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EFFECTIVENESS OF THE USE OF THE
OXYLATOR® EM-100
Minassian A. M., Aghababian R., Ciottone G., Manukian
G. P., and Boshyan A. R.
Emergency Department, Emergency Scientific Medical Center, Yerevan
Introduction | Study
Group and Methods | Results | Discussion
| Conclusions | Acknowledgments
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Introduction
Ventilating patients during emergency procedures is usually
performed under stress and demands a very high level of proficiency,
attention and dexterity. In the pre-hospital setting, and in
the emergency room, the devices under current use ae BVD's (Bag
Valve Devices), ATV's (Automatic Transport Ventilators), and
in some cases highly sophisticated ventilators. The most commonly
used device is the BVD due to its cost and portability, however
studies and experience have shown that BVD's do not provide
adequate ventilation, cause gastric insufflation, and are not
patient friendly devices during assisted ventilation. Furthermore,
BVD's require continuous training and retraining in an attempt
ot maintain the level of proficiency required to try to perform
adequate mechanical ventilation in stressful situations. recently
introduced, the Oxylator® EM-100 resuscitator-inhalator
device addresses the issues which have compromised the ability
of emergency personnel to ventilate adequately and efficiently.
The effectiveness of the Oxylator® EM-100 was studied to
determine its effectiveness in the emergency setting both in,
and out of hospital. the evaluation performed also assessed
its practicality, flexibility, user friendliness, and durability.
The device is portable, small, and provides three modes of ventilation
functions. It is a gas powered (O2) device which
delivers a constant flow of 36 L/min during inspiration, and
shuts off all flow during expiration, thus conserving available
oxygen supply when used out of hospital. The inspiration phase
of the breath cycle is pressure limited between 25 and 50 cmH2O.
The exhalation phase of the breath cycle is always passive.
Manually triggered breaths are activated by simple depression
of a button, and continue until the button is released, or the
maximum selected pressure limit is reached and the system terminates
flow to the patient, and subsequently passive exhalation begins.
Automatic mandatory and assisted breaths are provided upon depression
of the same button, followed by its rotation to a locking position.
This mode continues to provide a pressure limited inspiration
phase, followed by a flow monitored expiration phase, hence
the next inspiration phase is flow triggered (expiratory) when
PEEP level of 2 to 4 H2O is reached. A 15 L/min free
flow may also be selected for conscious, breathing patients
in need of a higher concentration of O2.
The device incorporates some very unique features which assist
in better airway management, these will not be mentioned in
this study in detail, however it is noteworthy to mention.
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Study Group and Methods
The study group (controlled and investigated) consisted of 41
cases, all over 10 kg body weight, requiring assisted ventilation
fro different pathological profiles in the emergency and intensive
care departments as well as intra-hospital transport. The patients
were monitored for SO2 levels during ventilation with the device.
Due to the lack of other sophisticated equipment (capnograph
etc.), and the conditions under which the study was carried
out, we were limited to gather further information for analysis.
The conditions under which the the Emergency Center operates
are less than desirable, for instance, the momentary loss of
power to the hospital necessitates alternate ventilation support
in the Emergency unit for those patients supported by an ICU
ventilator (PB).
The persons using the Oxylator® EM-100 were trained by the
manufacturer, the training time was less than 2 hours, and was
conducted as a group. The group consisted of emergency physicians,
anesthesiologists, nurses, and EMTs working in conjunction with
the ambulance service.
The equipment used were the Oxylator® EM-100s, portable
oxygen tanks (600 L capacity) with 3.5 bar regulated output
pressure, masks and endotracheal tubes, pulse oximeters. 2 ambulance
technicians and 4 emergency physicians were allowed to initiate
the ventilation support with the Oxylator® EM-100, nurses
and/or EMTs were requested to observe and adjust the device
if required.
The evaluation was performed based on the existing reports and
studies previously performed in reputable institutions around
the world 1, which have demonstrated acceptable clinical performance
values and outcome. The evaluation of the Oxylator® EM-100
was to establish the applicable scope of the device within the
emergency environment, determine its acceptability as an alternative
device to BVDs, and its extended capability as a short-term
transport ventilator.
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Results
The 41 cases occurred within a period of 14 months under the
supervision of the Chief of Intensive Care at the Emergency
Center. The device was used in different modes, depending on
the requirements of the patient, the following table shows the
usage.
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