Ongoing CPR with an onboard physician.

Introduction: Recent data are not available on ongoing CPR for emergency services with an onboard physician. The aim of the present study was to identify factors associated with the decision to transport patients to hospital with ongoing CPR and examine their survival to hospital discharge with good neurological status. Methods: An observational study based on a registry of out-of-hospital cardiac arrests attended to by emergency services with an onboard physician. All OHCA cases occurring between the 1st of January and the 31st of December 2022 were included. Patients receiving ongoing CPR during transport to the hospital were compared with patients pronounced dead at the scene following arrival of the care team. The dependent variable was ongoing CPR during transport to the hospital. The main characteristics and the neurological status of patients surviving to discharge were described. Results: A total of 9321 cases were included, of which 350 (3.7%) were transported to hospital with ongoing CPR. Such patients were young (59.9 ± 20.1 years vs 64.6 ± 16.9 years; p < 0.001; 95%CI: 0.98 [0.98; 0.99]) with arrest taking place outside of the home (151 [44.5%] vs 4045 [68.01%]; p < 0.001; 95%CI: 0.41 [0.31; 0.54]) and being witnessed by EMS (126 [36.0%] vs 667 [11.0%]; p < 0.001; 95%CI: 4.31 [3.19; 5.80]), whilst initial rhythm differed from asystole (164 [47.6%] vs 4325 [73.0%]; p < 0.01; 95%CI: 0.44 [0.33; 0.60]) and a mechanical device was more often employed during resuscitation and transport to hospital (199 [56.9%] vs 2050 [33.8%]; p < 0.001; 95%CI: 2.75 [2.10; 3.59]). Seven patients (2%) were discharged alive from hospital, five with ad integrum neurological recovery (CPC1) and two with minimally impaired neurological function (CPC2). Conclusions: The strategy of ongoing CPR is uncommon in EMS with an onboard physician. Despite their limited efficacy, the availability of mechanical chest compression devices, together with the possibility of specific hospital treatments, mainly ICP and ECMO, opens up the possibility of this approach with determined patients.

Factors influencing the perception of feeling safe in pre-hospital emergency care: A mixed-methods systematic review.

AIMS: To systematically describe the factors influencing the perception of feeling safe among patients receiving pre-hospital emergency care. BACKGROUND: Patient safety is a top priority worldwide. Little is known about how patients perceive safety during emergency health care and what the related factors are. DESIGN: A mixed-methods systematic review. METHODS: Six databases were searched to December 2021. Inclusion criteria were as follows: studies with patients of any age, framed in pre-hospital emergency care settings, referring to patient safety, addressing the perception of safety, and with a quantitative or qualitative research design. Exclusion criteria were as follows: conference records, abstracts, supplements, letters, editorials and reviews. The quality of the evidence was assessed with the Joanna Briggs Institute (JBI) checklists. A convergent integrated approach was followed according to the JBI methodology. The protocol was registered on PROSPERO (CRD42022306337). PRISMA 2020 guidelines were followed in reporting this review. RESULTS: Among the 5223 records identified, the whole texts of 35 articles were reviewed. Ten studies were relevant to the research question. Seven followed a qualitative methodology, with interviews or focus group. Three involved a quantitative methodology, with questionnaires or validated measures. The 74 findings were organised into 11 categories and then grouped into four dimensions: 'receiving a satisfying response from healthcare professionals when I need it', 'EMS personnel's professional competence', 'the variable and unfamiliar settings of pre-hospital emergencies', and 'patients' personal characteristics'. CONCLUSIONS: The perception of safety is influenced by many factors, which can be grouped into four independent dimensions. Quantitative and qualitative studies can provide us with complementary findings. RELEVANCE TO CLINICAL PRACTICE: Awareness of these factors enables us to act upon them. When patients feel safe their health outcomes improve, their anxiety decreases and they collaborate more actively. NO PATIENT OR PUBLIC CONTRIBUTION: Patients and caregivers shared their experiences in the articles included.

Description of basic competencies in clinical ultrasound imaging for emergency departments. / Competencias básicas de la ecografía clínica en los servicios de urgencias y emergencias.

TEXT: Recent years have seen great advances in the use of clinical ultrasound imaging in both hospital emergency departments and out-of-hospital settings. However, all new techniques require up-to-date definitions of competencies relevant to the clinical realities of different specialties and the geographic settings in which specialists work. To that end, a group of experts in clinical ultrasound reviewed the evidence available in the literature and strictly applied the Delphi method to define the competencies relevant to emergency physicians. The group worked with the starting premise that clinical ultrasound imaging should be a common competency across the specialty.

TEXTO: En los últimos años, la ecografía clínica (EC) ha sufrido un avance muy importante en su implantación dentro de los servicios de urgencias, tanto hospitalarios como extrahospitalarios, pero como toda técnica requiere un ámbito competencial definido, actualizado y enmarcado, tanto en la realidad clínica de la especialidad que desempeñamos como en la geográfica del país donde ejercemos. Por ello, un grupo de expertos en la materia ha desarrollado el presente documento en el que basándose por un lado en la evidencia disponible en la bibliografía científica y por otro en una metodología Delphi, planteó el objetivo de establecer un claro marco competencial base para todos los urgenciólogos, asumiendo como premisa inicial que la EC debería ser una competencia transversal común.

Lung Ultrasound Integration in Assessment of Patients with Noncritical COVID-19.

OBJECTIVES: Performing lung ultrasound during the clinical assessment of patients with suspicion of noncritical COVID-19 may increase the diagnostic rate of pulmonary involvement over other diagnostic techniques used in routine clinical practice. This study aims to compare complications (readmissions, emergency department [ED] visits, and length of outpatient follow-up) in the first 30 days after ED discharge in patients with confirmed COVID-19 who were managed with versus without lung ultrasound. MATERIALS AND METHODS: Prospective, observational, analytical study in noncritical patients with confirmed respiratory disease due to SARS-CoV-2, assessed in the ED of a tertiary Spanish hospital in March and April 2020. We compared 2 cohorts, differentiated by the use of lung ultrasound as a diagnostic tool. Complications were assessed (hospital admissions, ED revisits and days of outpatient follow-up) at 30 days postdischarge. RESULTS: Of the 88 included patients, 31% (n = 27) underwent an initial lung ultrasound, while 61 (68%) did not. In 82.5% of the patients evaluated with ultrasound, the most predominant areas affected were the posterobasal regions, in the form of focalized and confluent B-lines; 70.4% showed pleural irregularity in these same areas. Use of the lung ultrasound was associated with a greater probability of hospital admission (odds ratio 5.63, 95% confidence interval 3.31 to 9.57; p < 0.001). However, it was not significantly associated with mortality or short-term complications. CONCLUSIONS: Lung ultrasound could identify noncritical patients with lung impairment due to SARS-CoV-2, in whom other tests used routinely show no abnormalities. However, it has not shown a prognostic value in these patients and could generate a higher percentage of hospital admissions. More studies are still needed to demonstrate the clear benefit of this use.

Diagnostic yield of point-of-care ultrasound imaging of the lung in patients with COVID-19. / Capacidad diagnóstica de la ecografía clínica pulmonar en pacientes con COVID-19.

OBJECTIVES: To assess the diagnostic yield of point-of-care ultrasound imaging in patients suspected of having noncritical severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection but no apparent changes on a chest radiograph. MATERIAL AND METHODS: Cross-sectional analysis of a case series including patients coming to an emergency department in March and April 2020 with mild-moderate respiratory symptoms suspected to be caused by SARS-CoV-2. A point-of-care ultrasound examination of the lungs was performed on all participants as part of routine clinical care. Ultrasound findings were compared according to the results of SARS-CoV-2 test results. RESULTS: Fifty-eight patients with a median (interquartile range) age of 44.5 (34-67) years were enrolled; 42 (72.4%) were women. Twenty-seven (46.5%) had confirmed SARS-CoV-2 infection. Ultrasound findings were consistent with interstitial pneumonia due to coronavirus disease 2019 (COVID-19) in 33 (56.9%). Most were in cases with testconfirmed COVID-19 (100% vs 22.2% of cases with no confirmation; P < .001). The most common ultrasound findings in confirmed COVID-19 cases were focal and confluent B-lines in the basal and posterior regions of the lung (R1, 85.2%; R2, 77.8%; L1, 88.9%; and L2, 88.9%) and associated pleural involvement (70.4%, 70.4%, 81.5%, and 85.2%, respectively). The sensitivity of point-of-care ultrasound in the diagnosis of COVID-19 was 92.6% (95% CI, 75.7%-99.1%). Specificity was 85.2% (95% CI, 66.3%-95.8%); positive predictive value, 75.8% (95% CI, 59.6%- 91.9%); negative predictive value, 92% (95% CI, 74.0%-99.0%); and positive and negative likelihood ratios, 6.2 (95% CI, 6.0-6.5) and 0.1 (95% CI, 0.1-0.1), respectively. CONCLUSION: Point-of-care lung ultrasound could be useful for the diagnosis of noncritical SARS-CoV-2 infection when chest radiographs are inconclusive.

OBJETIVO: Evaluar el rendimiento diagnóstico de la ecografía clínica pulmonar en pacientes con sospecha de infección respiratoria no crítica por SARS-CoV-2 sin alteraciones evidentes en la radiografía de tórax. METODO: Estudio de una serie de casos con análisis transversal que incluyó pacientes con sospecha de infección respiratoria por SARS-CoV-2, sintomatología respiratoria leve-moderada y sin hallazgos patológicos concluyentes en la radiografía torácica, que consultaron en un servicio de urgencias durante marzo y abril de 2020. Se realizó una ecografía clínica pulmonar a todos los participantes como parte de la práctica clínica asistencial. Se compararon los hallazgos ecográficos en función del resultado del test SARS-CoV-2. RESULTADOS: Se estudiaron 58 pacientes [mediana de edad 44,5 (RIC 34-67) años; 42 (72,4%) mujeres], 27 (46,5%) con infección por SARS-CoV2 confirmada. Treinta y tres (56,9%) presentaron hallazgos ecográficos de neumonía intersticial por COVID-19, siendo más frecuente en los casos con COVID-19 confirmada (22,2% vs 100%; p < 0,001). Los hallazgos más frecuentes en los casos con COVID-19 confirmada fueron en áreas posterobasales (regiones R1, R2, L1, L2), en forma de líneas B focalizadas y confluentes (85,2%, 77,8%, 88,9% y 88,9%, respectivamente), con irregularidad pleural asociada (70,4%, 70,4%, 81,5% y 85,2%, respectivamente). El diagnóstico del COVID-19 mediante ecografía pulmonar clínica tuvo una sensibilidad de un 92,6% (IC 95%: 75,7-99,1%), una especificidad de un 85,2% (IC 95%: 66,3-95,8%), un valor predictivo positivo fue de un 75,8% (IC 95%: 59,6-91,9%), un valor predictivo negativo de un 92% (IC 95%: 74,0-99,0%), una razón de verosimilitud positiva de un 6,25 (IC 95%: 6,0-6,5) y una negativa de 0,1 (IC 95%: 0,1-0,1). CONCLUSIONES: El uso de la ecografía clínica pulmonar podría ser de ayuda diagnóstica en pacientes con sospecha de infección respiratoria no crítica por SARS-CoV-2 donde la radiografía de tórax no es diagnóstica.

[Effectiveness of a therapeutic practice on overweight in primary care]. / Eficacia de una intervención terapéutica sobre el exceso de peso en atención primaria.

OBJECTIVES: To evaluate the effectiveness of an intervention program on overweight to achieve a minimum decrease of 5% or a optimum of 10% of initial weight a year, and to identify the factors associated with slimming. DESIGN: Randomized controlled trial. SETTING: Urban health centre. PARTICIPANTS: Overweight subjects over 18 years old (n=169), wanting treatment or referred by their doctor. They were randomly assigned to the intervention (n=95) or control (n=70) group. INTERVENTIONS: Intervention group: yearly program with consultations every 15-21 days, using a low calorie diet, prescribing physical exercise, changing of habits and health education. CONTROL GROUP: low calorie diet, seen 3 times/year. RESULTS: The minimum weight loss was achieved in 6 months by 37.9% of the intervention group and by 21.4% of the control group. At one year, 45.3% of the intervention subjects and 24.3% of the control group reached this objective. The optimum loss of 10% was higher in the intervention group, but was not statistically significant. The minimum objective was associated with the intervention group (OR=4.5 [1.36-14.49]). It was also associated to the number of visits during therapy (OR=1.85 [1.50-2.29]) and diabetes (OR=10 [1.13-90.9]). CONCLUSIONS: The intervention group had a loss of 5% of initial weight in the first 6 months, 16.5% more than the control group, and 21% more in one year. Achieving the minimum objective was associated with the intervention group, the number of visits and the diagnosis of diabetes.