Survival to Discharge After Cardiac Arrest Attended by a Doctor-Paramedic Helicopter Emergency Medical Service: An Utstein-style Multiservice Review of 1085 Activations.

BACKGROUND: The presentation of outcomes after cardiac arrest presented by emergency medical service and in-hospital teams in the Utstein style allows for comparative analysis of populations and systems. Essex and Herts Air Ambulance Trust (EHAAT) and the East Anglian Air Ambulance (EAAA) are doctor-plus-paramedic prehospital care teams that respond to a large number of medical cardiac arrests. OBJECTIVE: To report the outcomes of medical cardiac arrests according to the Utstein style. METHODS: Retrospective database analysis and hospital follow-up of all cardiac arrests attended by either service over a 31-month period. Traumatic cardiac arrests were excluded. PRIMARY OUTCOME: survival and cerebral performance category at discharge from the hospital. RESULTS: There were 429 patients attended by the two services; 193 patients achieved return of spontaneous circulation, which was sustained at the time of handover to the hospital team. Of 140 patients for whom complete follow-up was available, the overall survival rate was 50.7%, 86% of whom had a Cerebral Performance Category of 1 or 2. The overall survival-to-discharge rate for all patients attended was 11.7%. CONCLUSION: Benchmarking of performance is essential to understand reasons for variability, and to allow individual systems to reflect on their own practices. We have described 31 months of data that pertain to medical cardiac arrest cases attended by our services and demonstrated a comparable survival rate to discharge with good neurological outcome.

Prehospital anaesthesia performed in a rural and suburban air ambulance service staffed by a physician and paramedic: a 16-month review of practice.

INTRODUCTION: This paper describes the first 16-months experience of prehospital rapid sequence intubation (RSI) in a rural and suburban helicopter-based doctor-paramedic service after the introduction of a standard operating procedure (SOP) already proven in an urban trauma environment. METHOD: A retrospective database review of all missions between October 2010 and January 2012 was carried out. Any RSI or intubation carried out was included, regardless of age or indication. Patients who were intubated by Ambulance Service personnel prior to the arrival of the East Anglian Air Ambulance (EAAA) team were excluded. RESULTS: The team was activated 1156 times and attended 763 cases. A total of 88 RSIs occurring within the study period were identified as having been carried out by the EAAA team and meeting inclusion criteria for review. There were no failed intubations that required a rescue surgical airway or the placement of a supraglottic airway device. For road traffic collisions (RTCs), the overall on-scene time for patients who required an RSI was 40 min (range 15-72 min). For all other trauma, the average on-scene time was 48 min (range 25-77 min), and for medical patients, the average time spent at scene was 41 min (range 15-94 min). CONCLUSIONS: We have demonstrated the successful introduction of a prehospital care SOP, already tested in the urban trauma environment, to a rural and suburban air ambulance service operating a fulltime doctor-paramedic model. We have shown a zero failed intubation rate over 16 months of practice during which time over 750 missions were flown, with 11.5% of these resulting in an RSI.

CD40mAb adjuvant induces a rapid antibody response that may be beneficial in post-exposure prophylaxis.

Active vaccination can be effective as a post-exposure prophylaxis, but the rapidity of the immune response induced, relative to the incubation time of the pathogen, is critical. We show here that CD40mAb conjugated to antigen induces a more rapid specific antibody response than currently used immunological adjuvants, alum and monophosphoryl lipid A.