Abstract
Introduction
Seizures count to critical situations emergency medical systems (EMS) are confronted
with.
Objectives
Evaluation of a modified treatment algorithm (MTAS-EMS) using diazepam and midazolam
due to a supply bottleneck of iv lorazepam in 2012.
Methods
Retrospective study where data from patients treated for seizures by the EMS of the
city of Zurich were analyzed. Effectiveness of the MTAS-EMS and i.v. diazepam in children
and adults was compared with respect of cessation of seizure without recurrence over
the period until arrival at the hospital. The chi-square and Fisher's exact test were
used to compare categorical data. The Student’s t-test and Mann Whitney test were used to compare numerical data. p-values < 0.05 are considered significant.
Results
Of 584 documented missions, 165 treated patients (126 adults and 39 children) were
included. 115 patients (80 adults and 35 children) were treated according the MTAS-EMS.
Cessation of seizure was achieved in 85% of the adults and in 97% of the children,
if all options of the MTAS-EMS were used. The first dose of nasal midazolam was more
successful in children compared to adults (p = 0.012). In adults, the single dose of i.v. diazepam terminated the seizure in 98%
(p = 0.001) compared to 57% for the single dose of iv and 64% for nasal midazolam.
Conclusions
The treatment success of the MTAS-EMS is high. However, in adults the single dose
of i.v. diazepam is as successful as the completely used MTAS-EMS and seems to be
superior to the single dose iv and nasal midazolam.
Keywords
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Article info
Publication history
Published online: July 08, 2019
Accepted:
May 13,
2019
Received in revised form:
May 10,
2019
Received:
May 11,
2018
Footnotes
Department to which the work is attributed: Blood Transfusion Service Zürich, SRC, Schlieren, Switzerland and University of Zurich, Zurich, Switzerland.
Oliver M. Theusinger designed the study, conducted the study, analyzed the data and wrote the manuscript. Peter Schenk designed the study, conducted the study and wrote the manuscript. Katharina Dette-Oltmann helped to write the manuscript. Sergio Mariotti designed the study, conducted the study and made significant contributions to the manuscript. Werner Baulig helped to conduct the study, and made significant contribution in the preparation of the manuscript.
Oliver M. Theusinger has received honoraria or travel support for consulting or lecturing from the following companies: CSL Behring Schweiz, Zurich, Switzerland, Vifor SA, Villars-sur-Glâne, Switzerland, Roche Pharma (Schweiz) AG, Reinach, Switzerland, Pentapharm AG, München, Germany, TEM International GmbH, München, Germany, Octapharma AG Lachen, Switzerland, Instrumentation Laboratory, Bedford, MA. The remaining authors have no conflicts of interest.
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