First-Response ABCDE Management of Status Epilepticus: A Prospective High-Fidelity Simulation Study - Kliem, P. S. C.; Tisljar, K.; Baumann, S. M.; Grzonka, P.; De Marchis, G. M.; Bassetti, S.; Bingisser, R.; Hunziker, S.; Marsch, S.; Sutter, R. (J Clin Med, 2022)
Respiratory infections following status epilepticus (SE) are frequent, and associated with higher mortality, prolonged ICU stay, and higher rates of refractory SE. Lack of airway protection may contribute to respiratory infectious complications. This study investigates the order and frequency of physicians treating a simulated SE following a systematic Airways-Breathing-Circulation-Disability-Exposure (ABCDE) approach, identifies risk factors for non-adherence, and analyzes the compliance of an ABCDE guided approach to SE with current guidelines. We conducted a prospective single-blinded high-fidelity trial at a Swiss academic simulator training center. Physicians of different affiliations were confronted with a simulated SE. Physicians (n = 74) recognized SE and performed a median of four of the five ABCDE checks (interquartile range 3-4). Thereof, 5% performed a complete assessment. Airways were checked within the recommended timeframe in 46%, breathing in 66%, circulation in 92%, and disability in 96%. Head-to-toe (exposure) examination was performed in 15%. Airways were protected in a timely manner in 14%, oxygen supplied in 69%, and antiseizure drugs (ASDs) administered in 99%. Participants' neurologic affiliation was associated with performance of fewer checks (regression coefficient -0.49; p = 0.015). We conclude that adherence to the ABCDE approach in a simulated SE was infrequent, but, if followed, resulted in adherence to treatment steps and more frequent protection of airways.
Keywords: journalArticle; 10531C_182422), the Bangerter-Rhyner Foundation (8472/HEG-DSV), and the Swiss; Bangerter-Rhyner-Stiftung; Basel and University of Basel; Ettore Balli; European hospitals, owned by the University Hospital Basel. Sabina Hunziker is; Fondazione; Foundation (No 320030_169379), the Research Fund of the University Basel, the; Jubilaumsstiftung for Medical Research; Roche, and Johnson & Johnson. The funders had no role in the design of the study,; Science Foundation; Science Funds (Wissenschaftsfonds) of the University Hospital; Scientific Society Basel, and the Gottfried Julia Bangerter-Rhyner Foundation. He; Society of General Internal Medicine (SSGIM). Stephan Marsch reports no; Stefano Bassetti reports no disclosures. Roland Bingisser is an editor of; Swiss Neurological Society; Swisslife; and Thermo Fisher GmbH. He received; aspiration; convulsive status epilepticus; disclosures. Gian Marco De Marchis was and is supported by the Swiss National; disclosures. Raoul Sutter received research grants from the Swiss National; emergency medicine; epilepsy; guidelines; manuscript, or the decision to publish the results; medstandards.com, a symptom-based medical decision-support tool licensed to 150; neurology; prospective study; received personal grants from UCB-pharma and holds stocks from Alcon, Novartis,; seizure; supported by the Swiss National Foundation (SNF) (Ref 10001C_192850/1 and; the De Quervain research grant; the collection, analysis, or interpretation of data, the writing of the; travel honoraria from Bayer and speaker honoraria from Medtronic and BMS/Pfizer.