An application of the learning curve-cumulative summation test to evaluate training for endotracheal intubation in emergency medicine.

OBJECTIVE: The learning curve-cumulative summation (LC-CUSUM) test allows for quantitative and individual assessments of the learning process. In this study, we evaluated the process of skill acquisition for performing endotracheal intubation (ETI) in three emergency medicine (EM) residents over a 2 year period in their first 2 years of their EM residency. METHODS: We evaluated 342 ETI cases performed by three EM residents using the LC-CUSUM test according to their rate of success or failure of ETI. A 90% success rate (SR) was chosen to define adequate performance and an SR of 80% was considered inadequate. After the learning phase, the standard CUSUM test was applied to ensure that performance was maintained. RESULTS: The mean number of ETI cases required to reach the predefined level of performance was 74.7 (95% CI 62.0 to 87.3). CUSUM tests confirmed that performance was maintained after the learning phase. CONCLUSIONS: By using the LC-CUSUM test, we were able to quantitatively monitor the acquisition of the skill of ETI by EM residents. The LC-CUSUM could be useful for monitoring the learning process for the training of airway management in the practice of EM.

Predictive Utility of Changes in Optic Nerve Sheath Diameter after Cardiac Arrest for Neurologic Outcomes.

The optic nerve sheath diameter (ONSD) can help predict the neurologic outcomes of patients with post-cardiac arrest (CA) return of spontaneous circulation (ROSC). We aimed to investigate the effect of ONSD changes before and after CA on neurologic outcomes in patients with ROSC after CA using brain computed tomography (CT). The study included patients hospitalized after CA, who had undergone pre- and post-CA brain CT between January 2001 and September 2020. The patients were divided into good and poor neurologic outcome (GNO and PNO, respectively) groups based on their neurologic outcome at hospital discharge. We performed between-group comparisons of the amount and rate of ONSD changes in brain CT and calculated the area under the curve (AUC) to determine their predictive value for neurologic outcomes. Among the 96 enrolled patients, 25 had GNO. Compared with the GNO group, the PNO group showed a significantly higher amount (0.30 vs. 0.63 mm; p = 0.030) and rate (5.26 vs. 12.29%; p = 0.041) of change. The AUC for predicting PNO was 0.64 (95% confidence interval = 0.53-0.73; p = 0.04), and patients with a rate of ONSD change >27.2% had PNO with 100% specificity and positive predictive value. Hence, ONSD changes may predict neurologic outcomes in patients with post-CA ROSC.

Association between Body Mass Index and Outcomes in Patients with Return of Spontaneous Circulation after Out-of-Hospital Cardiac Arrest: A Systematic Review and Meta-Analysis.

Increased body mass index (BMI) is a risk factor for cardiovascular disease, stroke, and metabolic diseases. A high BMI may affect outcomes of post-cardiac arrest patients, but the association remains debatable. We aimed to determine the association between BMI and outcomes in patients with return of spontaneous circulation (ROSC) after out-of-hospital cardiac arrest (OHCA). A systematic literature search was conducted using MEDLINE, EMBASE, and the Cochrane Library. Studies that included patients who presented ROSC after OHCA, had a recorded BMI, and were assessed for neurological outcomes and in-hospital mortality were included. To assess the risk of bias of each included study, we employed the Risk of Bias Assessment Tool for Non-randomized Studies. We assessed 2427 patients from six studies. Neurological outcomes were significantly poorer in underweight patients (risk ratio (RR) = 1.21; 95% confidence interval (CI) = 1.07-1.37; p = 0.002; I2 = 51%) than in normal-weight patients. Additionally, in-hospital mortality rate was significantly higher in underweight patients (RR = 1.35; 95% CI = 1.14-1.60; p<0.001; I2 = 21%) and in obese patients (RR = 1.25; 95% CI = 1.12-1.39; p<0.001; I2 = 0%) than in normal-weight patients. Poor neurological outcome is associated with underweight, and low survival rate is associated with underweight and obesity in patients with ROSC after OHCA.

Comparison of fit factors among healthcare providers working in the Emergency Department Center before and after training with three types of N95 and higher filter respirators.

INTRODUCTION: N95 or higher filtering respirators have been recommended in healthcare settings, although there is still a risk of infection due to the improper selection and wearing of respirators. We aimed to assess the effects of training with N95 or higher filter respirators on the protection performance of respirators among healthcare providers in the emergency medical center (EMC). METHODS: This randomized crossover study evaluated 23 healthcare providers. Quantitative fit tests (QNFTs) were performed before and after training using three types of N95 or higher filter respirators (cup-type, fold-type, valve-type). Training was performed by lecture, real-time feedback, and fit check. The primary outcome was the fit factor, and the secondary outcomes were overall fit factor, adequate protection rate, and respiratory preference. RESULTS: Fit factors, overall fit factor, and adequate protection rate were higher after training than before training for the 3 types of respirators (all P < .05). For normal breathing, fit factors before and after training were 121 (10-185) vs 192 (161-200) for cup-type, 200 (39-200) vs 200 (200-200) for fold-type, and 85 (18-157) vs 173 (117-200) for valve-type. For normal breathing, the adequate protection rates before and after training were 62 (0-100) vs 100 (90-100) for cup-type, 100 (0-100) vs 100 (100-100) for fold-type, and 19 (0-100) vs 100 (44-100) for valve-type (all P < .05). The most preferred respirator type was the valve-type (10 persons, 45.5%). CONCLUSIONS: Training on wearing an N95 or higher respirator improved the protection performance of respirators among healthcare providers working in the EMC. The selection of proper respirators and training would be beneficial to the safety of healthcare providers.

The use of dual accelerometers improves measurement of chest compression depth.

BACKGROUND: Chest compression (CC) feedback devices are used to perform CC measurements effectively and accurately on patients in hospital beds. However, these devices do not take account of the compression of the mattress, which results in overestimation of CC depth. In this study, we propose a new method using two accelerometers to overcome this limitation and thus measure compression depth more accurately when performing cardiopulmonary resuscitation (CPR) on patients. METHOD: One accelerometer was placed on the manikin's sternum (a1), and the other between the manikin's back and the mattress (a2). The compression depth was calculated by integrating the acceleration twice using a digital signal processing technique. We compared CC depth from dual accelerometers and single accelerometer (a1) on the foam and inflated air mattress with eight CPR providers. RESULT: When CC was done on a manikin lying on the floor, there was no significant difference between measurement techniques (p>0.05). When CC was done on a manikin lying on the foam and inflated air mattress supporting system, our method significantly improved the estimation of CC depth, irrespective of the presence or absence of a backboard (p<0.001). CONCLUSION: Measuring CC depth using two accelerometers is more effective than using one in increasing the accuracy of CC depth estimation when CPR is performed on the foam and inflated air mattress, regardless of the presence or absence of a backboard.