RESUMO
BACKGROUND: The association between chest compression (CC) pause duration and pediatric in-hospital cardiac arrest survival outcomes is unknown. The American Heart Association has recommended minimizing pauses in CC in children to <10 seconds, without supportive evidence. We hypothesized that longer maximum CC pause durations are associated with worse survival and neurological outcomes. METHODS: In this cohort study of index pediatric in-hospital cardiac arrests reported in pediRES-Q (Quality of Pediatric Resuscitation in a Multicenter Collaborative) from July of 2015 through December of 2021, we analyzed the association in 5-second increments of the longest CC pause duration for each event with survival and favorable neurological outcome (Pediatric Cerebral Performance Category ≤3 or no change from baseline). Secondary exposures included having any pause >10 seconds or >20 seconds and number of pauses >10 seconds and >20 seconds per 2 minutes. RESULTS: We identified 562 index in-hospital cardiac arrests (median [Q1, Q3] age 2.9 years [0.6, 10.0], 43% female, 13% shockable rhythm). Median length of the longest CC pause for each event was 29.8 seconds (11.5, 63.1). After adjustment for confounders, each 5-second increment in the longest CC pause duration was associated with a 3% lower relative risk of survival with favorable neurological outcome (adjusted risk ratio, 0.97 [95% CI, 0.95-0.99]; P=0.02). Longest CC pause duration was also associated with survival to hospital discharge (adjusted risk ratio, 0.98 [95% CI, 0.96-0.99]; P=0.01) and return of spontaneous circulation (adjusted risk ratio, 0.93 [95% CI, 0.91-0.94]; P<0.001). Secondary outcomes of any pause >10 seconds or >20 seconds and number of CC pauses >10 seconds and >20 seconds were each significantly associated with adjusted risk ratio of return of spontaneous circulation, but not survival or neurological outcomes. CONCLUSIONS: Each 5-second increment in longest CC pause duration during pediatric in-hospital cardiac arrest was associated with lower chance of survival with favorable neurological outcome, survival to hospital discharge, and return of spontaneous circulation. Any CC pause >10 seconds or >20 seconds and number of pauses >10 seconds and >20 seconds were significantly associated with lower adjusted probability of return of spontaneous circulation, but not survival or neurological outcomes.
Assuntos
Reanimação Cardiopulmonar , Parada Cardíaca , Humanos , Parada Cardíaca/mortalidade , Parada Cardíaca/terapia , Feminino , Masculino , Criança , Pré-Escolar , Reanimação Cardiopulmonar/mortalidade , Fatores de Tempo , Lactente , Resultado do Tratamento , AdolescenteRESUMO
PURPOSE: Temperature targets in patients with cardiac arrest and return of spontaneous circulation (ROSC) have changed. Changes to higher temperature targets have been associated with higher breakthrough fevers and mortality. A post-ROSC normothermia bundle was developed to improve compliance with temperature targets. METHODS: In August 2021, "ad hoc" normothermia at the discretion of the attending intensivist was initiated. In December 2021, a post-ROSC normothermia protocol was implemented, incorporating a rigorous, stepwise approach to fever prevention (temperature ≥ 37.8). We conducted a before-after cohort study of all adult patients post-ROSC who survived to intensive care unit admission between August 1, 2021, and April 1, 2022. They were divided into "ad hoc" and "protocol" groups. Clinical outcomes compared included fevers, active cooling, and paralytic use. RESULTS: Fifty-eight post-ROSC patients were admitted; 24 in the "ad hoc" and 34 in the "protocol" groups. Patient demographics were similar between groups. The "ad hoc" group had more shockable rhythms (67% vs 24%, P = .001) and cardiac catheterizations (42% vs 15%, P = .03). The "protocol" group were significantly less likely to have a fever at 40â h (6% vs 40%, P < .001) and 72â h (14% vs 65%, P ≤ .001). Patients in the normothermia "protocol" used significantly less neuromuscular blocking agents (24% vs 50%, P = .05). The normothermia "protocol" resulted in similar mortality (56% vs 58%, P = 1.0). CONCLUSION: Use of a normothermia "protocol" resulted in fewer fevers and less neuromuscular blocker administration compared to "ad hoc" management. A protocolized approach for improved quality of care should be considered in institutions adopting normothermia.
Assuntos
Febre , Pacotes de Assistência ao Paciente , Humanos , Masculino , Feminino , Pacotes de Assistência ao Paciente/normas , Pessoa de Meia-Idade , Idoso , Febre/terapia , Melhoria de Qualidade , Temperatura Corporal , Reanimação Cardiopulmonar/normas , Reanimação Cardiopulmonar/métodos , Parada Cardíaca/terapia , Parada Cardíaca/mortalidade , Unidades de Terapia Intensiva , Cuidados Críticos/normas , Cuidados Críticos/métodos , Protocolos Clínicos/normas , Resultado do TratamentoRESUMO
OBJECTIVES: To evaluate the prevalence of do-not-resuscitate status, assess the epidemiologic trends of do-not-resuscitate status, and assess the factors associated with do-not-resuscitate status in children after in-hospital cardiac arrest using large, multi-institutional data. DESIGN: Generalized estimating equations logistic regression model was used to evaluate the trends of do-not-resuscitate status and evaluate the factors associated with do-not-resuscitate status after cardiac arrest. SETTING: American Heart Association's Get With the Guidelines-Resuscitation Registry. PATIENTS: Children (< 18 yr old) with an index in-hospital cardiac arrest and greater than or equal to 1 minute of documented chest compressions were included (2006-2015). Patients with no return of spontaneous circulation after cardiac arrest were excluded. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: In total, 8,062 patients qualified for inclusion. Of these, 1,160 patients (14.4%) adopted do-not-resuscitate status after cardiac arrest. We found low rates of survival to hospital discharge among children with do-not-resuscitate status (do-not-resuscitate vs no do-not-resuscitate: 6.0% vs 69.7%). Our study found that rates of do-not-resuscitate status after cardiac arrest are highest in children with Hispanic ethnicity (16.4%), white race (15.0%), and treatment at institutions with larger PICUs (> 50 PICU beds: 17.8%) and at institutions located in North Central (17.6%) and South Atlantic/Puerto Rico (17.1%) regions of the United States. Do-not-resuscitate status was more common among patients with more preexisting conditions, longer duration of cardiac arrest, greater than 1 cardiac arrest, and among patients requiring extracorporeal cardiopulmonary resuscitation. We also found that trends of do-not-resuscitate status after cardiac arrest in children are decreasing in recent years (2013-2015: 13.8%), compared with previous years (2006-2009: 16.0%). CONCLUSIONS: Patient-, hospital-, and regional-level factors are associated with do-not-resuscitate status after pediatric cardiac arrest. As cardiac arrest might be a signal of terminal chronic illness, a timely discussion of do-not-resuscitate status after cardiac arrest might help families prioritize quality of end-of-life care.
Assuntos
Criança Hospitalizada/estatística & dados numéricos , Parada Cardíaca/terapia , Hospitais Pediátricos/estatística & dados numéricos , Ordens quanto à Conduta (Ética Médica) , Adolescente , American Heart Association , Criança , Pré-Escolar , Feminino , Parada Cardíaca/mortalidade , Hospitais Pediátricos/normas , Humanos , Lactente , Masculino , Alta do Paciente/estatística & dados numéricos , Guias de Prática Clínica como Assunto , Características de Residência , Fatores Socioeconômicos , Estados Unidos/epidemiologiaRESUMO
The International Liaison Committee on Resuscitation has initiated a near-continuous review of cardiopulmonary resuscitation science that replaces the previous 5-year cyclic batch-and-queue approach process. This is the first of an annual series of International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations summary articles that will include the cardiopulmonary resuscitation science reviewed by the International Liaison Committee on Resuscitation in the previous year. The review this year includes 5 basic life support and 1 pediatric Consensuses on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Each of these includes a summary of the science and its quality based on Grading of Recommendations, Assessment, Development, and Evaluation criteria and treatment recommendations. Insights into the deliberations of the International Liaison Committee on Resuscitation task force members are provided in Values and Preferences sections. Finally, the task force members have prioritized and listed the top 3 knowledge gaps for each population, intervention, comparator, and outcome question.
Assuntos
Cardiologia/normas , Reanimação Cardiopulmonar/normas , Serviços Médicos de Emergência/normas , Medicina de Emergência/normas , Medicina Baseada em Evidências/normas , Parada Cardíaca/terapia , Fatores Etários , Consenso , Parada Cardíaca/diagnóstico , Parada Cardíaca/mortalidade , Humanos , Parada Cardíaca Extra-Hospitalar/diagnóstico , Parada Cardíaca Extra-Hospitalar/mortalidade , Parada Cardíaca Extra-Hospitalar/terapia , Resultado do TratamentoRESUMO
Although perimortem delivery has been recorded in the medical literature for millennia, the procedural intent has evolved to the current fetocentric approach, predicating timing of delivery following maternal cardiopulmonary arrest to optimize neonatal outcome. We suggest a call to action to reinforce the concept that if the uterus is palpable at or above the umbilicus, preparations for delivery should be made simultaneous with initiation of maternal resuscitative efforts; if maternal condition is not rapidly reversible, hysterotomy with delivery should be performed regardless of fetal viability or elapsed time since arrest. Cognizant of the difficulty in determining precise timing of arrest in clinical practice, if fetal status is already compromised further delay while attempting to assess fetal heart rate, locating optimal surgical equipment, or transporting to an operating room will result in unnecessary worsening of both maternal and fetal condition. Even if intrauterine demise has already occurred, maternal resuscitative efforts will typically be markedly improved following delivery with uterine decompression. Consequently we suggest that perimortem cesarean delivery be renamed "resuscitative hysterotomy" to reflect the mutual optimization of resuscitation efforts that would potentially provide earlier and more substantial benefit to both mother and baby.
Assuntos
Cesárea , Parada Cardíaca/terapia , Histerotomia , Complicações Cardiovasculares na Gravidez/terapia , Resultado da Gravidez , Ressuscitação/normas , Acidentes de Trânsito , Adulto , Suporte Vital Cardíaco Avançado , Algoritmos , Embolia Amniótica/terapia , Feminino , Morte Fetal/prevenção & controle , Parada Cardíaca/mortalidade , Humanos , Guias de Prática Clínica como Assunto , Gravidez , Prognóstico , Ressuscitação/métodosRESUMO
'Calling' a code can be an ambiguous undertaking. Despite guidelines and the medical literature outlining when it is acceptable to stop resuscitation, code cessation and deciding what not to do during a code, in practice, is an art form. Familiarity with classic evidence suggesting most codes are unsuccessful may influence decisions about when to terminate resuscitative efforts, in effect enacting self-fulfilling prophesies. Code interventions and duration may be influenced by patient demographics, gender or a concern about the stewardship of scarce resources. Yet, recent evidence links longer code duration with improved outcomes, and advances in resuscitation techniques complicate attempts to standardise both resuscitation length and the application of advanced interventions. In this context of increasing clinical and moral uncertainty, discussions between patients, families and medical providers about resuscitation plans take on an increased degree of importance. For some patients, a 'bespoke' resuscitation plan may be in order.
Assuntos
Diretivas Antecipadas/ética , Reanimação Cardiopulmonar , Parada Cardíaca/prevenção & controle , Futilidade Médica/ética , Ordens quanto à Conduta (Ética Médica)/ética , Suspensão de Tratamento/ética , Atitude do Pessoal de Saúde , Reanimação Cardiopulmonar/ética , Reanimação Cardiopulmonar/métodos , Serviços Médicos de Emergência , Parada Cardíaca/mortalidade , Humanos , Futilidade Médica/psicologia , Suspensão de Tratamento/estatística & dados numéricosRESUMO
OBJECTIVES: To perform an updated meta-analysis of observational studies with unstratified cohort addressing whether compression-only cardiopulmonary resuscitation (CPR), compared with standard CPR, improves outcomes in adult patients with out-of-hospital cardiac arrest and a subgroup meta-analysis for the patients with cardiac etiology arrest. METHODS: We searched the relevant literature from MEDLINE and EMBASE databases. The baseline information and outcome data (survival to hospital discharge, favorable neurologic outcome at hospital discharge, and return of spontaneous circulation on hospital arrival) were extracted both in an out-of-hospital cardiac arrest and cardiac origin arrest subgroup. Meta-analyses were performed by using Review Manager 5.0. RESULTS: Eight studies involving 92,033 patients were eligible. Overall meta-analysis showed that standard CPR was associated with statistically improved survival to hospital discharge (risk ratio [RR], 0.95 [95% confidence interval, 0.91-0.99]) and return of spontaneous circulation on hospital arrival (RR, 0.95 [95% confidence interval, 0.92-0.99]) compared with compression-only CPR, but there is no significant difference in favorable neurologic outcome at hospital discharge between 2 CPR methods (RR, 0.97 [95% confidence interval, 0.91-1.04]). In the subgroup of patients with a cardiac cause of arrest, the pooled meta-analysis found compression-only CPR resulted in the similar survival to hospital discharge as standard CPR (RR, 0.99 [95% confidence interval, 0.94-1.05]). CONCLUSIONS: This meta-analysis found that compression-only CPR resulted in the similar survival rate as the standard CPR in the cardiac etiology subgroup. It is unclear for the patients with noncardiac cause of arrest and with long periods of untreated arrest.
Assuntos
Reanimação Cardiopulmonar , Massagem Cardíaca , Adulto , Parada Cardíaca/mortalidade , Parada Cardíaca/terapia , Humanos , Parada Cardíaca Extra-Hospitalar/mortalidade , Parada Cardíaca Extra-Hospitalar/terapia , Resultado do TratamentoRESUMO
OBJECTIVES: To investigate the effect of medical student involvement on the quality of actual cardiopulmonary resuscitation (CPR). METHODS: A digital video-recording system was used to record and analyze CPR procedures for adult patients from March 2011 to September 2012. RESULTS: Twenty-six student-involved and 40 non-student-involved cases were studied. The chest compression rate in the student-involved group was significantly higher than that in the non-student-involved group (P < .001). The proportion of compressions at "above 110 cpm" was higher in the student-involved group (P = .021), whereas the proportion at "90-110 cpm" was lower in the student-involved group (P = .015). The ratio of hands-off time to total manual compression time was significantly lower in the student-involved group than in the non-student-involved group (P = .04). In contrast, the student-involved group delivered a higher ventilation rate compared with the non-student-involved group (P = .02). The observed time delay to first compression and first ventilation were very similar between the groups. There were no significant differences between the groups in either return of spontaneous circulation or time from survival to discharge. CONCLUSION: Student-involved resuscitation teams were able to perform good CPR, with higher compression rates and fewer interruptions. However, the supervision from medical staff is still needed to ensure appropriate chest compression and ventilation rate in student-involved actual CPR in the emergency department.
Assuntos
Reanimação Cardiopulmonar/normas , Competência Clínica , Parada Cardíaca/terapia , Estudantes de Medicina , Reanimação Cardiopulmonar/educação , Serviço Hospitalar de Emergência , Feminino , Parada Cardíaca/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Gravação em Vídeo , Adulto JovemRESUMO
Out-of-hospital cardiac arrest continues to be an important public health problem, with large and important regional variations in outcomes. Survival rates vary widely among patients treated with out-of-hospital cardiac arrest by emergency medical services and among patients transported to the hospital after return of spontaneous circulation. Most regions lack a well-coordinated approach to post-cardiac arrest care. Effective hospital-based interventions for out-of-hospital cardiac arrest exist but are used infrequently. Barriers to implementation of these interventions include lack of knowledge, experience, personnel, resources, and infrastructure. A well-defined relationship between an increased volume of patients or procedures and better outcomes among individual providers and hospitals has been observed for several other clinical disorders. Regional systems of care have improved provider experience and patient outcomes for those with ST-elevation myocardial infarction and life-threatening traumatic injury. This statement describes the rationale for regional systems of care for patients resuscitated from cardiac arrest and the preliminary recommended elements of such systems. Many more people could potentially survive out-of-hospital cardiac arrest if regional systems of cardiac resuscitation were established. A national process is necessary to develop and implement evidence-based guidelines for such systems that must include standards for the categorization, verification, and designation of components of such systems. The time to do so is now.
Assuntos
Serviços Médicos de Emergência/métodos , Parada Cardíaca/terapia , Serviços Médicos de Emergência/organização & administração , Parada Cardíaca/mortalidade , Humanos , Infarto do Miocárdio/mortalidade , Infarto do Miocárdio/terapia , Saúde Pública/métodos , Ressuscitação/métodos , Estados Unidos , Ferimentos e Lesões/mortalidade , Ferimentos e Lesões/terapiaRESUMO
The automated external defibrillator (AED), in combination with effective cardiopulmonary resuscitation (CPR), is a critical part of the American Heart Association's "Chain of survival." Newer guidelines have simplified resuscitation and emphasized the importance of CPR in providing rapid and deep compressions with minimal interruptions; in fact, CPR should resume immediately after the shock given by the AED, without the delay entailed in checking for pulse or rhythm conversion. Our experience with the AED aboard aircraft, showing 40% long-term survival with the AED in ventricular fibrillation, demonstrated the safety and efficacy of the device. Despite this and other reports of successful AED deployment, AEDs are not yet available at all public locations. Prospective research, as undertaken by the Resuscitation Outcomes Consortium, will be the key to future refinements of the guidelines and enhanced survival with use of the AED in sudden cardiac arrest.
Assuntos
Reanimação Cardiopulmonar/métodos , Desfibriladores , Cardioversão Elétrica/instrumentação , Serviços Médicos de Emergência , Parada Cardíaca/terapia , Aeronaves , American Heart Association , Reanimação Cardiopulmonar/normas , Desfibriladores/normas , Cardioversão Elétrica/normas , Serviços Médicos de Emergência/normas , Acessibilidade aos Serviços de Saúde , Parada Cardíaca/mortalidade , Humanos , Guias de Prática Clínica como Assunto , Resultado do Tratamento , Estados UnidosRESUMO
Despite the passage of 50 years since the introduction of closed chest compression and mouth-to-mouth rescue breathing as the techniques of modern cardiopulmonary resuscitation (CPR), the simple techniques remain the backbone of successful resuscitation of victims of cardiac arrest. In particular, the importance of high quality chest compressions is increasingly clear. Current evidence demonstrates chest compressions should be provided at a rate of 100 compressions a minute to a depth of 4 to 5 cm (1.5 to 2 inches) with full chest recoil between compressions. Additionally, all efforts should be made to minimize interruptions in chest compressions, including single shock defibrillation and elimination of pulse check postdefibrillation in favor of continued chest compressions immediately postshock. The emphasis on high quality chest compressions is echoed in the most recent CPR guidelines of the American Heart Association and the International Liaison Committee on Resuscitation. The role of rescue breathing is currently debated; however, it is likely important in prolonged arrests or those of non-cardiac etiology. Current recommendations encourage inclusion of rescue breaths by trained responders, but allow for elimination of rescue breathing and emphasis on chest compressions for responders untrained or unconfident in rescue breathing. Early defibrillation is a key component to successful resuscitation of ventricular tachycardia and ventricular fibrillation arrest; however, implementation of defibrillation should be coordinated with CPR to minimize interruptions in chest compressions. Aside from early defibrillation, there are no clear adjuncts to CPR that improve survival. However, postresuscitation therapies such as therapeutic hypothermia may become an important part of early resuscitation management as tools to provide hypothermia become increasingly portable and capable of rapid cooling.
Assuntos
Reanimação Cardiopulmonar/métodos , Reanimação Cardiopulmonar/tendências , Parada Cardíaca/terapia , Algoritmos , American Heart Association , Reanimação Cardiopulmonar/normas , Cardioversão Elétrica/métodos , Guias como Assunto , Parada Cardíaca/mortalidade , Humanos , Hipotermia Induzida , Resultado do Tratamento , Estados UnidosRESUMO
The 2010 impact goal of the American Heart Association is to reduce death rates from heart disease and stroke by 25% and to lower the prevalence of the leading risk factors by the same proportion. Much of the burden of acute heart disease is initially experienced out of hospital and can be reduced by timely delivery of effective prehospital emergency care. Many patients with an acute myocardial infarction die from cardiac arrest before they reach the hospital. A small proportion of those with cardiac arrest who reach the hospital survive to discharge. Current health surveillance systems cannot determine the burden of acute cardiovascular illness in the prehospital setting nor make progress toward reducing that burden without improved surveillance mechanisms. Accordingly, the goals of this article provide a brief overview of strategies for managing out-of-hospital cardiac arrest. We review existing surveillance systems for monitoring progress in reducing the burden of out-of-hospital cardiac arrest in the United States and make recommendations for filling significant gaps in these systems, including the following: 1. Out-of-hospital cardiac arrests and their outcomes through hospital discharge should be classified as reportable events as part of a heart disease and stroke surveillance system. 2. Data collected on patients' encounters with emergency medical services systems should include descriptions of the performance of cardiopulmonary resuscitation by bystanders and defibrillation by lay responders. 3. National annual reports on key indicators of progress in managing acute cardiovascular events in the out-of-hospital setting should be developed and made publicly available. Potential barriers to action on cardiac arrest include concerns about privacy, methodological challenges, and costs associated with designating cardiac arrest as a reportable event.
Assuntos
American Heart Association , Serviços Médicos de Emergência/estatística & dados numéricos , Serviços Médicos de Emergência/normas , Parada Cardíaca/mortalidade , Notificação de Abuso , Humanos , Saúde Pública/normas , Saúde Pública/estatística & dados numéricos , Qualidade da Assistência à Saúde , Estados Unidos/epidemiologiaRESUMO
Experimental studies on therapeutic hypothermia in acute brain injury reported positive outcomes and identified two potential benefits, namely, reduction in seizure incidence and in intracranial pressure. Translating this evidence to humans is challenging, especially for conditions in pediatric patients, such as cardiac arrest, traumatic brain injury, and status epilepticus, among others. This narrative review aimed to discuss the current indications and benefits of therapeutic hypothermia in acute brain injury in the pediatric population (i.e., beyond the neonatal period) by analyzing the neurologic outcome and mortality data obtained from previous studies.
Assuntos
Lesões Encefálicas/terapia , Parada Cardíaca/terapia , Hipotermia Induzida , Estado Epiléptico/terapia , Lesões Encefálicas/mortalidade , Criança , Parada Cardíaca/mortalidade , Humanos , Estado Epiléptico/mortalidade , Resultado do TratamentoRESUMO
BACKGROUND: After resuscitation of cardiac arrest (CA), an acute circulatory failure occurs in about 50% of cases, which shares many characteristics with septic shock. Most frequently, supportive treatments are poorly efficient to prevent multiple organ failure and death. We evaluated whether an early plasma removal of inflammatory mediators using high cut-off continuous veno-venous hemodialysis (HCO-CVVHD) could improve hemodynamic status and outcome of these patients. PATIENTS AND METHODS: We performed a randomized open-label trial. Patients with post-cardiac arrest shock (defined as requirement of norepinephrine or epinephrine infusion > 1 mg/h) were included. The experimental group received 2 distinct sessions of HCO-CVVHD during the first 48 h following ICU admission. The control group received continuous veno-venous hemofiltration (CVVH) with standard membranes if needed. The primary endpoint was the delay to shock resolution asssessed by the length of catecholamine infusion. Number of vasopressors-free days at day 28, arterial blood pressure measures every 6-hours, daily fluid balance and mortality (ICU and day-28) were evaluated as secondary endpoints. RESULTS: 35 patients were included: 17 (median age 68.4, 59% male) in the HCO-CVVHD group and 18 (median age 66.3, 83% male) in the control group. Baseline characteristics did not differ between the two groups. Day-28 mortality rate was 64.7% and 72.2% in the HCO-CVVHD and control group, respectively (p = 0.72). Probability of vasopressors discontinuation over time was similar in the two groups (p for logrank test = 0.67). Number of day-28 catecholamine-free days was 25.1 [0, 26.5] and 24.5 [0, 26.2] in the HCO-CVVHD and control group, respectively (p = 0.65). No difference was observed regarding the daily-dose of vasopressors, arterial pressure profile and fluid balance. CONCLUSION: In cardiac arrest patients, HCO-CVVHD did not decrease the lenght of post-resuscitation shock and had no significant effect on hemodynamic profile. REGISTRATION: NCT00780299.
Assuntos
Reanimação Cardiopulmonar/efeitos adversos , Terapia de Substituição Renal Contínua/métodos , Insuficiência de Múltiplos Órgãos/prevenção & controle , Idoso , Citocinas/sangue , Feminino , Parada Cardíaca/complicações , Parada Cardíaca/mortalidade , Parada Cardíaca/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência de Múltiplos Órgãos/etiologiaRESUMO
On June 10, 2019, Mohammed Sayeed, a 75-year-old patient was admitted to the Nil Ratan Sircar Medical College and Hospital, Kolkata, West Bengal (1). He died that night due to a cardiac arrest and this led to a scuffle between the patient's family and duty doctors. In retaliation, the doctors refused to discharge the body, asserting that since the family claimed it was a suspicious death, a post-mortem was required. A mob arrived, and in the confrontation, a doctor was injured. The medicos struck work. Doctors and medical associations across the country have voiced unanimous support for the doctors, and called for protective legislation against the violence of the public. As a consequence of these nationwide doctors' protests, the Supreme Court has now proposed a law that protects doctors by severely punishing those who attack them (2). Meanwhile, it does seem as if such attacks are increasing.
Assuntos
Família/psicologia , Parada Cardíaca/mortalidade , Imperícia , Médicos/psicologia , Relações Profissional-Família , Violência no Trabalho/legislação & jurisprudência , Violência no Trabalho/prevenção & controle , Adulto , Idoso , Feminino , Humanos , Índia , Masculino , Pessoa de Meia-IdadeRESUMO
OBJECTIVE: To study the geographic size of out-of-hours districts, the availability of defibrillators and use of the national radio network in Norway. DESIGN: Survey. SETTING: The emergency primary healthcare system in Norway. SUBJECTS: A total of 282 host municipalities responsible for 260 out-of-hours districts. MAIN OUTCOME MEASURES: Size of out-of-hours districts, use of national radio network and access to a defibrillator in emergency situations. RESULTS: The out-of-hours districts have a wide range of areas, which gives a large variation in driving time for doctors on call. The median longest transport time for doctors in Norway is 45 minutes. In 46% of out-of-hours districts doctors bring their own defibrillator on emergency callouts. Doctors always use the national radio network in 52% of out-of-hours districts. Use of the radio network and access to a defibrillator are significantly greater in out-of-hours districts with a host municipality of fewer then 5000 inhabitants compared with host municipalities of more than 20,000 inhabitants. CONCLUSION: In half of out-of-hours districts doctors on call always use the national radio network. Doctors in out-of-hours districts with a host municipality of fewer than 5000 inhabitants are in a better state of readiness to attend an emergency, compared with doctors working in larger host municipalities.
Assuntos
Plantão Médico , Desfibriladores/estatística & dados numéricos , Cardioversão Elétrica/estatística & dados numéricos , Serviços Médicos de Emergência , Medicina de Família e Comunidade , Atenção Primária à Saúde , Ambulâncias , Sistemas de Comunicação entre Serviços de Emergência/estatística & dados numéricos , Parada Cardíaca/mortalidade , Parada Cardíaca/terapia , Humanos , Noruega , Papel do Médico , Médicos de Família , Meios de TransporteRESUMO
Commentary is provided on the pivotal paper by Weinsier and Krumdieck from 1981 describing 2 patients who developed profound and fatal refeeding syndrome following initiation of aggressive total parenteral nutrition. This classic description was among the first to describe the overwhelming cardiovascular and pulmonary manifestations that can accompany parenteral refeeding with carbohydrate in chronically malnourished patients. The syndrome has also been described with oral and enteral nutrition. One of the hallmarks of the syndrome is hypophosphatemia. Since 1981, dosing schemes for addressing hypophosphatemia have been refined. Other manifestations of the syndrome include other electrolyte abnormalities such as hypokalemia and hypomagnesemia, hyperglycemia, fluid and sodium retention, and neurologic and hematologic complications. Case reports of refeeding syndrome continue to be published, particularly in the anorexia nervosa population. Stressed, critically ill patients may be at risk of refeeding following short periods of fasting; hypophosphatemia is commonly encountered in this situation. It behooves the current nutrition support practitioner to keep in mind the types of patients at risk of refeeding syndrome and to approach refeeding of such patients with caution and careful monitoring.
Assuntos
Hipofosfatemia/prevenção & controle , Doenças Metabólicas/etiologia , Distúrbios Nutricionais/terapia , Nutrição Parenteral/efeitos adversos , Fosfatos/administração & dosagem , Nutrição Enteral/efeitos adversos , Parada Cardíaca/etiologia , Parada Cardíaca/mortalidade , Humanos , Hipofosfatemia/complicações , Doenças Metabólicas/mortalidade , Distúrbios Nutricionais/complicações , Distúrbios Nutricionais/mortalidade , Fosfatos/sangueRESUMO
The objective of this study was to evaluate the outcomes and associated factors for short-term success and long-term survival rates of resuscitated non-traumatic out-of-hospital cardiac arrest (OHCAs) in Denizli, Turkey. All non-traumatic OHCA patients from the Emergency Departments of the Pamukkale University and City Hospitals between the dates of January 1, 2004 and March 1, 2005 were included in this study. A successful outcome was defined as the return of spontaneous circulation or breathing, or evidence of a palpable pulse or a measurable blood pressure. Information on post-resuscitation long-term survival up to 9 months also was obtained by telephone. A total of 222 adults experiencing OHCAs were resuscitated. The number of successful outcomes was 85 (38.3%); 25 (11.2%) were discharged alive; and 21 (9.4%) were alive at the 9-month follow-up. The predicted mean arrest time was 11.7 min (95% confidence interval 10.27-13.2). Type of transportation to the Emergency Department (ambulance, 32.1% vs. private vehicle, 44.5%; p = 0.057), place of arrest (home, 32.6% vs. other, 44.0%; p = 0.08), first rhythm at the scene (asystole, 22.9% vs. ventricular fibrillation-pulseless ventricular tachycardia, 48.0%, vs. pulseless electrical activity, 12.5%; p = 0.056), and advanced cardiac life support starting time (the first 8 min, 46.8% vs. later than 8 min, 32.0%; p = 0.025) had an effect on outcome. Intensive public education for diagnosis and appropriate reporting of OHCA, the importance of bystander cardiopulmonary resuscitation, and the use of automated external defibrillators have an impact on the potential to increase the number of survivors.