Ep 269 - Monthly Round Up Janury 2025 - Prehospital Papers Galore!....
May 14, 2025
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Dive into groundbreaking research as the hosts discuss the Sub 30 feasibility study for pre-hospital ECMO, highlighting its rapid implementation challenges. They compare emergency anaesthesia practices between pre-hospital and in-hospital settings, uncovering variations in patient care. Learn about the effectiveness of physician-led pre-hospital teams and their potential impact on outcomes. The economic implications of advanced interventions in emergency care are also explored, alongside insights from the London Trauma Conference. Don't miss this eye-opening discussion!
The Sub-30 feasibility study highlighted the logistical challenges and limited patient suitability for pre-hospital ECMO, raising practical implementation concerns.
Comparative analysis of pre-hospital versus emergency department anaesthesia revealed significant time advantages in rapid sequence intubation, emphasizing the importance of timely intervention in trauma care.
Deep dives
Pre-Hospital eCPR Study Insights
The podcast discusses the Sub-30 feasibility study, which evaluated the potential for administering extra-corporeal membrane oxygenation (eCPR) pre-hospital within 30 minutes of cardiac arrest. Conducted in London, the study highlighted the logistical challenges of achieving this target, with an average time of 47 minutes to complete cannulation after initial response times that averaged about 14 minutes. Out of 43 potential candidates, only five were suitable for ECMO, and while two survived, their post-operative conditions indicated significant disability. The conversation emphasizes the study's ambitious nature and raises questions about the practicality and outcomes of implementing eCPR widely, particularly given that the initial results did not meet the high expectations set by its proponents.
Time to Emergency Anesthesia
Another key topic addressed is a study on the timing of emergency anesthesia, comparing pre-hospital rapid sequence intubation (RSI) against that conducted in emergency departments. The study revealed that RSI performed in the pre-hospital setting was consistently quicker, averaging 64 minutes compared to 132 minutes for emergency department cases. This time difference is crucial, particularly in trauma cases where rapid access to imaging and treatment is needed. However, the podcast points out the challenges of making direct comparisons due to patient variability and the inherent limitations of retrospective analyses, underscoring the nuances of decision-making in pre-hospital care.
Examining Physician-Led Pre-Hospital Teams
The effectiveness of physician-led pre-hospital teams compared to paramedic-led teams is critically examined in the podcast, referencing a systematic review of 23 studies. While this review suggests physician-led teams improve outcomes in trauma and cardiac arrest settings, the evidence is contested, particularly since most data is observational and reflects heterogeneous patient populations. The discussion highlights the need for caution in assuming superiority, as differing definitions of paramedic qualifications across countries complicate the findings. Ultimately, the podcast stresses that more research and nuanced understanding of training and service delivery models are required to justify the costs of implementing physician-led responses in pre-hospital systems.
In this episode of the St Emlyn's Podcast, Iain Beardsell and Simon Carley revisit January's blog posts and podcasts, covering several seminal studies relevant to emergency and pre-hospital care.
Topics include the Sub 30 Feasibility Study on pre-hospital ECMO, comparisons of pre-hospital versus in-hospital emergency anaesthesia, variations in maintenance of pre-hospital anaesthesia in trauma patients, and the effectiveness of physician-led pre-hospital teams.
They also discuss the economic implications of advanced pre-hospital interventions and highlight reviews from the London Trauma Conference.
00:00 Introduction and January Recap
01:58 Pre-Hospital ECPR Study: The Sub 30 Study
07:09 Emergency Anaesthesia: Pre-Hospital vs. Emergency Department
13:55 Maintenance of Pre-Hospital Anaesthesia: Variations in Practice
16:57 Physician-Led Pre-Hospital Teams: Do They Improve Outcomes?
22:12 Additional Insights and Upcoming Content
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