Dräger Oxylog® VE300: Evaluation in use by Critical Care Paramedics

BACKGROUND

The aim of this 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 the critical care paramedic group of SECAmb (South East Coast Ambulance Service NHS Foundation Trust).

Five Oxylog VE300 ventilators were provided by Dräger for the project. As there are 10 Critical Care Paramedic (CCP) bases across SECAmb, each ventilator was allocated to 2 separate bases, operating from the first base for 6 weeks, then from the second base for 6 weeks in 2019. CCPs in Great Britain have an extended scope of skills to deal and focus on treating the most vulnerable and high risk patients using advanced clinical procedures and equipment.
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 ventila-tors 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.

FIRST IMPRESSIONS OF THE TESTING PARAMEDICS

Overall, very impressed with it

Patient complexion improved clinically compared to initial
presentation… patient moved onto LUCAS and is thought to be mostly perfusion related due to more effective (mechanical) CPR.

Very easy to adjust settings as per patient need.

The crew loved it and they couldn’t stop talking about how
easy it was, how it seemed to do it quietly and efficiently with both i-gel and ETT.

It worked extremely well in PC and it was quick to change to
CPR mode when the patient arrested in VF again before achieving ROSC and going onto hospital ventilator.

Very easy to use and provided uncomplicated intra arrest ventilations

Worked perfectly during arrest without changing any settings.
Excellent for releasing bandwidth. Was fine even
during difficult extrication, much easier than BVM … .

SUMMARY

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 com-parison 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 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 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 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. It also provides a convenient solu-tion to the problem of needing to carry oxygen cylinders to drive the ventilator, by allowing their integration into the body of the device.