RESUMO
BACKGROUND: Endovascular therapeutic hypothermia (ETH) reduces the damage by ischemia/reperfusion cell syndrome in cardiac arrest and has been studied as an adjuvant therapy to percutaneous coronary intervention (PCI) in ST-elevation myocardial infarction (STEMI). New available advanced technology allows cooling much faster, but there is paucity of resources for training to avoid delays in door-to-balloon time (DTB) due to ETH and subsequently coronary reperfusion, which would derail the procedure. The aim of the study was to describe the process for the development of a simulation, training & educational protocol for the multidisciplinary team to perform optimized ETH as an adjunctive therapy for STEMI. METHODS AND RESULTS: We developed an optimized simulation protocol using modern mannequins in different realistic scenarios for the treatment of patients undergoing ETH adjunctive to PCI for STEMIs starting from the emergency room, through the CathLab, and to the intensive care unit (ICU) using the Proteus® Endovascular System (Zoll Circulation Inc™, San Jose, CA, USA). The primary endpoint was door-to-balloon (DTB) time. We successfully trained 361 multidisciplinary professionals in realistic simulation using modern mannequins and sham situations in divisions of the hospital where real patients would be treated. The focus of simulation and training was logistical optimization and educational debriefing with strategies to reduce waste of time in patient's transportation from different departments, and avoiding excessive rewarming during transfer. Afterwards, the EHT protocol was successfully validated in a trial randomizing 50 patients for 18 minutes cooling before coronary recanalization at the target temperature of 32 ± 1.0 ∘C or PCI-only. A total of 35 patients underwent ETH (85.7% [30/35] in 90 ± 15 minutes), without delays in the mean door-to-balloon time for primary PCI when compared to 15 control group patients (92.1 minutes versus 87 minutes, respectively; p = 0.509). CONCLUSIONS: Realistic simulation, intensive training and educational debriefing for the multidisciplinary team propitiated feasible endovascular therapeutic hypothermia as an adjuvant therapy to primary PCI in STEMI. CLINICALTRIALS: gov: NCT02664194.
Assuntos
Hipotermia Induzida , Infarto do Miocárdio , Intervenção Coronária Percutânea , Infarto do Miocárdio com Supradesnível do Segmento ST , Humanos , Hipotermia Induzida/efeitos adversos , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/terapia , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/métodos , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Fatores de Tempo , Resultado do TratamentoRESUMO
Este estudo, do tipo exploratório-descritivo, teve por objetivos avaliar a aplicabilidade do Nursing Activities Score como instrumento de medida da carga de trabalho na assistência aos pacientes da categoria de cuidados alta dependência de enfermagem e relacionar a pontuação média obtida com os tempos médios de assistência preconizados pelo Conselho Federal de Enfermagem. A coleta de dados para a determinação da pontuação do Nursing Activities Score ocorreu no período de 13 de julho a 01 de agosto de 2007, por meio de consulta aos prontuários dos pacientes internados na enfermaria de alta dependência de uma Unidade de Clínica Médica. A análise dos dados foi realizada mediante estatística descritiva e medida de variabilidade. O instrumento demonstrou ser aplicável a esses pacientes, sendo necessário o estabelecimento de diretrizes para a sua aplicação. Concluiu-se que o paciente classificado como alta dependência de enfermagem necessita, em média, de 12,3 horas de assistência nas 24 horas.
The objectives of this exploratory-descriptive study were to evaluate the applicability of the Nursing Activities Score as an instrument to measure workload in caring for patients classified into the category of high dependency on nursing care and to correlate the obtained mean scores with mean time of assistance proclaimed by the Brazilian Federal Nursing Council. Data was collected to determine the Nursing Activities Score in the period from July 13th to August 1, 2007 through means of consulting the patient charts of those interned in the high dependency ward of an out-patient clinic of a Medical Clinical Unit. Data analysis was performed by descriptive statistics and measure of variability. The instrument was effective for these patients, while the establishment of guidelines was needed for its application. It was concluded that the patient classified as high dependant on nursing care needs on average of 12.3 hours of assistance within a 24-hour period.
Estudio de tipo exploratorio-descriptivo, cuyos objetivos fueron: evaluar la aplicabilidad del Nursing Activities Score como instrumento de medida de la carga de trabajo en la asistencia a los pacientes de la categoría de cuidados de alta dependencia de enfermería, y además, relacionar la puntuación media obtenida con los tiempos medios de asistencia establecidos por el Consejo Federal de Enfermería. La recolección de los datos fue hecha en el período de 13 de julio a 1 de agosto de 2007, por medio de la consulta a los prontuarios de los pacientes internados en la enfermería de alta dependencia de una Unidad de Clínica Médica. El análisis de los datos se realizó por estadística descriptiva y por la medida de la variabilidad. El instrumento de análisis mostró ser eficaz para esos pacientes, siendo necesario el establecimiento de directrices para su aplicación. Este estudio concluyó que el paciente clasificado como de alta dependencia de enfermería necesita una media de 12,3 horas de asistencia, en un período de 24 horas.
