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1.
Circulation ; 149(8): e914-e933, 2024 02 20.
Artículo en Inglés | MEDLINE | ID: mdl-38250800

RESUMEN

Every 10 years, the American Heart Association (AHA) Emergency Cardiovascular Care Committee establishes goals to improve survival from cardiac arrest. These goals align with broader AHA Impact Goals and support the AHA's advocacy efforts and strategic investments in research, education, clinical care, and quality improvement programs. This scientific statement focuses on 2030 AHA emergency cardiovascular care priorities, with a specific focus on bystander cardiopulmonary resuscitation, early defibrillation, and neurologically intact survival. This scientific statement also includes aspirational goals, such as establishing cardiac arrest as a reportable disease and mandating reporting of standardized outcomes from different sources; advancing recognition of and knowledge about cardiac arrest; improving dispatch system response, availability, and access to resuscitation training in multiple settings and at multiple time points; improving availability, access, and affordability of defibrillators; providing a focus on early defibrillation, in-hospital programs, and establishing champions for debriefing and review of cardiac arrest events; and expanding measures to track outcomes beyond survival. The ability to track and report data from these broader aspirational targets will potentially require expansion of existing data sets, development of new data sets, and enhanced integration of technology to collect process and outcome data, as well as partnerships of the AHA with national, state, and local organizations. The COVID-19 (coronavirus disease 2019) pandemic, disparities in COVID-19 outcomes for historically excluded racial and ethnic groups, and the longstanding disparities in cardiac arrest treatment and outcomes for Black and Hispanic or Latino populations also contributed to an explicit focus and target on equity for the AHA Emergency Cardiovascular Care 2030 Impact Goals.


Asunto(s)
COVID-19 , Reanimación Cardiopulmonar , Servicios Médicos de Urgencia , Paro Cardíaco , Paro Cardíaco Extrahospitalario , Estados Unidos/epidemiología , Humanos , American Heart Association , Objetivos , Paro Cardíaco/terapia , COVID-19/terapia , Paro Cardíaco Extrahospitalario/terapia
2.
N Engl J Med ; 387(17): 1569-1578, 2022 10 27.
Artículo en Inglés | MEDLINE | ID: mdl-36300973

RESUMEN

BACKGROUND: Differences in the incidence of cardiopulmonary resuscitation (CPR) provided by bystanders contribute to survival disparities among persons with out-of-hospital cardiac arrest. It is critical to understand whether the incidence of bystander CPR in witnessed out-of-hospital cardiac arrests at home and in public settings differs according to the race or ethnic group of the person with cardiac arrest in order to inform interventions. METHODS: Within a large U.S. registry, we identified 110,054 witnessed out-of-hospital cardiac arrests during the period from 2013 through 2019. We used a hierarchical logistic regression model to analyze the incidence of bystander CPR in Black or Hispanic persons as compared with White persons with witnessed cardiac arrests at home and in public locations. We analyzed the overall incidence as well as the incidence according to neighborhood racial or ethnic makeup and income strata. Neighborhoods were classified as predominantly White (>80% of residents), majority Black or Hispanic (>50% of residents), or integrated, and as high income (an annual median household income of >$80,000), middle income ($40,000-$80,000), or low income (<$40,000). RESULTS: Overall, 35,469 of the witnessed out-of-hospital cardiac arrests (32.2%) occurred in Black or Hispanic persons. Black and Hispanic persons were less likely to receive bystander CPR at home (38.5%) than White persons (47.4%) (adjusted odds ratio, 0.74; 95% confidence interval [CI], 0.72 to 0.76) and less likely to receive bystander CPR in public locations than White persons (45.6% vs. 60.0%) (adjusted odds ratio, 0.63; 95% CI, 0.60 to 0.66). The incidence of bystander CPR among Black and Hispanic persons was less than that among White persons not only in predominantly White neighborhoods at home (adjusted odds ratio, 0.82; 95% CI, 0.74 to 0.90) and in public locations (adjusted odds ratio, 0.68; 95% CI, 0.60 to 0.75) but also in majority Black or Hispanic neighborhoods at home (adjusted odds ratio, 0.79; 95% CI, 0.75 to 0.83) and in public locations (adjusted odds ratio, 0.63; 95% CI, 0.59 to 0.68) and in integrated neighborhoods at home (adjusted odds ratio, 0.78; 95% CI, 0.74 to 0.81) and in public locations (adjusted odds ratio, 0.73; 95% CI, 0.68 to 0.77). Similarly, across all neighborhood income strata, the frequency of bystander CPR at home and in public locations was lower among Black and Hispanic persons with out-of-hospital cardiac arrest than among White persons. CONCLUSIONS: In witnessed out-of-hospital cardiac arrest, Black and Hispanic persons were less likely than White persons to receive potentially lifesaving bystander CPR at home and in public locations, regardless of the racial or ethnic makeup or income level of the neighborhood where the cardiac arrest occurred. (Funded by the National Heart, Lung, and Blood Institute.).


Asunto(s)
Población Negra , Reanimación Cardiopulmonar , Hispánicos o Latinos , Paro Cardíaco Extrahospitalario , Población Blanca , Humanos , Reanimación Cardiopulmonar/estadística & datos numéricos , Servicios Médicos de Urgencia/estadística & datos numéricos , Hispánicos o Latinos/estadística & datos numéricos , Renta/estadística & datos numéricos , Paro Cardíaco Extrahospitalario/epidemiología , Paro Cardíaco Extrahospitalario/etnología , Paro Cardíaco Extrahospitalario/terapia , Características de la Residencia/estadística & datos numéricos , Factores Raciales/estadística & datos numéricos , Incidencia , Estados Unidos/epidemiología , Sistema de Registros/estadística & datos numéricos , Población Blanca/estadística & datos numéricos , Población Negra/estadística & datos numéricos
3.
Circulation ; 148(12): 982-988, 2023 09 19.
Artículo en Inglés | MEDLINE | ID: mdl-37584195

RESUMEN

Targeted temperature management has been a cornerstone of post-cardiac arrest care for patients remaining unresponsive after return of spontaneous circulation since the initial trials in 2002 found that mild therapeutic hypothermia improves neurological outcome. The suggested temperature range expanded in 2015 in response to a large trial finding that outcomes were not better with treatment at 33° C compared with 36° C. In 2021, another large trial was published in which outcomes with temperature control at 33° C were not better than those of patients treated with a strategy of strict normothermia. On the basis of these new data, the International Liaison Committee on Resuscitation and other organizations have altered their treatment recommendations for temperature management after cardiac arrest. The new American Heart Association guidelines on this topic will be introduced in a 2023 focused update. To provide guidance to clinicians while this focused update is forthcoming, the American Heart Association's Emergency Cardiovascular Care Committee convened a writing group to review the TTM2 trial (Hypothermia Versus Normothermia After Out-of-Hospital Cardiac Arrest) in the context of other recent evidence and to present an opinion on how this trial may influence clinical practice. This science advisory was informed by review of the TTM2 trial, consideration of other recent influential studies, and discussion between cardiac arrest experts in the fields of cardiology, critical care, emergency medicine, and neurology. Conclusions presented in this advisory statement do not replace current guidelines but are intended to provide an expert opinion on novel literature that will be incorporated into future guidelines and suggest the opportunity for reassessment of current clinical practice.


Asunto(s)
Reanimación Cardiopulmonar , Hipotermia Inducida , Paro Cardíaco Extrahospitalario , Humanos , Adulto , Temperatura , American Heart Association , Coma/terapia , Paro Cardíaco Extrahospitalario/terapia , Sobrevivientes
4.
Circulation ; 147(24): 1854-1868, 2023 06 13.
Artículo en Inglés | MEDLINE | ID: mdl-37194575

RESUMEN

BACKGROUND: Basic life support education for schoolchildren has become a key initiative to increase bystander cardiopulmonary resuscitation rates. Our objective was to review the existing literature on teaching schoolchildren basic life support to identify the best practices to provide basic life support training in schoolchildren. METHODS: After topics and subgroups were defined, a comprehensive literature search was conducted. Systematic reviews and controlled and uncontrolled prospective and retrospective studies containing data on students <20 years of age were included. RESULTS: Schoolchildren are highly motivated to learn basic life support. The CHECK-CALL-COMPRESS algorithm is recommended for all schoolchildren. Regular training in basic life support regardless of age consolidates long-term skills. Young children from 4 years of age are able to assess the first links in the chain of survival. By 10 to 12 years of age, effective chest compression depths and ventilation volumes can be achieved on training manikins. A combination of theoretical and practical training is recommended. Schoolteachers serve as effective basic life support instructors. Schoolchildren also serve as multipliers by passing on basic life support skills to others. The use of age-appropriate social media tools for teaching is a promising approach for schoolchildren of all ages. CONCLUSIONS: Schoolchildren basic life support training has the potential to educate whole generations to respond to cardiac arrest and to increase survival after out-of-hospital cardiac arrest. Comprehensive legislation, curricula, and scientific assessment are crucial to further develop the education of schoolchildren in basic life support.


Asunto(s)
Reanimación Cardiopulmonar , Paro Cardíaco Extrahospitalario , Niño , Humanos , Preescolar , Estudios Retrospectivos , Estudios Prospectivos , Reanimación Cardiopulmonar/educación , Escolaridad
5.
MMWR Morb Mortal Wkly Rep ; 73(9): 199-203, 2024 Mar 07.
Artículo en Inglés | MEDLINE | ID: mdl-38451858

RESUMEN

Approximately 1,000 out-of-hospital cardiac arrests (OHCAs) are assessed by emergency medical services in the United States every day, and approximately 90% of patients do not survive, leading to substantial years of potential life lost (YPLL). Chicago emergency medical services data were used to assess changes in mean age and YPLL from nontraumatic OHCA in adults in biennial cycles during 2014-2021. Among 21,070 reported nontraumatic OHCAs during 2014-2021, approximately 60% occurred among men and 57% among non-Hispanic Black or African American (Black) persons. YPLL increased from 52,044 during 2014-2015 to 88,788 during 2020-2021 (p = 0.002) and mean age decreased from 64.7 years during 2014-2015, to 62.7 years during 2020-2021. Decrease in mean age occurred among both men (p<0.001) and women (p = 0.002) and was largest among Black men. Mean age decreased among patients without presumed cardiac etiology from 56.3 to 52.5 years (p<0.001) and among patients with nonshockable rhythm from 65.5 to 62.7 years (p<0.001). Further study is needed to assess whether similar trends are occurring elsewhere, and to understand the mechanisms that underlie these trends in Chicago because these mechanisms could help guide prevention efforts. Increased public awareness of the risk of cardiac arrest and knowledge of how to intervene as a bystander could help decrease associated mortality.


Asunto(s)
Reanimación Cardiopulmonar , Servicios Médicos de Urgencia , Paro Cardíaco Extrahospitalario , Masculino , Adulto , Humanos , Femenino , Estados Unidos , Persona de Mediana Edad , Paro Cardíaco Extrahospitalario/epidemiología , Paro Cardíaco Extrahospitalario/terapia , Chicago/epidemiología , Esperanza de Vida
6.
Emerg Med J ; 41(4): 201-209, 2024 Mar 21.
Artículo en Inglés | MEDLINE | ID: mdl-38429072

RESUMEN

BACKGROUND: In many countries including the USA, the UK and Canada, the impact of COVID-19 on people of colour has been disproportionately high but examination of disparities in patients presenting to ED has been limited. We assessed racial and ethnic differences in COVID-19 positivity and outcomes in patients presenting to EDs in the USA, and the effect of the phase of the pandemic on these outcomes. METHODS: This is a retrospective cohort study of adult patients tested for COVID-19 during, or 14 days prior to, the index ED visit in 2020. Data were obtained from the National Registry of Suspected COVID-19 in Emergency Care network which has data from 155 EDs across 27 US states. Hierarchical models were used to account for clustering by hospital. The outcomes included COVID-19 diagnosis, hospitalisation at index visit, subsequent hospitalisation within 30 days and 30-day mortality. We further stratified the analysis by time period (early phase: March-June 2020; late phase: July-September 2020). RESULTS: Of the 26 111 adult patients, 38% were non-Hispanic White (NHW), 29% Black, 20% Hispanic/Latino, 3% Asian and 10% all others; half were female. The median age was 56 years (IQR 40-69), and 53% were diagnosed with COVID-19; of those, 59% were hospitalised at index visit. Of those discharged from ED, 47% had a subsequent hospitalisation in 30 days. Hispanic/Latino patients had twice (adjusted OR (aOR) 2.3; 95% CI 1.8 to 3.0) the odds of COVID-19 diagnosis than NHW patients, after adjusting for age, sex and comorbidities. Black, Asian and other minority groups also had higher odds of being diagnosed (compared with NHW patients). On stratification, this association was observed in both phases for Hispanic/Latino patients. Hispanic/Latino patients had lower odds of hospitalisation at index visit, but when stratified, this effect was only observed in early phase. Subsequent hospitalisation was more likely in Asian patients (aOR 3.1; 95% CI 1.1 to 8.7) in comparison with NHW patients. Subsequent ED visit was more likely in Blacks and Hispanic/Latino patients in late phase. CONCLUSION: We found significant differences in ED outcomes that are not explained by comorbidity burden. The gap decreased but persisted during the later phase in 2020.


Asunto(s)
COVID-19 , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Negro o Afroamericano , COVID-19/diagnóstico , COVID-19/epidemiología , Prueba de COVID-19 , Servicio de Urgencia en Hospital , Hispánicos o Latinos , Pandemias , Estudios Retrospectivos , Estados Unidos/epidemiología , Blanco , Asiático , Grupos Raciales , Anciano
7.
Health Promot Pract ; : 15248399241246550, 2024 May 11.
Artículo en Inglés | MEDLINE | ID: mdl-38733315

RESUMEN

Introduction. While racial NIH funding disparities have been identified, little is known about the link between community demographics of institutions and NIH funding. We sought to evaluate the association between institution zip code characteristics and NIH funding. Methods. We linked the 2011-2021 NIH RePORTER database to Census data. We calculated the funding to each institution and stratified institutions into funding quartiles. We defined out independent variables as institution ZIP code level race/ethnicity (White, Black, and Hispanic), and socioeconomic status (household income, high school graduation rate, and unemployment rate). We used ordinal regression models to evaluate the association between institution ZIP code characteristics and grant funding quartile. Results. We included 731,548 grants (US$271,495,839,744) from 3,971 ZIP codes. The funding amounts in millions of U.S. dollars for the funding quartiles were fourth - 0.25, third - 1.1, second - 3.8, first - 43.5. Using ordinal regression, we found an association between increasing unemployment rate (OR = 1.03 [1.02, 1.05]), increasing high school graduation rate (OR = 3.6 [1.6, 8.4]), decreasing proportion of White people (OR = 0.4 [0.3, 0.5]), increasing proportion of Black people (OR = 1.3 [0.9, 1.8]), and increasing proportion of Hispanic/Latine people (OR = 2.5 [1.7, 3.5]) and higher grant funding quartiles. We found no association between household income and grant funding quartile. Conclusion. We found ZIP code demographics to be inadequate for evaluating NIH funding disparities, and the association between institution ZIP code demographics and investigator demographics is unclear. To evaluate and improve grant funding disparities, better grant recipient data accessibility and transparency are needed.

8.
Am J Emerg Med ; 74: 27-31, 2023 12.
Artículo en Inglés | MEDLINE | ID: mdl-37748266

RESUMEN

BACKGROUND: Smoking, alcohol use, and non-prescription drug use are associated with worsened COVID-19 outcomes in hospitalized patients. Whether there is an association between substance use and outcomes in patients with COVID-19 who visited the Emergency Department (ED) but did not require hospitalization has not been well established. We investigated whether smoking, alcohol, and non-prescription drug use were associated with worsened COVID-19 outcomes among such patients presenting to the ED. METHODS: We conducted a secondary analysis of a clinical trial which sought to determine the effect of early convalescent plasma administration in patients presenting to the ED within 7 days of onset of mild COVID-19 symptoms. The study recruited 511 participants who were aged 50 years or older or had one or more risk factors for severe COVID-19. The primary outcome was disease progression within 15 days after randomization, which was defined as a composite of hospital admission for any reason, seeking emergency or urgent care, or death without hospitalization. Secondary outcomes included: no hospitalization within 30 days post-randomization, symptom worsening on the 5-category COVID-19 outpatient ordinal scale within 15 days post-randomization, and all-cause mortality. Substance use was categorized into either use or never use based on participant self-report. Logistic regression models were used to determine the association between substance use and outcomes. RESULTS: The mean age of the 511 patients enrolled was 52 years and the majority were females (274, 54%). Approximately 213 (42%) were non-Hispanic Whites, 156 (30%) Hispanics, 100 (20%) non-Hispanic Blacks, 18 (4%) non-Hispanic Asian, 8 (1%) American Indian Alaskan, and 16 (3%) unknown race. Tobacco 152 (30%) was the most common substance use reported. Alcohol use 36 (7%) and non-prescription drug use 33 (6%) were less common. Tobacco use and non-prescription drug use were associated with an increased risk for meeting the primary outcome ((tobacco: adjusted odds ratio [aOR] =2.08; 95% confidence interval [CI]: 1.37-3.15) and (drug: aOR =2.41; 95%CI: 1.17-5.00)) and increased risk for symptom worsening on the 5-category COVID-19 outpatient scale ((tobacco: aOR = 1.62; 95%CI: 1.09-2.42) and (drug: aOR = 2.32 95% CI: 1.10-4.87)) compared to non-use after adjusting for age, sex, plasma administration, and comorbidity. CONCLUSION: Tobacco and non-prescription drug use but not alcohol use were associated with worsened COVID-19 outcomes in patients who did not require hospitalization on their initial presentation. Future studies should determine the quantity, duration, and type of drug/tobacco use that may worsen COVID-19.


Asunto(s)
COVID-19 , Trastornos Relacionados con Sustancias , Femenino , Humanos , Masculino , Persona de Mediana Edad , COVID-19/epidemiología , COVID-19/terapia , Sueroterapia para COVID-19 , Hospitalización , Medicamentos sin Prescripción , Pacientes Ambulatorios , Trastornos Relacionados con Sustancias/epidemiología , Brote de los Síntomas
9.
Curr Opin Crit Care ; 28(3): 229-236, 2022 06 01.
Artículo en Inglés | MEDLINE | ID: mdl-35653242

RESUMEN

PURPOSE OF REVIEW: Out-of-hospital cardiac arrest (OHCA) is a time-critical emergency in which a rapid response following the chain of survival is crucial to save life. Disparities in care can occur at each link in this pathway and hence produce health inequities. This review summarises the health inequities that exist for OHCA patients and suggests how they may be addressed. RECENT FINDINGS: There is international evidence that the incidence of OHCA is increased with increasing deprivation and in ethnic minorities. These groups have lower rates of bystander CPR and bystander-initiated defibrillation, which may be due to barriers in accessing cardiopulmonary resuscitation training, provision of public access defibrillators, and language barriers with emergency call handlers. There are also disparities in the ambulance response and in-hospital care following resuscitation. These disadvantaged communities have poorer survival following OHCA. SUMMARY: OHCA disproportionately affects deprived communities and ethnic minorities. These groups experience disparities in care throughout the chain of survival and this appears to translate into poorer outcomes. Addressing these inequities will require coordinated action that engages with disadvantaged communities.


Asunto(s)
Reanimación Cardiopulmonar , Paro Cardíaco Extrahospitalario , Desfibriladores , Inequidades en Salud , Humanos , Incidencia , Paro Cardíaco Extrahospitalario/epidemiología , Paro Cardíaco Extrahospitalario/terapia
10.
J Med Internet Res ; 24(7): e38324, 2022 07 22.
Artículo en Inglés | MEDLINE | ID: mdl-35839387

RESUMEN

Social media is an important tool for disseminating accurate medical information and combating misinformation (ie, the spreading of false or inaccurate information) and disinformation (ie, spreading misinformation with the intent to deceive). The prolific rise of inaccurate information during a global pandemic is a pressing public health concern. In response to this phenomenon, health professional amplifiers such as IMPACT (Illinois Medical Professional Action Collaborative Team) have been created as a coordinated response to enhance public communication and advocacy around the COVID-19 pandemic.


Asunto(s)
COVID-19 , Medios de Comunicación Sociales , Comunicación , Humanos , Pandemias , SARS-CoV-2
11.
BMC Med Inform Decis Mak ; 22(1): 21, 2022 01 25.
Artículo en Inglés | MEDLINE | ID: mdl-35078470

RESUMEN

BACKGROUND: A growing body of research has shown that machine learning (ML) can be a useful tool to predict how different variable combinations affect out-of-hospital cardiac arrest (OHCA) survival outcomes. However, there remain significant research gaps on the utilization of ML models for decision-making and their impact on survival outcomes. The purpose of this study was to develop ML models that effectively predict hospital's practice to perform coronary angiography (CA) in adult patients after OHCA and subsequent neurologic outcomes. METHODS: We utilized all (N = 2398) patients treated by the Chicago Fire Department Emergency Medical Services included in the Cardiac Arrest Registry to Enhance Survival (CARES) between 2013 and 2018 who survived to hospital admission to develop, test, and analyze ML models for decisions after return of spontaneous circulation (ROSC) and patient survival. ML classification models, including the Embedded Fully Convolutional Network (EFCN) model, were compared based on their ability to predict post-ROSC decisions and survival. RESULTS: The EFCN classification model achieved the best results across tested ML algorithms. The area under the receiver operating characteristic curve (AUROC) for CA and Survival were 0.908 and 0.896 respectively. Through cohort analyses, our model predicts that 18.3% (CI 16.4-20.2) of patients should receive a CA that did not originally, and 30.1% (CI 28.5-31.7) of these would experience improved survival outcomes. CONCLUSION: ML modeling effectively predicted hospital decisions and neurologic outcomes. ML modeling may serve as a quality improvement tool to inform system level OHCA policies and treatment protocols.


Asunto(s)
Servicios Médicos de Urgencia , Paro Cardíaco Extrahospitalario , Flujo de Trabajo , Adulto , Reanimación Cardiopulmonar , Toma de Decisiones , Humanos , Aprendizaje Automático , Modelos Teóricos , Paro Cardíaco Extrahospitalario/etiología , Paro Cardíaco Extrahospitalario/terapia
12.
Circulation ; 141(12): e654-e685, 2020 03 24.
Artículo en Inglés | MEDLINE | ID: mdl-32078390

RESUMEN

Cardiac arrest systems of care are successfully coordinating community, emergency medical services, and hospital efforts to improve the process of care for patients who have had a cardiac arrest. As a result, the number of people surviving sudden cardiac arrest is increasing. However, physical, cognitive, and emotional effects of surviving cardiac arrest may linger for months or years. Systematic recommendations stop short of addressing partnerships needed to care for patients and caregivers after medical stabilization. This document expands the cardiac arrest resuscitation system of care to include patients, caregivers, and rehabilitative healthcare partnerships, which are central to cardiac arrest survivorship.


Asunto(s)
Muerte Súbita Cardíaca/epidemiología , American Heart Association , Humanos , Supervivencia , Estados Unidos
13.
Health Promot Pract ; 22(5): 714-723, 2021 09.
Artículo en Inglés | MEDLINE | ID: mdl-32552138

RESUMEN

Background. Uncontrolled hypertension is the primary risk factor for the development of cardiovascular complications and particularly burdens racial/ethnic minority populations. Aim. To determine the effectiveness of a community hypertension screening, education, and empowerment intervention on blood pressure (BP) improvement. Method. We screened 152 participants across four churches in predominantly racial/ethnic minority neighborhoods for elevated BP. During this visit, those with BP ≥ 140/90 mmHg were enrolled in the study and completed interventions. Individuals with moderately elevated BP (≥140/90 and <160/100 mmHg; Group 1) viewed a 3-minute hypertension education video. Individuals with severely elevated BP (≥160/100 mmHg; Group 2) additionally viewed echocardiograms images with subclinical changes from uncontrolled hypertension and had a brief on-site medication review with a pharmacist. Both groups received automated BP monitors and information on neighborhood federally qualified health centers for primary care. Participants returned to each church for follow-up 3 months later. We analyzed BP difference at 3 months and percentage with controlled BP for each group. Results. For Group 1, mean baseline and follow-up BPs were 143.5/88.0 mmHg and 138.5/85.8 mmHg, respectively. For Group 2, BPs significantly decreased from 165.4/98.3 mmHg to 150.4/90.8 mmHg. After the intervention, participants with controlled BP for Groups 1 and 2 were 35.5% and 55.2%, respectively. Discussion. Participants in both groups had BP improvements. Greater improvements were in individuals at higher cardiovascular risk due to severely elevated BPs (≥160/100 mmHg). Conclusion. This pilot highlights the impact that streamlined empowerment interventions with dedicated health personnel can have in high-risk communities with elevated BPs.


Asunto(s)
Etnicidad , Hipertensión , Negro o Afroamericano , Antihipertensivos/uso terapéutico , Presión Sanguínea , Humanos , Hipertensión/diagnóstico , Hipertensión/tratamiento farmacológico , Grupos Minoritarios
14.
Circulation ; 140(24): e881-e894, 2019 12 10.
Artículo en Inglés | MEDLINE | ID: mdl-31722552

RESUMEN

The fundamentals of cardiac resuscitation include the immediate provision of high-quality cardiopulmonary resuscitation combined with rapid defibrillation (as appropriate). These mainstays of therapy set the groundwork for other possible interventions such as medications, advanced airways, extracorporeal cardiopulmonary resuscitation, and post-cardiac arrest care, including targeted temperature management, cardiorespiratory support, and percutaneous coronary intervention. Since 2015, an increased number of studies have been published evaluating some of these interventions, requiring a reassessment of their use and impact on survival from cardiac arrest. This 2019 focused update to the American Heart Association advanced cardiovascular life support guidelines summarizes the most recent published evidence for and recommendations on the use of advanced airways, vasopressors, and extracorporeal cardiopulmonary resuscitation during cardiac arrest. It includes revised recommendations for all 3 areas, including the choice of advanced airway devices and strategies during cardiac arrest (eg, bag-mask ventilation, supraglottic airway, or endotracheal intubation), the training and retraining required, the administration of standard-dose epinephrine, and the decisions involved in the application of extracorporeal cardiopulmonary resuscitation and its potential impact on cardiac arrest survival.


Asunto(s)
Reanimación Cardiopulmonar/normas , Servicios Médicos de Urgencia/normas , Servicio de Urgencia en Hospital/normas , Guías como Asunto , Paro Cardíaco/terapia , American Heart Association , Humanos , Respiración Artificial/normas , Estados Unidos
15.
Circulation ; 140(24): e895-e903, 2019 12 10.
Artículo en Inglés | MEDLINE | ID: mdl-31722563

RESUMEN

Survival after out-of-hospital cardiac arrest requires an integrated system of care (chain of survival) between the community elements responding to an event and the healthcare professionals who continue to care for and transport the patient for appropriate interventions. As a result of the dynamic nature of the prehospital setting, coordination and communication can be challenging, and identification of methods to optimize care is essential. This 2019 focused update to the American Heart Association systems of care guidelines summarizes the most recent published evidence for and recommendations on the use of dispatcher-assisted cardiopulmonary resuscitation and cardiac arrest centers. This article includes the revised recommendations that emergency dispatch centers should offer and instruct bystanders in cardiopulmonary resuscitation during out-of-hospital cardiac arrest and that a regionalized approach to post-cardiac arrest care may be reasonable when comprehensive postarrest care is not available at local facilities.


Asunto(s)
Reanimación Cardiopulmonar/normas , Servicios Médicos de Urgencia/normas , Servicio de Urgencia en Hospital/normas , Paro Cardíaco Extrahospitalario/terapia , American Heart Association , Tratamiento de Urgencia/normas , Humanos , Paro Cardíaco Extrahospitalario/mortalidad , Estados Unidos
16.
Curr Opin Crit Care ; 26(6): 603-611, 2020 12.
Artículo en Inglés | MEDLINE | ID: mdl-33002970

RESUMEN

PURPOSE OF REVIEW: Point-of-care ultrasound (POCUS) is commonly used during cardiac arrest to screen for potential causes and to inform termination of resuscitation. However, unique biases and limitations in diagnostic and prognostic test accuracy studies lead to potential for misinterpretation. The present review highlights recent evidence regarding POCUS in cardiac arrest, guides the incorporation of POCUS into clinical management, and outlines how to improve the certainty of evidence. RECENT FINDINGS: Multiple frameworks organize and direct POCUS during cardiac arrest. Although many are proofs of concept, several have been prospectively evaluated. Indirect evidence from undifferentiated shock suggests that POCUS offers better specificity than sensitivity as a diagnostic aid. The prognostic accuracy of POCUS during cardiac arrest to predict subsequent clinical outcomes is better characterized, but subject to unique biases and confounding. Low certainty direct evidence suggests that POCUS offers better specificity than sensitivity as a prognostic aid. SUMMARY: POCUS findings might indicate a particular diagnosis or encourage the continuation of resuscitation, but absence of the same is not sufficient in isolation to exclude a particular diagnosis or cease resuscitation. Until the evidence to support POCUS during cardiac arrest is more certain, it is best characterized as a diagnostic and prognostic adjunct.


Asunto(s)
Reanimación Cardiopulmonar , Paro Cardíaco , Paro Cardíaco/diagnóstico por imagen , Paro Cardíaco/terapia , Humanos , Sistemas de Atención de Punto , Pronóstico , Ultrasonografía
17.
Circulation ; 138(23): e740-e749, 2018 12 04.
Artículo en Inglés | MEDLINE | ID: mdl-30571262

RESUMEN

Antiarrhythmic medications are commonly administered during and immediately after a ventricular fibrillation/pulseless ventricular tachycardia cardiac arrest. However, it is unclear whether these medications improve patient outcomes. This 2018 American Heart Association focused update on advanced cardiovascular life support guidelines summarizes the most recent published evidence for and recommendations on the use of antiarrhythmic drugs during and immediately after shock-refractory ventricular fibrillation/pulseless ventricular tachycardia cardiac arrest. This article includes the revised recommendation that providers may consider either amiodarone or lidocaine to treat shock-refractory ventricular fibrillation/pulseless ventricular tachycardia cardiac arrest.


Asunto(s)
Antiarrítmicos/uso terapéutico , Reanimación Cardiopulmonar/métodos , Paro Cardíaco/tratamiento farmacológico , American Heart Association , Amiodarona/uso terapéutico , Servicios Médicos de Urgencia , Paro Cardíaco/etiología , Humanos , Lidocaína/uso terapéutico , Magnesio/uso terapéutico , Taquicardia Ventricular/complicaciones , Taquicardia Ventricular/patología , Estados Unidos , Fibrilación Ventricular/complicaciones , Fibrilación Ventricular/patología
18.
Health Promot Pract ; 20(1): 57-66, 2019 01.
Artículo en Inglés | MEDLINE | ID: mdl-29400084

RESUMEN

In Chicago, major disparities exist across ethnic groups, income levels, and education levels for common chronic conditions and access to care. Concurrently, many of Chicago's youth are unemployed, and the number of minorities pursuing health professions is low. In an effort to eliminate this health equity gap, the University of Illinois at Chicago convened a community-university-hospital partnership to implement the CHAMPIONS NETWork (Community Health And eMPowerment through Integration Of Neighborhood-specific Strategies using a Novel Education & Technology-leveraged Workforce). This innovative workforce training program is a "High School to Career Training Academy" to empower underserved youth to improve population health in their communities, expose them to careers in the health sciences, and provide resources for them to become community and school advocates for healthy lifestyles. This program differs from other traditional pipeline programs because it gives its students a paid experience, extends beyond the summer, and broadens the focus to population health with patient contact. The CHAMPIONS NETWork creates a new type of health workforce that is both sustainable and replicable throughout the United States.


Asunto(s)
Etnicidad/estadística & datos numéricos , Educación en Salud/organización & administración , Equidad en Salud/organización & administración , Grupos Minoritarios/educación , Estudiantes/estadística & datos numéricos , Adolescente , Chicago , Femenino , Humanos , Masculino , Instituciones Académicas , Estados Unidos
19.
J Natl Med Assoc ; 110(4): 326-329, 2018 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-30126556

RESUMEN

OBJECTIVE: Rates of bystander cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) use are lower in Hispanic compared to non-Hispanic white communities. Novel instructional methods that focus on population subgroups most likely to benefit must be explored. The purpose of this study was to determine the feasibility, efficiency, and participant demographics of 10-minute educational intervention on bystander CPR and AED use delivered at a pre-match festival for Major League Soccer (MLS) fans. METHODS: Results are reported with descriptive statistics. The primary outcomes included: (1) Training efficiency index for cardiac arrest (TEICA) defined as persons trained/volunteer hours; (2) cardiac arrest training yield (CATY) defined as percent participation by the target audience; and (3) percent of participants of Hispanic origin. Our secondary outcome was average post intervention knowledge survey score. RESULTS: CATY was 16% and TEICA was 3.81. Survey participation was 48.3% and 38.9% of survey participants were Hispanic. Average knowledge score post training was 87.5%. CONCLUSION: Soccer matches may be a suitable setting for provision of CPR and AED training to Hispanics. This intervention gives insight into a novel way of providing health education to Hispanics that can be applied to other behaviors.


Asunto(s)
Reanimación Cardiopulmonar/educación , Desfibriladores , Educación en Salud/métodos , Hispánicos o Latinos/educación , Paro Cardíaco Extrahospitalario/terapia , Fútbol , Adolescente , Adulto , Anciano , Niño , Preescolar , Femenino , Conocimientos, Actitudes y Práctica en Salud/etnología , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Encuestas y Cuestionarios , Adulto Joven
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