Effect of timing of advanced life support on out-of-hospital cardiac arrests at home.

AIM: In cases of out-of-hospital cardiac arrests (OHCA) occurring at home, Japanese emergency medical services personnel decide whether to provide treatment on the scene or during transport based on their judgment. This study aimed to evaluate the association between the timing of advanced life support (ALS) (i.e., endotracheal intubation [ETI] or adrenaline administration) for OHCA at home and prognosis. METHOD: This retrospective cohort study used data from the Japan Utstein Registry and emergency transport data collected from patients who underwent pre-hospital ETI (n = 6806) and received adrenaline (n = 22,636) between 2016 and 2019. The timing of ETI or adrenaline administration was determined as "on the scene" or "in the ambulance." Multiple logistic regression analysis was used to estimate the association among the timing of ALS implementation, pre-hospital return of spontaneous circulation (ROSC), and survival at 1 month. RESULT: ETI on the scene was significantly positively associated with pre-hospital ROSC (adjusted odds ratio [AOR], 1.81; 95% confidence interval [CI], 1.57-2.09) and survival at 1 month (AOR, 1.81; 95% CI, 1.47-2.23). Adrenaline administration on the scene was significantly positively associated with pre-hospital ROSC (AOR, 2.51; 95% CI, 2.33-2.70) and survival at 1 month (AOR, 2.13; 95% CI, 1.89-2.40). CONCLUSION: Our analysis suggests performing ALS on the scene was associated with pre-hospital ROSC and survival at 1 month. Further efforts are needed to increase the rate of ALS implementation on the scene by emergency life-saving technicians.

Enhancing ACLS training effects through video-assisted boosting methods: A comparative analysis of self-simulation and model simulation videos.

AIMS: To assess the impact of learner-participation and instructor-led simulation videos on nurses' CPR skills, focusing on iterative learning to boost proficiency in ACLS. BACKGROUND: Advanced cardiac life support (ACLS) training is crucial for nurses, especially to improve cardiopulmonary resuscitation (CPR) proficiency, for which an effective training strategy is needed. DESIGN: A quasi-experimental, pretest-posttest design was implemented to assess the impact of self-simulation and model simulation videos on sustaining CPR education. METHODS: The research was carried out at a university hospital in Korea from August 2021 to July 2022. A total of 110 nurses were allocated into three groups based on the building of their workplace in the hospital. Each group watched training videos at 4-month intervals after the simulation training. The self-video group viewed simulations featuring their participation, while the model video group watched instructor-led simulations. A comparison group participated in the simulations without subsequent video boosting. RESULTS: Both the self-video and model video groups exhibited significantly superior ACLS performance compatred with the comparison group at both four months (H = 70.33, p <.001) and eight months (H = 81.52, p <.001) following the intervention, with large effect sizes (self-video vs. comparison: d = 4.73 at four months, d = 12.54 at eight months; model video vs. comparison: d = 4.53 at four months, d = 11.01 at eight months). ACLS knowledge scores also significantly increased over time in both intervention groups (self-video: χ² = 22.09, p <.001; model video: χ² = 24.13, p <.001), but not in the comparison group (χ² = 3.75, p =.153). There were no significant differences among the groups in terms of CPR self-efficacy or stress at either time point. CONCLUSION: Supplementary training using simulation videos is an effective method for maintaining and enhancing nurses' ACLS competency, offering a sustainable approach to repetitive CPR training. This study underscores the value of incorporating recorded simulation videos in clinical training, offering insights into efficient methods for continuous learning and CPR proficiency among nursing professionals.

Effects of gamification in advanced life support training for clinical nurses: A cluster randomized controlled trial.

BACKGROUND: Cardiopulmonary resuscitation training is a mandatory competency, especially for healthcare professionals. However, the spread of COVID-19 caused a sharp decline in the number of participants on advanced life support training, thereby accelerating the diversification of educational methods. Gamification is an increasingly popular method of diversifying instruction, but its effectiveness remains controversial. AIM: To evaluate the effectiveness of gamification learning in advanced life support training. DESIGN: A cluster randomized controlled trial. SETTING: A single advanced life support training center. PARTICIPANTS: Clinical nurses who are currently practicing in a hospital. METHODS: A part of the existing advanced life support course was gamified using Kahoot! platform. Conventional learning and gamified learning were each conducted 11 times, and the level of knowledge after training was assessed. The assessment questions were categorized into advanced life support algorithms, teamwork, and cardiac arrest rhythms. RESULTS: A total of 267 were enrolled in the study, and 148 and 139 learners were assigned to CL and GL, respectively. There was no difference in post-training knowledge related to teamwork, and cardiac arrest rhythms between the conventional learning and gamified learning groups, but knowledge related to the advanced life support algorithm was low in the gamified learning group. CONCLUSIONS: Even if the learners are the same, advanced life support gamification training can lead to negative outcomes depending on the simplicity or goal of the training content. To improve the effectiveness of the training, various methods of gamification training should be applied depending on the goal and content of the training.

Advanced life support interventions during intra-operative cardiac arrest among adults as reported to the 7th National Audit Project of the Royal College of Anaesthetists.

BACKGROUND: Few existing resuscitation guidelines include specific reference to intra-operative cardiac arrest, but its optimal treatment is likely to require some adaptation of standard protocols. METHODS: We analysed data from the 7th National Audit Project of the Royal College of Anaesthetists to determine the incidence and outcome from intra-operative cardiac arrest and to summarise the advanced life support interventions reported as being used by anaesthetists. RESULTS: In the baseline survey, > 50% of anaesthetists responded that they would start chest compressions when the non-invasive systolic pressure was < 40-50 mmHg. Of the 881 registry patients, 548 were adult patients (aged > 18 years) having non-obstetric procedures under the care of an anaesthetist, and who had arrested during anaesthesia (from induction to emergence). Sustained return of spontaneous circulation was achieved in 425 (78%) patients and 338 (62%) were alive at the time of reporting. In the 365 patients with pulseless electrical activity or bradycardia, adrenaline was given as a 1 mg bolus in 237 (65%). A precordial thump was used in 14 (3%) patients, and although this was associated with return of spontaneous circulation at the next rhythm check in almost three-quarters of patients, in only one of these was the initial rhythm shockable. Calcium (gluconate or chloride) and 8.4% sodium bicarbonate were given to 51 (9%) and 25 (5%) patients, but there were specific indications for these treatments in less than half of the patients. A thrombolytic drug was given to 5 (1%) patients, and extracorporeal cardiopulmonary resuscitation was used in 9 (2%) of which eight occurred during cardiac procedures. CONCLUSIONS: The specific characteristics of intra-operative cardiac arrest imply that its optimal treatment requires modifications to standard advanced life support guidelines.

ChatGPT's Performance in Cardiac Arrest and Bradycardia Simulations Using the American Heart Association's Advanced Cardiovascular Life Support Guidelines: Exploratory Study.

BACKGROUND: ChatGPT is the most advanced large language model to date, with prior iterations having passed medical licensing examinations, providing clinical decision support, and improved diagnostics. Although limited, past studies of ChatGPT's performance found that artificial intelligence could pass the American Heart Association's advanced cardiovascular life support (ACLS) examinations with modifications. ChatGPT's accuracy has not been studied in more complex clinical scenarios. As heart disease and cardiac arrest remain leading causes of morbidity and mortality in the United States, finding technologies that help increase adherence to ACLS algorithms, which improves survival outcomes, is critical. OBJECTIVE: This study aims to examine the accuracy of ChatGPT in following ACLS guidelines for bradycardia and cardiac arrest. METHODS: We evaluated the accuracy of ChatGPT's responses to 2 simulations based on the 2020 American Heart Association ACLS guidelines with 3 primary outcomes of interest: the mean individual step accuracy, the accuracy score per simulation attempt, and the accuracy score for each algorithm. For each simulation step, ChatGPT was scored for correctness (1 point) or incorrectness (0 points). Each simulation was conducted 20 times. RESULTS: ChatGPT's median accuracy for each step was 85% (IQR 40%-100%) for cardiac arrest and 30% (IQR 13%-81%) for bradycardia. ChatGPT's median accuracy over 20 simulation attempts for cardiac arrest was 69% (IQR 67%-74%) and for bradycardia was 42% (IQR 33%-50%). We found that ChatGPT's outputs varied despite consistent input, the same actions were persistently missed, repetitive overemphasis hindered guidance, and erroneous medication information was presented. CONCLUSIONS: This study highlights the need for consistent and reliable guidance to prevent potential medical errors and optimize the application of ChatGPT to enhance its reliability and effectiveness in clinical practice.

Impact of Student Pharmacist State Anxiety on Vasopressor Calculation Accuracy in Advanced Cardiac Life Support Simulations.

OBJECTIVE: To assess the impact of student pharmacist state anxiety on vasopressor calculation accuracy in advanced cardiac life support (ACLS) simulations. METHODS: Third-year professional students participated in 2 ACLS-related simulation laboratory sessions. In week 1, students completed 3 calculations at their workstation with no stressors. Students were then randomized into teams for a bedside simulation where they independently completed 3 additional calculations either with or without stressors. Team assignments were maintained for week 2 where all participants completed a high-fidelity ACLS simulation that included a team vasopressor calculation. At both encounters, calculation accuracy was assessed as well as pre- and post-state anxiety using the Spielberger State-Trait Anxiety Inventory (STAI) survey tool. RESULTS: Students' (N = 145) trait anxiety aligned with normative data for similarly aged professional students. Post-simulation state anxiety in week 1 was found to be higher for those completing the activity with stressors than without (STAI score 44.7 vs 36.9) paired with lower bedside calculation accuracy, despite similar initial workstation calculation accuracy. In week 2, pre-simulation state anxiety score and calculation accuracy were not significantly different between the 2 groups. However, the state anxiety score significantly increased post-simulation for those exposed to stress in the previous week. CONCLUSION: Stress negatively impacted student pharmacist vasopressor calculation accuracy. However, the repeated exposure to a stressed simulation did not result in a significant difference in pre- or post-simulation state anxiety score or calculation accuracy when compared to a non-stressed control. Consideration should be made whether to include more "real-life" simulations in student pharmacist education.

Programa Nacional de Desfibrilhação Automática Externa: Impacto na recuperação de circulação espontânea das vítimas de paragem cardiorrespiratória / National Program for Automatic External Defibrillation: Impact on the recovery of spontaneous circulation in victims of cardiorespiratory arrest

Introdução: A paragem cardiorrespiratória extra-hospitalar (PCREH) é uma das principais causas de morte na Europa, apresentando custos extremamente elevados em termos de morbilidade e mortalidade, revelando-se um problema de saúde pública muito pertinente. Os países desenvolvidos têm implementado diversos sistemas de resposta comunitária para fazer face à PCREH, no entanto a sua epidemiologia e desfecho continuam a apresentar uma grande variabilidade. Em Portugal foi implementado o Programa Nacional de Desfibrilhação Automática Externa, tendo como objetivo nuclear a instalação de uma rede nacional de desfibrilhação automática externa (DAE). O presente estudo tem como objetivo determinar a taxa de recuperação de circulação espontânea (RCE) das vítimas de PCREH e identificar os fatores que a promovem. Metodologia: Através de amostragem não probabilística, intencional, constituiu-se uma amostra de 472 vítimas de PCREH do Município de Viseu, cuja sua paragem cardiorrespiratória ocorreu no período de 2016 a 2018, tendo a mesma sido inserida no Registo Nacional de Paragem Cardiorrespiratória Pré-hospitalar (RNPCR). Definiu-se como hipótese de investigação a existência de relação significativa entre a RCE das vítimas de PCREH com variáveis sociodemográficas, causa, local, circunstâncias, rapidez de atendimento, meios de resposta e manobras de reanimação cardiorrespiratória (RCR). O instrumento de colheita de dados utilizado foi a plataforma do Registo Nacional de Paragem Cardiorrespiratória Pré-hospitalar (RNPCR-PH). Na análise de dados recorreu-se a técnicas de estatística descritiva e inferencial, nomeadamente o teste t de Student, o teste de WilcoxonMann-Whitney, o teste do Qui-quadrado (χ2) de Pearson e o teste exato de Fisher, com um nível de significância de 0,05 (α = 0,05). Resultados: O estudo revelou uma taxa de RCE à entrada da vítima de PCREH na unidade de saúde de 6,8%, identificando como potenciais fatores favoráveis à RCE a ocorrência da PCREH em espaços públicos, presenciada (com maior expressividade quando ocorre perante a equipa de emergência médica extra-hospitalar (EMEH), o início imediato de manobras de Suporte Básico de Vida (SBV) e a realização de desfibrilhação precoce (quando indicada), com um impacto substancialmente mais favorável quando realizados antes da chegada da equipa de EMEH. Evidenciou ainda, como fatores potencialmente favoráveis à RCE, a chegada precoce da equipa EMEH junto da vítima de PCREH e todas as manobras realizadas pela mesma com especial relevo para as manobras de SBV. Ficou ainda evidenciado como um preditor favorável à manutenção da condição de RCE o facto da vítima, à chegada da VI equipa de EMEH, já se encontrar com circulação, ventilação ou estado de consciência recuperados. Conclusão: Embora a taxa de RCE revelada pelo estudo (6,8%) seja baixa, encontra-se enquadrada na realidade observada em outros países europeus. Apesar disso, a análise dos fatores identificados como tendo potencial impacto positivo na RCE e das caraterísticas sociodemográficas e clínicas da amostra e respetivos dados relacionados com a PCREH, permite fornecer informação que poderá servir de base para identificar variáveis modificáveis que claramente estão a contribuir para a baixa taxa de RCE das vítimas de PCREH que se verifica no Município de Viseu.

Introduction: Out-of-hospital cardiac arrest (OHCA) is one of the leading causes of death in Europe, with extremely high costs in terms of morbidity and mortality, revealing itself to be a very relevant public health problem. Developed countries have implemented several community response systems to deal with OHCA. However, its epidemiology and outcome continue to show great variability. In Portugal, the National Automated External Defibrillation Programme was implemented with the main purpose of setting up a national automatic external defibrillation (AED) network. This study aims to determine the rate of return of spontaneous circulation (ROSC) of victims of OHCA and identify the factors that potentiate it. Methodology: A sample of 472 OHCA victims from the Municipality of Viseu, whose cardiac arrest occurred between 2016 and 2018, was selected through a purposive non-probability sampling and recorded in the National Pre-hospital Cardiac Arrest Register (RNPCR). The research hypothesis was defined as the existence of a significant relationship between the ROSC of the OHCA victims with sociodemographic variables, cause, location, circumstances, response time, means of response and cardiorespiratory resuscitation (CRR) manoeuvres. The data collection tool used was the National Registry of Pre-hospital Cardiac-Respiratory Arrest (RNPCR-PH) platform. Descriptive and inferential statistical techniques were used in data analysis, namely Student's t-test, Wilcoxon-Mann-Whitney test, Pearson's chi-square (χ2) test and Fisher's exact test, with a significance level of 0.05 (α = 0.05). Results: The study revealed an ROSC rate at the OHCA victim's arrival at the health unit of 6.8%, identifying as potential favourable ROSC factors the occurrence of OHCA in public spaces, witnessed (with bigger expressiveness when it occurs in the presence of the medical emergency team), the immediate initiation of Basic Life Support (BLS) manoeuvres and the performance of early defibrillation (when indicated), with a substantially more favourable impact when performed before the arrival of the medical emergency team. The early arrival of the medical emergency team to assist the OHCA victim and all the manoeuvres performed by the team, with special emphasis on BLS manoeuvres, were also highlighted as potentially favourable factors for ROSC. It was also evidenced as a favourable predictor for the maintenance of the ROSC condition the fact that, at the arrival of the medical emergency team, the victim already had recovered one of the following: circulation, ventilation and consciousness. Conclusion: Although the OHR rate revealed by this study (6.8%) is low, it is in line with the reality observed in other European countries. Despite this, the analysis of the factors identified VIII as having a potential positive impact on ROSC, the socio-demographic and clinical sample characteristics and respective OHCA related data provide information that may serve as a basis to identify modifiable variables that clearly contribute to the low rate of ROSC in OHCA victims in the Municipality of Viseu.

Estimulación cardíaca temporal de larga duración con cable activo y marcapaso permanente externo / Long-term temporary cardiac pacing with active lead and external permanent pacemaker

INTRODUCCIÓN. La estimulación cardíaca temporal de larga duración con cable activo y marcapaso permanente externo es una técnica recientemente incluida en las guías de manejo de bradicardias sintomáticas. CASOS CLÍNICOS. Se describen 4 casos de pacientes sometidos a estimulación cardíaca temporal de larga duración con cable activo y marcapaso permanente externo de la unidad de Hemodinámica del Hospital de Especialidades Carlos Andrade Marín, con indicaciones diversas. DISCUSIÓN. El tiempo medio de permanencia con el cable activo y el marcapaso externalizado fue 23 días. No hubo complicaciones del procedimiento. Un paciente falleció por causas no relacionadas con la estimulación y 2 se recuperaron en sus domicilios. CONCLUSIÓN. La técnica de estimulación temporal utilizando marcapasos permanentes recuperados se muestra extremadamente útil para mantener un marcapaso cardíaco seguro, incluso ambulatorio y por largo tiempo, hasta el implante de dispositivos definitivos. Su limitación es la factibilidad de hacerlo solo en centros de tercer nivel.

INTRODUCTION. Long-duration temporary cardiac pacing with active lead and permanent external pacemaker is a technique recently included in the guidelines for the management of symptomatic bradycardias. CLINICAL CASES. We describe 4 cases of patients who underwent long-duration temporary cardiac pacing with active lead and external permanent pacemaker at the Hemodynamics Unit of the Hospital de Especialidades Carlos Andrade Marín, with different indications. DISCUSSION. The mean length of stay with the active lead and externalized pacemaker was 23 days. There were no procedural complications. One patient died of causes unrelated to pacing and 2 recovered at home. CONCLUSIONS. The technique of temporary pacing using retrieved permanent pacemakers is extremely useful for maintaining safe cardiac pacing, even on an outpatient basis and for a long period of time, until implantation of definitive devices. Its limitation is the feasibility of doing it only in third level centers.

Principales recomendaciones de reanimación cardiopulmonar y atención cardiovascular de emergencia para el año 2020 / Best practice recommendations for cardiopulmonary resuscitation and emergency cardiovascular care for 2020

Las altas tasas de letalidad y mortalidad a causa del paro cardiorespiratorio por fibrilación ventricular son considerados un problema de salud pública, cobrando gran relevancia la posibilidad de que sean revertidos rápidamente con la presencia de profesionales capacitados o por personal "lego" actualizados en reanimación cardiopulmonar. El objetivo del presente artículo de revisión fue analizar las nuevas recomendaciones de la American Heart Association para reanimación cardiopulmonar y atención cardiovascular de emergencia para el año 2020.

High rates of lethality and mortality due to ventricular fibrillation cardiorespiratory arrest are considered a public health problem, Thus, the possibility of reversed quickly by trained professionals or updated "lego" staff in cardiopulmonary resuscitation is taking great relevance. The objective of this review article was to discuss the New Recommendations of the American Heart Association for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care for 2020.

Atención de Enfermería en el paciente adulto con Paro Cardiorrespiratorio en el Hospital General San Francisco / Nursing care in the adult patient with Cardiorespiratory Arrest at the San Francisco General Hospital

1. INTRODUCCIÓNSegún la Organización Mundial de la Salud (OMS) se registran cada año más de 17 200 000 fallecimientos a nivel del mundo por causas cardiovasculares1-3.La enfermedad coronaria causa habitual de Paro Cardiorrespiratorio (PCR) en adultos4. Los pacientes de mayor riesgo corresponden a 50 y 70 años de edad, en un 70% hombres vs 30% mujeres, el 80% de estos se dan por Fibrilación Ventricular (FV) o Taquicardia Ventricular Sin Pulso (TVSP), datos registrados en 20175-7.En el Ecuador, acorde al Instituto Na-cional de Estadísticas y Censos (INEC) en el año 2019 se registraron 8 779 muertes a causa de isquemias del corazón, convir-tiéndose en la principal causa de morta-lidad general con un 11,80%8.En esta ruta se describe cuál es el papel de la enfermera como parte del equipo de respuesta ante un PCR, con base a las Guías de la American Heart Association (AHA).El procedimiento a seguir está expre-sado en el contexto de la Taxonomía de la North American Nursing Diagnosis Asso-ciation (NANDA), Nursing Interventions Classification (NIC), el nombre y siglas en inglés de la clasificación estandarizada y codificada de las intervenciones de en-fermería y Nursing Outcomes Classifica-tion (NOC), la clasificación de resultados obtenidos luego de los cuidados.

1. INTRODUCTIONAccording to the World Health Organiza-tion (WHO), more than 17 200 000 deaths worldwide are registered each year from cardiovascular causes1-3.Coronary heart disease is a common cause of Cardiorespiratory Arrest (CRP) in adults4 The highest risk patients co-rrespond to 50 and 70 years of age, 70% men vs 30% women, 80% of these are due to Ventricular Fibrillation (VF) or Pulseless Ventricular Tachycardia (PVT), data recorded in 20175-7. In Ecuador, according to the National Ins-titute of Statistics and Censuses (INEC) in 2019, 8 779 deaths were recorded due to ischemia of the heart, becoming the main cause of general mortality with 11.80%8.This route describes the role of the nurse as part of the response team to a CRA, based on the American Heart Association (AHA) Guidelines.The procedure to be followed is expressed in the context of the Taxonomy of the North American Nursing Diagnosis As-sociation (NANDA), Nursing Interven-tions Classification (NIC), the name and acronym in English of the standardized and coded classification of nursing inter-ventions and Nursing Outcomes Classifi-cation (NOC), the classification of results obtained after care.

Medical Behavior in Cardiorespiratory Arrest before and After Simulation Based on Advanced Cardiac Life Support (ACLS) Course

Abstract Background: The Advanced Cardiac Life Support (ACLS) course is designed to teach cardiovascular emergency, aiming to promote a harmonious and synchronized work of the entire hospital team, making the multidisciplinary job more effective in the execution of cardiopulmonary resuscitation (CPR). Objective: To compare the effectiveness of CPR performed between physicians trained on ACLS and non-trained physicians. Methods: A questionnaire was applied to physicians working at the emergency room of hospitals in Curitiba, state of Paraná, whose resolution required theoretical and practical knowledge about CPR. For analysis, descriptive statistics and Fisher's association analysis were used, and the medians of the groups were evaluated by Mann-Whitney/Kruskal-Wallis with significance of 5%. Results: Thirty-four physicians were volunteers, of whom 20 had taken the ACLS course (Group A) and 14 had not (Group B). The trained physicians obtained the highest median (4.00 vs. 3.00, p = 0.06) of correct answers. Group A scored at least 3 of the 5 questions in the questionnaire, showing better performance than Group B (OR = 6.75, 95% CI, 1.1 < OR < 41.0, p = 0.04). The year of the course did not significantly change the performance in the questionnaire. Conclusion: It is suggested that the ACLS course was effective in qualifying physicians to handle situations of cardiorespiratory arrest properly, which was reproduced by the better performance in the resolution of the questionnaire. It is believed that when the sample of volunteers is increased, the trends found materialize the other hypotheses proposed.

Eficácia temporal da formação em suporte avançado de vida no conhecimento dos enfermeiros / Temporal effectiveness of advanced life support training on nurses' knowledge

Introdução: Quando ocorre uma Paragem Cardiorrespiratória, em ambiente intra-hospitalar, o sucesso no socorro depende da interação harmoniosa dos vários intervenientes, nomeadamente da equipa multidisciplinar. Os Enfermeiros são, em ambiente de prestação de cuidados, os profissionais que geralmente fazem a primeira avaliação à vítima em Paragem Cardiorrespiratória, pelo que é fundamental que possuam os conhecimentos em Reanimação Cardiorrespiratória. No caso dos Enfermeiros que desenvolvem a sua prática profissional em contexto relacionado com a pessoa em situação crítica, a formação em Suporte Avançado de Vida é indispensável. Contudo, a evidência relativa à eficácia temporal da formação em SAV no conhecimento dos enfermeiros carece de mais estudos. Metodologia: Foi desenvolvido um estudo quantitativo, descritivo-correlacional e transversal com o objetivo de relacionar os conhecimentos teóricos em SAV, dos Enfermeiros, com o tempo decorrido desde a formação, avaliando a eficácia temporal do conhecimento e compreendendo possíveis fatores influenciadores. A amostra foi composta por 69 Enfermeiros. Resultados e Conclusões: O tempo decorrido desde a última formação em Suporte Avançado de Vida teve um impacto negativo no conhecimento dos Enfermeiros. Os Enfermeiros cujo contexto prático se desenvolve num ambiente de prestação de cuidados à Pessoa em Situação Crítica, apresentaram níveis de conhecimento nitidamente superiores sendo, assim, o contexto promotor de uma maior eficácia temporal dos conhecimentos, o que permitiu concluir que a formação em Suporte Avançado de Vida deve ter sempre uma componente prática e adaptada ao contexto de prestação de cuidados, principalmente nas situações em que o contacto com a pessoa em situação crítica é esporádico.

Miocarditis fulminante en adultos por el virus de la influenza B: reporte de dos casos y revisión de la literatura / Fulminant myocarditis due to the influenza B virus in adults: Report of two cases and literature review

Resumen La miocarditis es una enfermedad inflamatoria del miocardio. Las infecciones virales son la causa más común, aunque también puede deberse a reacciones de hipersensibilidad y de etiología autoinmunitaria, entre otras. El espectro clínico de la enfermedad es variado y comprende desde un curso asintomático, seguido de dolor torácico, arritmias y falla cardiaca aguda, hasta un cuadro fulminante. El término 'fulminante' se refiere al desarrollo de un shock cardiogénico con necesidad de soporte vasopresor e inotrópico o dispositivos de asistencia circulatoria, ya sea oxigenación por membrana extracorpórea o balón de contrapulsación intraaórtico. Cerca del 10 % de los casos de falla cardiaca por miocarditis corresponde a miocarditis fulminante. La miocarditis por influenza se considera una condición infrecuente; no obstante, su incidencia ha aumentado desde el 2009 a raíz de la pandemia de influenza por el virus AH1N1. Por su parte, la miocarditis por influenza de tipo B sigue siendo una condición infrecuente. Se describen aquí dos casos confirmados de miocarditis fulminante por el virus de la influenza B atendidos en un centro cardiovascular, que requirieron dispositivos de asistencia circulatoria mecánica.

Abstract Myocarditis is an inflammatory disease of the myocardium. Viral infections are the most common cause, although it can also be due to hypersensitivity reactions and autoimmune etiology, among other causes. The clinical spectrum of the disease is varied, from an asymptomatic course, followed by chest pain, arrhythmias, and acute heart failure, to a fulminant episode. The term fulminant refers to the development of cardiogenic shock with a need for vasopressor support and inotropic or assisted circulation devices either extracorporeal membrane oxygenation (ECMO) or intra-aortic counterpulsation balloon. About 10% of cases of heart failure due to myocarditis correspond to fulminant myocarditis. Influenza myocarditis has been considered an infrequent condition. However, its incidence has increased since 2009 as a result of the AH1N1 pandemic; otherwise, myocarditis due to the Influenza type B virus remains an infrequent entity. We describe the experience in a cardiovascular center of two confirmed cases of fulminant myocarditis due to influenza B that required circulatory assistance devices.