Volume 82, Supplement 1 October 2011
ISSN 0300-9572
IN THIS ISSUE Abstracts
Resuscitation 2011 Implementation Scientific Symposium of the European Resuscitation Council Valletta, Malta, 14 –15 October 2011
Available online at www.sciencedirect.com
Volume 82 (2011)
Official Journal of the European Resuscitation Council also affiliated with the American Heart Association, the Australian Resuscitation Council, the New Zealand Resuscitation Council, the Resuscitation Council of Southern Africa, and the Japan Resuscitation Council
Available online at www.sciencedirect.com
for online access via your library
The European Resuscitation Council invites you to its 11th Scientific Congress. This will be in Vienna, Austria in the splendid Hofburg.
www.resuscitation2012.eu
Vol. 82, Suppl. 1
RESUSCITATION
October 2011
CONTENTS Resuscitation is abstracted/indexed by: Current Contents, Science Citation Index, Expanded, Index Medicus, PubMed/Medline and EMBASE. Also covered in the abstract and citation database SCOPUS®
Abstracts
Resuscitation 2011 Implementation Scientific Symposium of the European Resuscitation Council Valletta, Malta, 14–15 October 2011
Oral Presentations
S1
Poster Presentations
S10
Author Index
S35
Official Journal of the European Resuscitation Council also affiliated with the American Heart Association, the Australian Resuscitation Council, the New Zealand Resuscitation Council, the Resuscitation Council of Southern Africa and the Japan Resuscitation Council
FOUNDING EDITOR:
Harold Hillman, Surrey, UK
EDITOR-IN-CHIEF: EDITORS:
Jerry Nolan, Bath, UK Joseph P. Ornato, Richmond, Virginia, USA Michael Parr, Sydney, Australia Gavin Perkins, Warwick, UK Jasmeet Soar, Bristol, UK
EDITOR EMERITUS:
Douglas Chamberlain, Brighton, UK
EDITORIAL BOARD
Benjamin Abella (USA) Janusz Andres (Poland) Richard Arntz (Germany) Tom P. Aufderheide (USA) Wayne Barbee (USA) Lance B. Becker (USA) Robert Berg (USA) John E. Billi (USA) Leo Bossaert (Belgium) Bernd Böttiger (Germany) Pierre Carli (France) Maaret Castrén (Sweden) Erga Cerchiari (Italy) Charles Deakin (UK) Hans Domanovitz (Austria) Dana Edelson (USA) Judith Finn (Australia) Romergryko Geocadin (USA) Ximena Grove (Chile) Kyle Gunnerson (USA)
Henry R. Halperin (USA) Alfred Hallstrom (USA) Anthony J. Handley (UK) Johan Herlitz (Sweden) Ian Jacobs (Australia) Karl B. Kern (USA) Walter G.J. Kloeck (South Africa) Rudi W. Koster (The Netherlands) Freddy Lippert (Denmark) Andrew Lockey (UK) David Lockey (UK) Carsten Lott (Germany) Matthew Huei-Ming Ma (Taiwan) Koen Monsieurs (Belgium) Peter Morley (Australia) Vincent Mosesso (USA) Vinay Nadkarni (USA) Mauro Oddo (Switzerland) Andrew Padkin (UK) Mary Ann Peberdy (USA)
Paul E. Pepe (USA) Timothy Rainer (Hong Kong) Colin Robertson (UK) Claudio Sandroni (Italy) Eillyne Seow (Singapore) Markus Skrifvars (Finland) Petter Andreas Steen (Norway) Fritz Sterz (Austria) Kjetil Sunde (Norway) Keiichi Tanaka (Japan) Wanchun Tang (USA) Sergio Timerman (Brazil) Andrew Trauers (Canada) Joseph Varon (USA) Kevin R. Ward (USA) Myron L. Weisfeldt (USA) Volker Wenzel (Austria) Lars Wiklund (Sweden) Jackie Younker (UK) David Zideman (UK)
STATISTICAL ADVISOR Robin Prescott (UK)
Volume 82 (2011)
AMSTERDAM—BOSTON—LONDON—NEW YORK—OXFORD—PARIS—SAN DIEGO—ST. LOUIS
© 2011, Elsevier Ireland Ltd. All rights reserved. This journal and the individual contributions contained in it are protected under copyright by Elsevier Ireland Ltd., and the following terms and conditions apply to their use: Photocopying Single photocopies of single articles may be made for personal use as allowed by national copyright laws. Permission of the Publisher and payment of a fee is required for all other photocopying, including multiple or systematic copying, copying for advertising or promotional purposes, resale, and all forms of document delivery. Special rates are available for educational institutions that wish to make photocopies for non-profit educational classroom use. For information on how to seek permission visit www.elsevier.com/healthpermissions or call: (+44) 1865 843830 (UK) / (+1) 215 239 3804 (USA). Derivative Works Subscribers may reproduce tables of contents or prepare lists of articles including abstracts for internal circulation within their institutions. Permission of the Publisher is required for resale or distribution outside the institution. Permission of the Publisher is required for all other derivative works, including compilations and translations (please consult www.elsevier.com/permissions). Electronic Storage or Usage Permission of the Publisher is required to store or use electronically any material contained in this journal, including any article or part of an article (please consult www.elsevier.com/permissions). Except as outlined above, no part of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without prior written permission of the Publisher. Notice No responsibility is assumed by the Publisher for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions or ideas contained in the material herein. Because of rapid advances in the medical sciences, in particular, independent verification of diagnoses and drug dosages should be made. Although all advertising material is expected to conform to ethical (medical) standards, inclusion in this publication does not constitute a guarantee or endorsement of the quality or value of such product or of the claims made of it by its manufacturer. Funding body agreements and policies Elsevier has established agreements and developed policies to allow authors whose articles appear in journals published by Elsevier, to comply with potential manuscript archiving requirements as specified as conditions of their grant awards. To learn more about existing agreements and policies please visit http://www.elsevier.com/fundingbodies
EUROPEAN RESUSCITATION COUNCIL Interdisciplinary Council for Resuscitation Medicine and Emergency Medical Care
Objectives and activities The Organisation has the objective “To preserve human life by making high quality resuscitation available to all.” The Organisation shall pursue its objective, inter alia, by the following activities: • Promoting and strengthening the network of National Resuscitation Councils (hereafter called NRCs, as defined in the Bylaws) in Europe. • Producing guidelines and recommendations appropriate to Europe for the practice of Cardiopulmonary and Cerebral Resuscitation (CPR). • Updating these guidelines in the light of critical review of CPR science and practice. • Promoting the audit of resuscitation practice including standardisation of records of resuscitation attempts. • Designing and supporting standardised teaching programmes suitable for all trainees in Europe ranging from the lay public to the qualified healthcare professional. • Promoting and co-ordinating appropriate research. • Organising relevant congresses and other scientific meetings in Europe. • Promoting political and public awareness of resuscitation requirements and practice in Europe. • Promoting exchanges among different healthcare professional disciplines. • Advising relevant European and other national and international bodies on all matters related to CPR. The main geographic focus of the ERC is Europe, defined as the countries according to the definition of the Council of Europe (www.coe.int). However, the foregoing activities may be expanded outside Europe where deemed fit. Board and General Assembly Board: • Chairman: Bernd Böttiger • Vice-chair: Maaret Castrén • Secretary: Dominique Biarent • Treasurer: Anthony Handley • Director Guidelines and ILCOR: Koen Monsieurs • Director External Affairs: Marios Georgiou • Director Science and Research: Ruud Koster • Director Congresses: Jan Bahr • Chief Editor: Jerry Nolan • Representative of the Advisory Committee: Leo Bossaert • Effective NRC representative: Violetta Raffay • Second NRC representative: Hildigunnur Svavarsdóttir (without voting rights) • CEO: Bart Vissers (ex officio – without voting rights) General Assembly: Board members Strategic Domains • Domain leader NRCs and Membership: Freddy Lippert Working groups • To be appointed
International Course Committees Representative
Deputy
BLS/AED-P
Anthony Handley
ALS & GIC
John Ballance
ILS
Jasmeet Soar
NLS
Sam Richmond
Jonathan Wyllie
EPLS
Dominique Biarent
Robert Bingham Souhail Alouini
European Associations Representative
Deputy
ESA
Guttorm Brattebø
Nejib Karoui
ESC
Nikolaos Nikolaou
ESICM
Jacques Duranteau
EuSEM
Marc Sabbe
Abdel Bellou
European Red Cross Societies
Pascal Cassan
Susanne Schunder-Tatzber
Representative
Deputy
Austria
Michael Baubin
Gudrun Burda
Belgium
Pierre Mols
Alexandre Ghuysen
Tony Hosmans
Walter Renier
Bosnia and Herzegovina
Hajrudin Havi´c
Vedad Herenda
Croatia
Silvija Hunyadi-Anticˇevi´c
Boris Filipovi´c-Grcˇ i´c
Cyprus
Marios Georgiou
Marios Ioannides
Czech Republic
Anatolij Truhlárˇ
Marek Uhlírˇ
Denmark
Torsten Lauritsen
Jens Rolund Hansen
Egypt
Gamal Eldin Abbas Khalifa
Finland
Tom Silfvast
Jouni Kurola
France
Pierre Carli
Caroline Telion
Germany
Burkhard Dirks
Hans-Richard Arntz
Hungaria
Csaba Dioszeghy
Iceland
Hildigunnur Svavarsdóttir
Felix Valsson
Italy
Manrico Gianolio
Thomas Pellis
Malta
Mary Rose Cassar
Anna Spiteri
National Resuscitation Councils
Netherlands
Friso van Marion Ank van Drenth
Norway
Kristian Lexow
Bjørn Bendz
Thomas Rajka
Conrad Bjørshol
Poland
Janusz Andres
Paweł Krawczyk
Portugal
Miguel Félix
Ernestina Gomes
Romania
Valentin Georgescu
Diana Cimpoiesu
Russia
Viktor Moroz
Artem Kuzovlev
Serbia
Violetta Raffay
Zlatko Fišer
Slovenia
Dušan Vlahovi´c
Primož Gradišek
Spain
Antonio Caballero
Sweden
Leif Svensson
Andreas Claesson
Switzerland
Luciano Anselmi
Urs Klemmer
Tunisia
Souhail Alouini
Nejib Karoui
Turkey
Kubilay Demirağ
Şule Akın
United Arab Emirates
Ahmed Samir
United Kingdom
Gavin Perkins
Andrew Lockey
Representatives from different European countries, elected by the Associate Gold members • To be appointed For more detailed information, please read the ERC statutes, available at https://www.erc.edu/index.php/docLibrary/ en/viewDoc/1297/3/.
Memberships When registering with a free guest account on the ERC site (www.erc.edu), you can access the following benefits: • participation in ERC forums • download the 2010 Guidelines, ERC posters, presentations etc. • stay updated with our ERC Newsletter By becoming an Associate Gold Member of the ERC, you will enjoy these additional benefits: • subscription to Resuscitation, the official Journal of the ERC (12 issues a year) • online access to Resuscitation (also earlier issues and articles in press) • 10 % reduction in the ERC shop • special registration rates at ERC congresses The membership fee for Associate Gold Members is €140 (paper and electronic version of Resuscitation) or €115 per calendar year (electronic version only of Resuscitation). If you register during the year, you only pay for the remaining part. Our Web Shop will calculate your membership fee. Please go to www.erc.edu/membership in order to become a member or renew your full membership. Instructors receive an additional discount on their ERC membership. We also offer combined memberships with several National Resuscitation Councils. Please check our Web Shop for detailed information. ERC Manuals Our Web Shop offers the following training manuals, based on the latest ERC guidelines: • Cardiopulmonary Resuscitation/AED Provider (CPR/AED-P) • CPR/AED-P supplement • Immediate Life Support (ILS) • Advanced Life Support (ALS) • European Paediatric Immediate Life Support (EPILS) • European Paediatric Life Support (EPLS) • Newborn Life Support (NLS) • Cardiopulmonary Resuscitation-AED Instructor (CPR/AED-I) • Generic Instructor (GIC) Also available is the comprehensive Summary booklet Guidelines 2010 and the full Resuscitation Guidelines 2010 book. Associate Gold Members receive an additional 10% discount on their ERC Web shop orders. More information More information about the ERC can be obtained from the European Resuscitation Council vzw Drie Eikenstraat 661 2650 Edegem Belgium Tel. +32 3 826 93 21 Fax +32 3 826 93 23
[email protected] www.erc.edu
Resuscitation 82S1 (2011) S1–S34
Abstracts
Resuscitation 2011 Implementation Scientific Sympoisium of the European Resuscitation Council, Valletta, Malta, 14–15 October 2011
Oral Presentations
AS02 A feasibility study of the role of regional cerebral oxygen saturation monitoring as a marker of return of spontaneous circulation in cardiac arrest
AS01 How salty may it be? Effect of inhaled hypertonic saline solution to treat infants hospitalized with viral bronchiolitis 1
1
2
3
Jasmijn Teunissen , Anne Hochs , Anja Vaessen-Verberne , Annemie Boehmer , Carien Smeets 4 , Hein Brackel 5 , Rene van Gent 6 , Judith Wesseling 7 , Ronald de Moor 8 , Philippe Rosias 9 , Steven Potgieter 10 , Richard Droog 12 , Han Hendriks 1 , Danielle Logtens-Stevens 7 , Mariska Janssen-Heijnen 1 , Bettina Loza 1 1
VieCuri MC, Venlo, The Netherlands Amphia MC, Breda, The Netherlands 3 Maasstad Ziekenhuis, Rotterdam, The Netherlands 4 St. Elisabeth Ziekenhuis, Tilburg, The Netherlands 5 Catharina Ziekenhuis, Eindhoven, The Netherlands 6 Maxima MC, Velthoven, The Netherlands 7 Alysis Zorggroep, Arnhem, The Netherlands 8 Twee Steden Ziekenhuis, Tilburg, The Netherlands 9 Orbis MC, Sittard, The Netherlands 10 Laurentius Ziekenhuis, Roermond, The Netherlands 11 Elkerliek Ziekenhuis, Helmond, The Netherlands 12 AZM, Academic Hospital, Maastricht, The Netherlands 2
Background: At present only symptomatic treatment is available for acute viral bronchiolitis, none of these are evidence-based. Recent trials inclusive a Cochrane review show a reduction in hospital stay after inhalation of 3% hypertonic saline solution. This randomised double-blind, placebo-controlled interventional multicenter trial, performed at 12 Dutch hospitals, compares nebulization with hypertonic saline, either a 3% or 6%, with 0.9% isotonic saline. The primary end point is the time to discharge, aiming to achieve a 25% reduction in hospital stay. Secondary endpoints are the need of supplemental oxygen, tubefeeding, admission to PICU. Methods: Children younger than two years with clinical diagnosis of viral bronchiolitis, not responding to a single inhalation with Salbutamol may be included after informed parental consent. Trial medication will be nebulized three times daily until discharge criteria are met. Calculated power of 90% requires totally 195 patients. Results: The analysis was performed on the data of 230 patients, all included in the seasons 2009–April 2011. Patient characteristics and the number of exclusions didn’t differ significantly. The duration of hospital stay, need for tube feeding and supplemental oxygen shows no significant difference. Need to PICU admission could not be influenced by none of the concentration of hypertonic saline solution. Conclusions: Preliminary analysis showed no significant reduction in hospital stay, need for supplemental oxygen, tube feeding and the need to PICU admission. The use of 6% hypertonic saline solution seems to be safe also in younger than 1 month of life but has no additional benefit even compared with 0.9%. More research will be necessary to find a definitive conclusion about the effect of hypertonic saline solution. Literature: 1. Yhang L, Mendoza-Sassi RA, Wainwright C, Classen TP. Nebulized saline solution for acute bronchiolitis in infants. The Cochrane Library 2008, Issue 4. 2. Mandelberg A, Amirov I. Hypertonic Saline or High Volume Normal Saline for Viral bronchiolitis: Mechanisms and Rationale. Pediatric Pulmonology 2010;45:36–40.
Sam Parnia 1,2 1 2
State University of New York, Stony Brook Medical Center, Stony Brook, NY, USA University of Southampton, Southampton, UK
Background: A non-invasive “real time” monitor of cerebral perfusion during cardiac arrest is not available. Cerebral oximetry has been utilized during surgery but its role in cardiac arrest care and the optimal measurement parameters associated with return of spontaneous circulation (ROSC) are not understood. Objectives: To investigate the feasibility of using a commercially available cerebral oximeter (Invos 5100c, Somanetics, Troy, USA) to measure regional brain oxygen saturation (rSO2) during in-hospital cardiac arrest and determine the optimal rSO2 parameters that correspond with ROSC. Methods: Cerebral oximetry was applied to 14 in-hospital cardiac arrest patients and continuous data was collected until either ROSC was achieved or CPR was terminated. The mean rSO2, median rSO2, as well as mean and median rSO2 in the last five minutes prior to ROSC or termination of CPR were measured. Results: The use of cerebral oximetry during cardiac arrest and the application of the sensor (completed in 60±30 s) did not interfere with patient care. ROSC was achieved in 21% (n=3) of cases. Patients with ROSC had a significantly higher total mean (32±5 vs 21±7 p
