Research Review: 2008 ACEP Research Forum
Wednesday, February 11, 2009
Elizabeth Criss, NP, MED, MS, CEN, CCRN
I usually don’t use abstracts as the basis for this column, primarily because the findings aren’t peer reviewed. However, sometimes I come across interesting abstracts that provide insight into current research trends. Here are some examples from the 2008 American College of Emergency Physicians’ Research Forum, which were published in the Annals of Emergency Medicine October 2008 supplement.
Injuries When Ambulatory
Heavrin BS, Richling R, Hemphill R: "Do ambulatory trauma patients have serious injuries?" Abstract #335
This was a small study, with fewer than 140 patients, that evaluated the likelihood of serious injury in patients who were ambulatory following a motor vehicle crash. Out of the group, 13.6% were admitted to the hospital, and 1.8% required emergency department (ED) intubation due to traumatic brain injury. By far, the most common injuries were related to soft-tissue damage. With further study, the authors conclude that being ambulatory could become part of determining who needs a trauma center.
In a time of hospital budget woes, this might be an important finding.
When To Intubate
Lobel D, Likourezos A, Farahani C, et al: "Successful implementation of an etomidate-facilitated endotracheal intubation protocol in an urban ground transport ambulance system." Abstract #174
This study compared intubations performed before and after protocol implementation for overall success rates. Pre- and post-protocol, the majority of intubations were related to cardiac arrest. For a small group of non-cardiac-arrest patients, the use of etomidate increased overall success rates by 5%.
Nowhere in the abstract is there information on complications, deaths, or how many patients were intubated without sedation before the protocol. (This is why you should be cautious when reading abstracts.) This study could shed light on airway management, but first the authors must consider all factors.
Scene Time Importance
Cudnik MT, Newgard CD, Sayre MR, et al: "Scene time does not impact mortality in trauma patients." Abstract #171
This study evaluated more than 4,500 trauma patients with a mean scene time of 14.4 minutes for survivors and 15.3 minutes for non-survivors. A regression analysis of age, injury severity score (ISS), revised trauma score (RTS), scene time and mode of transport demonstrated that scene time was the only factor not associated with mortality. The authors found the same result when the regression analysis included type of trauma, GCS, or only those with an initial blood pressure less than 90 mmHg.
This could change the way EMS approaches trauma patients. Maybe "scoop and run" isn’t better than "stay and play."
Weichenthal LA, Manternach S, Stroh G, et al: "The impact of suspension of diversion on an emergency medical service system." Abstract #91
Many systems use ambulance diversion as a way to level out the distribution of patients. This study evaluated what happened to three hospitals when diversion was stopped. The number of patients in all the EDs increased, but interestingly the number of patients waiting in
the ED for in-patient beds declined. As far as the effect on the EMS system, median times for transport and return to service also decreased.
The use of 9-1-1 for routine transport isn’t going to go away anytime soon. The number of ED beds is not likely to increase anytime soon, either. So finding ways to work within the system is vital to an efficiently functioning EMS system and ED.
Eckstein M: "Impact of new CPR/Advanced Cardiac Life Support guidelines on outcome from out-of-hospital cardiac arrest." Abstract #87
This study evaluated the effect of two minutes of continuous chest compression CPR combined with 20 minutes of on-scene care on the rate of return of spontaneous circulation (ROSC) and the number of field terminations of care. The authors found the number of patients who had ROSC nearly doubled, and the number of field terminations of care nearly tripled with this protocol.
This certainly indicates the value of the new CPR guidelines in providing more effective and probably more compassionate care in the prehospital environment.
Song for CPR
Matlock D, Hafner JW, Bockewitz EG, et al: "‘Stayin’ Alive’: A pilot study to test the effectiveness of a novel mental metronome in maintaining appropriate compression rates in simulated cardiac arrest scenarios." Abstract #83
These authors evaluated the effectiveness of using music, specifically "Stayin’ Alive" from Saturday Night Fever , to provide a reference rate for chest compression. Fifteen participants practiced chest compressions while listening to the music and were tested again five weeks later. The participants were able to provide appropriate CPR—compressions at 100 times per minute, good hand placement and full recoil. The majority of the participants felt that learning the compression rate with the help of the music made retention much easier.
Some instructors already use this tip. But it’s nice that someone took the time to collect evidence that supports using this analogy in the classroom.