A Machine Learning Trauma Triage Model for Critical Care Transport.

Importance: Under austere prehospital conditions, rapid classification of injured patients for intervention or transport is essential for providing lifesaving care. Discerning which patients need care most urgently further allows for optimal allocation of limited resources. These triage processes are hindered by the limited diagnostic resources and modalities available in the prehospital environment.

ASSOCIATIONS BETWEEN HEART RATE VARIABILITY AND NEED FOR LIFESAVING INTERVENTION IN A LARGE HELICOPTER EMS SERVICE.

Background : Heart rate variability (HRV) measures give insight into the autonomic regulation of cardiac function in healthy and critically ill patients. The ease and predictive potential of HRV measures may be valuable in optimizing prehospital triage. In this retrospective study, we hypothesized that HRV measures, specifically sample entropy, measured early in emergency transport would predict the need for a prehospital lifesaving intervention (LSI) in a large, heterogeneous cohort of critically ill patients.

Improving Bystander Response: How Long Does It Take to Retrieve an AED From Varying Distances.

Objectives: Survival from out-of-hospital cardiac arrest (OHCA) is low, with less than 10% surviving to hospital discharge. Early defibrillation can improve survival from an OHCA with a shockable rhythm. Cell phone applications alert rescuers as to where victims are and where automated external defibrillators (AEDs) are located, but guidance on choosing between going to the victim and doing cardiopulmonary resuscitation and retrieving an AED is lacking.

Defining the terminology of first responders alerted for out-of-hospital cardiac arrest by medical dispatch centres: An international consensus study on nomenclature.

Aim: Emergency medical services target to reduce time to cardiopulmonary resuscitation and defibrillation by alerting additional individuals to out-of-hospital cardiac arrest (OHCA). Multiple terms are used to describe these individuals, potentially causing confusion and hindering comparisons. This international consensus study aimed to establish standardised terminology.

American Heart Association Automated External Defibrillator Symposium: Summary and Recommendations.

The American Heart Association (AHA) introduced public access defibrillation more than 30 years ago. Since then, we have seen the growth of public access defibrillation programs across many settings within communities. However, despite high expectations that the availability of automated external defibrillators (AEDs) and more integrated public access defibrillation programs would dramatically increase cardiac arrest survival, AEDs are used in the United States in only 4% of out-of-hospital cardiac arrests and survival rates have remained disappointingly low.

Chest Compressions Synchronized to Native Cardiac Contractions are More Effective than Unsynchronized Compressions for Improving Coronary Perfusion Pressure in a Novel Pseudo-PEA Swine Model.

Objectives: Pulseless electrical activity (PEA) arrest, which includes pseudo-PEA, is increasingly common and survival remains dismal. We hypothesized that mechanical chest compressions synchronized to native cardiac contractions improve coronary perfusion pressure (CPP) during pseudo-PEA resuscitation.

Methods: We developed a model of pseudo-PEA by infusing high dose esmolol intravenously into anesthetized, intubated, and central arterial and venous catheterized swine to a goal of 45 mm Hg mean arterial blood pressure (MAP).

Words to live by: Using medic impressions to identify the need for prehospital lifesaving interventions.

Background: Prehospital emergencies require providers to rapidly identify patients' medical condition and determine treatment needs. We tested whether medics' initial, written impressions of patient condition contain information that can help identify patients who require prehospital lifesaving interventions (LSI) prior to or during transport.

Methods: We analyzed free-text medic impressions of prehospital patients encountered at the scene of an accident or injury, using data from STAT MedEvac air medical transport service from 2012 to 2021.

Association Between Finger Plethysmographic Features and Impedance-Based Thoracic Fluid Content Measurement in a Lower Body Negative Pressure Model of Hemorrhagic Shock.

Introduction: Timely identification of the need for lifesaving intervention in battlefield conditions may be improved through automated monitoring of the injured warfighter. Technologies that combine maximal noninvasive insight with minimal equipment footprint give the greatest opportunity for deployment at scale with inexperienced providers in forward areas. Finger photoplethysmography (PPG) signatures are associated with impending hemorrhagic shock but may be insufficient alone.

Association of the Revised Trauma Score with Mortality and Prehospital LSI Among Trauma and Non-Trauma Patients.

Objectives: The combination of broad conditional applicability and ease of data collection make some general risk scores an attractive tool for clinical decision making under acute care conditions. To date, general risk scores have demonstrated moderate levels of accuracy for key outcomes, but there are no definitive general scores integrated universally into prehospital care. The objective of our study was to demonstrate a relationship between the Revised Trauma Score (RTS) and prehospital lifesaving interventions (LSI) and downstream hospital mortality among a large, diverse, multi-year cohort of critical care transport patients.

Revisiting the "Scanty Science" of Prehospital Emergency Care 25 Years Later.

Objective: We aimed to quantify the number of prehospital randomized controlled trials (RCTs) published in the 25 years since the Callaham editorial and review his perception of prehospital emergency care as "scanty" science.

Methods: We replicated Callaham's methods to retrieve publications related to prehospital randomized controlled trials (RCTs). This study systematically searched over 35 million citations cataloged by the National Library of Medicine in the PubMed Database between January 1, 1998, and December 31, 2022.

Relationships of Jugular Bulb Parameters with Cerebral Perfusion and Metabolism After Resuscitation from Cardiac Arrest: A Post-Hoc Analysis of Experimental Studies Using a Minipig Model.

Background: Cerebral blood flow (CBF) decreases in the first few hours or days following resuscitation from cardiac arrest, increasing the risk of secondary cerebral injury. Using data from experimental studies performed in minipigs, we investigated the relationships of parameters derived from arterial and jugular bulb blood gas analyses and lactate levels (jugular bulb parameters), which have been used as indicators of cerebral perfusion and metabolism, with CBF and the cerebral lactate to creatine ratio measured with dynamic susceptibility contrast magnetic resonance imaging and proton magnetic resonance spectroscopy, respectively.

Methods: We retrospectively analyzed 36 sets of the following data obtained during the initial hours following resuscitation from cardiac arrest: percent of measured CBF relative to that at the prearrest baseline (%CBF), cerebral lactate to creatine ratio, and jugular bulb parameters, including jugular bulb oxygen saturation, jugular bulb lactate, arterial-jugular bulb oxygen content difference, cerebral extraction of oxygen, jugular bulb-arterial lactate content difference, lactate oxygen index, estimated respiratory quotient, and arterial-jugular bulb hydrogen ion content difference.

Severity-Driven Trends in Mortality in a Large Regionalized Critical Care Transport Service.

Objective: The epidemiology accompanying helicopter emergency medical services (HEMS) transport has evolved as agencies have matured and become integrated into regionalized health systems, as evidenced primarily by nationwide systems in Europe. System-level congruence between Europe and the United States, where HEMS is geographically fragmentary, is unclear. In this study, we provide a temporal, epidemiologic characterization of the largest standardized private, nonprofit HEMS system in the United States, STAT MedEvac.

The association of clinical, treatment, and demographic characteristics with rearrest in a national dataset.

Introduction: Following initial resuscitation from out-of-hospital cardiac arrest, rearrest frequently occurs and has been associated with adverse outcomes. We aimed to identify clinical, treatment, and demographic characteristics associated with prehospital rearrest at the encounter and agency levels.

Methods: Adult non-traumatic cardiac arrest patients who achieved ROSC following EMS resuscitation in the 2018-2021 ESO annual datasets were included in this study.

Assessment of the Effects of Sodium Nitroprusside Administered Via Intracranial Subdural Catheters on the Cerebral Blood Flow and Lactate Using Dynamic Susceptibility Contrast Magnetic Resonance Imaging and Proton Magnetic Resonance Spectroscopy in a Pig Cardiac Arrest Model.

Background Cerebral blood flow (CBF) is impaired in the early phase after return of spontaneous circulation. Sodium nitroprusside (SNP) administration via intracranial subdural catheters improves cerebral cortical microcirculation. We determined whether the SNP treatment improves CBF in the subcortical tissue and evaluated the effects of this treatment on cerebral lactate.

The Association of Prehospital End-Tidal Carbon Dioxide with Survival Following Out-of-Hospital Cardiac Arrest.

Objective: End tidal carbon dioxide (ETCO) is often used to assess ventilation and perfusion during cardiac arrest resuscitation. However, few data exist evaluating the relationship between ETCO values and mortality in the context of contemporary resuscitation practices. We aimed to explore the association between ETCO and mortality following out-of-hospital cardiac arrest (OHCA).

The Association of Combined Prehospital Hypotension and Hypoxia with Outcomes following Out-of-Hospital Cardiac Arrest Resuscitation.

Background: Prehospital post-resuscitation hypotension and hypoxia have been associated with adverse outcomes in the context of out-of-hospital cardiac arrest (OHCA). We aimed to investigate the association between clinical outcomes and post-resuscitation hypoxia alone, hypotension alone, and combined hypoxia and hypotension.

Methods: We used the 2018-2021 ESO annual datasets to conduct this study.

Benefits, key protocol components, and considerations for successful implementation of extracorporeal cardiopulmonary resuscitation: a review of the recent literature.

The application of venoarterial extracorporeal membrane oxygenation (ECMO) in patients unresponsive to conventional cardiopulmonary resuscitation (CPR) has significantly increased in recent years. To date, three published randomized trials have investigated the use of extracorporeal CPR (ECPR) in adults with refractory out-of-hospital cardiac arrest. Although these trials reported inconsistent results, they suggest that ECPR may have a significant survival benefit over conventional CPR in selected patients only when performed with strict protocol adherence in experienced emergency medical services-hospital systems.

Sodium bicarbonate administration is associated with improved survival in asystolic and PEA Out-of-Hospital cardiac arrest.

Background: Sodium bicarbonate ("bicarb") administration in out-of-hospital cardiac arrest (OHCA) is intended to counteract acidosis, although there is limited clinical evidence to support its routine administration. We sought to analyze the association of bicarb with resuscitation outcomes in non-traumatic OHCA.

Methods: Records were obtained from the 2019-2020 ESO Data Collaborative prehospital electronic health record database, spanning 1,322 agencies in 50 states.

Association of prehospital post-resuscitation peripheral oxygen saturation with survival following out-of-hospital cardiac arrest.

Background: Hypoxia and hyperoxia following resuscitation from out-of-hospital cardiac arrest (OHCA)may cause harm by exacerbating secondary brain injury. Our objective was to retrospectively examine theassociationof prehospital post-ROSC hypoxia and hyperoxia with the primary outcome of survival to discharge home.

Methods: We utilized the 2019-2021 ESO Data Collaborative public use research datasets for this study (ESO, Austin, TX).

Sudden Electrocardiogram Rhythm Changes after Return of Spontaneous Circulation in Porcine Models of Out-of-Hospital Cardiac Arrest: A Phenomenological Report.

Background: Observation of the electrocardiogram (ECG) immediately following return of spontaneous circulation (ROSC) in resuscitated swine has revealed the interesting phenomenon of sudden ECG rhythm changes (SERC) that occur in the absence of pharmacological, surgical, or other medical interventions.

Objective: We sought to identify, quantify, and characterize post-ROSC SERC in successfully resuscitated swine.

Methods: We reviewed all LabChart data from resuscitated approximately 4- to 6-month-old swine used for various experimental protocols from 2006 to 2019.

Association of prehospital hypotension depth and dose with survival following out-of-hospital cardiac arrest.

Introduction: Hypotension following resuscitation from out-of-hospital cardiac arrest (OHCA) may cause harm by exacerbating secondary brain injury; however, limited research has explored this relationship. Our objective was to examine the association between duration and depth of prehospital post return of spontaneous circulation (ROSC) hypotension and survival.

Methods: We utilized the 2019 and 2020 ESO Data Collaborative public use research data sets for this study (ESO, Austin, TX).