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Kottmann A, Pasquier M, Carron PN, Maudet L, Rouvé JD, Suppan L, Caillet-Bois D, Riva T, Albrecht R, Krüger A, Sollid SJM. Feasibility of quality indicators on prehospital advanced airway management in a physician-staffed emergency medical service: survey-based assessment of the provider point of view. BMJ Open 2024; 14:e081951. [PMID: 38453207 PMCID: PMC10921492 DOI: 10.1136/bmjopen-2023-081951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 02/20/2024] [Indexed: 03/09/2024] Open
Abstract
OBJECTIVE We aimed to determine the feasibility of quality indicators (QIs) for prehospital advanced airway management (PAAM) from a provider point of view. DESIGN The study is a survey based feasibility assessment following field testing of QIs for PAAM. SETTING The study was performed in two physician staffed emergency medical services in Switzerland. PARTICIPANTS 42 of the 44 emergency physicians who completed at least one case report form (CRF) dedicated to the collection of the QIs on PAAM between 1 January 2019 and 31 December 2021 participated in the study. INTERVENTION The data required to calculate the 17 QIs was systematically collected through a dedicated electronic CRF. PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcomes were provider-related feasibility criteria: relevance and acceptance of the QIs, as well as reliability of the data collection. Secondary outcomes were effort to collect specific data and to complete the CRF. RESULTS Over the study period, 470 CRFs were completed, with a median of 11 per physician (IQR 4-17; range 1-48). The median time to complete the CRF was 7 min (IQR 3-16) and was considered reasonable by 95% of the physicians. Overall, 75% of the physicians assessed the set of QIs to be relevant, and 74% accepted that the set of QIs assessed the quality of PAAM. The reliability of data collection was rated as good or excellent for each of the 17 QIs, with the lowest rated for the following 3 QIs: duration of preoxygenation, duration of laryngoscopy and occurrence of desaturation during laryngoscopy. CONCLUSIONS Collection of QIs on PAAM appears feasible. Electronic medical records and technological solutions facilitating automatic collection of vital parameters and timing during the procedure could improve the reliability of data collection for some QIs. Studies in other services are needed to determine the external validity of our results.
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Affiliation(s)
- Alexandre Kottmann
- Emergency Department, Department of Interdisciplinary Centres, Lausanne University Hospital, Lausanne, Vaud, Switzerland
- Medicine, REGA, Zurich, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Vaud, Switzerland
- Department of Anaesthesiology and Pain Medicine, Inselspital University Hospital Bern, Bern, Switzerland
- Department of Research and Development, Norwegian Air Ambulance Foundation, Drøbak, Norway
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Mathieu Pasquier
- Emergency Department, Department of Interdisciplinary Centres, Lausanne University Hospital, Lausanne, Vaud, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Vaud, Switzerland
| | - Pierre-Nicolas Carron
- Emergency Department, Department of Interdisciplinary Centres, Lausanne University Hospital, Lausanne, Vaud, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Vaud, Switzerland
| | - Ludovic Maudet
- Emergency Department, Department of Interdisciplinary Centres, Lausanne University Hospital, Lausanne, Vaud, Switzerland
- Anaesthesiology, Department of Interdisciplinary Centres, Lausanne University Hospital, Lausanne, Vaud, Switzerland
| | - Jean-Daniel Rouvé
- Anaesthesiology, Department of Interdisciplinary Centres, Lausanne University Hospital, Lausanne, Vaud, Switzerland
| | - L Suppan
- Division of Emergency Medicine, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Geneve, Switzerland
| | - David Caillet-Bois
- Emergency Department, Department of Interdisciplinary Centres, Lausanne University Hospital, Lausanne, Vaud, Switzerland
| | - Thomas Riva
- Department of Anaesthesiology and Pain Medicine, Inselspital University Hospital Bern, Bern, Switzerland
- Faculty of Medicine, University of Bern, Bern, Switzerland
| | - Roland Albrecht
- Medicine, REGA, Zurich, Switzerland
- Faculty of Medicine, University of Bern, Bern, Switzerland
| | - Andreas Krüger
- Department of Research and Development, Norwegian Air Ambulance Foundation, Drøbak, Norway
- Department of Emergency Medicine and Prehospital Services, St. Olavs University Hospital, Trondheim, Norway
- Institute of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Stephen Johan Mikal Sollid
- Department of Research and Development, Norwegian Air Ambulance Foundation, Drøbak, Norway
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
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Park CR, Nam JG, Lee JH, Hwang JC, Lee SH. Safety and efficacy of pelvic arterial embolization for primary postpartum hemorrhage in hemodynamically stable and hemodynamically unstable patients: Is it "time" for a paradigm change? J Gynecol Obstet Hum Reprod 2024; 53:102762. [PMID: 38432627 DOI: 10.1016/j.jogoh.2024.102762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 02/11/2024] [Accepted: 02/29/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Pelvic artery embolization (PAE) is an effective and safe technique for treating postpartum hemorrhage (PPH) with hemodynamic stability. However, its use in hemodynamically unstable patients remains controversial. PURPOSE To determine the safety and efficacy of pelvic arterial embolization (PAE) according to the hemodynamic state of primary postpartum hemorrhage (PPH) patients. METHODS This cohort study was conducted retrospectively, using data from January 2004 to December 2021, in a resource-rich setting at a tertiary Level 1 trauma academic center. A total of 437 patients were diagnosed with PPH during the study period. Of these 437 patients, 161 with primary PPH who underwent PAE were enrolled in the study. The outcomes assessed included the clinical success rate, mortality, the overall success rate, predictive factors for failed PAE, and time-dependent changes in hemodynamic parameters, such as systolic blood pressure (SBP), heart rate (HR), and shock index (SI). Propensity score (PS) matching analysis was performed to assess the influence of specific variables or conditions on the outcomes. RESULTS Of the 161 patients who underwent PAE for primary PPH (mean age, 32.9 ± 4.3 [SD]), 85 were retrospectively categorized as having hemodynamic stability (mean age, 32.6 ± 4.1 [SD]), while 76 were categorized as having hemodynamic instability (mean age, 33.3 ± 4.4 [SD]). This study showed PAE for primary PPH had a success rate of 91.9 %, with no significant difference in mortality rates between the groups. The clinical success rate was 98.8 % for patients with hemodynamic stability and 84.2 % for those with hemodynamic instability (p < .001). The overall success rate was 98.8 % for hemodynamic stability and 89.5 % for hemodynamic instability (p = .014). After propensity score matching, the clinical success rate was higher in hemodynamically stable patients than in unstable ones (100 % vs. 86.3 %, p = .013). However, there was no significant difference in the overall success rate (100 % vs. 90.2 %, p = .056). Among the PS-matched population, predictive factors for the failed PAE in primary PPH were hemodynamic instability (adjusted odds ratio [aOR] 21.22, 95 % CI 1.27-355.76; p = .034) and emergency Cesarean delivery with accompanying hemorrhag (aOR 54.00, 95 % CI 11.93-244.56; p = .008). In three groups within a PS-matched population - hemodynamically stable, unstable with successful outcomes, and unstable with unsuccessful outcomes, a generalized linear mixed model (GLMM) analysis for time-dependent changes in hemodynamic parameters revealed a statistically significant difference in SBP, HR, and SI at various time points. CONCLUSION Pelvic arterial embolization of primary postpartum bleeding in hemodynamic instability has been identified as an alternative, safe, and effective life-saving procedure for multidisciplinary treatment in resource-rich environments even after the baseline characteristics are balanced by the PS matching, suggesting it is a primary care option.
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Affiliation(s)
- Chang Ryul Park
- Department of Thoracic Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Jeong Gu Nam
- Department of Radiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Jong Hwa Lee
- Department of Radiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Jae Cheol Hwang
- Department of Radiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Sang Hun Lee
- Department of Obstetrics and Gynecology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea, 877, Bangeojinsunhwando-ro, Dong-gu, Ulsan 44033, South Korea.
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Kaneko K, Hagisawa K, Kinoshita M, Ohtsuka Y, Sasa R, Hotta M, Saitoh D, Sato K, Takeoka S, Terui K. Early treatment with Fibrinogen γ-chain peptide-coated, ADP-encapsulated Liposomes (H12-(ADP)-liposomes) ameliorates post-partum hemorrhage with coagulopathy caused by amniotic fluid embolism in rabbits. AJOG GLOBAL REPORTS 2023; 3:100280. [PMID: 38046530 PMCID: PMC10690637 DOI: 10.1016/j.xagr.2023.100280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023] Open
Abstract
BACKGROUND Amniotic fluid embolism is an unpredictable and sometimes lethal complication of childbirth. Fibrinogen γ-chain peptide-coated, ADP-encapsulated Liposomes (H12-(ADP)-liposomes), which were developed as a platelet substitute, may be useful to control postpartum hemorrhage with consumptive coagulopathy. OBJECTIVE This study aimed to establish a hemodynamically stable amniotic fluid embolism animal model and evaluate the efficacy of H12-ADP-liposome infusion in the initial management of postpartum hemorrhage complicated with amniotic fluid embolism-involved coagulopathy. STUDY DESIGN Pregnant New Zealand white rabbits (28th day of pregnancy or normal gestation period of 29-35 days) underwent cesarean delivery, followed by intravenous administration of amniotic fluid (a total of 3.0 mL administered in 4 doses over 9 minutes). Thereafter, uncontrolled postpartum hemorrhage was induced by transecting the right midartery and concomitant vein in the myometrium. After initial bleeding for 5 minutes, rabbits received isovolemic fluid resuscitation through the femoral vein with an equivalent volume of blood loss every 5 minutes for 60 minutes. The transfusion regimens included platelet-rich plasma, platelet-poor plasma, and a bolus administration of H12-ADP-liposomes followed by platelet-poor plasma transfusion (8 rabbits per group). Moreover, 60 minutes after initiation of bleeding, rabbits received surgical hemostasis by ligation of bleeding vessels, except in cases with spontaneous hemostasis. RESULTS The administration of amniotic fluid caused thrombocytopenia (56±3 × 103/μL) and prolonged both clotting time (before administration: 130.0±3.0 to 171.0±5.0 seconds) and prothrombin time (4.5±0.1 to 4.7±0.1 seconds). After the initial 5-minute bleeding in the rabbits, the mean arterial pressure fell to 43±2 mm Hg. Platelet-poor plasma transfusion alone further prolonged clotting time and prothrombin time at 60 minutes (192.0±10.0 and 5.2±0.1 seconds, respectively) with decreasing mean arterial pressure to <40 mm Hg. By contrast, the administration of H12-ADP-liposomes followed by platelet-poor plasma transfusion reduced the prolonged clotting time (153.0±5.0 seconds) and prothrombin time (4.9±0.1 seconds) similar to platelet-rich plasma transfusion (154.0±11.0 and 4.9±0.1 seconds, respectively) at 60 minutes. These rabbits maintained a mean arterial pressure of >45 mm Hg throughout the experiment. H12-ADP-liposome infusion and platelet-poor plasma transfusion and platelet-rich plasma transfusion yielded spontaneous hemostasis in 4 of 8 rabbits, whereas platelet-poor plasma transfusion did not stop bleeding in any of the rabbits. The total blood loss was 59±17 mL in the H12-ADP-liposomes and platelet-poor plasma group, which was half of that in the platelet-poor plasma group (124±10 mL). CONCLUSION H12-ADP-liposome infusion may be effective in the initial management of postpartum hemorrhage complicated with amniotic fluid embolism, resulting in mitigation of consumptive coagulopathy.
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Affiliation(s)
- Koki Kaneko
- Department of Anesthesiology, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan (Drs Kaneko and Terui)
| | | | | | | | - Ruka Sasa
- Department of Traumatology, National Defense Medical College Research Institute, Tokorozawa, Saitama, Japan (Drs Sasa and Saitoh)
| | - Morihiro Hotta
- Department of Life Science and Medical Bioscience, Graduate School of Advanced Science and Engineering, Waseda University, Shinjuku-ku, Tokyo, Japan (Mr Hotta)
| | - Daizoh Saitoh
- Department of Traumatology, National Defense Medical College Research Institute, Tokorozawa, Saitama, Japan (Drs Sasa and Saitoh)
| | - Kimiya Sato
- Pathology (Dr Sato), National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Shinji Takeoka
- Institute for Advanced Research of Biosystem Dynamics, Research Institute for Science and Engineering, Waseda University, Shinjuku-ku, Tokyo, Japan (Dr Takeoka)
| | - Katsuo Terui
- Department of Anesthesiology, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan (Drs Kaneko and Terui)
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