Ultra-acute diagnostics for stroke: Large-scale implementation of prehospital biomarker sampling.

OBJECTIVES: Blood-based biomarkers could enable early and cost-effective diagnostics for acute stroke patients in the prehospital setting to support early initiation of treatments. To facilitate development of ultra-acute biomarkers, we set out to implement large-scale prehospital blood sampling and determine feasibility and diagnostic timesavings of this approach. MATERIALS AND METHODS: Emergency medical services (EMS) personnel of the Helsinki metropolitan area were trained to collect prehospital blood samples from thrombolysis candidates using a cannula adapter technique. Time delays, sample quality, and logistics were investigated between May 20, 2013 and May 19, 2014. RESULTS: Prehospital blood sampling and study recruiting were successfully performed for 430 thrombolysis candidates, of which 50% had ischemic stroke, 14.4% TIA, 13.5% hemorrhagic stroke, and 22.1% stroke mimics. A total of 66.3% of all samples were collected during non-office hours. The median (interquartile range) emergency call to prehospital sample time was 33 minutes (25-41), and the median time from reported symptom onset or wake-up to prehospital sample was 53 minutes (38-85; n=394). Prehospital sampling was performed 31 minutes (25-42) earlier than hospital admission blood sampling and 37 minutes (30-47) earlier than admission neuroimaging. Hemolysis rate in serum and plasma samples was 6.5% and 9.3% for EMS samples, and 0.7% and 1.6% for admission samples. CONCLUSIONS: Prehospital biomarker sampling can be implemented in all EMS units and provides a median timesaving of more than 30 minutes to first blood sample. Large prehospital sample sets will enable development of novel ambulance biomarkers to improve early differential diagnosis and treatment of thrombolysis candidates.

Out-of-hospital paediatric emergencies: a prospective, population-based study.

BACKGROUND: We wanted to study the incidence, distribution and characteristics of paediatric out-of-hospital emergency care on a population level. This knowledge could ameliorate the design and education of emergency medical services and their personnel. METHODS: We studied all (n = 1863) emergency medical services responses and the patient records for paediatric patients (age 0-16 years) in Helsinki, Finland (population 603,968, paediatric population 92,742) during a 12-month period (2012). Patient characteristics, diagnoses, time intervals, medical treatments, procedures, vital measurements and outcome of out-of-hospital treatment were available for analysis. RESULTS: The incidence of emergency medical services -treated paediatric out-of-hospital emergencies was 3.8/1000 inhabitants and 20/1000 1-16-year-old inhabitants. This formed 4.5% of all emergency calls, while children have a threefold share of the population (15%). Falls, dyspnoea, seizures and poisonings account for half of all emergencies. Few patients suffered from a life-threatening condition or trauma. Cardiac arrest or need for advanced life support measures (e.g. intubation) was rare. After evaluation by the emergency medical services, only half of the patients (56%) needed ambulance transportation to hospital. Only 30 (3.7%) of the non-transported patients made an unpremeditated visit to the emergency department after the original contact with the emergency medical services. All of them were well upon arrival to the emergency department. CONCLUSION: Paediatric out-of-hospital emergencies are infrequent and have specific characteristics differing from the adult population. The design and training of emergency medical services and their personnel should focus on evaluation and management of the most frequent situations.

Airway management in cardiac arrest--comparison of the laryngeal tube, tracheal intubation and bag-valve mask ventilation in emergency medical training.

Tracheal intubation (ETI) is considered the method of choice for securing the airway and for providing effective ventilation during cardiac arrest. However, ETI requires skills which are difficult to maintain especially if practised infrequently. The laryngeal tube (LT) has been successfully tested and used in anaesthesia and in simulated cardiac arrest in manikins. To compare the initiation and success of ventilation with the LT, ETI and bag-valve mask (BVM) in a cardiac arrest scenario, 60 fire-fighter emergency medical technician (EMT) students formed teams of two rescuers at random and were allocated to use these devices. We found that the teams using the LT were able to initiate ventilation more rapidly than those performing ETI (P < 0.0001). The LT and ETI provided equal minute volumes of ventilation, which was significantly higher than that delivered with the BVM (P < 0.0001). Our data suggest that the LT may enable airway control more rapidly and as effectively as ETI, and compared to BVM, may provide better minute ventilation when used by inexperienced personnel.

The functional status and perceived quality of life in long-term survivors of out-of-hospital cardiac arrest.

BACKGROUND: Limited data exist on how long-term survivors after pre-hospital cardiac arrest lead their lives. This study assessed functional status and perceived quality of life in patients surviving for 15 years after successful resuscitation from witnessed out-of-hospital cardiac arrest as a result of ventricular fibrillation. METHODS: A 15-year follow-up study of 59 1-year survivors after successful pre-hospital resuscitation who were thoroughly evaluated at 3 and 12 months after out-of-hospital cardiac arrest. Eleven patients were still alive 15 years later. Ten of them were reached and underwent a comprehensive neuropsychological and neurological examination. Cognitive performance was evaluated and compared with individual results 15 years earlier and with an age-matched control group. The cause and time of death of the non-survivors were established. RESULTS: All 10 evaluated long-term survivors lived at home and were independent in their activities of daily living. Their mean age was 72 years. In nine patients there was no change in the present neurological status compared with the status at 1 year after resuscitation, and in one patient it had improved. Five patients were cognitively intact. In four patients mild cognitive problems had emerged or slightly progressed. All but one were satisfied with their perceived quality of life. By the time of examination, the mean survival time for the 1-year survivors was 7 years, and the mean age at the time of death was 70 years. CONCLUSION: Once good outcome after cardiac arrest is achieved, it can be maintained for more than 10 years.