conscious, a more vertical position may be preferable to reduce the risk of vomiting.

In summary, “These updated guidelines are based on the latest available evidence and are designed to inform trained rescuers and the public how to proceed in resuscitating people who have drowned. Drowning can be fatal. Our recommendations maximise balancing the need for rapid rescue and resuscitation, while prioritising rescuer safety,” Dezfulian said.

Source: American Heart Association