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. 2022 Jan 15;11(2):435.
doi: 10.3390/jcm11020435.

First-Response ABCDE Management of Status Epilepticus: A Prospective High-Fidelity Simulation Study

Paulina S C Kliem  1   2 , Kai Tisljar  1 , Sira M Baumann  1 , Pascale Grzonka  1 , Gian Marco De Marchis  3   4 , Stefano Bassetti  4   5 , Roland Bingisser  4   6 , Sabina Hunziker  4   7 , Stephan Marsch  1   4 , Raoul Sutter  1   3   4
Affiliations

First-Response ABCDE Management of Status Epilepticus: A Prospective High-Fidelity Simulation Study

Paulina S C Kliem et al. J Clin Med. .

Abstract

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: aspiration; convulsive status epilepticus; emergency medicine; epilepsy; guidelines; neurology; prospective study; seizure.

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Conflict of interest statement

Paulina S.C. Kliem, Kai Tisljar, Sira M. Baumann, and Pascale Grzonka report no disclosures. Gian Marco De Marchis was and is supported by the Swiss National Science Foundation; Science Funds (Wissenschaftsfonds) of the University Hospital Basel and University of Basel; Bangerter-Rhyner-Stiftung; Swisslife Jubiläumsstiftung for Medical Research; Swiss Neurological Society; Fondazione Ettore Balli; the De Quervain research grant; and Thermo Fisher GmbH. He received travel honoraria from Bayer and speaker honoraria from Medtronic and BMS/Pfizer. Stefano Bassetti reports no disclosures. Roland Bingisser is an editor of medstandards.com, a symptom-based medical decision-support tool licensed to 150 European hospitals, owned by the University Hospital Basel. Sabina Hunziker is supported by the Swiss National Foundation (SNF) (Ref 10001C_192850/1 and 10531C_182422), the Bangerter-Rhyner Foundation (8472/HEG-DSV), and the Swiss Society of General Internal Medicine (SSGIM). Stephan Marsch reports no disclosures. Raoul Sutter received research grants from the Swiss National Foundation (No 320030_169379), the Research Fund of the University Basel, the Scientific Society Basel, and the Gottfried Julia Bangerter-Rhyner Foundation. He received personal grants from UCB-pharma and holds stocks from Alcon, Novartis, Roche, and Johnson & Johnson. The funders had no role in the design of the study, the collection, analysis, or interpretation of data, the writing of the manuscript, or the decision to publish the results.

Figures

Figure 1
Figure 1
Details of the clinical scenario, the ABCDE examinations, and the measures which should have been taken in response of the clinical findings. GCS = Glasgow Coma Scale.
Figure 2
Figure 2
Executed ABCDE system checks (A) and deduced treatment measures (B) during management of a simulated status epilepticus. ASDs = antiseizure drugs.
Figure 3
Figure 3
Participants’ characteristics, associated with adherence and non-adherence to the ABCDE approach, during management of a simulated status epilepticus. CI = confidence interval; * Neurologic affiliation was the only significant association with increased odds for not checking airways (OR 0.31, 95% CI 0.1–0.94, p = 0.038).
See this image and copyright information in PMC

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