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In Triatoma infestans it was observed pyrethroid resistance attributed in part to an elevated oxidative metabolism mediated by cytochromes P450. The nicotinamide adenine dinucleotide phosphate (NADPH) cytochrome P450 reductase (CPR) plays a crucial role in catalysing the electron transfer from NADPH to all cytochrome P450s. The daily variations in the expression of CPR gene and a P450 gene (CYP4EM7), both associated with insecticide resistance, suggested that their expressions would be under the endogenous clock control. To clarify the involvement of the clock in orchestration of the daily fluctuations in CPR and CYP4M7 genes expression, it was proposed to investigate the effect of silencing the clock gene period (per) by RNA interference (RNAi). The results obtained allowed to establish that the silencing of per gene was influenced by intake schemes used in the interference protocols. The silencing of per gene in T. infestans reduced its expression at all the time points analysed and abolished the characteristic rhythm in the transcriptional expression of per mRNA. The effect of the per gene silencing in the expression profiles at the transcriptional level of CPR and CYP4EM7 genes showed the loss of rhythmicity and demonstrated the biological clock involvement in the regulation of t heir expression.
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Ritmo Circadiano , Resistência a Inseticidas , Interferência de RNA , Triatoma , Animais , Triatoma/genética , Triatoma/efeitos dos fármacos , Resistência a Inseticidas/genética , Ritmo Circadiano/genética , Proteínas de Insetos/genética , Proteínas de Insetos/metabolismo , Regulação da Expressão Gênica/efeitos dos fármacos , Sistema Enzimático do Citocromo P-450/genética , NADPH-Ferri-Hemoproteína Redutase/genética , NADPH-Ferri-Hemoproteína Redutase/metabolismo , Vetores de DoençasRESUMO
Although endotracheal intubation is usually a simple and fast procedure in dogs, some situations can be challenging and lead to the risk of tube misplacement in the esophagus-a life-threatening complication. Hence, confirming intubation is a cornerstone whenever this procedure is performed. Methods such as direct visualization or capnography present limitations insofar as they may be unreliable or unavailable under some circumstances. Ultrasound has emerged as a promising tool to confirm intubation in medicine. However, so far little research has been done on the subject in veterinary medicine. This study's main goal was to investigate ultrasound performed by veterinary students as a confirmation method for intubation in canine cadavers after a brief training session (25 minutes). A total of 160 exams were performed with a microconvex probe by 20 students in 11 different cadavers on left and right recumbencies. Overall accuracy was 70.6% with a median success rate of 75% and a median time to diagnosis of 25 seconds. The number of correct diagnoses was statistically higher than the wrong ones (p<0.05) without difference between recumbencies. Sensitivity, specificity, and positive and negative predictive values were 72.5%, 68.8%, 69.9%, and 71.4%, respectively. The fastest diagnosis was performed in just 4 seconds, and among the top-performers, one student had 100% accuracy with a mean time to diagnosis of 16.8 seconds, and four students had approximately 88% accuracy. This study showed for the first time that even inexperienced veterinary students can have acceptable accuracy in confirming endotracheal intubation in dogs after a brief training session.
Apesar de a intubação endotraqueal em cães ser frequentemente um procedimento simples e rápido, algumas situações podem ser desafiadoras e levar ao risco de posicionamento da sonda no esôfago - uma grave complicação. Portanto, a confirmação da intubação é uma etapa crucial sempre que o procedimento for realizado. Métodos como visualização direta ou capnografia apresentam limitações e podem ser pouco confiáveis ou indisponíveis sob certas circunstâncias. A ultrassonografia surgiu como uma ferramenta promissora para confirmação da intubação na medicina. Contudo, até o momento pouco foi estudado na veterinária. O objetivo deste estudo foi investigar a ultrassonografia realizada por estudantes de veterinária como método de confirmação para a intubação em cadáveres caninos após um breve treinamento (25 minutos). Foram realizados 160 exames com transdutor microconvexo por 20 estudantes em 11 cadáveres nos decúbitos direito e esquerdo. A acurácia geral foi 70.6% com medianas de taxa de sucesso de 75% e de tempo para diagnóstico de 25 segundos. O número de diagnósticos corretos foi estatisticamente superior aos errados (p<0.05) sem diferença entre decúbitos. Sensibilidade, especificidade, valor preditivo positivo e negativo foram, respectivamente: 72.5%; 68.8%; 69.9% e 71.4%. O diagnóstico mais rápido se deu em 4 segundos e entre os estudantes com melhor performance, um se destacou com 100% de acurácia e tempo médio para diagnóstico de 16.8 segundos enquanto quatro outros obtiveram 88% de acurácia. Este estudo demonstrou pela primeira vez que mesmo estudantes de veterinária inexperientes podem atingir uma acurácia aceitável na confirmação da intubação endotraqueal em cães após um breve treinamento.
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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.
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Reanimação Cardiopulmonar , Parada Cardíaca Extra-Hospitalar , Humanos , Rhode Island , Reanimação Cardiopulmonar/educação , Parada Cardíaca Extra-Hospitalar/terapia , Instituições Acadêmicas , EstudantesRESUMO
Introduction: Statistics show nowadays, bystanders provided Cardiopulmonary Resuscitation (CPR) in 40-46% of all out-of-the-hospital cardiac arrests. Strategies must focus on specialized training for non-medical personnel. Engaging new generations in self-care depends on the development of new approaches to address the issue. The objective of this study was to assess the efficacy of an innovative training in CPR through the perception of the participants. Material and methods: This study considered a quantitative approach with a descriptive and correlational design. This study had a convenience sample of 103 participants from undergraduate programs in different disciplines: Engineering, Health, Law, and Design with participated voluntarily in the innovate training. To understand the efficacy of the innovative training data was collected of the participants through a self-assessment rubric. While participants were taken part in the training, an expert assessor was observing the performance and scored the procedure using a similar rubric. Both rubrics use a 5-point Likert scale to assess the level of agreement with each sentence. Results: Self-assessment results show that students excel on identifying if a patient has a pulse (mean=4.47) and if a patient is breathing (mean=4.52). The results of the expert assessment indicate a higher level of performance in hand positioning (mean=4.75) and compression-ventilation coordination (mean=4.77).Discussion: These results are encouraging as participants gained confidence on basic procedures, the main challenges are still on skills that rely deeply on practice. Therefore, this training might need to be offered periodically, as any certification offered for health professionals. This study is a first attempt to design an innovative short term and effective training that universities can replicate to prepare their students for these life-saving skills.
Introducción:Las estadísticas muestran que hoy en día los transeúntes realizan la reanimación cardiopulmonar (RCP) en el 40-46% de las paradas cardíacas extrahospitalarias. Las estrategias deben centrarse en la formación especializada del personal no médico, por lo que es importante desarrollar; nuevos enfoques para abordar el tema y comprometer a las generaciones más jóvenes en el autocuidado. El objetivo de este estudio fue evaluar la eficacia de un entrenamiento innovador en RCP a través de la percepción de los participantes.Ma-terial y métodos: Se utilizó un diseño cuantitativo para correlacionar ambas medidas de rendimiento. Este estudio consideró un enfoque cuantitativo con un diseño descriptivo y correlacional. Este estudio tuvo una muestra de conveniencia de 103 participantes de programas de pregrado en diferentes disciplinas: Ingeniería, Salud, Derecho y Diseño con participación voluntaria en el entrenamiento innovador. Para entender la eficacia de la formación innovadora se recogieron datos de los participantes a través de una rúbrica de autoevaluación. Mien-tras los participantes participaban en la formación, un evaluador experto observaba la actuación y puntuaba el procedimiento utilizando una rúbrica similar. Ambas rúbricas utilizan una escala Likert de 5 puntos para evaluar el nivel de acuerdo con cada frase.Resultados: Los resultados de la autoevaluación muestran que los estudiantes destacan en la identificación de si un paciente tiene pulso (media=4,47) y si un paciente respira (media=4,52). Los resultados de la evaluación de expertos indican un mayor nivel de rendimiento en la colocación de las manos (media=4,75) y en la coordinación compresión-ventilación (media=4,77). Discusión: Estos resultados son alentadores, ya que los participantes ganaron confianza en los procedimientos básicos; los principales retos siguen siendo las habilidades que dependen en gran medida de la práctica. Por lo tanto, es posible que esta formación deba ofrecerse periódicamente, como cualquier certificación ISSN: 0719-1855 © Dirección de Extensión y Educación Continua, Escuela de Medicina, Pontificia Universidad Católica de Chile. http://arsmedica.cl26ARS MEDICA Revista de Ciencias Médicas Volumen 46 número 3 año 2021Segura et al.ofrecida a los profesionales de la salud. Este estudio es un primer intento de diseñar una formación innovadora, eficaz y de corta duración, que las universidades pueden replicar para preparar a sus estudiantes en estas habilidades que salvan vidas.
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OBJECTIVE: To investigate if high anti-Müllerian hormone (AMH) concentration is a useful tool to predict the outcome of assisted reproductive treatment. METHODS: Retrospective cohort study involving 520 patients who underwent IVF/ICSI procedures in a university hospital. We measured the serum AMH level on day 3 of the menstrual cycle. Based on AMH levels, we divided the patients into three groups as follows: low (<25th percentile) AMH group, average (25th to 75th percentile) AMH group and high (>75th percentile) AMH group. We recorded the fertilization rate (FR), the number of oocytes retrieved, the number of good quality embryos (GQEs) and the clinical pregnancy rate (CPR). RESULTS: There was no difference between the three AMH groups in terms of maternal age, body mass index (BMI), follicle-stimulating hormone (FSH), estradiol (E2), luteinizing hormone (LH) and testosterone (T) in the IVF/ICSI cycles. The women in the high serum AMH group had a higher number of retrieved oocytes than those in the low or average AMH groups (p < 0.01) in the IVF/ICSI cycles. Compared with the low or average AMH groups, the women with high AMH levels had a higher number of good quality embryos (GQEs) in the IVF/ICSI cycles (p < 0.01). However, high AMH women had no significantly higher clinical pregnancy rate (CPR) compared to the women in the low or average AMH groups. In addition, for the prediction of CPR, the AMH levels alone were not an independent predictor of CPR for IVF and ICSI cycles in the ROC curve analysis. CONCLUSIONS: High anti-Müllerian hormone levels are an independent predictor of the number of retrieved oocytes and good quality embryos (GQEs), but might not reflect the likelihood of higher clinical pregnancy rates (CPR) in IVF/ICSI treatment.
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Hormônio Antimülleriano , Injeções de Esperma Intracitoplásmicas , Feminino , Fertilização in vitro , Humanos , Indução da Ovulação , Gravidez , Taxa de Gravidez , Estudos RetrospectivosRESUMO
The SARS-CoV-2 pandemic that we are currently experiencing has produced new clinical scenarios, within these, prone ventilation is one of the most frequent, especially in critically ill patients, exposing us to having to perform CPR on a patient who is in a prone position. The first suggestion of a prone CPR technique was made by McNeil in 1989. To date, there have been several cases of prone CPR described, most using the technique described by McNeil or small variations of these, achieving success in resuscitation. The technique consists of positioning oneself over the patient who is in a prone position, sitting on his buttocks and resting our hands on the back of the chest and then compressing the chest using a forward swinging motion at an average speed of 40 compressions per minute, with the aim of allowing passive re-expansion of the chest. At the same time, to maintain a patent airway, either victim's arms should be positioned below their forehead so that the bridge of the nose rests on the flexion crease of the elbow, with the nose pointing directly downward. For the defibrillation in prone, two possible alternative positions of the patches/ paddles have been described that have been used successfully: position one of the patches under the patient in prone, in relation to the area of greatest ventricular mass, and the other in his back, specifically on the right shoulder blade. The second one used two patches positioned on the patient's back, one in the lower left region just posterior to the mid-axillary line and the other just below the right shoulder blade. It has been shown that the compressions performed in the prone would be as or more effective than those performed in the supine position with the standard technique, the prone technique also presenting the benefit of producing passive ventilation simultaneously with the same compression maneuver. The situation we are living in deserves to take all the tools we have, so this technique presents a viable alternative to perform in clinical practice, however, more studies are needed in this regard to establish if there is a real benefit from this technique regarding the classical technique. Expert recommendations for CPR have emerged in the context of the COVID-19 patient in which there is consensus that it is reasonable to initiate resuscitation in the prone position in COVID-19 patients who are intubated and ventilated in this same position.
La pandemia de SARS-CoV-2 que vivimos actualmente ha producido nuevos escenarios clínicos, dentro de estos la ventilación en prono es uno de los más frecuentes, sobre todo en pacientes críticos, exponiéndonos a tener que realizar una RCP a un paciente que se encuentra en prono. La primera sugerencia de una técnica de RCP en prono fue realizada por McNeil en 1989. A la fecha existen diversos casos descritos de RCP en prono, la mayoría utilizando la técnica descrita por McNeil o pequeñas variaciones de estas, logrando éxito en la reanimación. La técnica consiste en posicionarse sobre el paciente que se encuentra en prono, sentándose el reanimador sobre las nalgas de este y apoyando las manos sobre la parte posterior del tórax para luego comprimir el tórax mediante un movimiento de balanceo hacia adelante a una velocidad promedio de 40 compresiones por minuto, con el objetivo de permitir la reexpansión pasiva del tórax. A la vez, para mantener la vía aérea permeable se debe posicionar cualquiera de los brazos de la víctima por debajo de su frente de manera que el puente de la nariz descansara sobre el pliegue de flexión del codo con la nariz apuntando directamente hacia abajo. Para la desfibrilación en prono se han descrito dos posibles posiciones alternativas de los parches/ paletas que han sido utilizadas de forma exitosa: posicionar uno de los parches bajo el paciente en prono, en relación a la zona de mayor masa ventricular y el otro en la espalda de este, específicamente sobre la escápula derecha; utilizar dos parches posicionados en la espalda del paciente, uno en la región izquierda baja justo posterior a la línea axilar media y el otro justo bajo la escápula derecha. Se ha evidenciado que las compresiones realizadas en prono serían tanto o más efectivas que las realizadas en supino con la técnica estándar, presentando la técnica en prono también el beneficio de producir una ventilación pasiva de forma simultánea con la misma maniobra de compresión. La situación que vivimos amerita tomar todas las herramientas con las que contamos, por lo que esta técnica presenta una alternativa viable de realizar en la práctica clínica, sin embargo, hacen falta más estudios al respecto para poder establecer si existe un real beneficio de esta técnica respecto a la técnica clásica. Han surgido recomendaciones de expertos para la RCP en el contexto del paciente COVID-19 en las cuales existe consenso respecto a que es razonable iniciar la reanimación en posición prona en pacientes COVID-19 que se encuentran intubados y siendo ventilados en esta misma posición.
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Humanos , Decúbito Ventral , Reanimação Cardiopulmonar/métodos , COVID-19RESUMO
Introducción: El paro cardiorrespiratorio es el cese súbito del gasto cardiaco y de la ventilación espontánea y eficaz; y la reanimación cardiopulmonar es el conjunto de pautas estandarizadas de desarrollo secuencial. Objetivo: Identificar el nivel de información de especialistas y residentes de Medicina General Integral sobre reanimación cardiopulmonar básica y avanzada en adultos. Se realizó una investigación descriptiva de corte transversal en el municipio Sagua la Grande en los meses abril-junio de 2017. El universo estuvo constituido por un total de 98 especialistas y residentes de Medicina General Integral que laboran en la Atención Primaria de Salud. La muestra se seleccionó a través de un muestreo no probabilístico quedó constituida por 40 médicos (20 especialistas y 20 residentes). La recogida de la información se realizó encuesta a especialistas y residentes con un total de 20 preguntas. Se recogen datos acerca de la categoría profesional y años de experiencia de los especialistas que permitieron caracterizar a la muestra. Resultados: Las calificaciones de inaceptable en la reanimación cardiopulmonar básica (62,5 por ciento), avanzada (77,5 por ciento) y total (55 por ciento) respectivamente. Conclusiones: Los resultados insatisfactorios fueron similares en los especialistas, como en los residentes de medicina general integral(AU)
Introduction: Cardiorespiratory arrest is the sudden cessation of cardiac output, together with spontaneous and effective ventilation. Cardiopulmonary resuscitation is the group of standardized guidelines for sequential development. Objective: To identify the level of information of family medicine specialists and residents about basic and advanced cardiopulmonary resuscitation in adults. Methods: A descriptive, cross-sectional investigation was carried out in Sagua la Grande Municipality, in the months from April to June 2017. The study population was made up by a total of 98 family medicine specialists and residents who work in primary healthcare level. The sample was chosen through non-probabilistic sampling and made up by 40 doctors (20 specialists and 20 residents). The information was gathered conducting a 20-question survey on specialists and residents. Data were collected regarding the professional category and years of experience of the specialists, which allowed characterizing the sample. Results: In basic cardiopulmonary resuscitation, the assessment was unacceptable (62.5 percent), advanced (77.5 percent), and full (55 percent). Conclusions: The unsatisfactory results were similar in both specialists and residents of family medicine(AU)
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Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Reanimação Cardiopulmonar/métodos , Epidemiologia Descritiva , Estudos TransversaisRESUMO
ANTECEDENTES Y OBJETIVO Alrededor de un 60% de paros cardio respiratorios ocurren fuera de un establecimiento asistencial, lo que hace difícil el inicio de maniobras de reanimación cardiopulmonar. Más aún, las compresiones torácicas no siempre se realizan de forma continua impactando en la sobrevida de los pacientes. Para mejorar esta situación, se ha sugerido implementar dispositivos de compresión torácica mecánica. En este contexto el Servicio de Salud Viña del Mar-Quillota solicita esta síntesis de evidencia con el objetivo de evaluar si existen diferencias entre la compresión torácica manual y un sistema de compresión torácica mecánica. METODOLOGÍA Se formuló una estrategia de búsqueda la cual se utilizó en 4 bases de datos con el objetivo de identificar revisiones sistemáticas que abordaran la pregunta formulada. Como las revisiones sistemáticas no siempre reportaron adecuadamente los resultados, se extrajeron los datos de los estudios primarios contemplados. Se utiliza la metodología de certeza de evidencia GRADE. Se incluyeron todas las intervenciones que compararan sistemas de compresión torácica automáticos contra la compresión manual realizada en pacientes adultos que presentaron un paro cardio respiratorio extrahospitalario. Se excluyeron intervenciones realizadas dentro del hospital; uso de equipos después del fallo de la compresión torácica manual y la comparación de otras intervenciones. Se priorizan los dispositivos de tipo LUCAS® y AutoPulse®, excluyendo otro tipo de dispositivos. RESULTADOS Se utilizan 9 revisiones sistemáticas El uso del dispositivo LUCAS en comparación con la compresión torácica manual en ambientes no hospitalarios: -Probablemente hace poca o ninguna diferencia en la proporción de pacientes que sobreviven con buena función neurológica a un paro cardiorespiratorio. -No aumenta ni reduce la proporción de pacientes que a un paro cardiorespiratorio, mientras que probablemente no produce una mayor tasa de complicaciones El uso del dispositivo AutoPulse en comparación con la compresión torácica manual en ambientes no hospitalarios: -Reduciría la proporción de pacientes que sobreviven con buena función neurológica a un paro cardiorespiratorio, mientras que aumenta ligeramente la tasa de complicaciones. El análisis de evaluación económica, realizado por el NHS de Inglaterra, dio por resultado que el LUCAS-2 no es costo-efectivo en comparación a la compresión torácica manual.
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Equipe de Respostas Rápidas de Hospitais , Parada Cardíaca , Efetividade , ChileRESUMO
Una de cada cinco muertes en adultos en países desarrollados se debe a causas cardiovasculares; la mitad de esas muertes se produce de forma súbita y un gran porcentaje en el ámbito extrahospitalario. Las medidas de prevención se dividen en: aquellas destinadas a prevenir en primer lugar que el evento de muerte súbita cardíaca suceda, y aquellas cuyo objetivo es actuar en el momento en que el evento de muerte súbita está sucediendo. Las primeras tienen como objetivo disminuir las principales causas de muerte súbita en países desarrollados: las cardiopatías estructurales (cuya principal causa es la enfermedad coronaria). En este sentido, con el fin de intentar paliar el desarrollo de una cardiopatía que predisponga a la aparición de arritmias fatales y la MSC, se implementan medidas de prevención primarias higiénico-dietéticas y farmacológicas (con el objetivo de disminuir y el controlar los factores de riesgo) y, en aquellos con enfermedad cardiovascular ya establecida, se implementan las estrategias secundarias farmacológicas y/o quirúrgicas (revascularización, reemplazo valvular, etc.). El segundo abordaje surge del hecho de que, a pesar de todas estas medidas, un gran número de pacientes presentará eventos arrítmicos en el ámbito extrahospitalario (MSCEH), ya sea porque aunque recibieron el tratamiento óptimo presentan aún un elevado riesgo de MSC, porque no fueron diagnosticados a tiempo o porque a pesar de haber hecho estudios complementarios el diagnóstico es muy dificultoso. Existen dos estrategias: la primera son los dispositivos de cardiodesfibrilación implantables (o, más recientes, los chalecos vestibles). Estos aparatos están indicados para una población seleccionada, sea por haber presentado ya un episodio de muerte súbita abortado, o por presentar una cardiopatía (estructural o genética) que predisponga a una mayor probabilidad de sufrir un evento. La segunda estrategia es la educación y el desarrollo de programas de salud pública que permitan capacitar a la población general en la realización de RCP y el uso de desfibriladores automáticos externos (DEAs), los cuales deberían estar disponibles en cualquier lugar público. Múltiples estudios demostraron que el acceso de la población general al aprendizaje de maniobras de RCP sencillas y pragmáticas y la presencia de DEAs se traduce en un gran aumento de sobrevida sin secuelas en víctimas de MSCEH. (AU)
One of every five deaths in adults is due to cardiovascular causes, in developed countries, and half of these deaths will occur suddenly. A large percentage occur in the out of hospital setting, so measures to prevent it are divided into: those designed to prevent, in the first place, the sudden cardiac death event from happening and those whose purpose is to act when the sudden death event that has already occurred and it´s ongoing. The first aims to reduce the main causes of sudden death in developed countries: structural heart disease (with coronary heart disease as its main cause). In this regard, with the purpose to mitigate the development of a heart disease that predisposes the occurrence of fatal arrhythmias and SCD, we have primary prevention measures, like healthy life style conduct with or without pharmacological treatment, (whose objective is the reduction and control of cardiovascular risk factors) and, in those with cardiovascular disease already established, there is an implementation of pharmacological and / or surgical strategies (Revascularization, valve replacement, etc.). The second objective arises from the fact that, despite all these preventive and therapeutic measures, a large number of patients will present out-of-hospital cardiac arrest (OHCA) either because although they received optimal treatment they still remain in high risk of SCD, even because they were not diagnosed on time, or because despite having complementary studies made the diagnosis is very difficult. There are two well strategies: the first are implantable cardio-defibrillation devices (or, more recently, wearable vests). These are indicated for a selected population, either because they have already presented an episode of sudden aborted death, or because they have heart disease (structural or genetic), which predisposes to a greater probability of suffering an event. The second strategy is the education and development of public health programs that enable the general population to be trained in CPR and the use of external automatic defibrillators. (AEDs) should be available in any public place. Multiple studies showed that access to the general population for learning simple and pragmatic CPR maneuvers and the presence of AEDs is making an impact on a significant increase in survival without consequences in OHCA victims. (AU)
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Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Fibrilação Ventricular/complicações , Morte Súbita Cardíaca/etiologia , Morte Súbita Cardíaca/prevenção & controle , Morte Súbita Cardíaca/epidemiologia , Reanimação Cardiopulmonar , Taquicardia Ventricular/complicações , Cardioversão Elétrica , Incidência , Causas de Morte , Fatores Etários , AtletasRESUMO
OBJECTIVES: To describe the frequency and extent of delivery room resuscitation and evaluate the association of delivery room resuscitation with neonatal outcomes in moderately preterm (MPT) infants. STUDY DESIGN: This was an observational cohort study of MPT infants delivered at 290/7 to 336/7 weeks' gestational age (GA) enrolled in the Neonatal Research Network MPT registry. Infants were categorized into 5 groups based on the highest level of delivery room intervention: routine care, oxygen and/or continuous positive airway pressure, bag and mask ventilation, endotracheal intubation, and cardiopulmonary resuscitation including chest compressions and/or epinephrine use. The association of antepartum and intrapartum risk factors and discharge outcomes with the intensity of resuscitation was evaluated. RESULTS: Of 7014 included infants, 1684 (24.0%) received routine care and no additional resuscitation, 2279 (32.5%) received oxygen or continuous positive airway pressure, 1831 (26.1%) received bag and mask ventilation, 1034 (14.7%) underwent endotracheal intubation, and 186 (2.7%) received cardiopulmonary resuscitation. Among the antepartum and intrapartum factors, increasing GA, any exposure to antenatal steroids and prolonged rupture of membranes decreased the likelihood of receipt of all levels of resuscitation. Infants who were small for GA (SGA) had increased risk of delivery room resuscitation. Among the neonatal outcomes, respiratory support at 28 days, days to full oral feeds and length of stay were significantly associated with the intensity of delivery room resuscitation. Higher intensity of resuscitation was associated with increased risk of mortality. CONCLUSIONS: The majority of MPT infants receive some level of delivery room resuscitation. Increased intensity of delivery room interventions was associated with prolonged respiratory and nutritional support, increased mortality, and a longer length of stay.
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Reanimação Cardiopulmonar/estatística & dados numéricos , Pressão Positiva Contínua nas Vias Aéreas/estatística & dados numéricos , Intubação Intratraqueal/estatística & dados numéricos , Oxigenoterapia/estatística & dados numéricos , Salas de Parto , Feminino , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Recém-Nascido Pequeno para a Idade Gestacional , Masculino , Avaliação de Resultados em Cuidados de Saúde , Estudos Prospectivos , Sistema de Registros , Fatores de RiscoAssuntos
Reanimação Cardiopulmonar , Parada Cardíaca , Coração , Humanos , Iowa , Instituições AcadêmicasRESUMO
Introduction Effective ventilation during cardiopulmonary resuscitation (CPR) is essential to reduce morbidity and mortality rates in cardiac arrest. Hyperventilation during CPR reduces the efficiency of compressions and coronary perfusion. Problem How could ventilation in CPR be optimized? The objective of this study was to evaluate non-invasive ventilator support using different devices. METHODS: The study compares the regularity and intensity of non-invasive ventilation during simulated, conventional CPR and ventilatory support using three distinct ventilation devices: a standard manual resuscitator, with and without airway pressure manometer, and an automatic transport ventilator. Student's t-test was used to evaluate statistical differences between groups. P values <.05 were regarded as significant. RESULTS: Peak inspiratory pressure during ventilatory support and CPR was significantly increased in the group with manual resuscitator without manometer when compared with the manual resuscitator with manometer support (MS) group or automatic ventilator (AV) group. CONCLUSION: The study recommends for ventilatory support the use of a manual resuscitator equipped with MS or AVs, due to the risk of reduction in coronary perfusion pressure and iatrogenic thoracic injury during hyperventilation found using manual resuscitator without manometer. Lacerda RS , de Lima FCA , Bastos LP , Vinco AF , Schneider FBA , Coelho YL , Fernandes HGC , Bacalhau JMR , Bermudes IMS , da Silva CF , da Silva LP , Pezato R . Benefits of manometer in non-invasive ventilatory support. Prehosp Disaster Med. 2017;32(6):615-620.
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Reanimação Cardiopulmonar/instrumentação , Competência Clínica , Manometria/instrumentação , Feminino , Humanos , Masculino , Manequins , Adulto JovemRESUMO
Introducción: El paro cardiorrespiratorio es la documentación de la pérdida del pulso y respiración. La resucitación cardiopulmonar (RCP) está compuesta por compresiones torácicas interpuestas por ventilaciones, las cuales pueden producir el retorno de circulación espontánea, un ritmo y pulso viable. Los parámetros de cómo realizar RCP están definidas por guías consensuadas, pero estos no son rutinariamente medidos, por lo que la calidad es desconocida. Objetivos: Determinar el grado de conocimiento teórico y práctico del manejo del paro cardiorrespiratorio en estudiantes de 6to. año de la Facultad de Medicina de la Universidad Francisco Marroquín utilizando simuladores clínicos. Metodología: Estudio descriptivo y abierto, donde se incluyeron 26 estudiantes usando simuladores de alta fidelidad de RCP, las cuales proveen respuestas fisiológicas realísticas, por medio de algoritmos matemáticos generados por programas en computadoras. Resultados: De los 26 estudiantes 0% aprobó el examen teórico con un promedio de 77.4 puntos; en la evaluación práctica ninguna pareja logró una efectividad mayor al 80%. El promedio de la profundidad de las compresiones fue de 3.38 cm, el promedio de liberación post-compresión fue de 51% y el promedio de tiempo de interrupción total fue 79 segundos. El análisis estadístico demostró que no hay relación entre los resultados del test teórico y la efectividad en las compresiones y ventilaciones en el manejo del paro cardiorrespiratorio. Conclusiones: Se pudo evidenciar que los estudiantes no tienen la competencia apropiada en Soporte Vital Básico y Avanzado, por lo que se recomienda enfocar los cursos de Advance Cardiac Life Support (ACLS) a un mayor abordaje práctico con simuladores fisiológicos y que los estudiantes realicen el curso en periodos de tiempo más seguidos. Palabras clave: Paro Cardiorrespiratorio, Simulaciones fisiológicas, compresiones efectivas, ventilaciones efectivas, ACLS, RCP
A cardiorespiratory arrest is the documentation of absence of pulse and respiration. The cardiopulmonary resuscitation (CPR) is composed of chest compressions interposed by ventilations that will increase the probability of spontaneous circulation return and a viable pulse and rhythm. The parameters of how of perform CPR are defined by consensus guides but these aren't routinely measured in the practice setting, so the quality thereof is unknown. Objective: Determine the degree of theoretical and practical knowledge of the management of cardiorespiratory arrest in students coursing 6th year of Medical School at the University Francisco Marroquín using clinical simulators. Methodology: Descriptive, open study with 26 students using RCP high fidelity simulators providing real physiologic responses throw the use of mathematic algorithms generated by computerized programs. Results: Of the 26 students, 0% approved the theoretical test, with an average grade of 77.4 points. In the practical evaluation, none of the couples achieved greater effectiveness than 80% when doing compressions or ventilations. The average of compression depth was 3.38cm, the post-compression release average was 51%; and the total interruption time average was 79 seconds. The statistical analysis showed there wasn't a relationship between the grades of the theoretical test and the effectiveness of compressions and ventilations in the management of a cardiorespiratory arrest. Conclusions: It is evident that the students don't have proper competition in the management of the Basic and Advance Life Support. It's recommended to focus ACLS courses to a more practical approach with physiological simulators and encourage students to take the course at least once a year while in their hospital rotations. Keywords: Cardiorespiratory arrest, effective compressions, effective ventilations, clinical simulators, ACLS, CPR
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BACKGROUND: Bystander cardiopulmonary resuscitation (CPR) improves survival after prehospital cardiac arrest. While community CPR training programs have been implemented across the US, little is known about their acceptability in non-US Latino populations. OBJECTIVES: The purpose of this study was to identify barriers to enrolling in CPR training classes and performing CPR in San José, Costa Rica. METHODS: After consulting 10 San José residents, a survey was created, pilot-tested, and distributed to a convenience sample of community members in public gathering places in San José. Questions included demographics, CPR knowledge and beliefs, prior CPR training, having a family member with heart disease, and prior witnessing of a cardiac arrest. Questions also addressed barriers to enrolling in CPR classes (cost/competing priorities). The analysis focused on two main outcomes: likelihood of registering for a CPR class and willingness to perform CPR on an adult stranger. Odds ratios and 95% CIs were calculated to test for associations between patient characteristics and these outcomes. RESULTS: Among 371 participants, most were male (60%) and <40 years old (77%); 31% had a college degree. Many had family members with heart disease (36%), had witnessed a cardiac arrest (18%), were trained in CPR (36%), and knew the correct CPR steps (70%). Overall, 55% (95% CI, 50-60%) indicated they would "likely" enroll in a CPR class; 74% (95% CI, 70-78%) would perform CPR on an adult stranger. Cardiopulmonary resuscitation class enrollment was associated with prior CPR training (OR: 2.6; 95% CI, 1.6-4.3) and a prior witnessed cardiac arrest (OR: 2.0; 95% CI, 1.1-3.5). Willingness to perform CPR on a stranger was associated with a prior witnessed cardiac arrest (OR: 2.5; 95% CI, 1.2-5.4) and higher education (OR: 1.9; 95% CI, 1.1-3.2). Believing that CPR does not work was associated with a higher likelihood of not attending a CPR class (OR: 2.4; 95% CI, 1.7-7.9). Fear of performing mouth-mouth, believing CPR is against God's will, and fear of legal risk were associated with a likelihood of not attending a CPR class and not performing CPR on a stranger (range of ORs: 2.4-3.9). CONCLUSION: Most San José residents are willing to take CPR classes and perform CPR on a stranger. To implement a community CPR program, barriers must be considered, including misgivings about CPR efficacy and legal risk. Hands-only CPR programs may alleviate hesitancy to perform mouth-to-mouth. Schmid KM , Mould-Millman NK , Hammes A , Kroehl M , Quiros García R , Umaña McDermott M , Lowenstein SR . Barriers and facilitators to community CPR education in San José, Costa Rica. Prehosp Disaster Med. 2016;31(5):509-515.
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Reanimação Cardiopulmonar/educação , Educação em Saúde , Parada Cardíaca Extra-Hospitalar/terapia , Adulto , Pesquisa Participativa Baseada na Comunidade , Costa Rica , Serviços Médicos de Emergência , Feminino , Educação em Saúde/estatística & dados numéricos , Humanos , Masculino , Razão de Chances , Inquéritos e QuestionáriosRESUMO
OBJECTIVES: To describe procedural characteristics of tracheal intubation (TI) during cardiopulmonary resuscitation (CPR) in a pediatric emergency department, and to characterize interruptions in CPR associated with TI performance. METHODS: Retrospective single center case series. Resuscitations in a pediatric ED are videorecorded for quality improvement. Children who underwent TI while receiving chest compressions were eligible for inclusion. Intubations done by methods other than direct laryngoscopy were excluded. Background data included patient age and training background of intubator. Data on intubation attempts (success, laryngoscopy time) and chest compressions (interruptions, duration of pauses) were collected. RESULTS: Between December 2012 and February 2014, 32 patients had 59 TI attempts performed during CPR. Overall first attempt success at TI was 15/32 (47%); a median of 2 attempts were made per patient (range 1 to 4). Median laryngoscopy time was 47s (range 8-115s). 32/59 (54%) TI attempts had an associated interruption in CPR; the median interruption duration was 25s (range 3-64s). TI attempts without interruption in CPR were successful in 20/32 (63%) compared to 11/27 (41%) when CPR was paused (p=0.09). Laryngoscopy time was not significantly different between TI attempts with (47±21s) and without (47±26s; p=0.2) interruptions in compressions. 25/32 (78%) of pauses exceeded 10s in duration. CONCLUSIONS: TI during pediatric CPR results in significant interruptions in chest compressions. Procedural outcomes were not significantly different between attempts with and without compressions paused. In children receiving CPR, TI should be performed without pausing chest compressions.
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Reanimação Cardiopulmonar/métodos , Intubação Intratraqueal/métodos , Garantia da Qualidade dos Cuidados de Saúde/métodos , Gravação em Vídeo , Adolescente , Adulto , Criança , Pré-Escolar , Serviço Hospitalar de Emergência , Humanos , Lactente , Recém-Nascido , Estudos Retrospectivos , Adulto JovemRESUMO
OBJECTIVES: This study was designed to assess cardiopulmonary resuscitation quality and rescuer fatigue when rescuers perform one or two minutes of continuous chest compressions. METHODS: This prospective crossover study included 148 lay rescuers who were continuously trained in a cardiopulmonary resuscitation course. The subjects underwent a 120-min training program comprising continuous chest compressions. After the course, half of the volunteers performed one minute of continuous chest compressions, and the others performed two minutes, both on a manikin model. After 30 minutes, the volunteers who had previously performed one minute now performed two minutes on the same manikin and vice versa. RESULTS: A comparison of continuous chest compressions performed for one and two minutes, respectively, showed that there were significant differences in the average rate of compressions per minute (121 vs. 124), the percentage of compressions of appropriate depth (76% vs. 54%), the average depth (53 vs. 47 mm), and the number of compressions with no errors (62 vs. 47%). No parameters were significantly different when comparing participants who performed regular physical activity with those who did not and participants who had a normal body mass index with overweight/obese participants. CONCLUSION: The quality of continuous chest compressions by lay rescuers is superior when it is performed for one minute rather than for two minutes, independent of the body mass index or regular physical activity, even if they are continuously trained in cardiopulmonary resuscitation. It is beneficial to rotate rescuers every minute when performing continuous chest compressions to provide higher quality and to achieve greater success in assisting a victim of cardiac arrest. .
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Feminino , Humanos , Masculino , Anticorpos Antibacterianos/sangue , Neoplasias Colorretais/virologia , Infecções por Helicobacter/sangue , Helicobacter pylori/imunologiaRESUMO
BACKGROUND: End-tidal carbon dioxide (ETCO2) correlates with systemic blood flow and resuscitation rate during cardiopulmonary resuscitation (CPR) and may potentially direct chest compression performance. We compared ETCO2-directed chest compressions with chest compressions optimized to pediatric basic life support guidelines in an infant swine model to determine the effect on rate of return of spontaneous circulation (ROSC). METHODS AND RESULTS: Forty 2-kg piglets underwent general anesthesia, tracheostomy, placement of vascular catheters, ventricular fibrillation, and 90 seconds of no-flow before receiving 10 or 12 minutes of pediatric basic life support. In the optimized group, chest compressions were optimized by marker, video, and verbal feedback to obtain American Heart Association-recommended depth and rate. In the ETCO2-directed group, compression depth, rate, and hand position were modified to obtain a maximal ETCO2 without video or verbal feedback. After the interval of pediatric basic life support, external defibrillation and intravenous epinephrine were administered for another 10 minutes of CPR or until ROSC. Mean ETCO2 at 10 minutes of CPR was 22.7±7.8 mm Hg in the optimized group (n=20) and 28.5±7.0 mm Hg in the ETCO2-directed group (n=20; P=0.02). Despite higher ETCO2 and mean arterial pressure in the latter group, ROSC rates were similar: 13 of 20 (65%; optimized) and 14 of 20 (70%; ETCO2 directed). The best predictor of ROSC was systemic perfusion pressure. Defibrillation attempts, epinephrine doses required, and CPR-related injuries were similar between groups. CONCLUSIONS: The use of ETCO2-directed chest compressions is a novel guided approach to resuscitation that can be as effective as standard CPR optimized with marker, video, and verbal feedback.
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Dióxido de Carbono/metabolismo , Reanimação Cardiopulmonar/métodos , Expiração , Parada Cardíaca/terapia , Hemodinâmica , Monitorização Fisiológica/métodos , Respiração Artificial , Fatores Etários , Animais , Animais Recém-Nascidos , Percepção Auditiva , Biomarcadores/metabolismo , Testes Respiratórios , Capnografia , Modelos Animais de Doenças , Retroalimentação Psicológica , Parada Cardíaca/diagnóstico , Parada Cardíaca/metabolismo , Parada Cardíaca/fisiopatologia , Valor Preditivo dos Testes , Suínos , Análise e Desempenho de Tarefas , Fatores de Tempo , Gravação em Vídeo , Percepção VisualRESUMO
OBJECTIVE: To compare medical emergency response plan (MERP) and automated external defibrillator (AED) prevalence and define the incidence and outcomes of sudden cardiac arrest (SCA) in high schools before and after AED legislation. STUDY DESIGN: In 2011, Tennessee Secondary School Athletic Association member schools were surveyed regarding AED placement, MERPs, and on-campus SCAs within the last 5 years. Results were compared with a similar study conducted in 2006, prior to legislation requiring AEDs in schools. RESULTS: Of the schools solicited, 214 (54%, total enrollment 182â289 students) completed the survey. Compared with 2006, schools in the 2011 survey had a significantly higher prevalence of MERPs (84% vs 71%, P < .001), annual practice (56% vs 36%, P < .001), medical emergency communication systems (80% vs 62%, P < .001), and defibrillators (90% vs 47%, P < .001). No differences were noted in the prevalence of cardiopulmonary resuscitation training (20% vs 17%, P = .58) or full compliance with American Heart Association guidelines (11% vs 7%, P = .16). Twenty-two SCA victims were identified, yielding a 5-year incidence of 1 in 10 schools. CONCLUSIONS: After state legislation, schools demonstrated a significant increase in MERPs and on-campus defibrillators but rates of cardiopulmonary resuscitation training and overall compliance with guidelines remained low.