RESUMEN
BACKGROUND: Data on out-of-hospital cardiac arrest are still scarce, very varied, and indicate a poor prognosis for traumatic events. OBJECTIVES: To describe the out-of-hospital/in-hospital survival, survival time, and neurological conditions of those treated by advanced life support units and submitted to cardiopulmonary resuscitation and compare the results of clinical and traumatic cardiac arrests. METHODS: This is a cohort study carried out in three stages; in the first two, data were collected from the Mobile Emergency Care Service forms and medical records; then, the Brain Performance Category Scale was applied in the third stage. The sample consisted of resuscitated victims aged ≥18 years. Fisher's and log-rank tests were used to compare the causes, considering a significance level of 5%. RESULTS: 852 patients were analyzed; 20.66% were hospitalized, 4.23% survived until transfer or discharge, and 58.33% had a favorable outcome one year after arrest. There was an association between pre/in-hospital survival and the nature of the occurrence (p=0.026), but there was no difference between the survival curves (p=0.6). CONCLUSIONS: Survival of hospitalization after out-of-hospital cardiac arrest was low; however, most who survived to be discharged achieved a favorable outcome after one year. The survival time of those hospitalized after clinical and traumatic events were similar, but pre-hospital survival was higher among trauma patients.
FUNDAMENTO: Dados sobre Parada Cardiorrespiratória extra-hospitalar ainda são escassos, muito variados e indicam mau prognóstico para eventos traumáticos. OBJETIVOS: Descrever a sobrevivência extra/intra-hospitalar, o tempo de sobrevivência e as condições neurológicas dos atendidos por unidades de suporte avançado à vida e submetidos a ressuscitação cardiopulmonar e comparar os resultados das paradas cardiorrespiratórias de natureza clínica e traumática. MÉTODOS: Estudo de coorte, realizado em três etapas, nas duas primeiras, os dados foram coletados em fichas do Serviço de Atendimento Móvel de Urgências e prontuários, na terceira, foi aplicada a Escala de Categoria de Performance Cerebral. A casuística foi de vítimas reanimadas com idade ≥18 anos. Os testes de Fisher e log-rank foram empregados na comparação das causas, considerando nível de significância de 5%. RESULTADOS: Foram analisados 852 pacientes, 20,66% foram hospitalizados, 4,23% sobreviveram até transferência ou alta, 58,33% apresentaram desfecho favorável um ano após parada. Houve associação entre sobrevivência pré/intra-hospitalar e natureza da ocorrência (p=0,026), porém não houve diferença entre as curvas de sobrevivência, p=0,6. CONCLUSÕES: A sobrevivência à hospitalização após parada cardiorrespiratória extra-hospitalar foi baixa, porém, a maioria dos sobreviventes à alta alcançaram desfecho favorável após um ano. O tempo de sobrevivência dos hospitalizados após eventos de natureza clínica e traumática foram similares, porém a sobrevida pré-hospitalar foi maior entre os traumatizados.
Asunto(s)
Reanimación Cardiopulmonar , Servicios Médicos de Urgencia , Paro Cardíaco Extrahospitalario , Humanos , Adolescente , Adulto , Paro Cardíaco Extrahospitalario/terapia , Paro Cardíaco Extrahospitalario/etiología , Estudios de Cohortes , Reanimación Cardiopulmonar/métodos , Hospitales , Resultado del TratamientoRESUMEN
The proposal to implement the use of External Automated Defibrillators in public spaces arose more than 30 years ago as a means to reduce the mortality of out-of-hospital cardiac arrest events. Worldwide, deployment programs of these devices have demonstrated efficacy and effec- tiveness, reflected in concrete and tangible results. As a response to the global scenario, in Colombia 5 years ago legislation was passed to rule over the implementation of these devices in spaces of high confluence. The aim of this article is to expose the issues with implementation of EADs in the Bus Rapid Transport System of Bogota, TransMilenio, from a critical and analytical perspective; showing the existing flaws in the primary attention of cardiac arrest.
La propuesta de implementar el uso de Desfibriladores Externos Automático en espacios públicos surgió hace cerca de 30 años como una herramienta para disminuir la mortalidad de los eventos de paro cardíaco extrahospitalarios. Los programas de despliegue de estos dispositivos a nivel mundial han demostrado eficacia y efectividad, reflejada en cifras concretas y tangibles. Ante el panorama mundial, hace 5 años Colombia legisló a favor de la implementación de estos dispositivos en espacios de alta afluencia. Este artículo busca exponer el problema de la implementación de los DEA en el principal sistema masivo de transporte de Bogotá, TransMilenio, desde una perspectiva crítica y analítica, mostrando el déficit en la atención primaria de los paros cardíacos.
Asunto(s)
Humanos , Reanimación Cardiopulmonar , Vehículos a Motor , Desfibriladores , Paro Cardíaco Extrahospitalario/terapia , Transportes , ColombiaRESUMEN
La parada cardiorrespiratoria extrahospitalaria (PCR) es una de las principales causas de morbilidad y mortalidad en todo el mundo. Aunque la desfibrilación precoz y la reanimación cardiopulmonar de alta calidad han mejorado, las tasas de supervivencia de una PCR extrahospitalaria se sitúan sobre el 8%, variando entre el 0 y el 18%, frente al 15-34% en el caso de parada cardiorrespiratoria intrahospitalaria. La capnografía es una monitorización no invasiva recomendada por las guías de práctica clínica actuales que estima el gasto cardiaco durante la parada cardiorrespiratoria y es útil para confirmar la intubación traqueal, valorar la calidad de la reanimación cardiopulmonar y ser signo precoz de recuperación de la circulación espontánea. Recientemente se ha descrito que durante la RCP de un ritmo desfibrilable la valoración del EtCO2 previa a la descarga puede tener un valor pronóstico del éxito de la desfibrilación. La línea de investigación que analiza la utilidad de la capnografía para valorar el momento óptimo de la administración de la descarga y el pronóstico de éxito de la misma es prometedora, pero los resultados actuales no son lo suficientemente robustos como para poder concluir que las mediciones de EtCO2 puedan afectar a la toma de decisiones durante las maniobras de RCP avanzada y recomendar su uso en la práctica clínica. Los resultados de los estudios analizados aportan una evidencia inicial de que cuanto mayores son los valores de EtCO2 antes de la desfibrilación mayor es la probabilidad de éxito de la misma, aunque el diseño observacional de los mismos, sin grupo control, nos impide afirmarlo con evidencia suficiente. En caso de que existiese esta asociación, se podría inferir que disponer de esta medición daría buenos resultados en el RCP, pero esto sería una hipótesis que requeriría su propia investigación. No se han encontrado ensayos clínicos que comparen el éxito (RCE, supervivencia) entre maniobras de RCP realizadas con capnógrafo frente a RCP sin capnógrafo. El umbral numérico de EtCO2 para una desfibrilación satisfactoria se ha establecido entre 20 y 40 mmHg. En este momento están registrados en Clinical Trialsgov tres estudios sobre la capnografía en parada cardiorrespiratoria en el ámbito extrahos pitalario. Ninguno de ellos tiene como hipótesis el uso de la capnografía asociada a desfibrilación. Es preciso desarrollar estudios prospectivos bien diseñados que aporten más evidencia sobre el tema analizado. Respecto a la seguridad de la tecnología, ésta se muestra bastante segura, siendo importante respetar las advertencias respecto a situaciones de medidas afectadas por errores de aplicación de sensores, ciertas condiciones medioambientales y ciertas afecciones del paciente. La toma incorrecta de decisiones por interpretación errónea de la monitorización capnográfica también afectaría a la seguridad del paciente, hecho que se previene con la adecuada formación del personal sanitario. Diferentes publicaciones describen la necesidad de investigación en el desarrollo de algoritmos para depurar los artefactos de las compresiones torácicas en las tasas de ventilación y en el capnograma que podrían integrarse como un software en el monitor/desfibrilador. De esa forma tanto la capnografía como la capnometría podrían ofrecer datos más fiables.
Out-of-hospital cardiorespiratory arrest (OHCA) is a leading cause of morbidity and mortality worldwide. Although early defibrillation and high-quality cardiopulmonary resuscitation have improved, survival rates for out-of-hospital CRA are around 8%, ranging from 0-18%, compared to 15-34% for in-hospital cardiorespiratory arrest. Capnography is a non-invasive monitoring recommended by current clinical practice guidelines that estimates cardiac output during cardiorespiratory arrest and is useful for confirming tracheal intubation, assessing the quality of cardiopulmonary resuscitation and as an early sign of recovery of spontaneous circulation. It has recently been described that during CPR of a shockable rhythm, the assessment of EtCO2 prior to shock may have a prognostic value for the success of defibrillation. The line of research analyzing the usefulness of capnography in assessing the optimal timing of shock delivery and the prognosis of shock success is promising, but the current results are not sufficiently robust to conclude that EtCO2 measurements can affect decision making during advanced CPR maneuvers and to recommend their use in clinical practice. The results of the studies analyzed provide initial evidence that the higher the EtCO2 values before defibrillation, the greater the probability of successful defibrillation, although the observational design of these studies, without a control group, prevents us from affirming this with sufficient evidence. In the event that this association exists, it could be inferred that having this measurement would give good results in CPR, but this would be a hypothesis that would require its own investigation. No clinical trials have been found that compare the success (ROSC, survival) between CPR maneuvers performed with a capnograph versus CPR without a capnograph. The numerical threshold of EtCO2 for successful defibrillation has been established between 20 and 40 mmHg. Three studies on capnography in cardiorespiratory arrest in the out-of-hospital setting are currently registered in Clinical Trialsgov. None of them hypothesised the use of capnography in association with defibrillation. There is a need to develop well-designed prospective studies that provide more evidence on the topic under analysis. Regarding the safety of the technology, it appears to be quite safe, although it is important to respect the warnings regarding measurement situations affected by sensor application errors, certain environmental conditions and certain patient conditions. Incorrect decision making due to misinterpretation of capnographic monitoring would also affect patient safety, which can be prevented by adequate training of healthcare staff. Several publications describe the need for research in the development of algorithms to debug chest compression artefacts in ventilation rates and in the capnogram that could be integrated as software in the monitor/defibrillator. In that way both capnography and capnometry could provide more reliable data.
Asunto(s)
Reanimación Cardiopulmonar/instrumentación , Reanimación Cardiopulmonar/métodos , Capnografía/métodos , Desfibriladores , Paro Cardíaco Extrahospitalario/terapiaRESUMEN
Fewer than 15% of people who have out-of-hospital cardiac arrests survive, but chances of survival can be tripled with effective bystander cardiopulmonary resuscitation (CPR). The majority of states, including Rhode Island, require high school CPR training, yet the impact of this is not well studied. A 33-question REDCap survey regarding cardiac arrest preparedness, CPR education, and barriers to CPR training was emailed to high school staff in Rhode Island. There were 62 responses; 26% reported their school taught CPR and 94% felt it was important for students to have CPR certification. Barriers included time (85%), budget (82%), and materials (79%). Over 80% felt students would not be able to perform high-quality CPR or properly use a defibrillator. Despite laws requiring CPR training and the belief by school staff of the importance of CPR training, the majority of students are not receiving CPR training. Staff report students do not have the ability to perform effective CPR or use a defibrillator.
Asunto(s)
Reanimación Cardiopulmonar , Paro Cardíaco Extrahospitalario , Humanos , Rhode Island , Reanimación Cardiopulmonar/educación , Paro Cardíaco Extrahospitalario/terapia , Instituciones Académicas , EstudiantesRESUMEN
BACKGROUND: The rate of survival to hospital discharge is less than 10% for out-of-hospital cardiac arrest (OHCA). AIM: To develop and implement a Chilean prospective, standardized cardiac arrest registry following the Utstein criteria. MATERIAL AND METHODS: We conducted a prospective registry for patients presenting at an urban, academic, high complexity emergency department (ED) after having an OHCA. The facility serves approximately 10% of the national population. Data were registered and analyzed following the Utstein criteria for reporting OHCA. RESULTS: For three years, 289 patients aged 59 ± 19 years (63% men) were included. Fifty seven percent of patients were taken to a health care facility for the first medical assessment by relatives or witnesses and 34% was assisted and transferred by prehospital personnel. In the subgroup of non-traumatic OHCA, 28% (n = 54) received bystander cardiopulmonary resuscitation (CPR). The registered cardiac rhythms were asystole (61%), pulseless electrical activity (PEA) (25%) and ventricular tachycardia (VT) or ventricular fibrillation (VF) (11%). The overall survival rate to discharge from the hospital was 10%, while survival with mRankin score 0-1 was 5%. The median hospitalization length of stay was 18 days among those who survived, compared with five days for the group of patients that died during the hospital stay. CONCLUSIONS: OHCA is an important cause of death in Chile. The development of a national registry that follows the International Liaison Committee on Resuscitation guidelines is the first step to assess the profile of OHCA in the region. It will provide crucial information to identify prognostic factors and variables that can help develop standards of care and set up the basis to optimize cardiac arrest management within our country and region.
Asunto(s)
Humanos , Masculino , Femenino , Reanimación Cardiopulmonar , Servicios Médicos de Urgencia , Paro Cardíaco Extrahospitalario/terapia , Paro Cardíaco Extrahospitalario/epidemiología , Chile/epidemiología , Sistema de Registros , HospitalesRESUMEN
BACKGROUND: The rate of survival to hospital discharge is less than 10% for out-of-hospital cardiac arrest (OHCA). AIM: To develop and implement a Chilean prospective, standardized cardiac arrest registry following the Utstein criteria. MATERIAL AND METHODS: We conducted a prospective registry for patients presenting at an urban, academic, high complexity emergency department (ED) after having an OHCA. The facility serves approximately 10% of the national population. Data were registered and analyzed following the Utstein criteria for reporting OHCA. RESULTS: For three years, 289 patients aged 59 ± 19 years (63% men) were included. Fifty seven percent of patients were taken to a health care facility for the first medical assessment by relatives or witnesses and 34% was assisted and transferred by prehospital personnel. In the subgroup of non-traumatic OHCA, 28% (n = 54) received bystander cardiopulmonary resuscitation (CPR). The registered cardiac rhythms were asystole (61%), pulseless electrical activity (PEA) (25%) and ventricular tachycardia (VT) or ventricular fibrillation (VF) (11%). The overall survival rate to discharge from the hospital was 10%, while survival with mRankin score 0-1 was 5%. The median hospitalization length of stay was 18 days among those who survived, compared with five days for the group of patients that died during the hospital stay. CONCLUSIONS: OHCA is an important cause of death in Chile. The development of a national registry that follows the International Liaison Committee on Resuscitation guidelines is the first step to assess the profile of OHCA in the region. It will provide crucial information to identify prognostic factors and variables that can help develop standards of care and set up the basis to optimize cardiac arrest management within our country and region.
Asunto(s)
Reanimación Cardiopulmonar , Servicios Médicos de Urgencia , Paro Cardíaco Extrahospitalario , Masculino , Humanos , Femenino , Paro Cardíaco Extrahospitalario/epidemiología , Paro Cardíaco Extrahospitalario/terapia , Chile/epidemiología , Hospitales , Sistema de RegistrosRESUMEN
PURPOSE OF REVIEW: In sudden out-of-hospital cardiac arrest, bystander cardiopulmonary resuscitation (CPR) is one of the most important elements of the chain of survival. Since 2015, international health societies and associations have recognized KIDS SAVE LIVES (KSL) as an essential initiative on CPR principles dissemination among schoolchildren. Children can be potential multipliers of the CPR competencies by teaching families, relatives, and friends. This review aimed to determine the main CPR issues raised in the KSL-associated publications. RECENT FINDINGS: We found 12 Editorials, 9 Letters, 2 Special Reports, 4 Reviews, 2 Guidelines, 9 Original Articles and 17 Conference Presentations on KSL history, the schoolchildren CPR education, and KSL program implementation in several countries. In nine original studies, the main issues were instructors' and learners' CPR knowledge, skills, and retention, gender and physical aspects affecting CPR performance, types of KSL programs and new technologies to teach CPR. SUMMARY: The KSL-associated literature is limited to support KSL benefits. However, the KSL could potentially contribute to improve out-of-hospital CPR performed by lay people at earlier age in different countries. Children are an important target group to diffuse CPR principles ('CHECK-CALL-COMPRESS'), as they are curious, motivated and enjoy teaching others.
Asunto(s)
Reanimación Cardiopulmonar , Paro Cardíaco Extrahospitalario , Niño , Humanos , Paro Cardíaco Extrahospitalario/terapiaRESUMEN
BACKGROUND: Double/dual defibrillation (DD) has been proposed as an alternative treatment for refractory ventricular fibrillation (VF). This topic has been poorly researched and data on survival rates are limited. OBJECTIVE: This systematic review and meta-analysis evaluates whether DD improves outcomes among patients with refractory VF in- and out-of-hospital cardiac arrest compared with standard defibrillation. METHODS: A literature search was conducted on July 20, 2019 using MEDLINE via PubMed, Embase, Scopus, and the Cochrane Database of Systematic Reviews. We gave all results as a pooled odds ratio (OR) and 95% confidence interval (CI). Heterogeneity was assessed by calculating the I2 statistic and was deemed significant for a p value of < 0.10 or I2 ≥ 50%. The quality of evidence was evaluated according to Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines. RESULTS: We included 27 records, of which 4 cohort studies totaling 1061 patients were included in the quantitative analysis. Of these, 20.5% (n = 217) received the intervention. DD had no effect on return of spontaneous circulation (OR 0.68; 95% CI 0.44-1.04; I2 = 41%, p = 0.08) (GRADE: Very low), survival to admission (OR 0.77; 95% CI 0.51-1.17; I2 = 18%, p = 0.22) (GRADE: Very low), or survival to discharge (OR 0.66; 95% CI 0.38-1.15; I2 = 0%, p = 0.14) (GRADE: Very low). CONCLUSIONS: DD did not improve any outcomes of interest. Therefore, it is imperative that a well-designed study in this area be conducted. Ideally, conducting a randomized controlled trial in this population should be attempted to obtain a higher level of scientific evidence.
Asunto(s)
Reanimación Cardiopulmonar , Servicios Médicos de Urgencia , Paro Cardíaco Extrahospitalario , Cardioversión Eléctrica , Hospitales , Humanos , Paro Cardíaco Extrahospitalario/terapia , Ensayos Clínicos Controlados Aleatorios como Asunto , Tasa de Supervivencia , Fibrilación Ventricular/terapiaRESUMEN
OBJECTIVES: Postcardiac arrest care bundles following adult cardiac arrest are associated with improved survival to discharge. We aimed to evaluate whether a clinical pathway and computerized order entry were associated with improved pediatric postcardiac arrest care and discharge outcomes. DESIGN: Single-center retrospective before-after study. SETTING: Academic PICU. PATIENTS: Patients who suffered an in- or out-of-hospital cardiac arrest from January 2008 to December 2015 cared for in the PICU within 12 hours of sustained return of circulation. INTERVENTION: Deployment of a postcardiac arrest clinical pathway and computerized order entry system. MEASUREMENTS AND MAIN RESULTS: There were 380 patients included-163 in the pre-pathway period and 217 in the post-pathway period. Primary outcome was percent adherence to pathway clinical goals at 0-6 and 6-24 hours post-return of circulation and to diagnostics (continuous electroencephalogram monitoring, head CT for out-of-hospital cardiac arrests, echocardiogram). Secondary outcomes included survival to hospital discharge and survival with favorable neurologic outcome (Pediatric Cerebral Performance Category of 1-3 or no change from baseline). The pre-pathway and post-pathway groups differed in their baseline Pediatric Cerebral Performance Category scores and the following causes of arrest: airway obstruction, arrhythmias, and electrolyte abnormalities. Pathway adherence was not significantly different between the pre-pathway and post-pathway groups, with the exception of higher rates of continuous electroencephalogram monitoring (45% vs 64%; p < 0.001). There was no difference in survival to hospital discharge between the two groups (56% vs 67%; adjusted odds ratio, 1.68; 95% CI, 0.95-2.84; p = 0.05). Survival to discharge was higher in the post-pathway group for the in-hospital cardiac arrest cohort (55% vs 76%; adjusted odds ratio, 3.06; 95% CI, 1.44-6.51; p < 0.01). There was no difference in favorable neurologic outcome between all patients (adjusted odds ratio, 1.21; 95% CI, 0.72-2.04) or among survivors (adjusted odds ratio, 0.72; 95% CI, 0.27-1.43). CONCLUSIONS: After controlling for known potential confounders, the creation and deployment of a postcardiac arrest care pathway and computerized order entry set were not associated with improvement in pathway adherence or overall outcomes, but was associated with increased survival to hospital discharge for children with in-hospital cardiac arrests.
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Reanimación Cardiopulmonar , Paro Cardíaco Extrahospitalario , Adulto , Niño , Estudios Controlados Antes y Después , Vías Clínicas , Humanos , Paro Cardíaco Extrahospitalario/terapia , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
OBJECTIVES: Tailoring hypothermia duration to ischemia duration may improve outcome from out-of-hospital cardiac arrest. We investigated the association between the hypothermia/ischemia ratio and functional outcome in a secondary analysis of data from the Resuscitation Outcomes Consortium Amiodarone, Lidocaine, or Placebo Study trial. DESIGN: Cohort study of out-of-hospital cardiac arrest patients screened for Resuscitation Outcomes Consortium-Amiodarone, Lidocaine, or Placebo Study. SETTING: Multicenter study across North America. PATIENTS: Adult, nontraumatic, out-of-hospital cardiac arrest patients screened for Resuscitation Outcomes Consortium-Amiodarone, Lidocaine, or Placebo Study who survived to hospital admission and received targeted temperature management between May 2012 and October 2015. INTERVENTIONS: Targeted temperature management in comatose survivors of out-of-hospital cardiac arrest. We defined hypothermia/ischemia ratio as total targeted temperature management time (initiation through rewarming) divided by calculated total ischemia time (approximate time of arrest [9-1-1 call or emergency medical services-witnessed] to return of spontaneous circulation). MEASUREMENTS AND MAIN RESULTS: The primary outcome was hospital survival with good functional status (modified Rankin Score, 0-3) at hospital discharge. We fitted logistic regression models to estimate the association between hypothermia/ischemia ratio and the primary outcome, adjusting for demographics, arrest characteristics, and Resuscitation Outcomes Consortium enrolling site. A total of 3,429 patients were eligible for inclusion, of whom 36.2% were discharged with good functional outcome. Patients had a mean age of 62.0 years (SD, 15.8), with 69.7% male, and 58.0% receiving lay-rescuer cardiopulmonary resuscitation. Median time to return of spontaneous circulation was 21.1 minutes (interquartile range, 16.1-26.9), and median duration of targeted temperature management was 32.9 hours (interquartile range, 23.7-37.8). A total of 2,579 had complete data and were included in adjusted regression analyses. After adjustment for patient characteristics and Resuscitation Outcomes Consortium site, a greater hypothermia/ischemia ratio was associated with increased survival with good functional outcome (odds ratio, 2.01; 95% CI, 1.82-2.23). This relationship, however, appears to be primarily driven by time to return of spontaneous circulation in this patient cohort. CONCLUSIONS: Although a larger hypothermia/ischemia ratio was associated with good functional outcome after out-of-hospital cardiac arrest in this cohort, this association is primarily driven by duration of time to return of spontaneous circulation. Tailoring duration of targeted temperature management based on duration of time to return of spontaneous circulation or patient characteristics requires prospective study.
Asunto(s)
Coma/etiología , Coma/terapia , Hipotermia Inducida/métodos , Isquemia Miocárdica/fisiopatología , Paro Cardíaco Extrahospitalario/complicaciones , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Temperatura Corporal , Coma/mortalidad , Servicios Médicos de Urgencia , Femenino , Mortalidad Hospitalaria/tendencias , Humanos , Hipotermia Inducida/mortalidad , Masculino , Persona de Mediana Edad , Isquemia Miocárdica/etiología , América del Norte , Paro Cardíaco Extrahospitalario/mortalidad , Paro Cardíaco Extrahospitalario/terapia , Evaluación de Procesos y Resultados en Atención de Salud , Alta del Paciente , Estudios Prospectivos , Estudios Retrospectivos , Factores Socioeconómicos , Factores de Tiempo , Centros Traumatológicos/estadística & datos numéricosAsunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Desfibriladores , Paro Cardíaco Extrahospitalario/terapia , Voluntarios , Cardioversión Eléctrica , Tasa de Supervivencia , Estudios Prospectivos , Paro Cardíaco Extrahospitalario/mortalidad , Accesibilidad a los Servicios de Salud , Japón/epidemiologíaRESUMEN
BACKGROUND: Cardiopulmonary resuscitation is usually taught in universities through theoretical lectures and simulations on mannequins with low retention of knowledge and skills. New teaching methodologies have been used to improve the learning, placing the student at the center of the process. Likewise, the outside community knows next to nothing about cardiopulmonary resuscitation. Patients who have an out-of-hospital cardiac arrest will die if the effective maneuvers are not promptly done. Learning by teaching could be a way to answer both requirements. It was therefore decided to evaluate whether the medical students' cardiopulmonary resuscitation performance would improve when they teach other people, and if those people could learn with them effectively. METHODS: A non-randomized controlled trial was designed to assess whether teaching Basic Life Support would increase students' learning. Socially engaged, seeking to disseminate knowledge, 92 medical students were trained in Basic Life Support and who subsequently trained 240 community health professionals. The students performed theoretical and practical pre- and post-tests whereas the health professionals performed theoretical pre- and post-tests and one practical test. In order to assess the impact of teaching on students' learning, they were divided into two groups: a case group, with 53 students, reassessed after teaching health professionals, and a control group, with 39 students, reassessed before teaching. RESULTS: The practical students' performance of the case group went from 13.3 ± 2.1 to 15.3 ± 1.2 (maximum = 17, p < 0.001) and theoretical from 10.1 ± 3.0 to 16.4 ± 1.7 (maximum = 20, p < 0.001) while the performance of the control group went from 14.4 ± 1.6 to 14.4 ± 1.4 (p = 0.877) and from 11.2 ± 2.6 to 15.0 ± 2.3 (p < 0.001), respectively. The theoretical performance of the health professionals changed from 7.9 ± 3.6 to 13.3 ± 3.2 (p < 0.001) and the practical performance was 11.7 ± 3.2. CONCLUSIONS: The students who passed through the teaching activity had a theoretical and practical performance superior to that of the control group. The community was able to learn from the students. The study demonstrated that the didactic activity can be an effective methodology of learning, besides allowing the dissemination of knowledge. The University, going beyond its academic boundaries, performs its social responsibility.
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Técnicos Medios en Salud/educación , Reanimación Cardiopulmonar/educación , Competencia Clínica/normas , Educación de Pregrado en Medicina , Aprendizaje , Paro Cardíaco Extrahospitalario/terapia , Estudiantes de Medicina , Enseñanza , Brasil , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Masculino , Evaluación de Programas y Proyectos de Salud , Enseñanza/normas , Adulto JovenRESUMEN
BACKGROUND: Transesophageal echocardiography (TEE) has been proposed as a modality to assess patients in the setting of cardiac arrest, both during resuscitation care and following return of spontaneous circulation (ROSC). In this study we aimed to assess the feasibility and clinical impact of TEE during the emergency department (ED) evaluation during out-of-hospital cardiac arrest (OHCA). MATERIALS AND METHODS: We conducted a prospective observational study consisting of a convenience sample of adult patients presenting to the ED of an urban university medical center with non-traumatic OHCA. TEE was performed by emergency physicians following intubation. Images and clinical data were analyzed. TEE was used intra-arrest in order to assist in diagnosis, assess cardiac activity and determine CPR quality by assessing area of maximal compression (AMC), using a 4 view protocol. RESULTS: A total of 33 OHCA patients were enrolled over a one-year period, 21 patients (64%) presented with ongoing CPR and 12 (36%) presented with ROSC. The 4-view protocol was completed in 100% of the cases, with an average time from ED arrival to TEE of 12 min (min 3 max 30 SD 8.16). Fine ventricular fibrillation (VF) was recognized in 4 (12%) cases thought to be in asystole, leading to defibrillation, and 2 cases of pseudo-PEA were identified. Right ventricular (RV) dilation, was seen in 12 (57%) intraarrest cases. Intra-cardiac thrombus was found in one case, leading to thrombolysis. The AMC was identified over the aortic root or LVOT in 53% of cases. TEE was found to have diagnostic, therapeutic or prognostic clinical impact in 32 of the 33 cases (97%). CONCLUSIONS: TEE is feasible and clinically impactful during OHCA management. Resuscitative TEE may allow for characterization of cardiac activity, including identification of pseudo-PEA and fine VF, determination of reversible pathology, and optimization of CPR quality.
Asunto(s)
Ecocardiografía Transesofágica , Servicio de Urgencia en Hospital , Paro Cardíaco Extrahospitalario/diagnóstico por imagen , Sistemas de Atención de Punto , Adulto , Anciano , Anciano de 80 o más Años , Reanimación Cardiopulmonar , Femenino , Humanos , Masculino , Persona de Mediana Edad , Paro Cardíaco Extrahospitalario/terapia , Estudios ProspectivosRESUMEN
BACKGROUND: A sudden cardiac arrest (SCA) occurs when the heart abruptly stops beating; because of the nature of SCA, capturing data in the out-of-hospital setting from actual bystander response is difficult. Current technologies such as virtual reality (VR) allow the creation of scenarios programmed for heightened realism. No studies have used an immersive VR system to observe lay bystander response. OBJECTIVE: We sought to characterize lay bystander response to an unannounced simulated VR SCA event during a multisensory scenario. METHODS: Using a VR wearable device combined with a cardiopulmonary resuscitation (CPR) recording manikin, we created a 3-minute multisensory SCA scenario that allowed for the observation of lay bystander response. Subjects were unaware of the nature of the emergency event but were told to respond how they would to an emergency situation. Subject's ability to proceed through the American Heart Association's Chain of Survival and their CPR quality were recorded. Frequencies and percentages were calculated using descriptive statistics. RESULTS: Between June 2016 and June 2017, 119 lay subjects were enrolled. Of those, 92% asked for 911 to be called, 81% attempted CPR, 13% requested an automated external defibrillator (AED), and 6% used the AED; 82% stated that they felt as if they were at a real SCA event. Cardiopulmonary resuscitation data were collected (n = 81), the mean CC rate was 93.5 ± 22.4 cpm, and the mean CC depth was 38.4 ± 13.8 mm. CONCLUSIONS: In our unannounced, immersive VR SCA observational study of lay bystanders, most subjects attempted CPR, although the majority did not use an AED.
Asunto(s)
Reanimación Cardiopulmonar/educación , Paro Cardíaco Extrahospitalario/terapia , Realidad Virtual , Adulto , Desfibriladores , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Masculino , Maniquíes , Persona de Mediana Edad , Factores de TiempoAsunto(s)
Reanimación Cardiopulmonar/instrumentación , Desfibriladores , Cardioversión Eléctrica/instrumentación , Accesibilidad a los Servicios de Salud , Paro Cardíaco Extrahospitalario/terapia , Tiempo de Tratamiento , Humanos , Paro Cardíaco Extrahospitalario/diagnóstico , Paro Cardíaco Extrahospitalario/mortalidad , Paro Cardíaco Extrahospitalario/fisiopatología , Resultado del TratamientoRESUMEN
Out-of-hospital cardiopulmonary arrest (OHCA) is highly lethal. Although overall survival is increasing, hospital discharge with good neurological prognosis remains low and highly variable. In some countries, protocols are being implemented, which include techniques in cardiopulmonary resuscitation, allowing a better neurological prognosis for those patients who undergo an OHCA. Following these new techniques and the incorporation of these new protocols already accepted in the guidelines of advanced cardiopulmonary resuscitation, we report a 54 years old male who presented an OHCA and received advanced cardiopulmonary by a professional team in situ. He was transferred to the emergency department, where optimal advanced resuscitation was continued, until the connection to extracorporeal cardiopulmonary support, with the aim of reestablishing blood flow, a technique known as cardiopulmonary resuscitation (ECPR: extracorporeal cardiopulmonary resuscitation). The patient was discharged from the hospital 25 days later.