Does the Mainz Emergency Evaluation Scoring (MEES) in combination with capnometry (MEESc) help in the prognosis of outcome from cardiopulmonary resuscitation in a prehospital setting?

We present an improved Mainz Emergency Evaluation Scoring (MEES) combined with capnometry. MEES combined with capnometry in a new scoring system MEESc compared with MEES is significantly better and has greater value in predicting survival after cardiopulmonary resuscitation (CPR) in patients with normothermic nontraumatic cardiac arrest. We show that higher pre-CPR and final post-CPR values of partial end-tidal CO(2) pressure (p(et) CO(2)) at the time of the return of spontaneous circulation (ROSC) are connected with improved rate of survival. In our prospective clinical study we observed 246 patients 18 years of age and over who were found in nontraumatic normothermic cardiac arrest from February 1998 to February 2001. 128 (52%) were men. Initial and final (post-CPR) values of p(et) CO(2) were significantly higher in the group of patients with ROSC and in those who survived than in the group of patients without ROSC and those who died. All the patients with ROSC and those who survived had initial values of p(et) CO(2) higher than 1.33 kPa (10 mmHg). The mean of all the initial values of pet CO2 in patients without ROSC was 2.12 kPa+/-0.68 and the mean of all the final values in patients with ROSC was 3.11 kPa+/-0.55 kPa. Our study shows that the initial and final values of p(et) CO(2) of less than 2.13 kPa are connected with higher mortality rate and the values of less than 1.33 kPa incompatible with survival in normothermic nontraumatic cardiac arrest. We also must not forget the fact that prehospital use of the improved MEESc system enabled more efficient communication between the prehospital and hospital setting.     

Is current training in basic and advanced cardiac life support (BLS & ACLS) effective? A study of BLS & ACLS knowledge amongst healthcare professionals of North-Kerala

BACKGROUND: Healthcare professionals are expected to have knowledge of current basic and advanced cardiac life support (BLS/ACLS) guidelines to revive unresponsive patients.METHODS: A cross-sectional study was conducted to evaluate the current practices and knowledge of BLS/ACLS principles among healthcare professionals of North-Kerala using pretested self-administered structured questionnaire. Answers were validated in accordance with American Heart Association's BLS/ACLS teaching manual and the results were analysed.RESULTS: Among 461 healthcare professionals, 141 (30.6%) were practicing physicians, 268 (58.1%) were nurses and 52 (11.3%) supporting staff. The maximum achievable score was 20 (BLS 15/ ACLS 5). The mean score amongst all healthcare professionals was 8.9±4.7. The mean score among physicians, nurses and support staff were 8.6±3.4, 9±3.6 and 9±3.3 respectively. The majority of healthcare professionals scored ≤50% (237, 51.4%); 204 (44.3%) scored 51%-80% and 20 (4.34%) scored >80%. Mean scores decreased with age, male sex and across occupation. Nurses who underwent BLS/ACLS training previously had significantly higher mean scores (10.2±3.4) than untrained (8.2±3.6, P=0.001). Physicians with <5 years experience (P=0.002) and nurses in the private sector (P=0.003) had significantly higher scores. One hundred and sixty three (35.3%) healthcare professionals knew the correct airway opening manoeuvres like head tilt, chin lift and jaw thrust. Only 54 (11.7%) respondents were aware that atropine is not used in ACLS for cardiac arrest resuscitation and 79 (17.1%) correctly opted ventricular fibrillation and pulseless ventricular tachycardia as shockable rhythms. The majority of healthcare professionals (356, 77.2%) suggested that BLS/ACLS be included in academic curriculum.CONCLUSION: Inadequate knowledge of BLS/ACLS principles amongst healthcare professionals, especially physicians, illuminate lacunae in existing training systems and merit urgent redressal.     

Fluid resuscitation with 6 % hydroxyethyl starch (130/0.4 and 130/0.42) in acutely ill patients: systematic review of effects on mortality and treatment with renal replacement therapy

Purpose

To determine whether fluid resuscitation of acutely ill adults with 6 % hydroxyethyl starch (6 % HES 130) with a molecular weight of 130 kD and a molar substitution ratio of approximately 0.4 (6 % HES 130) compared with other resuscitation fluids results in a difference in the relative risk of death or treatment with renal replacement therapy (RRT).

Methods

Systematic review and meta-analysis of randomized controlled trials comparing intravascular fluids for resuscitation of hospitalised adults that reported mortality or treatment with RRT. The risk of bias was assessed independently by two reviewers and meta-analysis was performed using random effects.

Results

Thirty-five trials enrolling 10,391 participants were included. The three largest trials had the lowest risk of bias, were published (or completed) in 2012, and together enrolled 77 % of all participants. Death occurred in 928 of 4,691 patients (19.8 %) in the 6 % HES 130 group versus 871 of 4,720 (18.5 %) in the control fluid groups relative risk (RR) in the 6 % HES 130 group 1.08, 95 % confidence interval (CI) 1.00 to 1.17, I ² = 0 %). Treatment with RRT occurred in 378 of 4,236 patients (8.9 %) in the 6 % HES 130 group versus 306 of 4,260 (7.2 %) in the control fluid group (RR in the 6 % HES 130 group 1.25, 95 % CI 1.08 to 1.44, I ² = 0 %).

Conclusions

The quality and quantity of data evaluating 6 % hydroxyethyl starch (130/0.4 and 130/0.42) as a resuscitation fluid has increased in the last 12 months. Patients randomly assigned to resuscitation with 6 %HES 130 are at significantly increased risk of being treated with RRT.     

Effect of total number of pulses of radial extracorporeal shock wave therapy (rESWT) on hamstring muscle spasticity in children with spastic type cerebral palsy: A randomized clinical trial

Purpose To evaluate the efficacy and safety of radial extracorporeal shock wave therapy (rESWT) according to total number of pulses on hamstring muscle spasticity in children with spastic type cerebral palsy (CP).Methods This study is a randomized controlled trial consisting of thirteen patients with spastic CP, 9 males and 4 females, aged 5 to 14 years (mean age 9.2). Twenty-five spastic hamstring muscles were divided in four groups. Group I: 500 pulses, Group II: 1, 000 pulses, Group III: 1, 5...