Reciprocal Abstract Publication

Editor’s note: Hong Kong Journal of Emergency Medicine has partnered with a small group of selected journals of international emergency medicine societies to share from each a highlighted research study, as selected monthly by their editors. Our goals are to increase awareness of our readership to research developments in the international emergency medicine literature, promote collaboration among the selected international emergency medicine journals, and support the improvement of emergency medicine world-wide, as described in the WAME statement at http://www.wame.org/about/policystatements#Promoting%20Global%20Health. Abstracts are reproduced as published in the respective participating journals, and are not peer reviewed or edited by Hong Kong Journal of Emergency Medicine.

Annals of Emergency Medicine

Intraosseous vascular access is associated with lower survival and neurologic recovery among patients with out-of-hospital cardiac arrest

Takahisa Kawano, Brian Grunau, Frank X Scheuermeyer, Koichiro Gibo, Christopher B Fordyce, Steve Lin, Robert Stenstrom, Robert Schlamp, Sandra Jenneson, Jim Christenson

Kawano et al. Ann Emerg Med 2018. http://dx.doi.org/10.1016/j.annemergmed.2017.11.015

Study objective: We seek to determine the effect of intraosseous over intravenous vascular access on outcomes after out-of-hospital cardiac arrest.

Methods: This secondary analysis of the Resuscitation Outcomes Consortium Prehospital Resuscitation Using an Impedance Valve and Early Versus Delayed (PRIMED) study included adult patients with nontraumatic out-of-hospital cardiac arrests treated during 2007–2009, excluding those with any unsuccessful attempt or more than one access site. The primary exposure was intraosseous versus intravenous vascular access. The primary outcome was favorable neurologic outcome on hospital discharge (modified Rankin Scale score ≤3). We determined the association between vascular access route and out-of-hospital cardiac arrest outcome with multivariable logistic regression, adjusting for age, sex, initial emergency medical services–recorded rhythm (shockable or nonshockable), witness status, bystander cardiopulmonary resuscitation, use of public automated external defibrillator, episode location (public or not), and time from call to paramedic scene arrival. We confirmed the results with multiple imputation, propensity score matching, and generalized estimating equations, with study enrolling region as a clustering variable.

Results: Of 13,155 included out-of-hospital cardiac arrests, 660 (5.0%) received intraosseous vascular access. In the intraosseous group, 10 of 660 patients (1.5%) had favorable neurologic outcome compared with 945 of 12,495 (7.6%) in the intravenous group. On multivariable regression, intraosseous access was associated with poorer out-of-hospital cardiac arrest survival (adjusted odds ratio 0.24; 95% confidence interval: 0.12–0.46). Sensitivity analyses revealed similar results.

Conclusion: In adult out-of-hospital cardiac arrest patients, intraosseous vascular access was associated with poorer neurologic outcomes than intravenous access.

How to cite this article:

Kawano, T, Grunau, B, Scheuermeyer, FX, et al. Intraosseous vascular access is associated with lower survival and neurologic recovery among patients with out-of-hospital cardiac arrest. Ann Emerg Med 2018. http://dx.doi.org/10.1016/j.annemergmed.2017.11.015

African journal of emergency medicine

Assessing the impact of an emergency trauma course for senior medical students in Kenya

Wanjiku G, Janeway H, Foggle J, Partridge R, Wanga Y, Kearney A, Levine AC, Carter J, Tabu JS

Wanjiku et al. Afr J Emerg Med. 2017; 7(4): 167–171. https://doi.org/10.1016/j.afjem.2017.04.013

Introduction: Ninety percent of all injury-related deaths occur in low- and middle-income countries. The World Health Organization (WHO) recommends short, resource-specific trauma courses for healthcare providers. Studies show that teaching trauma courses to medical students in developed countries leads to significant increases in knowledge and skill. High costs hinder widespread and sustained teaching of these courses in low-income countries.

Methods: A two-day trauma course was designed for students at Moi College of Health Sciences in Eldoret, Kenya. Participants underwent pre- and post-course written and simulation testing and rated their confidence in 21 clinical scenarios and 15 procedures pre- and post-course using a 5-point Likert scale. A subset of the students was re-evaluated 9 months post-course. Using the paired t-test, mean written, simulation and confidence scores were compared pre-course, immediately post-course and 9 months post-course.

Results: Twenty-two students were enrolled. Written test score means were 61.5% pre-course and 76.9% post-course, mean difference 15.5% (p < 0.001). Simulation test score means were 36.7% pre-course and 82.2% post-course, mean difference 45.5% (p < 0.001). Aggregate confidence scores were 3.21 pre-course and 4.72 post-course (scale 1–5). Ten out of 22 (45.5%) students were re-evaluated 9 months post-course. Results showed written test score mean of 75%, simulation score mean of 61.7%, and aggregate confidence score of 4.59 (scale 1–5). Mean differences between immediate post- and 9 months post-course were 1.6% (p = 0.75) and 8.7% (p = 0.10) for the written and simulation tests, respectively.

Conclusion: Senior Kenyan medical students demonstrated statistically significant increases in knowledge, skills and confidence after participating in a novel student trauma course. Nine months post-course, improvements in knowledge skills and confidence were sustained.

Emergencias

Risk of influenza transmission in a hospital emergency department during the week of highest incidence

Miguel Esteve-Esteve, Daniel Bautista-Rentero, Vicente Zanón-Viguer

Esteve-Esteve et al. Emergencias. 2018; 30: 7–13. http://emergencias.portalsemes.org/descargar/riesgo-de-transmisin-de-gripe-en-un-servicio-de-urgencias-hospitalario-en-periodo-de-mxima-incidencia-epidmica/

Cited: Esteve-Esteve M, Bautista-Rentero D, Zanón-Viguer V. Risk of influenza transmission in a hospital emergency department during the week of highest incidence. Emergencias. 2018; 30: 7–13.

Objectives: To estimate the risk of influenza transmission in patients coming to a hospital emergency department during the week of highest incidence and to analyze factors associated with transmission.

Methods: Retrospective observational analysis of a cohort of patients treated in the emergency room during the 2014–2015 flu season. The following variables were collected from records: recorded influenza diagnosis, results of a rapid influenza confirmation test, point of exposure (emergency department, outpatient clinic, or the community), age, sex, flu vaccination or not, number of emergency visits, time spent in the waiting room, and total time in the hospital. We compiled descriptive statistics and performed bivariate and multivariate analyses by means of a Poisson regression to estimate relative risk (RR) and 95% CIs.

Results: The emergency department patients had a RR of contracting influenza 3.29 times that of the community exposed population (95% confidence interval (CI): 1.53–7.08, p = .002); their risk was 2.05 times greater than that of outpatient clinic visitors (95% CI: 1.04–4.02, p = .036). Emergency patients under the age of 15 years had a 5.27 greater risk than older patients (95% CI: 1.59–17.51; p = .007). The RR of patients visiting more than once was 11.43 times greater (95% CI: 3.58–36.44; p < .001). The risk attributable to visiting the emergency department risk was 70.5%, whereas risk attributable to community exposure was 2%.

Conclusions: The risk of contracting influenza is greater for emergency department patients than for the general population or for patients coming to the hospital for outpatient clinic visits. Patients under the age of 15 years incur greater risk.

Emergency Medicine Journal

Ketamine procedural sedation in the emergency department of an urban tertiary hospital in Dar es Salaam, Tanzania

Zlatan Coralic, Hendry R Sawe, Juma A Mfinanga, Alfredo Cortez, Jennifer Koehl, Hannah Siroker, Teri A Reynolds

Coralic et al. Emergency Med J. 2018; 35(4): 214–219. http://dx.doi.org/10.1136/emermed-2017-206974

Study objective: We describe ketamine procedural sedations and associated adverse events in low-acuity and high-acuity patients in a resource limited emergency department (ED).

Methods: This was a prospective observational study of ketamine procedural sedations at the Emergency Medical Department at the Muhimbili National Hospital in Dar es Salaam, Tanzania. We observed consecutive procedural sedations and recorded patient demographics, medications, vital signs, pulse oximetry, capnography and a priori defined adverse events (using standard definitions in emergency medicine sedation guidelines). All treatment decisions were at the discretion of the treating providers who were blinded to study measurements to simulate usual care. Data collection was unblinded if predefined safety parameters were met. For all significant adverse and unblinding events, ketamine causality was determined via review protocol. Additionally, providers and patients were assessed for sedation satisfaction.

Results: We observed 54 children (median 3 years, range 11 days–15 years) and 45 adults (median 33 years, range 18–79 years). The most common indications for ketamine were burn management in children (55.6%) and orthopedic procedures in adults (68.9%). Minor adverse events included nausea/vomiting (12%), recovery excitation (11%) and one case of transient hypertension. There were nine (9%) patients who had decreased saturation readings (SpO₂ ≤ 92%). There were three deaths, all in severely injured patients. After review protocol, none of the desaturations or patient deaths were thought to be caused by ketamine. No patient experienced ketamine-related laryngospasm, apnea or permanent complications. Overall, ketamine was well tolerated and resulted in high patient and provider satisfaction.

Conclusion: In this series of ketamine sedations in an urban, resource-limited ED, there were no serious adverse events attributable to ketamine.