Search

Patients with atrial fibrillation (AF) and oral anticoagulation (OAC) failure may benefit from left atrial appendage closure (LAAC), however, the evidence is scarce. We report outcomes of LAAC in patients with OAC failure compared to those with classic indications of OAC contraindications.Prospective registry of LAAC with Amplatzer or WATCHMAN device followed by dual antiplatelet therapy (DAPT) was analyzed (05.2014-11.2019). The study group included patients with OAC failure defined as stroke/TIA/PE/LAA thrombus (n = 39) during OAC, whereas the control group consisted of patients with OAC contraindications (n = 156). Structured follow-up at 3, 6, and 12 months was done.The study group compared to controls was younger [73 (IQR, 62-77) vs 74 (IQR, 68-81) years, P = 0.046], with higher CHAPatients after LAAC for OAC failure and unremarkable prior bleeding history presented with high residual stroke and low bleeding risks. Therefore concomitant long-term OAC or prolonged DAPT should strongly be considered in this population.

Background: Transcatheter left atrial appendage closure (LAAC) is performed in patients unsuitable for long-term anticoagulation, predominantly due to prior bleeding events. The study aimed to investigate the incidence and predictors of clinically significant bleeding (CSB) post-LAAC. Methods: Consecutive patients after LAAC with an Amplatzer or WATCHMAN device were analyzed (05.2014–11.2019). Bleeding was classified as CSB when associated with at least one of the following: death, ≥2 g/dL hemoglobin drop, ≥2 blood units transfusion, critical anatomic site, or hospitalization/invasive procedure. Results: Among 195 patients (age 74 (68–80), 43.1% females, HAS-BLED score 2.0 (2.0–3.0)), during median follow-up of 370 (IQR, 358–392) days, there were 15 nonprocedural CSBs in 14 (7.2%) patients. Of those, 9 (60.0%) occurred during postprocedural dual antiplatelet therapy (DAPT) (median 46 (IQR: 16–60) days post-LAAC) vs. 6 (40%) after DAPT discontinuation (median 124 (81–210) days post-LAAC), translating into annualized CSB rates of 14.0% (per patient-year on DAPT) vs. 4.6% (per patient-year without DAPT). In 92.9% (13/14) of patients, the post-LAAC nonprocedural CSB was a recurrence from the same site as bleeding pre-LAAC. In the multivariable model, admission systolic blood pressure (SBP) > 127 mmHg (HR = 10.73, 1.37–84.26, p = 0.024), epistaxis history (HR = 5.84, 1.32–25.89, p = 0.020), permanent atrial fibrillation (AF) (HR = 4.55, 1.20–17.20, p = 0.025), and prior gastrointestinal bleeding (HR = 3.35, 1.01–11.08, p = 0.048) predicted post-LAAC CSB. Conclusions: Nonprocedural CSBs after LAAC, with a similar origin as the pre-LAAC bleedings, were observed predominantly during postprocedural DAPT and predicted by elevated admission SBP, prior epistaxis, permanent AF, and gastrointestinal bleeding history. Whether a more reserved post-LAAC antiplatelet regimen and stringent blood pressure control may improve LAAC outcomes remains to be studied.

We hypothesized that the Airtraq laryngoscope (Airtraq LLC, Bonita Springs, Fla) is beneficial for intubation of pediatric manikins while performing cardiopulmonary resuscitation (CPR). In the present study, we evaluated the effectiveness of the Macintosh (MAC) laryngoscope (HEINE Optotechnik, Munich, Germany) and Airtraq in 3 simulated CPR scenarios. A randomized crossover simulation trial was designed. Eighty-three nurses intubated the trachea of a PediaSIM CPR training manikin (FCAE HealthCare, Sarasota, Fla) using the MAC and Airtraq in a normal airway scenario, normal airway with chest compression scenario, and difficult airway with chest compression scenario. The participants were directed to perform a maximum of 3 attempts in each scenario. The success rate, time to intubation, Cormack & Lehane grade, dental compression, and the ease of intubation were measured. All participants performed successful intubation with the Airtraq in all 3 scenarios. In all scenarios, the success rate was significantly higher and the time to intubation was significantly shorter with the Airtraq than with the MAC. Glottic visualization using the Cormack-Lehane scale was also better when using Airtraq in all scenarios. In this manikin study, we found that the Airtraq can be used successfully for the intubation of pediatric manikins with normal and difficult airways by medical staff without previous experience in pediatric intubation. Moreover, intubation can be achieved without interrupting chest compression. The use of the Airtraq compared with the MAC led to faster time to intubation. Nevertheless, we recommend that the performance of the Airtraq and the MAC during CPR should be further evaluated in a clinical setting.

Acute cardiopulmonary failure after emergency coronary artery bypass grafting (CABG) is a complex thera­peutic problem due to its high mortality rate. This paper reports the safety and effectiveness of extracorpor­eal membrane oxygenation (ECMO) in treating acute cardiopulmonary failure following emergency CABG. A 37-day period of mechanical circulation support and extracorporeal blood oxygenation with the ECMO method served as a bridge to recovery. At day 34 following the disconnection of ECMO, a patient with EF > 35% was transferred to a rehabilitation ward. The procedure can be successful only when the physi­cians, nurses and perfusionists of the intensive care team cooperate closely.

Introduction: Totally implantable venous access systems (TIVAS), Swan-Ganz (SG) and central venous catheters (CVC) allow easy and repetitive entry to the central cardiovascular system. Fragments of them may be released inadvertently into the cardiovascular system during their insertion or as a result of mechanical complications encountered during long-term utilization. Aim : To present results of percutaneous retrieval of embolized fragments of central venous devices or knotted SG and review the procedural aspects with a series of detailed angiographies. Material and methods : Between January 2003 and December 2012 there were 14 (~0.025%) successful retrievals in 13 patients (44 ±16 years, 15% females) of embolized fragments of TIVAS (n = 10) or CVC (n = 1) or of dislodged guide-wires (n = 2) or knotted SG (n = 1). Results : Foreign bodies with the forward end located in the right ventricle (RV), as well as those found in the pulmonary artery (PA), often required repositioning with a pigtail catheter as compared to those catheter fragments which were located in the right atrium (RA) and/or great vein and possessed an accessible free end allowing their direct ensnarement with the loop snare (57.0% (4/7) vs. 66.7% (2/3) vs. 0.0% (0/3); p = 0.074 respectively). Procedure duration was 2–3 times longer among catheters retrieved from the PA than among those with the forward edge located in the RV or RA (30 (18–68) vs. 13.5 (11–37) vs. 8 min (8–13); p = 0.054 respectively). The SG catheter knotted in the vena cava superior (VCS) was encircled with the loop snare introduced transfemorally, subsequently cut at its skin entrance and then pulled down inside the 14 Fr vascular sheath. Conclusions : By using the pigtail catheter and the loop snare, it is feasible to retrieve centrally embolized fragments or knotted central venous access devices.

Introduction The gold standard for airway management in the pre-hospital and hospital care still remains endotracheal intubation. Purpose Comparison of the standard laryngoscope with Macintosh blade (MAC), laryngoscope TruView EVO2 (EVO) and videolaryngoscope TruView PCD (PCD) during child intubation in two rescue scenarios: (1) the patient with cervical spine immobilization, (2) the patient with cervical spine immobilization and tongue edema. Material and methods This was randomized, cross-over, simulation trial. Fifty-two paramedics participated in the study. We analyzed intubation time, the effectiveness of the first attempt of intubation, total efficiency, Cormack-Lehane grade, dental compression and ease of intubation. Results Time to intubation (median [interquartile range]) using MAC, EVO and PCD was varied and amounted to: 26.5 s [23–30,5] vs. 29 s [25-33.5] vs. 20.5 s [18–23] for scenario A and 38.3 s [30–47] vs. 36 s [30,5–45] vs. 24 s [22–27,5] for scenario B. Efficacy first attempt intubation during scenario A was 53.8% vs. 76.8% vs. 100% (MAC EVO PCD), while during scenario B it was 48.1% vs. 73.1% vs. 96.2%. Conclusions In this manikin study, paramedics performed with greater efficiency intubation using a videolaryngoscope TruView PCD, both in scenarios A and B. Videolaryngoscope TruView PCD may be an alternative to the standard direct laryngoscopy.

A 62-years-old woman was admitted to the hospital because of chronic cough, expectoration of thick mucus, hoarseness and tightness in the precordial area. Computed Tomography (CT) examination revealed the presence of a giant intrapericardial tumor with the dimensions of 80 × 38 × 32 mm. It was located anteriorly and laterally to the left atrium, posteriorly to the pulmonary trunk and the ascending aorta. This hypodense change modeled the left atrium without evidence of invasion. CT coronary angiography and 3-dimensional reconstruction were applied to enable precise planning of cardiac surgery. CT evaluation confirmed that it is possible to remove the tumor without damage to the adjacent left main coronary artery. The patient underwent cardiac surgery with sternotomy and cardiopulmonary bypass. A cohesive, smooth, vascularized tumor pedunculated to the left atrial epicardium was visualized. The location and dimensions corresponded to those determined by CT scan examination. The entire tumor was successfully dissected together with adjacent adipose and fibrous tissue. Histological evaluation revealed the presence of myxoid cells, blood vessels, degenerative changes, and microcalcifications embedded in profuse hyalinized stroma. Those histological features enabled identification of the intrapericardial tumor as a myxoma. Follow-up CT examination did not demonstrate any signs of recurrence of the myxoma. According to our knowledge, a myxoma located inside the pericardial sac has never been described before.

Introduction Ensuring intravascular access during the state of immediate threat to life is a key element of the provision of medical treatment. Purpose The aim of the study was to compare the time for obtaining the infusion and the effective intraosseous and intravenous access performed by emergency medical students in relation to a pediatric patient during simulated hypovolemic shock scenario. Material and methods The study was a randomized crossover study. Fifty-three emergency medical students performed intravenous access using standard intravenous cannula (SKD) and intraosseous access using a Bone Injection Gun (B.I.G.) at random section. We measured efficacy of intravascular access, time needed for intravascular access (time T1), time to stabilize the intravascular injection (time T2) and time of infusion line connection (time T3). In addition, we investigated the ease of the procedure and the preferences of participants. Results The efficacy of the first intravascular access attempts with the use of SKD and B.I.G. was respectively 81.1% and 96.2% (p = 0.023). The overall efficacy of both methods was 100%. The median duration of access (time T1) was 39 s (IQR, 32–46) for SAD and 15 s (IQR, 12–21) for B.I.G. (p Conclusions In this trial with the use of manikin which simulates a 6-year-old child, paramedic students who do not have prior experience with intraosseous access devices were able with higher efficiency and a shorter time than a standard intravenous cannula performed intravascular access.

Introduction The main cause of cardiac arrest in pediatric patients is respiratory failure. Objective To test the ability of paramedics to intubate the trachea of a child by means of the standard Macintosh [MAC] laryngoscope vs the Clarus Leviatan fiberoptic stylet (FPS) during 3-airway scenarios. Methods This was a randomized crossover manikin study involving 89 paramedics. The participants performed tracheal intubations using the MAC laryngoscope and the Clarus Leviatan FPS in 3 pediatric airway scenarios: scenario A, normal airway without chest compression (CC); scenario B, normal airway with CC; and scenario C, difficult airway with CC. Results A total of 89 paramedics participated in this study. In scenario A, the FPS maintained a better success rate at first attempt (97.8% vs 88.9%; P =.73) and time required to intubate (17 [interquartile range, 15-21) seconds vs 18 [interquartile range, 16-22] seconds; P =.67) when compared with MAC. In scenarios B and C, the results with FPS were significantly better than those with MAC ( P Conclusions This study suggested that the FPS could be used as an option for airway management even for paramedics with little experience. Future studies should explore the efficacy of FPS in pediatric clinical emergency settings.

Background: Airway control is a potentially lifesaving procedure, but intubation by direct laryngoscopy may be difficult. The aim of this study was to assess the success rate of tracheal intubation using the Macintosh laryngoscope and Supraglottic Airway Laryngopharyngeal Tube (S.A.L.T) device. Methods: This is a randomised cross-over study involving 120 paramedics utilising the Macintosh laryngoscope and S.A.L.T. during simulated cardiopulmonary resuscitation (CPR) on a manikin. We compared times to successful intubation and intubation success rates for intubation using Macintosh and S.A.L.T. performed by paramedics, during CPR with and without chest compression. Results: Mean intubation times for conventional laryngoscopic intubation and S.A.L.T. without chest compressions were 31.52 ± 7.23 s and 17.97 ± 5.33 s, respectively ( P < 0.001). Conclusions: Intubation via the S.A.L.T. was more successful than conventional laryngoscopic intubation, regardless of whether chest compressions were interrupted or not.

Backgroud Advanced airway management and endotracheal intubation (ETI) during cardiopulmonary resuscitation (CPR) is more difficult than, for example, during anesthesia. However, new devices such as video laryngoscopes should help in such circumstances. The aim of this study was to compare the performance of 4 intubation devices in pediatric manikin-simulated CPR. Methods One hundred two paramedics participated in this study. None had prior experience in video laryngoscopy. After a standardized audiovisual lecture lasting 45 minutes, the paramedics participated in a practical demonstration using the advanced pediatric patient simulator PediaSIM CPR (FCAE HealthCare, Sarasota, FL), which was designed to be an accurate representation of a 6-year-old child. Cardiopulmonary resuscitation was performed using LUCAS-2 (Physio-Contro, Redmond, WA). Afterward, paramedics were instructed to perform ETI using 4 intubation devices (MacGrathMAC, GlideScope, AirTraq, and Miller Laryngoscope Blade [Miller]) in a randomized sequence. The primary outcome was the success rate of tracheal intubation. The secondary outcome was the time to intubation. Results The mean time to intubation was 30.7 ± 15.3, 28.6 ± 15.9, 24.1 ± 5.0, and 39.3 ± 14.7 seconds (McGrath, GlideScope, AirTraq, and Miller, respectively); and the success ratio of intubation for the devices was 100% vs 100% vs 100% vs 77.5%, respectively. Conclusions Child ETI performed by paramedics during uninterrupted chest compression often has a low success rate. In contrast, McGrath, GlideScope, and AirTraq intubation devices are fast, safe, and easy to use. Within the limitations of a manikin study, this study suggests that inexperienced medical staff might benefit from using video laryngoscopy devices for child emergency airway management.

Introduction Endotracheal intubation is still considered the gold standard for airway management. Purpose Comparison of the effectiveness of child intubation using the Pentax AWS S-100 video-laryngoscope (AWS) and laryngoscope with Macintosh blade (MAC) in two scenarios during continuous chest compression: (1) normal airway, (2) limited neck mobility. Material and methods This was a randomized crossover manikin trial. Fifty-eight paramedic students performed intubations on a manikin in each of two scenarios. The sequence of scenarios and intubating devices were randomized. Time to complete intubation, the efficacy of first intubation attempt, the overall success rate, Cormack-Lehane grade, dental compression and ease of intubation were determined. Results The times (median[interquartile range]) to complete tracheal intubation were significantly shorter with the AWS than with the MAC in all two scenarios (18 [16–21] vs. 25 [21–29] s, 23 [20–25] vs. 36 [31–43] s, respectively). The overall success rate was higher with the AWS than the MAC also in both scenarios (100 vs. 84.5%, 91.4 vs. 68.9%, respectively). Conclusions In the manikin study, paramedic students performed intubation using AWS with higher efficiency and shorter time than with the laryngoscope with Macintosh blade. This relationship applies to both test scenarios.

Introduction We hypothesized that the Laryngoscope with Fiber Optic Reusable Flexible Tip English Macintosh blade (TMAC) is beneficial for the intubation of child manikins while performing cardiopulmonary resuscitation (CPR). In the present study, we evaluated the effectiveness of the conventional Macintosh laryngoscope (MAC) and TMAC in 3 simulated CPR scenarios. Methods A randomized crossover simulation trial was designed. One hundred seven paramedics intubated the trachea of a PediaSIM CPR training manikin (FCAE HealthCare, Sarasota, FL) using the MAC and TMAC in a normal airway scenario (scenario A), normal airway with chest compression scenario (scenario B), and difficult airway with chest compression scenario (scenario C). The participants were directed to make a maximum of 3 attempts in each scenario. The success rate, time required for intubation, Cormack-Lehane grade, dental compression, and the ease of intubation were measured. Results The median time of intubation with MAC and TMAC in scenario A was 19.6 (interquartile range [IQR], 18-23) vs 19 (IQR, 16.2-21.8); in scenario B, 29.5 (IQR, 25-31) vs 26 (IQR, 23.5-29) seconds; and in scenario C, 38 (IQR, 32.5-45) vs 29 (IQR, 25-31) seconds, respectively. The overall efficacy for each of the scenarios was as follows: in scenario A, it was 100% vs 100%; in scenario B, it was 79.4% vs 100% (P = .007); and in scenario C, it was 68.2% vs 90.7% (P Conclusions The TMAC seems to be a superior intubating device compared with the conventional MAC when used in simulated normal and difficult child airway with chest compression scenarios. Future studies should explore the efficacy of TMAC in pediatric clinical emergency settings.

The aim of the study was to compare the intubation times and success rates of various laryngoscopes during resuscitation in pediatric emergency intubation with uninterrupted chest compression on a standardized pediatric manikin model. This was a randomized crossover study with 107 paramedic participants. We compared times to successful intubation, intubation success rates, and glottic visibility using a Cormack–Lehane grade for Macintosh, Intubrite®, Coopdech®, and Copilot® laryngoscopes. One hundred seven paramedics (mean age 31.2 ± 7.5 years) routinely involved in the management of prehospital care participated in this study. Intubation success rates (overall effectiveness), which was the primary study endpoint, were highest for the Coopdech® and CoPilot® devices (100 %) and were lowest for Intubrite® (89.7 %, p

Introduction Endotracheal intubation is the gold standard of airway management during resuscitation. Purpose Comparison of efficacy of child intubation using Levitan stylet and laryngoscope with Miller blade during simulated normal and difficult airways during CPR. Material and methods In the study opened, randomized, crossover trial, 117 paramedics participated. They performed endotracheal intubation in two scenarios: normal and difficult airways during chest compression using two methods in randomized order. Results Endotracheal intubation using Levitan was associated with statistically better results than with the laryngoscope with Miller blade in both normal and difficult airways (p Conclusions During intubation in the laboratory simulation, paramedics performed intubation using the guide Levitan with higher efficiency and in less time than using a laryngoscope with Miller blade.

Background The study was designed to investigate the success rate and time of insertion intraosseous access during simulated resuscitation. Material and methods This was a randomized crossover study involving 107 paramedics. They were timed from start of insertion attempt to successful insertion and asked to score perceived difficulty of intraosseus access devices. Bone injection gun (BIG) (WaisMed Company, Houston, TX), EZ-IO (Vidacare, Shavano Park, TX) and Jamshidi (Carefusion, San Diego, CA) were used in this study. Results Success rates for first intraosseus iniecition attempt were higher for the BIG (91.59%) than EX-IO (82.66%) or Jamshidi (47.66%). Mean procedure time was 2.0 ± 0.7 vs 3.1 ± 0.9 minutes for EZ-IO vs 4.2 ± 1.0 minutes for Jamshidi. Conclusions The use of BIG is associated with excellent success rates for insertion and appears easier to use than EZ-IO or Jamshidi Intraosseus Needle. Further work to evaluate the use of the intraosseus access device in the emergency medical services is required.

When technically feasible, device closure is the treatment of choice for ostium secundum atrial septal defect (ASD) [(1)][1]. Three-dimensional (3D) transesophageal echocardiography (TEE) has recently emerged as a powerful tool that can accurately guide device selection in ASD closure [(2,3)][2]. We

Reduction of cardiovascular death might have a significant effect on the long-term survival rates of renal transplant recipients (RTRs). The aim of the study was to assess the relation between arterial stiffness and graft function, adipose tissue content, and hydration status in patients after kidney transplantation (KTx). The study included 83 RTR patients (mean age: 55 ± 13 years) who had been admitted to a nephrology-transplantation outpatient clinic 0.5 to 24 years after KTx. Clinical and laboratory data were analyzed and eGFR was calculated with the CKD-EPI formula. Arterial stiffness was assessed in all RTRs with pulse wave propagation velocity (PWV) with the use of a complior device. In addition, fluid and nutritional status was assessed with a Tanita BC 418 body composition analyzer. The control group consisted of 31 hospital workers who received no medication and had no history of cardiovascular disease. Multivariable linear regression analysis, with PWV as a dependent variable, retained the following independent predictors in the final regression model: red blood cell distribution width (RDW) (B = 0.323; P = 0.004), age (B = 0.297; P = 0.005), tacrolimus therapy (B = −0.286; P = 0.004), and central DBP (B = 0.185; P = 0.041). Multivariable linear regression analysis with eGFR as a dependent variable retained the following independent predictors in the final regression model; creatinine concentration (B = −0.632; P = 0.000), hemoglobin (B = 0.280; P = 0.000), CRP (B = −0.172; P = 0.011), tacrolimus therapy (B = 0.142; P = 0.039), and triglycerides (B = −0.142; P = 0.035). Our data indicates that: kidney transplant recipients can present modifiable CVD risk factors linked to increased arterial stiffness, DBP, waist circumference, SCr, time on dialysis, CyA therapy, and visceral fat mass; RDW is a parameter associated with arterial stiffness; and parameters such as CyA therapy, time on dialysis, PWV, RDW, and triglycerides show negative associations with the allograft function assessed with eGFR.

Background Out-of-hospital cardiac arrest is a leading cause of mortality and serious neurological morbidity in Europe. We aim to investigate the effect of 3 cardiopulmonary resuscitation (CPR) feedback devices on effectiveness of chest compression during CPR. Methods This was prospective, randomized, crossover, controlled trial. Following a brief didactic session, 140 volunteer nurses inexperienced with feedback CPR devices attempted chest compression on a manikin using 3 CPR feedback devices (TrueCPR, CPR-Ezy, and iCPR) and standard basic life support (BLS) without feedback. Results Comparison of standard BLS, TrueCPR, CPR-Ezy, and iCPR showed differences in the effectiveness of chest compression (compressions with correct pressure point, correct depth, and sufficient decompression), which are, respectively, 37.5%, 85.6%, 39.5%, and 33.4%; compression depth (44.6 vs 54.5 vs 45.6 vs 39.6 mm); and compression rate (129.4 vs 110.2 vs 101.5 vs 103.5 min −1 ). Conclusions During the simulated resuscitation scenario, only TrueCPR significantly affected the increased effectiveness compression compared with standard BLS, CPR-Ezy, and iCPR. Further studies are required to confirm the results in clinical practice.

Airway control is a potentially lifesaving procedure, but intubation by direct laryngoscopy may be difficult. The aim of this study was to assess the success rate of tracheal intubation using the Macintosh laryngoscope and Supraglottic Airway Laryngopharyngeal Tube (S.A.L.T) device.This is a randomised cross-over study involving 120 paramedics utilising the Macintosh laryngoscope and S.A.L.T. during simulated cardiopulmonary resuscitation (CPR) on a manikin. We compared times to successful intubation and intubation success rates for intubation using Macintosh and S.A.L.T. performed by paramedics, during CPR with and without chest compression.Mean intubation times for conventional laryngoscopic intubation and S.A.L.T. without chest compressions were 31.52 ± 7.23 s and 17.97 ± 5.33 s, respectively (P0.001).Intubation via the S.A.L.T. was more successful than conventional laryngoscopic intubation, regardless of whether chest compressions were interrupted or not.

Background Endotracheal intubation is considered a criterion standard for securing the airway during cardiopulmonary resuscitation, yet it requires a very skillful operator. The aim of the study was to investigate whether paramedic staff can successfully use the Pentax Airway Scope AWS-S200 video laryngoscope (AWS) for intubating with 3 simulated airway scenarios. Methods It was a randomized nonblinded crossover simulation trial. Fifty-four paramedics performed intubation using an AWS in a manikin, with 3 airway scenarios: scenario A, normal airway; scenario B, normal airway with chest compression (CC); and scenario C, difficult airway with CC. Results Median intubation times for the AWS during scenarios A, B, and C were 20 seconds (interquartile range [IQR], 19-23 seconds), 22 seconds (IQR, 20-25 seconds), and 26 seconds (IQR, 23-29 seconds), respectively, and the respective overall success rates of intubation were 100%, 100%, and 94.4%. Conclusion In this manikin study, paramedics could successfully intubate using the AWS, regardless of CCs being interrupted or not, even when a patient's airway was difficult.

Endotracheal intubation (ETI) is an essential resuscitation procedure in children. Video laryngoscopes have been developed to avoid intubation failures in a variety of scenarios, including cardiopulmonary resuscitation. We hypothesized that the video laryngoscope RIFL (AI Medical Devices, Inc, Williamston, MI) offers advantages in the ETI of a pediatric manikin while performing chest compressions (CCs).Randomized nonblinded crossover simulation trial conducted among 132 paramedics with no prior experience with RIFL. Each participant performed intubations with Miller (MIL; Mercury Medical, Clearwater, FL) laryngoscope and RIFL in a PediaSIM CPR training manikin (FCAE HealthCare, Sarasota, FL) in 3 airway scenarios: (a) normal airway at rest (without concomitant CC), (b) normal airway with mechanically controlled CC, and (c) difficult airway with concomitant CC. The primary outcome was the time to intubation, and secondary one was the success of the intubation attempt.In the manikin at rest with normal airway, nearly all participants performed successful ETI both with MIL and RIFL, with similar intubation times. However, in the other scenarios (normal and difficult airway with uninterrupted CC), the results with RIFL were significantly better than with MIL (P.05) for all the analyzed variables (success of first attempt, overall success rate, time to intubation, Cormac-Lehane grade, dental compression, and easy of intubation scores).In simulated child arrest scenarios with normal/difficult airway conditions and with concomitant mechanical CC, paramedics performed better with the RIFL video laryngoscope than with the standard MIL.

Deutschland GmbH, Grasbrunn, Germany). The bougie is a 60-cm guide with a curved end and depth markers (OR 15 Ch), which was designed to assist in tracheal tube exchange during difficult intubation. This study was a randomized crossover manikin trial. Each participant attempted the exchange in scenarios with and without chest compression, and the order of scenarios and the participants was randomized using a computer-generated randomized sequence (www. researchrandomizer.com; Fig. 2: Supplementary data). The survey was conducted in March 2015 and was attended by 75 paramedics who exchanged an LT (size 4; VBM Medizintechnik GmbH) for an ETT (ID 7.5; Smiths Medical Deutschland GmbH) in the 2 aforementioned scenarios. The procedures were performed on a METIman Prehospital manikin (CAE HealthCare, Saint-Laurent, Quebec, Canada). Chest compression was performed using a LUCAS-2 (Physio-Control, Redmond, WA). The tube exchange timewas defined as the time from the participant picking up the introducer to ventilation of themanikin's lungs. A procedure was determined to have failed when the time taken to insert an ETT exceeded 120 seconds. Results are shown as median and interquartile range (IQR) and absolute numbers and percentages (%). Statistical analysiswas performed using Statistica version 12 forWindows (StatSoft, Inc, Tulusa, OK). P b .05 was considered as statistically significant. Times needed to successful intubation were compared using the Wilcoxon signed rank test. There were no significant differences in the LT exchange effectiveness in scenarios with and without chest compression (P = .89; Table). Of the 75 participants, 2 failed the LT exchange in the scenario without chest compression, and 4 failed in the scenario with chest compression. Median time to LT exchange in both scenarios varied: 59.3 seconds (IQR, 35.7-68.3 seconds) vs 64.9 seconds (IQR, 41.481.3 seconds). We conclude that LT exchange using the bougie intubation stylet may be useful in the rapid intubation of patients during CPR. Using the bougie for LT exchange seems to be faster than using a fiberscope, as indicated in the study by Budde et al [1]. More studies are required to confirm these results. Figure. View of the glottic opening through the LT-D. Supplementary data to this article can be found online at http://dx. doi.org/10.1016/j.ajem.2015.04.049.

Ensuring an open airway during cardiopulmonary resuscitation is fundamental. The aim of this study was to determine the success rate of blind intubation during simulated cardiopulmonary resuscitation by untrained personnel.Four devices were compared in a simulated resuscitation scenario: ILMA (Intavent Direct Ltd, Buckinghamshire, United Kingdom), Cobra PLA (Engineered Medical Systems Inc, Indianapolis, IN), Supraglottic Airway Laryngopharyngeal Tube (SALT) (ECOLAB, St. Paul, MN), and Air-Q (Mercury Medical, Clearwater, FL). A group of 210 paramedics intubated a manikin with continuous chest compressions.The mean times to intubation were 40.46 ± 4.64, 33.96 ± 6.23, 17.2 ± 4.63, and 49.23 ± 13.19 seconds (SALT vs ILMA, Cobra PLA, and Air-Q; P.05). The success ratios of blind intubation for the devices were 86.7%, 85.7%, 100%, and 71.4% (SALT vs ILMA, Cobra PLA, and Air-Q; P.05).The study showed that the most efficient device with the shortest blind intubation time was the SALT device.

Introduction The aim of the study was to compare the efficacy of the TruView EVO2, TruView PCD, and Miller laryngoscopes for tracheal intubation during cardiopulmonary resuscitation with and without chest compressions (CCs) by paramedics in an infant manikin model. Methods This was an open, prospective, randomized, simulated trial. After a brief didactic session, 78 volunteer paramedics attempted to intubate a manikin using TruView EVO2, TruView PCD, and Miller laryngoscopes during resuscitation with and without CC scenarios. Primary end point was intubation success rate and secondary was time to intubation with each device. Glottic view using a Cormack-Lehane grade in using each device was also assessed. Results In scenario with uninterrupted CCs, the median time to intubation using the TruView EVO2, TruView PCD, and Miller varied with the times being 25.3 seconds (interquartile range [IQR], 23-30.5 seconds) vs 20.2 seconds (IQR, 18-23 seconds) vs 24.4 seconds (IQR, 21-28 seconds), respectively. The overall success rate of intubation during CC for the devices were 94.9% vs 100% vs 92.1%. During intubation without CC, median time to intubation varied and amounted to 24.9 seconds (IQR, 21-29.6 seconds) for TruView EVO2, 18.3 seconds (IQR, 16-21.3 seconds) for TruView PCD, and 19.4 seconds (IQR, 17-23.3 seconds) for Miller laryngoscope. The overall success rate of intubation without CC for all devices was 100%. Conclusions For infant tracheal intubation with TruView PCD, when used by paramedics, the malleable TruView PCD showed shorter intubation time and higher overall success rate in a simulated CC scenario than TruView EVO2 or Miller laryngoscopes. Further clinical studies are necessary to confirm these initial positive findings.

Background: High effectiveness of chest compressions is an important element of cardiopulmonary resuscitation (CPR), improving survival and reducing neurological deficits resulting from sudden cardiac arrest. Aim: Evaluation of the effectiveness of standard manual chest compressions (SMCC) and CPR with the use of two CPR feed­back devices: TrueCPR and PocketCPR. Methods: 167 paramedics participated in the study. The participants were randomised to perform SMCC, CPR using the TrueCPR device, and CPR using a smartphone with the PocketCPR application in a crossover fashion. Results: Comparison of SMCC, TrueCPR and PocketCPR showed differences in the effectiveness of chest compressions (40.3%, 85.5% and 28.8%, respectively), compression depth (49.5, 56.5 and 50.3 mm, respectively), and compression rate (118.5, 105.1, and 89.5 min –1 , respectively). Conclusions: During simulated CPR, TrueCPR device significantly increased the effectiveness of chest compressions compared to SMCC and the use of PocketCPR smartphone application. Further studies are required to confirm these findings in clinical practice.

BACKGROUND The quality of life may determine the efficacy of renal replacement therapy (RRT). The purpose of the study was to compare the health-related quality of life (HRQOL) of end-stage renal disease (ESRD) patients depending on RRT method. MATERIAL/METHODS The studies were conducted on 120 patients divided into 3 groups depending on RRT method: 30 peritoneal dialysis (PD) patients, 40 hemodialysis (HD) patients, and 47 post-kidney transplantation (KTx) patients. The following research tools were used: (1) Medical Outcomes Study 36 - the Short Form (SF-36 v.1); (2) Kidney Disease Quality of Life Short Form (KDQOL-SF™ v.1.3); and (3) disease history. The relevance level was p

Summary Background The study was designed to compare the effectiveness of 3 video laryngoscopes with the Miller laryngoscope during pediatric resuscitation. Material and methods This was a randomized crossover study involving 87 paramedics and 54 nurses. The primary end point of the study was the success rate of blind tracheal intubation, whereas the secondary end point was defined as the time from insertion of a device to the first manual ventilation of the manikin's lungs. Results The median time to intubation using the Pentax, Truview, GlideScope, and Miller varied with the times being 20.6 (interquartile range [IQR], 18-27) vs 20.1 (IQR, 18-23.3) vs 30.2 (IQR, 29.6-35) vs 41.3 (IQR, 33-45.2) seconds, respectively. The overall success ratios of intubation for the devices were 100% vs 100% vs 100% vs 79.4%. Conclusions We concluded that, in a pediatric manikin scenario, the video laryngoscopes are safe devices and can be used for pediatric intubation during uninterrupted chest compressions. Further clinical studies are necessary to confirm these initial positive findings.

BACKGROUND In renal replacement therapy (RRT) patients, the target values of blood pressure (BP) are being continuously modified and excessive fat tissue may even have a protective impact on the risk of mortality due to cardiovascular causes - the "obesity paradox". The purpose of the study was to compare the occurrence of hypertension (HTN) and its underlying causes in patients in the first year after kidney transplantation (KTx), and hemodialysis (HD) or peritoneal dialysis (PD) patients. MATERIAL/METHODS A group of 120 RRT patients (PD, n=30; HD, n=40; KTx, n=50) was analyzed. The following research tools were used: (1) 24- or 44-h ambulatory blood pressure monitoring (ABPM); (2) bioelectrical impedance analysis (BIA); (3) traditional method - office BP; (4) Morisky-Green test; and (5) disease history. The significance level was p