South East Coast Ambulance Service NHS Foundation Trust (SECAmb) critical care paramedics have given feedback on the
Dräger Oxylog® VE300 ventilator, following its use during a product evaluation which was undertaken by Kingston University and St George’s University of London. Interestingly, a special focus of the evaluation was the included CPR mode built into the ventilator in order to test its overall usability in daily practice.
The aim of the evaluation was to assess, audit, and evaluate the use of the Dräger Oxylog® VE300 ventilator and the attitudes of its users towards the device during the period when it was being trialed by SECAMb’s critical care paramedics.
Five Oxylog VE300 ventilators were provided by Dräger for the project. As there are ten critical care paramedic (CCP) bases across SECAmb, each ventilator was allocated to two separate bases; operating from the first base for six weeks, and then from the second base for another six weeks in 2019.
The extended scope of skills and experience which CCPs possess when it comes to treating treating the most vulnerable and high-risk patients using advanced clinical procedures and equipment made them perfect candidates to offer reliable feedback about the overall functionality and usefulness of the Oxylog VE300 ventilator.
In total, they used the Oxylog VE300 in 55 different ventilation cases with all available ventilation modes: intra-arrest/ CPR mode, post ROSC/apnoeic patients, transport, handover, and NIV/CPAP. The CPR mode was used in more than every second ventilation case.
CPR in Advanced Life Support
During CPR, ILCOR guidelines on ventilation are rarely achieved due to a tendency to either over or under ventilate patients, both in terms of frequency and tidal volume. Most mechanical ventilators have difficulties with this as they struggle to cope with high airway pressures generated during CPR.
The Dräger Oxylog VE300 is a prehospital ventilator with a ‘CPR mode’, which is pre-set to deliver ILCOR recommended ventilations as well as modulate flow during compressions in order to effectively deliver tidal volumes without excessive airway pressure.
More than 80% Positive Feedback
The majority of clinicians had a positive experience, and various themes were evident by their comments. Participants suggested that they felt the overall care they provided was enhanced in comparison to using existing equipment.
Clinicians were impressed with the device and its capabilities, and most felt it allowed them to deliver additional and beneficial care to their patients. Whilst feedback was varied, the majority (81.8%) felt that their overall experience was positive.
The CCPs felt that the handover experience was improved by the use of the device, as they felt it helped them deliver a smooth and professional handover with minimal interruptions.
Usage and Alarms
The case mix which was identified
when analysing the usage data clearly shows a high percentage of usage in cardiac arrest, and of the CPR mode. This demonstrates a use for an advanced ventilator with this function, as the currently available ventilator in South East Coast Ambulance Service does not tolerate usage during CPR.
The majority of respondents found the alarms helpful, and comments were varied in terms of reasons why, but a common theme was that individuals were grateful for being alerted to a specific issue that could be addressed.
Mechanical Chest Compression Systems and Supraglottic Airways
The Oxylog VE300 appears on the whole to deliver what it is designed to do. It delivers mechanical ventilation in a range of modes including, uniquely, a CPR mode. This allows clinicians to deploy the device whilst CPR is ongoing: both with human-delivered CPR or, as provided in a small number of cases in this product evaluation, in combination with the LUCAS® Mechanical Chest Compression System.
There were also examples of this device working effectively with the i-gel® supraglottic airway, instead of formal endotracheal intubation. The Oxylog VE300 also provides a further convenient solution to the problem of needing to carry oxygen cylinders to drive the ventilator by allowing their integration into the body of the device.