A Conceptual Framework to Reduce Inpatient Preventable Deaths.

Background: Efforts to reduce preventable deaths in the in-hospital setting should target both cardiopulmonary arrest (CPA) prevention and optimal resuscitation. This requires consideration of a broad range of clinical issues and processes. A comprehensive, integrated system of care (SOC) that links data collection with a modular education program to reduce preventable deaths has not been defined.

Addition of Audiovisual Feedback During Standard Compressions Is Associated with Improved Ability.

Introduction: A benefit of in-hospital cardiac arrest is the opportunity for rapid initiation of "high-quality" chest compressions as defined by current American Heart Association (AHA) adult guidelines as a depth 2-2.4 inches, full chest recoil, rate 100-120 per minute, and minimal interruptions with a chest compression fraction (CCF) ≥ 60%. The goal of this study was to assess the effect of audiovisual feedback on the ability to maintain high-quality chest compressions as per 2015 updated guidelines.

A focused investigation of expedited, stack of three shocks versus chest compressions first followed by single shocks for monitored ventricular fibrillation/ventricular tachycardia cardiopulmonary arrest in an in-hospital setting.

Background: In cases of in-hospital-witnessed ventricular fibrillation/ventricular tachycardia (VF/VT) arrest, it is unclear whether cardiopulmonary resuscitation prior to defibrillation attempt or expedited stacked defibrillation attempt is superior.

Methods: Retrospective, observational study of all admitted patients with continuous cardiac monitoring who suffered VF/VT arrest between July 2005 and June 2013. In the stacked shock period (2005-2008), institutional protocols advocated early defibrillation with administration of 3 stacked shocks with brief pauses between each single defibrillation attempt to confirm sustained VF/VT.

A novel configuration of a traditional rapid response team decreases non-intensive care unit arrests and overall hospital mortality.

Background: In-hospital cardiopulmonary arrest (CPA) accounts for substantial morbidity and mortality. Rapid response teams (RRTs) are designed to prevent non-intensive care unit (ICU) CPA through early detection and intervention. However, existing evidence has not consistently demonstrated a clear benefit.

Preoxygenation reduces desaturation events and improves intubation success.

Objective: Oxygen desaturation occurs frequently in the course of prehospital rapid sequence intubation (RSI) and is associated with increased morbidity and mortality. Preoxygenation with positive pressure ventilation by bag valve mask may delay the onset of desaturation. The purpose of this study was to evaluate implementation of a targeted preoxygenation protocol including the use of positive pressure ventilation on desaturation events and intubation success during air medical RSI.

Preliminary report of a mathematical model of ventilation and intrathoracic pressure applied to prehospital patients with severe traumatic brain injury.

Background: Inadvertent hyperventilation is associated with poor outcomes from traumatic brain injury (TBI). Hypocapnic cerebral vasoconstriction is well described and causes an immediate and profound decrease in cerebral perfusion. The hemodynamic effects of positive-pressure ventilation (PPV) remain incompletely understood but may be equally important, particularly in the hypovolemic patient with TBI.

Assessment of the addition of prehospital continuous positive airway pressure (CPAP) to an urban emergency medical services (EMS) system in persons with severe respiratory distress.

Background: The use of continuous positive airway pressure (CPAP) assisted ventilation in the emergency department(ED) has been well described.

Objectives: The purpose of this study was to measure the efficacy of adding pre-hospital CPAP to an urban emergency medical service (EMS) respiratory distress protocol on persons with respiratory distress.

Methods: A historical cohort analysis of consecutive patients between 2005 and 2010.

Gender differences in scene time, transport time, and total scene to hospital arrival time determined by the use of a prehospital electrocardiogram in patients with complaint of chest pain.

Background: Recent studies have described a gender bias against women in the setting of acute coronary syndrome (ACS).

Objectives: We sought to measure the impact that a prehospital electrocardiogram (PH ECG) has on prehospital total scene time to hospital arrival time, comparing men and women with the complaint of chest pain (cCP).

Methods: This study retrospectively analyzed San Diego Emergency Medical Services (EMS) runsheets of patients with cCP before and after implementation of the PH ECG protocol.

Latency of pulse oximetry signal with use of digital probes associated with inappropriate extubation during prehospital rapid sequence intubation in head injury patients: case examples.

Background: Endotracheal intubation remains the definitive skill needed for airway management of both medical and surgical patients treated in the prehospital and hospital arenas. Subsequently, rapid sequence intubation (RSI) protocols have been established for various first-line emergency service providers. Because RSI results in the paralysis of skeletal muscles, with a subsequent period of apnea and an increased potential for oxygen desaturation, the accuracy of pulse oximetry (SpO(2)) data is critical in guiding pre-oxygenation efforts and indicating abandonment of intubation attempts to avoid hypoxic injury.