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BACKGROUND: It has been reported that the manual chest compression and decompression (MCCD) maneuver can increase lung volume in patients receiving invasive mechanical ventilation (IMV), but some important questions related to this maneuver require answers: how long the effects of MCCD on lung volume remain, and whether there are effects on other respiratory and hemodynamic variables. METHODS: Patients receiving IMV support in an intensive care unit (ICU) with signs of hypoventilation, hypoexpansion, or atelectasis were eligible to receive the MCCD maneuver. Immediately before the maneuver, respiratory and hemodynamic parameters were collected. Then, 20 MCCD maneuvers were performed while measured the same parameters. After 10 min, all parameters were measured again. The primary outcome was the tidal volume (Vt ) during the MCCD maneuver and after 10 min compared to the previous Vt . RESULTS: Of the 255 patients who were mechanically ventilated in the study period, 105 patients composed the final cohort. The MCCD increased inspiratory tidal volume (iVt ), expiratory tidal volume (eVt ), and chest dynamic compliance (Cdyn ) during the application of the maneuver, but after 10 min, these parameters returned to their basal levels. The MCCD maneuver did not change the peak pressure, respiratory rate, peripheral oxygen saturation (SpO2 ), heart rate, or blood pressure. There was no difference in increased iVt in patients with sedation, respiratory comorbidity, or obesity. Further, there was no association between the iVt response to the MCCD and the admission diagnosis, and no correlation with the ICU length of stay, IMV duration, or APACHE II score. IMPLICATIONS OF PHYSIOTHERAPY PRACTICE: We concluded that MCCD increased iVt , eVt , and Cdyn during the application of the maneuver, but this effect was not observed after 10 min. Randomized controlled trials should be performed in the future to investigate the mechanism involved in increasing Vt and the possible impact of the MCCD maneuver on ICU outcomes.

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OBJECTIVES: To investigate the effects of ventilation mode and manual chest compression (MCC) application on the flow bias generated during positive end-expiratory pressure-zero end-expiratory pressure (PEEP-ZEEP) in mechanically ventilated patients. PEEP-ZEEP is an airway clearance manoeuvre with the potential to exceed the flow bias required to remove secretions. However, the ventilation mode applied during the manoeuvre has not been standardised. DESIGN: Randomised crossover trial. PARTICIPANTS: Nineteen mechanically ventilated patients. INTERVENTIONS: Patients were randomised to receive PEEP-ZEEP in volume-controlled and pressure-controlled modes, and with or without MCC. MAIN OUTCOME MEASURES: The difference in flow bias - assessed by the peak expiratory flow (PEF) and peak inspiratory flow (PIF) ratio and difference - between PEEP-ZEEP applied in both ventilation modes, and with and without MCC. RESULTS: The expiratory flow bias was significantly higher in the volume-controlled mode than the pressure-controlled mode. This result was caused by a lower PIF in the volume-controlled mode. PEEP-ZEEP applied in the pressure-controlled mode did not achieve the PEF-PIF difference threshold to clear mucus. Moreover, in the majority of cycles of PEEP-ZEEP applied in the pressure-controlled mode, an inspiratory flow bias was generated, which might embed mucus. PEF was 8l/minute higher with MCC compared with without MCC, which increased the PEF-PIF difference by the same amount. No haemodynamic or respiratory adverse effects were found. CONCLUSIONS: If applied in the volume-controlled mode, PEEP-ZEEP can achieve the flow bias needed to expel pulmonary secretions. However, this is not the case in the pressure-controlled mode. MCC can augment the flow bias generated by PEEP-ZEEP, but its application may be dispensable. CLINICAL TRIAL REGISTRATION: http://www.ensaiosclinicos.gov.br/rg/RBR-223xv8/.

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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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Introducción. Las compresiones cardíacas (CC) de alta calidad son el principal componente de la reanimación cardiopulmonar (RCP). Objetivos: Evaluar la profundidad de las CC durante las maniobras de RCP realizadas sobre un simulador pediátrico. Secundariamente, explorar la asociación entre la profundidad de las CC con respecto al género, nivel de formación, índice de masa corporal y entrenamiento físico periódico. Material y métodos. Trabajo prospectivo de observación experimental. Se incluyeron médicos residentes de Pediatría, pediatras, enfermeros y otros profesionales capacitados en RCP que asistían a niños. Se registró, mediante un software, la profundidad de las CC mientras realizaban maniobras de RCP durante 2 minutos. Se definió como equivalente a cansancio el deterioro en el número de CC adecuadas en profundidad (> 50 mm) mayor de 3 entre el primero y el último ciclo. Resultados. Participaron 137 sujetos (85,4 % de mujeres). Solamente 48 (35,8 %) presentaron un desempeño adecuado en cuanto a la profundidad. Se observaron diferencias significativas en favor del género masculino (p < 0,0001) y de los pediatras formados por sobre el resto (p 0,038). El 36,5 % de los participantes empeoraron su desempeño en cuanto a la profundidad a los dos minutos. No se observaron diferencias significativas en cuanto al índice de masa corporal y actividad física. Conclusiones. Las CC disminuyeron en profundidad al cabo de dos minutos. No hubo asociación con el índice de masa corporal ni la actividad física habitual de los reanimadores, pero sí en cuanto a género y nivel de formación.

Introduction. High-quality chest compressions (CCs) are the main component of cardiopulmonary resuscitation (CPR). Objectives. T o assess the depth of CCs during CPR using a pediatric patient manikin. A secondary objective was to explore the association between CC depth and sex, level of training, body mass index, and periodic physical training. Material and methods. Prospective study with experimental observation. Pediatric residents, pediatricians, nurses, and other health care providers trained in CPR and who attended children were included. A software program was used to record the depth of CCs while performing CPR during 2 minutes. Tiredness was defined as a deterioration in the number of adequately deep CCs (> 50 mm) by more than 3 CCs between the first and the last cycles. Results. A total of 137 subjects participated (85.4 % were women). Only 48 participants (35.8 %) showed an adequate performance in terms of depth. Significant differences were observed for men (p < 0.0001) and trained pediatricians compared to the rest (p = 0.038). A worsening was observed in performance in terms of depth after 2 minutes in 36.5 % of participants. No significant differences were observed in relation to body mass index and physical activity. Conclusions. Depth rate reduced after 2 minutes. No association was observed with the body mass index or regular physical activity of resuscitators but with their sex and level of training.

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INTRODUCTION: High-quality chest compressions (CCs) are the main component of cardiopulmonary resuscitation (CPR). Objectives. T o assess the depth of CCs during CPR using a pediatric patient manikin. A secondary objective was to explore the association between CC depth and sex, level of training, body mass index, and periodic physical training. MATERIAL AND METHODS: Prospective study with experimental observation. Pediatric residents, pediatricians, nurses, and other health care providers trained in CPR and who attended children were included. A software program was used to record the depth of CCs while performing CPR during 2 minutes. Tiredness was defined as a deterioration in the number of adequately deep CCs (> 50 mm) by more than 3 CCs between the first and the last cycles. RESULTS: A total of 137 subjects participated (85.4 % were women). Only 48 participants (35.8 %) showed an adequate performance in terms of depth. Significant differences were observed for men (p < 0.0001) and trained pediatricians compared to the rest (p = 0.038). A worsening was observed in performance in terms of depth after 2 minutes in 36.5 % of participants. No significant differences were observed in relation to body mass index and physical activity. CONCLUSIONS: Depth rate reduced after 2 minutes. No association was observed with the body mass index or regular physical activity of resuscitators but with their sex and level of training.

Introducción. Las compresiones cardíacas (CC) de alta calidad son el principal componente de la reanimación cardiopulmonar (RCP). Objetivos: Evaluar la profundidad de las CC durante las maniobras de RCP realizadas sobre un simulador pediátrico. Secundariamente, explorar la asociación entre la profundidad de las CC con respecto al género, nivel de formación, índice de masa corporal y entrenamiento físico periódico. Material y métodos. Trabajo prospectivo de observación experimental. Se incluyeron médicos residentes de Pediatría, pediatras, enfermeros y otros profesionales capacitados en RCP que asistían a niños. Se registró, mediante un software, la profundidad de las CC mientras realizaban maniobras de RCP durante 2 minutos. Se definió como equivalente a cansancio el deterioro en el número de CC adecuadas en profundidad (> 50 mm) mayor de 3 entre el primero y el último ciclo. Resultados. Participaron 137 sujetos (85,4 % de mujeres). Solamente 48 (35,8 %) presentaron un desempeño adecuado en cuanto a la profundidad. Se observaron diferencias significativas en favor del género masculino (p < 0,0001) y de los pediatras formados por sobre el resto (p 0,038). El 36,5 % de los participantes empeoraron su desempeño en cuanto a la profundidad a los dos minutos. No se observaron diferencias significativas en cuanto al índice de masa corporal y actividad física. Conclusiones. Las CC disminuyeron en profundidad al cabo de dos minutos. No hubo asociación con el índice de masa corporal ni la actividad física habitual de los reanimadores, pero sí en cuanto a género y nivel de formación.

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BACKGROUND: Recommendations regarding ventilation during cardiopulmonary resuscitation (CPR) are based on a low level of scientific evidence. We hypothesized that practices about ventilation during CPR might be heterogeneous and may differ worldwide. To address this question, we surveyed physicians from several countries on their practices during CPR. METHODS: We used a Web-based opinion survey. Links to the survey were sent by e-mail newsletters and displayed on the Web sites of medical societies involved in CPR practice from December 2013 to March 2014. RESULTS: 1,328 surveys were opened, and 548 were completed (41%). Responses came from 54 countries, but 64% came from 6 countries. Responders were mostly physicians (89%). From this group, 97% declared following specific CPR guidelines. Regarding practices, 28% declared always or frequently adopting only continuous chest compressions without additional ventilation. With regard to mechanical chest compression devices, 38% responded that such devices were available to them; when used, 28% declared always or frequently experiencing problems with ventilation such as frequent alarms. During bag-mask ventilation in intubated patients, 18% declared stopping chest compression during insufflation, and 39% applied > 10 breaths/min, which conflicts with international CPR guidelines. When a ventilator was used, the volume controlled mode was the most common strategy cited, but there was heterogeneity regarding ventilator settings for PEEP, trigger, FIO2 , and breathing frequency. SpO2 and end-tidal CO2 were the 2 most monitored variables cited. CONCLUSIONS: Physicians indicated heterogeneous practices that often differ significantly from international CPR guidelines. This may reflect the low level of evidence and a lack of detailed recommendations concerning ventilation during CPR.

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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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El paro cardíaco neonatal suele producirse por asfixia, de modo que se ha mantenido la secuencia de reanimación A-B-C, con una relación compresión-ventilación de 3:1.Menos del 1% de los neonatos necesita maniobras de reanimación. El recientemente nacido (RN) debe ser secado, calentado, colocado piel con piel con su madre y cubierto con una manta para mantener la temperatura, vigilando la respiración, la actividad y el color de la piel. Si alguno de los tres aspectos antes mencionados no se están presentes de forma adecuada, el RN debe recibir: A.- estabilización inicial: calor, liberar la vía aérea en caso de ser necesario, secar y estimular. B.- ventilación, C.- compresión torácica y D.- administración de epinefrina y/o expansión de volumen. El paso inicial de toda resucitación es calentar al niño colocándolo debajo de una fuente de calor radiante, posicionar la cabeza en posición de olfateo para abrir la vía aérea, limpiar la vía aérea en caso de ser necesario con una perilla de succión o sonda de aspiración, secarlo y estimularlo gentilmente. De ser necesario se administrará oxígeno suplementario, ventilación a presión positiva con dispositivo autoinflable con reservorio que permite administrar presión al final de la espiración. Las compresiones torácicas están indicadas con una frecuencia cardiaca de 60 por minuto a pesar de una ventilación adecuada con oxigeno suplementario por 30 segundos. Cuando la gestación, el peso al nacer o las anormalidades congénitas estén asociadas con muerte temprana y cuando la alta morbilidad sea inaceptable entre los supervivientes, la resucitación no está indicada.

Neonatal cardiac arrest is usually produced by asphyxia; therefore, the sequence of resuscitation A-B-C has been maintained with a ratio compression-ventilation 3:1.Less than 1% of neonates need resuscitation. The newly born (NB) must be dried, heated, placed skin-toskin with his mother and covered with a blanket to maintain the temperature, monitor respiration, activity and skin color. If any of the three aspects mentioned above are not present in an appropriate manner, the NB must receive: A. -initial stabilization: heat, clearance of the air way if necessary, dry and stimulate. B -ventilation, C. - chest compression and D. -administration of epinephrine and/or volume expansion. The initial step of any resuscitation is to heat the child by placing it under a radiant heat source, positioning the head in a sniffing position to open the airway, clean the air way if necessary with a suction bulb or aspiration probe, dry and stimulate gently. If necessary, supplemental oxygen should be administered, as well as positive pressure ventilation with an automatically inflated device with a reservoir that allows applying pressure at the end of expiration. The chest compressions are indicated with a heart rate of 60 per minute despite adequate ventilation with supplemental oxygen for 30 seconds. When gestation, birth weight, or congenital abnormalities are associated with early death and when the high morbidity is unacceptable among survivors, resuscitation is not indicated.