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PubMed1991

Treatment and career attitudes of prehospital care providers associated with potential exposure to HIV/AIDS.

Career and treatment attitudes related to potential human immunodeficiency virus and acquired immunodeficiency syndrome (HIV/AIDS) exposure are reported based on a survey of 1,228 Maryland career and volunteer prehospital care providers trained to provide basic (BLS) and advanced (ALS) life support. Sixty-five percent stated potential exposure to HIV/AIDS was a major occupational stressor. Ninety-two percent stated they would treat HIV/AIDS patients if protected. Given a choice, 38% would avoid providing treatment to HIV/AIDS patients. Eighteen percent considered resigning from emergency medical services (EMS) work. An attitudinal scale (AIDSTRESS) was developed to evaluate overall treatment and career reactions. Respondents with significantly higher (more negative reactions) AIDSTRESS scores were: BLS providers, men, paid providers, personnel with more than 3 years of field experience, those working in urban areas, personnel with no formal education beyond high school, and those who stated that their HIV/AIDS training was inadequate. Implications of the findings for quality of care, career decision making, and inservice education are discussed.

Adolescent↗
PubMed1994

A forgotten need: paediatric resuscitation training.

This article highlights the fact that there are currently no real official recommendations regarding the provision of paediatric resuscitation training in the UK. All too often, this teaching features as no more than an 'add on' to adult resuscitation sessions. This is a thoroughly inadequate situation as the relatively infrequent occurrence and different aetiology of paediatric arrests necessitates specific training, based on standard guidelines, and adapted to meet the needs of the various groups who have contact with children. A three-tiered package of training is recommended, starting with nationwide paediatric Basic Life Support (BLS) training for the general public. In addition to BLS, healthcare personnel need to be trained in appropriate use of airway adjuncts. Paediatric Advanced Life Support (ALS) is also essential for all medical, nursing and paramedical staff who come into contact with acutely-ill children. In an attempt to address the need for ALS, the PALS (Paediatric Advanced Life Support) course, has been implemented in the UK. Adapted from the American PALS course, it aims to provide appropriate personnel with a systematic, research-based approach to acutely-ill children in emergency situations.

Cardiopulmonary Resuscitation↗
PubMed2004

Simultaneous kissing stents (SKS) technique for treating bifurcation lesions in medium-to-large size coronary arteries.

The treatment of bifurcation lesions (BLs) is associated with high procedural complication and restenosis rates. Two techniques of BL interventions were compared: the simultaneous kissing stents (SKS) technique, involving 2 stents, 1 in the main vessel and 1 in the side branch (n = 100), and the conventional stent strategy (CSS) technique, involving a stent in the main vessel and provisional stenting for the side branch (n = 100). In-hospital and 30-day major adverse cardiac events were greater in the CSS group, with significantly less procedure time with the SKS technique. The incidence of target lesion revascularization was 5% in the SKS group and 18% in the CSS group (p = 0.007). Therefore, the SKS technique seems to be rapid, safe, and effective for the treatment of medium- to large-size BLs, with a trend toward fewer acute complications and promising mid-term results.

Abciximab↗
PubMed2005

Bioconversion of industrial wastewater and wastewater sludge into Bacillus thuringiensis based biopesticides in pilot fermentor.

Starch industry wastewater (SWW), slaughterhouse wastewater (SHWW) and secondary sludges from three different wastewater treatment plants (Jonquière--JQS, Communauté Urbaine de Québec--CUQS and Black lake-BLS) were used as raw materials for the production of Bacillus thuringiensis (Bt) based biopesticides in a pilot scale fermentor (100 L working volume). The slaughterhouse wastewater exhibited the lowest Bt growth and entomotoxcity (Tx) potential (measured against spruce budworm) due to low availability of carbon, nitrogen and other nutrients. Performance variation (growth, sporulation, proteolytic activity and Tx potential) within the three types of sludges was directly related to the availability of nitrogen and carbohydrates, which could change with sludge origin and methods employed for its generation. The Tx potential of Bt obtained in different secondary sludges (JQS: 12 x 10(9) SBU/L; CUQS: 13 x 10(9) SBU/L and BLS: 16 x 10(9) SBU/L) and SWW (18 x 10(9) SBU/L) was higher than the soybean based synthetic medium (10 x 10(9) SBU/L). The maximum protease activity was obtained in CUQ secondary sludge (4.1 IU/mL) due to its high complex protein concentration. Nevertheless, high carbohydrate concentration in SWW repressed enzyme production. The secondary sludges and SWW were found to be suitable raw materials for high potency Bt biopesticide production.

Agriculture↗
PubMed2004

Anaphylaxis in the prehospital setting.

Many Emergency Medical Services (EMS) systems have adopted epinephrine auto-injector (EAI) use by Basic Life Support (BLS) personnel, and several states now require that BLS personnel be trained and authorized to use EAIs. The objectives of this observational study were: 1) to examine EMS case definitions of allergy/anaphylaxis, 2) to ascertain the incidence of EMS calls for allergy/anaphylaxis and administration of epinephrine, and 3) to quantify the rate of deaths due to anaphylaxis. Data were solicited by e-mail, mail, and telephone from National Association of State EMS Directors (NASEMSD) members, state EMS offices, and state medical examiner and vital statistics offices. Simple descriptive statistics were used to analyze the data. The following was found: 1) there is no standardization of case definitions among states. Some use the terms "allergic reaction" and "anaphylaxis" in EMS protocols without definition, whereas others provide lengthy, specific definitions, with detailed criteria for epinephrine administration; 2) excluding two outliers at 0.04% and 3.9%, nine EMS system databases totaling over 2.8 million runs contained between 0.34% and 0.82% of runs for allergy/anaphylaxis. Seven of these databases reported on epinephrine administration, with rates between 0.16% and 31.1%, and four of the seven clustered between 8.8% and 14.8%. There was little uniformity in the data provided by seven states on deaths due to anaphylaxis, with rates from 0% to 0.94%. Although limited by the lack of data from many states, roughly 0.5% of EMS runs are for allergy/anaphylaxis complaints, with epinephrine administered in roughly one-tenth of these. State death rates from anaphylaxis vary considerably, with rates from 0% to 0.94% reported.

Anaphylaxis↗
PubMed2005

Conserved residues of the bare lymphocyte syndrome transcription factor RFXAP determine coordinate MHC class II expression.

RFXAP is required for the transcriptional regulation of MHC-II genes. Mutations in RFXAP are the genetic basis for complementation group D cases of the bare lymphocyte syndrome (BLS) immunodeficiency. Comparative genomic sequence analysis was conducted and found that only the C-terminal half of the protein is conserved among vertebrates. The C-terminal third of RFXAP, which contained an extensive glutamine-rich tract, could rescue HLA-DR, but not HLA-DQ or HLA-DP expression in a BLS cell line. To understand this phenomenon, a detailed analysis of the role of specific sequences in the C-terminal third of RFXAP with respect to MHC-II regulation was undertaken. Surprisingly, mutation of the conserved glutamine residues had no effect on activity, whereas mutation of hydrophobic and other conserved residues resulted in discoordinate MHC-II isotype expression. Moreover, mutation of potential phosphorylation sites abolished RFXAP activity. The ability of RFXAP mutants to rescue one isotype, but not another was investigated by their ability to form RFX complexes, bind DNA in vivo, recruit CIITA to promoters and to activate a series of chimeric reporter genes. The results suggest that certain RFXAP mutants exaggerate isotype promoter-specific differences and form transcriptionally inefficient activation complexes with factors at the neighboring cis-acting elements. These results show a distinction in factor recognition that is associated with specific MHC-II isotypes and may explain the basis of allele-specific expression differences.

Amino Acid Sequence↗
PubMed2004

Automated external defibrillation by untrained deaf lay rescuers.

INTRODUCTION: The use of automated external defibrillators (AEDs) by lay rescuers can reduce the time to defibrillation, improving survival after out-of-hospital cardiac arrest. However, some people have hearing defects that can prevent them from understanding the AED verbal prompts. Moreover, even rescuers with normal hearing function may not easily understand the AED verbal prompts when operating in a noisy environment. This study was designed to assess the capability of rescuers to defibrillate effectively using an AED which included visual prompts. METHODS AND RESULTS: Nine deaf employees with no previous experience in basic life support (BLS) or defibrillation were asked to defibrillate a manikin following the text prompts of a Heartstart FR2+ AED. Subjects were tested before and after a 6 h BLS-AED course carried out with the help of a sign language interpreter. Before training, seven out of nine deaf subjects (78%) were able to defibrillate, eight out of nine subjects (89%) placed the pads correctly, and the mean time to defibrillation was 101.3 +/- 28.4 s. After the course, all subjects were able to complete the defibrillation sequence and place the pads correctly. The mean post-course time to defibrillation was 47.8 +/- 5.4 s (P < 0.001). None of the nine subjects touched the manikin during charging of the defibrillator and shock delivery before or after the course. CONCLUSIONS: This study demonstrates that untrained deaf rescuers can use AEDs appropriately providing that the defibrillator has visual instructions. Training improves defibrillator use and reduces time to defibrillation.

Cardiopulmonary Resuscitation↗
PubMed2005

Transthoracic impedance does not affect defibrillation, resuscitation or survival in patients with out-of-hospital cardiac arrest treated with a non-escalating biphasic waveform defibrillator.

OBJECTIVE: This is a study of the influence of transthoracic impedance (TTI) on defibrillation, resuscitation and survival in patients with out-of-hospital cardiac arrest (OHCA), treated with a non-escalating impedance-compensating 150 J biphasic waveform defibrillator. METHODS: Cardiac arrest data from two EMS systems were analyzed retrospectively. All witnessed arrests from patients who presented with a shockable rhythm and were treated initially by BLS personnel were included (n = 102). For each defibrillation and resuscitation outcome variable, we tested differences in mean TTI for successful versus unsuccessful outcome. The effect of call-to-shock time on overall outcome was also examined. RESULTS: Initial shocks defibrillated 90% [83-95%] (95% confidence interval) of patients. Cumulative success with two shocks was 98% [93-100%] and with three shocks was 99% [95-100%]. TTI averaged 90 +/- 23 Omega. First-shock success, cumulative success through two shocks and cumulative success through the first-shock series were unrelated to TTI, as were BLS ROSC, pre-hospital ROSC, hospital admission and discharge. In contrast and consistent with previous findings, call-to-shock time was highly predictive of survival. CONCLUSIONS: High impedance patients were defibrillated by the biphasic waveform used in this study at high rates with a fixed energy of 150 J and without energy escalation. Rapid defibrillation rather than differences in patient impedance accounts for resuscitation success.

Cardiography, Impedance↗
PubMed2006

Reaching the public via a multi media campaign as a first step to nationwide public access defibrillation.

Public access defibrillation (PAD) is a promising strategy to fight sudden cardiac death. The Austrian Red Cross provided automated external defibrillators (AEDs) and basic life support (BLS) training as an "all inclusive package" combined with on site consultation and maintenance with annual retraining as a part of a nationwide PAD programme. A multi media campaign was started to promote the package and to increase awareness about sudden cardiac death. Data about the campaign, its recognition by the public in Austria and the number of packages were recorded. Sixty-eight percent of the Austrian public above the age of 15 years were able to recall the multi media campaign. Comparing the periods before and after the campaign, the number of website hits climbed significantly from 2,931 hits/month (1,866-6,168) to 4,812 hits/month (3,432-13,434) (p=0.0276). The number of AED services implemented before the campaign increased significantly (p=0.0026) in the time after the campaign. Therefore, we conclude that a multi media campaign is useful to stimulate public discussion and it encourages companies to buy "all inclusive packages" containing AEDs, BLS training, on site consultation and maintenance. These measures represent a possible first step in introducing PAD but it seems that they have to be continued on a constant basis.

Adolescent↗
PubMed2006

An evaluation of the effectiveness of the Opportunities for Resuscitation and Citizen Safety (ORCS) defibrillator training programme designed for older school children.

OBJECTIVES: The aim of our study was to evaluate the effect of an automated external defibrillation (AED) training programme on the knowledge, attitudes and application of BLS and AED use in young people of secondary school age in Manchester, United Kingdom. METHOD: Students from two schools who had piloted Opportunities for Resuscitation and Citizen Safety (ORCS) in the academic year 2004/2005 volunteered to partake in the study. This 'ORCS intervention' group was compared against a control group, which consisted of students who had no formal training in resuscitation nor, to our knowledge, any other form of life support training during their time at secondary school. All students were assessed and scored on their knowledge and performance of the BLS algorithm (in accordance with the UK Resuscitation Council ('Resuscitation Guidelines for the Citizen') and the use of a trainer defibrillator on a fictional cardiac arrest scenario. RESULTS: We compared 34 ORCS-trained students with 25 control students, all aged between 13 and 16 years. Approximately, twice as many ORCS-trained students than the control students performed many parts of the algorithm correctly, such as checking for danger, checking for response, opening the airway and checking for breathing. More than three times as many ORCS-trained students than controls correctly performed CPR (50% versus 12% of students). As expected, the use of the AED was the part of the algorithm performed worst, but was performed correctly by six times as many ORCS students as controls (27% versus 4% of students). CONCLUSIONS: This study demonstrates that training through the ORCS scheme has a positive influence on the ability of secondary school teenagers to perform emergency life support (ELS), but particularly in their ability to deploy an AED and perform CPR.

Adolescent↗
PubMed2006

Immediate life support (ILS) training Impact in a primary care setting?

OBJECTIVE: To evaluate immediate life support (ILS) training in a primary care setting. METHODS: A 12 month pre/post-quasi-experimental and qualitative evaluation of ILS training across the counties of Devon and Cornwall (UK). Data were collected via feedback forms, pre/post course knowledge and skills tests and by focus group interviews with key stakeholders. RESULTS: One hundred and seventy-three professionals from 10 courses took part in the evaluation with a response rate of 93%. Feedback on the course was overwhelmingly positive. A significant improvement in both skills (p < or = 0.001) and knowledge (p < or = 0.001) was shown. However, a proportion of participants had a decline in knowledge by the end of the course. Those attending ILS had a significantly higher knowledge score at the start of the course (p = 0.002) than a group attending a BLS course, indicating that the preparatory course manual had been beneficial. Knowledge did not decline significantly by 6 months but skills did (p = 0.02), but remained higher than pre-course levels (p < or = 0.001). Knowledge (p = 0.008) and skill (p < or = 0.002) retention following the ILS course was significantly higher than in the BLS course sub-group, indicating the added value of ILS. The focus groups raised a number of themes relating to release of staff; funding issues; and the observed and reported effects of assessment inequity mainly relating to 'failure to fail' and 'dove and hawk' approaches. CONCLUSION: The course leads to a significant increase in skills and knowledge with good knowledge retention. Skill decline is significant which raises questions about the practice of practitioners who are not updated regularly. Issues of funding, staff resources and the assessment ethics and strategy need to be addressed.

Advanced Cardiac Life Support↗
PubMed2003

Level of prehospital care and risk of mortality in patients with and without severe blunt head injury.

OBJECTIVES: To determine the association between mortality and the level of prehospital care in severely injured blunt trauma patients with or without severe head injury. METHOD: Retrospective review of 2010 severe blunt trauma patients (injury severity score (ISS) >15) with or without severe head injury in a tiered trauma system involving ambulance officers (basic life support (BLS) and advanced life support (ALS)) and physicians, and a Level 1 trauma centre. RESULTS: After adjusting for age, type of head injury, glasgow coma scale score (GCS), systolic blood pressure, ISS and prehospital time, intensive care unit (ICU) admission modified the association between level of prehospital care and mortality. In those patients without ICU admission, patients in the paramedic and physician-staffed emergency services group were more likely to die than patients in the BLS ambulance group (odds ratio (OR) 2.18, 95% confidence intervals (CI): 1.05-4.55; 4.27, 95% CI: 1.46-12.45, respectively). Among patients who survived to ICU treatment, however, there was no association between level of prehospital care and risk of mortality. Presence or absence of a head injury did not modify the risk of mortality. CONCLUSIONS: The level of prehospital care was associated with the risk of mortality. This was modified by whether the patient survived long enough to be admitted to the ICU.

Adult↗
PubMed2002

Evaluation of calibration data in capillary electrophoresis using artificial neural networks to increase precision of analysis.

Increase of precision in capillary electrophoresis can be achieved applying suitable markers and evaluating calibration curves and data analysis with artificial neural networks. They are able to account for errors in both x- and y-axes, nonlinear response of detector and non-linearity of calibration curves eventually. A comparison of the artificial neural networks approach with ordinary least-squares (OLS) and bivariate least-squares regression (BLS) was done. While OLS and BLS give similar results, the method proposed and tested in analysis of several pharmaceutical products yields lower prediction errors than traditional linear least-squares methods and the precision of analysis was found in the range 0.5-1.5% relative.

Calibration↗
PubMed1999

Eosinophilic airway inflammation in nasal polyposis.

BACKGROUND: Asthma and asymptomatic bronchial hyperresponsiveness (BHR) are frequent findings in patients with nasal polyposis (NP). OBJECTIVE: To elucidate mechanisms responsible for the development of BHR, we initiated a prospective study of bronchial inflammation as assessed by bronchial lavage (BL) and bronchial biopsy specimens in 35 patients with noninfectious NP. METHODS: BHR was determined with methacholine provocation testing. Differential cell count, ECP, and histamine and tryptase levels were determined in BLs. Pathologic examination of bronchial biopsy specimens was performed with May-Grünwald-Giemsa stain to assess the number of lymphocytes. Indirect immunoenzymatic methods were used to identify eosinophils and mast cells. RESULTS: Fourteen patients did not exhibit BHR (group A); 7 patients had asymptomatic BHR (group B); and 14 patients had BHR associated with asthma (group C). Patients of group C tended to have a longer duration of nasal symptoms than those of groups A and B. FEV1 (L) was significantly lower in group C than in groups A and B. The number and percentage of eosinophils were significantly higher in BLs in groups B and C than in group A (P <. 05). Patients of groups B and C had a significantly higher number of eosinophils in bronchial submucosa (14.0 +/- 1.5/mm2 and 19.0 +/- 1. 9/mm2, respectively) than patients of group A (0.1 +/- 0.1/mm2). The number of lymphocytes was also higher in groups B and C than in group A. FEV1 (percent of predicted value) and eosinophil number within bronchial mucosa correlated negatively. CONCLUSION: Our results demonstrate that patients with NP and asymptomatic BHR had an eosinophilic bronchial inflammation similar to that observed in asthmatic patients with NP, whereas patients with NP without BHR do not feature eosinophilic lower airways inflammation. The clinical relevance of these results requires careful follow-up to determine whether eosinophilic inflammation in these patients precedes and is responsible for the development of obvious asthma.

Adult↗
PubMed1996

Cost-effectiveness analysis of potential improvements to emergency medical services for victims of out-of-hospital cardiac arrest.

STUDY OBJECTIVE: To measure the incremental cost-effectiveness of various improvements to emergency medical services (EMS) systems aimed at increasing survival after out-of-hospital cardiac arrest. METHODS: We performed cost-effectiveness analysis based on (1) metaanalysis of effectiveness of the various EMS systems, (2) costing of each component of EMS systems, (3) modeling of the relationship between the proportion of cardiac arrest victims who receive CPR and the proportion of individuals trained, (4) modeling of the relationship between response time interval and the characteristics of the EMS system, (5) measurement of quality of life, and (6) decision analysis to combine the results of the first five components. RESULTS: The incremental cost-effectiveness ratio for a 48-second improvement in mean response time in a one-tier EMS system yielded by the addition of more EMS providers was $368,000 per quality-adjusted life year (QALY). For improved response time in a two-tier EMS system by the addition of more basic life support (BLS)/BLS-defibrillator (BLS-D) providers to the first tier, the ratio was $53,000 per QALY with pump vehicles or $159,000 per QALY with ambulances. Change from a one-tier EMS to a two-tier EMS system by the addition of initial BLS/BLS-D providers in pump vehicles as the first tier was associated with a cost per QALY of $40,000. Change from one-tier EMS to two-tier EMS by the addition of initial BLS/BLS-D providers in ambulances as the first tier was associated with a cost per QALY of $94,000. CONCLUSION: The most attractive options in terms of incremental cost-effectiveness were improved response time in a two-tier EMS system or change from a one-tier to a two-tier EMS system. Future research should be directed toward identification of the costs of instituting the first tier of a two-tier EMS system and identification of cost-effective methods of improving response time.

Cardiopulmonary Resuscitation↗
PubMed1996

Geriatric use of emergency medical services.

STUDY OBJECTIVE: To quantify use by geriatric patients of emergency medical services (EMS) compared with that by young adult patients. METHODS: We conducted a retrospective, consecutive case series over a 6-month period in a suburban, all-paramedic municipal EMS system serving 76,500 residents, of whom approximately 15% are 65 years of age or older and 33% are between 25 and 45 years old. Patient age, the sole entry criterion, was used to distinguish two groups: the young adult group, defined as patients 25 to 45 years old; and the geriatric group, defined as patients 65 years or older. RESULTS: Of the 2,712 patients whose cases were reviewed during the study period, 1,734 (65%) met the entry criterion. The geriatric group (n=1,043) accounted for 39% of the total call volume, compared with the young adult group (n=690), which accounted for 25% of total call volume. Patients in the young adult group were 7.3 times more likely to have been in a motor vehicle accident, whereas the GP group was 2.6 times more likely to have cardiorespiratory complaints, 1.8 times more likely to have fallen, and 1.7 times more likely to have minor medical problems requiring transportation and more frequently required advanced life support (ALS) care (54% versus 33%) (P<.001 for all comparisons). Scene times for geriatric patients were found to be longer than those for young adults (ALS, P<.001; basic life support [BLS], P<.05). However, costs billed to the patient were greater for young adults for all care rendered (BLS, P<.001; ALS, P<.05). CONCLUSION: Use by geriatric patients of EMS differed significantly from that by young adults. Geriatric patients used EMS more frequently and required more ALS care than did young adults. Although geriatric patients required longer scene times for EMS care, young adults incurred greater charges for service. These findings, although perhaps system specific, speak to the need for ongoing analysis of EMS health care delivery to better serve a population increasing in age.

Adult↗
PubMed1999

Modifiable factors associated with improved cardiac arrest survival in a multicenter basic life support/defibrillation system: OPALS Study Phase I results. Ontario Prehospital Advanced Life Support.

STUDY OBJECTIVES: This study was conducted to identify modifiable factors associated with survival for prehospital cardiac arrest in a large, multicenter EMS system with basic life support/defibrillation (BLS-D) level of care. METHODS: This observational cohort study constitutes Phase I of the 3-phase Ontario Prehospital Advanced Life Support (OPALS) Study. Included were all adults who had cardiac arrest before EMS arrival in 21 urban/suburban communities that operate under the jurisdiction of 1 ambulance services branch, have 911 telephone service, and provide ambulance defibrillation but no prehospital advanced life support (ALS). Central dispatch and ambulance records were reviewed according to the Utstein guidelines. Associations between multiple patient and EMS factors and survival to discharge were assessed by univariate then stepwise logistic regression analyses. RESULTS: From January 1, 1991, to January 31, 1995, 5,335 eligible patients were treated. Of these, 46.8% of cardiac arrests were witnessed by citizens, 14.5% received bystander CPR, 25.6% received CPR by fire or police, and 38.2% had an initial rhythm of ventricular fibrillation/ventricular tachycardia (VF/VT). The mean interval from call received to vehicle stopped was 6.7 minutes. Survival was 3.5% overall and 8.8% for VF/VT. Multivariate analysis found the following factors to be independently associated with survival (odds ratio with 95% confidence intervals): age.81 (. 73,.89), bystander-witnessed arrest 4.05 (2.78, 5.90), bystander CPR 2.98 (2.07, 4.29), CPR by fire or police 2.20 (1.46, 3.31), and response interval call received to vehicle stopped.76 (.71,.82). CONCLUSION: This represents the largest multicenter BLS-D study of prehospital cardiac arrest yet conducted and clearly indicates that patient survival may be improved by optimization of EMS response intervals, bystander CPR, as well as first-responder CPR by fire or police.

Adolescent↗
PubMed2001

Prehospital use of minimally invasive direct cardiac massage (MID-CM): a pilot study.

BACKGROUND: Internal cardiac compressions are more efficient than closed chest compressions (CCC) in cardiac arrest (CA). AIM OF THE STUDY: To evaluate the prehospital feasibility of performing a new method of minimally invasive direct cardiac massage (MID-CM TheraCardia Inc.). METHODS: Prospective non-randomized open study, after ethical committee approval. Inclusion of 18-85 years old patients in witnessed CA if BLS>5 min and unsuccessful ACLS>20 min after CA. The MID-CM is an atraumatic manual cardiac pumping system deployed in the thoracic cavity through a small incision. Evaluation of: ease of insertion and performing MID-CM, complications, end-tidal CO(2) (PETCO(2)), non invasive arterial blood pressure (NIBP) and return of spontaneous circulation (ROSC). Values are mean+/-SD (min-max). RESULTS: Twenty-five patients included. Mean age 59+/-16 years (26-85); BLS started at 8+/-5 min (0-20), compressions started at 47+/-10 min (29-74) after CA. Dissection and insertion was fast and easy (<1 min). Deployment of the MID-CM was difficult in two patients because of pericardium adhesions and cardiomegaly. In six patients compressions were more difficult because of a 'stone heart' phenomenon. Compressions were possible during ambulance transport of four patients. There was a good palpable carotid pulse in all patients receiving internal compressions. There was a trend in increase of PETCO(2) compared to CCC. NIBP could be measured during MID-CM compressions in 9 patients (systolic>85 mmHg), never during CCC. Seven patients had a ROSC, but only four patients were admitted alive. There was no long term survival. One patient had a serious complication (heart rupture). DISCUSSION: Prehospital use of MID-CM is possible, but it is not comparable to any other resuscitation technique. Training of medical teams is mandatory to obtain good skills and to avoid complications. Further studies are necessary to evaluate efficiency and survival compared to closed chest compressions.

Adult↗