The discussion kicks off with insights on the UK REBOA trial, diving into its questionable benefits for trauma patients compared to standard care. There’s an intriguing look at dual sequential defibrillation methods for treating refractory VF, especially in obese patients, and how they stack up against traditional techniques. Finally, the potential of video livestreaming from medical scenes is explored, examining how it might improve dispatch accuracy and resource allocation in emergency situations. It's a blend of science and innovation!
The potential benefits of prehospital partial RABOA include improved blood pressure in trauma patients, although survival rates remain a concern.
Dual sequential cardioversion techniques for atrial fibrillation in obese patients show significantly higher success rates compared to traditional methods.
Deep dives
Exploring RABOA's Feasibility in Pre-Hospital Settings
Partial RABOA, or resuscitative endovascular balloon occlusion of the aorta, offers a method for managing life-threatening hemorrhages by temporarily controlling blood flow. Recent studies indicate that the technique can improve blood flow to vital organs and buy time in critical situations. A particular observational study focused on trauma patients showed that pre-hospital application of zone 1 RABOA was feasible, with notable improvements in systolic blood pressure among patients. Though survival to hospital discharge was low, the findings suggest potential when executed in pre-hospital environments, despite caution around delays and potential ischemic complications.
Dual Cardioversion: A New Approach for Obese Patients
As the prevalence of atrial fibrillation (AF) rises, especially among obese patients, there's growing concern regarding the efficacy of traditional cardioversion methods in this group. A study comparing single versus dual cardioversion techniques revealed significantly higher success rates with dual cardioversion, achieving success in 98% of patients compared to 87% for the single approach. This suggests that enhanced delivery methods may be needed to address higher failure rates in obese individuals seeking treatment for AF. The implications indicate a potential shift in practice for treating AF in obese patients, emphasizing the need to evaluate the specifics of electrical pathways and pad placements.
The Potential of Live Video Streaming in EMS Dispatch
The use of bystander video live streaming during emergency calls is being explored to enhance dispatch effectiveness, particularly in critical care scenarios. A feasibility trial evaluated the impact of streaming on resource allocation, assessing the ability to improve decision-making in real-time. Successful implementation was noted in a substantial number of cases, with a significant proportion of critical care dispatches being standby due to available visual information. While the trial exhibited promise, it also highlighted the need for further studies to examine the overall cost-benefit and efficacy of live streaming technology in emergency medical services.
Collaboration for Improved Patient Care
The collaboration with Medical Zoll Corporation is enhancing the free open-access model for healthcare education and awareness, facilitating significant educational events. The partnership aims to improve clinical knowledge surrounding critical care practices such as defibrillation strategies and high-quality CPR. An upcoming live event in Birmingham underscores the commitment to advancing emergency care and patient outcomes through enhanced collaborative efforts. Such initiatives are essential for fostering athletic professional development and improving healthcare-related outcomes in real-time emergency situations.
The UK REBOA trial left many with doubts over its utility for trauma patients in ED. The time from injury to its use was around 90 minutes and the trial was stopped when it didn't reduce and maybe even increased mortality compared to standard care alone.
But what effect does REBOA have when used prehospitally and how feasible is it? Our first paper, from London HEMS, looks at this and gives a fascinating insight into it's use and the physiological response seen with it.
We've recently looked at dual sequential defibrillation for refractory VF with the DOSE-VF trial. Our second paper this month looks at how a double defibrillator strategy, in the context of cardioversion for AF, may affect restoration of sinus rhythm in obese patients.
Finally we take a look at the use of video livestreaming from scene to EMS, in a feasibility RCT. How can it affect accurate dispatch of the most appropriate resources and what impact does it have on those that use it?
Once again we’d love to hear any thoughts or feedback either on the website or via X @TheResusRoom!
Simon & Rob
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