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.

2020 EACTS/ELSO/STS/AATS Expert Consensus on Post-Cardiotomy Extracorporeal Life Support in Adult Patients.

Post-cardiotomy extracorporeal life support (PC-ECLS) in adult patients has been used only rarely but recent data have shown a remarkable increase in its use, almost certainly due to improved technology, ease of management, growing familiarity with its capability and decreased costs. Trends in worldwide in-hospital survival, however, rather than improving, have shown a decline in some experiences, likely due to increased use in more complex, critically ill patients rather than to suboptimal management. Nevertheless, PC-ECLS is proving to be a valuable resource for temporary cardiocirculatory and respiratory support in patients who would otherwise most likely die. Because a comprehensive review of PC-ECLS might be of use for the practitioner, and possibly improve patient management in this setting, the authors have attempted to create a concise, comprehensive and relevant analysis of all aspects related to PC-ECLS, with a particular emphasis on indications, technique, management and avoidance of complications, appraisal of new approaches and ethics, education and training.

An evaluation of manual tidal volume and respiratory rate delivery during simulated resuscitation.

INTRODUCTION: Excessive minute ventilation during cardiac arrest may cause lung injury and decrease the effectiveness of cardiopulmonary resuscitation (CPR). However, little is known about how clinicians deliver tidal volumes and respiratory rates during CPR. METHODS: In this cross-sectional study, licensed practitioners attending an American Heart Association (AHA) Advanced Cardiac Life Support (ACLS) course performed CPR and manual ventilation on a high-fidelity simulator during the megacode portion of the course. Delivered tidal volumes and respiratory rates were measured on a monitor. During the first scenario, results were not displayed to participants, but were displayed during the second scenario. RESULTS: Fifty-two clinicians participated in this study. Average height was 169 (157,178) cm. Pre-monitor display tidal volumes delivered were larger in male participants compared to female participants (684.6 ± 134.4 vs 586.7 ± 167.6 ml, P = 0.05). Those using medium-sized gloves delivered smaller tidal volumes than those using small or large gloves. Twenty-two (42.3%) delivered tidal volume in the range of 5-8 ml/kg of predicted body weight for the simulation manikin, and 35 (67.3%) delivered tidal volumes with >20% variability among breaths. All participants met the target respiratory rate around 10 breaths/min. CONCLUSION: Tidal volume delivery varied greatly during manual ventilation and fewer than half participants delivered tidal volume at 5-8 ml/kg to the manikin. Sex and glove size appeared to impact tidal volume delivery when the participants were unaware of what they were delivering. Participants were able to meet the target respiratory rate around 10 without audio or visual feedback.

After a century, Epinephrine's role in cardiac arrest resuscitation remains controversial.

BACKGROUND: Epinephrine is recommended in contemporary educational efforts by the American Heart Association (AHA) as central to adult Advanced Cardiac Life Support (ACLS). However, the International Liaison Committee on Resuscitation (ILCOR) 2019 recommendations update describes large evidentiary gaps for epinephrine use in cardiopulmonary resuscitation, highlighting that clinical and experimental evidence do not support the current AHA recommendations. OBJECTIVE: This controversies article was written as a response to updated AHA and ILCOR adult ACLS recommendations in late 2019. This report summarizes and evaluates the evidence surrounding epinephrine for cardiac arrest with a focus on the historical perspective of epinephrine research. DISCUSSION: According to the 2019 AHA ACLS guidelines, epinephrine is an integral component of adult out-of-hospital cardiac arrest resuscitation. Epinephrine improves rates of return of spontaneous circulation and might provide benefit at different doses or in select resuscitation scenarios, such asystole as an initial rhythm at onset of resuscitation efforts. However, evidence indicates potential harms with routine use of standard dose epinephrine (1 mg/10 mL), with no improvement in neurologic or long-term outcomes. CONCLUSIONS: Despite years of use and inclusion in resuscitation guidelines, epinephrine is not associated with improved neurologic outcomes. The AHA Emergency Cardiovascular Care committee should revise ACLS guidelines reflecting evidence that standard-dose epinephrine offers little benefit to successful patient recovery including neurologic outcomes. Future resuscitation guidelines should reflect this important consideration.

Association of Prehospital Advanced Life Support by Physician With Survival After Out-of-Hospital Cardiac Arrest With Blunt Trauma Following Traffic Collisions: Japanese Registry-Based Study.

Importance: Controversy remains as to whether advanced life support (ALS) or basic life support (BLS) is superior for critically ill and injured patients, including out-of-hospital cardiac arrest (OHCA) and major trauma, in the prehospital setting. Objective: To assess whether prehospital ALS should be provided for traumatic OHCA and who should perform it. Design, Setting, and Participants: Japanese government-managed nationwide population-based registry data of patients with OHCA transported to an emergency hospital were analyzed. Patients who experienced traumatic OHCA following a traffic collision from 2013 to 2014 were included. Patients provided prehospital ALS by a physician were compared with both patients provided ALS by emergency medical service (EMS) personnel and patients with only BLS. The data were analyzed on May 1, 2017. Exposures: Advanced life support by physician, ALS by EMS personnel, or BLS only. Main Outcomes and Measures: The primary outcome was 1-month survival. The secondary outcomes were prehospital return of spontaneous circulation and favorable neurologic outcomes with the Glasgow-Pittsburgh cerebral performance category score of 1 or 2. Results: A total of 4382 patients were included (mean [SD] age, 57.5 [22.2] years; 67.9% male); 828 (18.9%) received prehospital ALS by physician, 1591 (36.3%) received prehospital ALS by EMS personnel, and 1963 (44.8%) received BLS only. Among these patients, 96 (2.2%) survived 1 month after OHCA, including 26 of 828 (3.1%) for ALS by physician, 25 of 1591 (1.6%) for ALS by EMS personnel, and 45 of 1963 (2.3%) for BLS. After adjusting for potential confounders using multivariable logistic regression, ALS by physician was significantly associated with higher odds for 1-month survival compared with both ALS by EMS personnel and BLS (adjusted OR, 2.13; 95% CI, 1.20-3.78; and adjusted OR, 1.94; 95% CI, 1.14-3.25; respectively), whereas there was no significant difference between ALS by EMS personnel and BLS (adjusted OR, 0.91; 95% CI, 0.54-1.51). A propensity score-matched analysis in the ALS cohort showed that ALS by physician was associated with increased chance of 1-month survival compared with ALS by EMS personnel (risk ratio, 2.00; 95% CI, 1.01-3.97; P = .04). This association was consistent across a variety of sensitivity analyses. Conclusions and Relevance: In traumatic OHCA, ALS by physician was associated with increased chance of 1-month survival compared with both ALS by EMS personnel and BLS.

Rural EMS en route IV insertion improves IV insertion success rates and EMS scene time.

BACKGROUND: Emergency medical service (EMS) personnel are trained to insert intravenous (IV) lines at trauma scenes if the time for insertion does not prolong scene time. However, EMS providers continue to insert IV lines on scene. METHODS: A rural EMS provider provided trauma patient EMS IV insertion data for a 1-year period. No IV lines were inserted en route during this period. During the following 1-year period, a prospective trauma patient study protocol was instituted in which all IV insertions were attempted while en route to the emergency room. RESULTS: Three hundred six trauma patients had IV attempts on scene, and 341 trauma patients had IV insertion attempts en route. The average EMS on-scene time with IV insertions on scene was 19.8 minutes (IV insertion success, 79%) compared with 13.9 minutes (IV insertion success, 93%) on-scene time with IV insertions en route. CONCLUSIONS: EMS IV insertion en route significantly decreases on-scene time and improves IV insertion success rates.

Can course format influence the performance of students in an advanced cardiac life support (ACLS) program?

Advanced cardiac life support (ACLS) is a problem-based course that employs simulation techniques to teach the standard management techniques of cardiovascular emergencies. Its structure is periodically revised according to new versions of the American Heart Association guidelines. Since it was introduced in Brazil in 1996, the ACLS has been through two conceptual and structural changes. Detailed documented reports on the effect of these changes on student performance are limited. The objective of the present study was to evaluate the effect of conceptual and structural changes of the course on student ACLS performance at a Brazilian training center. This was a retrospective study of 3266 students divided into two groups according to the teaching model: Model 1 (N = 1181; 1999-2003) and Model 2 (N = 2085; 2003-2007). Model 2 increased practical skill activities to 75 percent of the total versus 60 percent in Model 1. Furthermore, the teaching material provided to the students before the course was more objective than that used for Model 1. Scores greater than 85 percent in the theoretical evaluation and approval in the evaluation of practice by the instructor were considered to be a positive outcome. Multiple logistic regression was used to adjust for potential confounders (specialty, residency, study time, opportunity to enhance practical skills during the course and location where the course was given). Compared to Model 1, Model 2 presented odds ratios (OR) indicating better performance in the theoretical (OR = 1.34; 95 percentCI = 1.10-1.64), practical (OR = 1.19; 95 percentCI = 0.90-1.57), and combined (OR = 1.38; 95 percentCI = 1.13-1.68) outcomes. Increasing the time devoted to practical skills did not improve the performance of ACLS students.

[Advanced life support under special circumstances: part 1]. / Erweiterte kardiopulmonale Reanimation in besonderen Situationen: Teil 1.

Based on the 2005 International Consensus Conference on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations of the International Liaison Committee on Resuscitation (ILCOR), guidelines were published for managing basic and advanced life-saving procedures in the event of cardiac arrest. The fact that special circumstances sometimes must be considered in patient treatment resulted in a separate chapter. This first part of a two-part article reviews essential information as well as necessary modifications of the standard advanced life support algorithm in cases of life-threatening drowning, asthma, anaphylaxis, and poisoning. The second part will deal with electrolyte disorders, hypothermia, electrical emergencies, trauma, cardiac arrest during pregnancy, and cardiac surgery.

The importance of advanced cardiac life support certification in office-based surgery.

BACKGROUND: Safety in office-based surgery remains of paramount importance. Accordingly, many consider Advanced Cardiac Life Support training a critical component of safety preparation for office-based surgery. A survey was recently designed and distributed to assess the experience and attitudes of board-certified plastic surgeons toward Advanced Cardiac Life Support training. METHODS: A two-page, 14-question survey was mailed to the 4581 members of the American Society of Plastic Surgeons. The anonymous survey consisted of multiple choice questions eliciting status of Advanced Cardiac Life Support certification, use of office-based surgery, experience with adverse cardiac and respiratory events, and opinions on mandating Advanced Cardiac Life Support training. RESULTS: The total number of surveys returned was 1461 (32 percent). Current Basic Life Support and Advanced Cardiac Life Support certification was 65.6 percent and 44.9 percent, respectively. Over the past 10 years, 29 percent of plastic surgeons participated in a cardiac or respiratory arrest, and 43.9 percent of these surgeons acted as the code leader; 60.2 percent of plastic surgeons felt Advanced Cardiac Life Support certification should be required, but only 26 percent of these felt it should be mandated to maintain board certification. CONCLUSIONS: Historically, Advanced Cardiac Life Support and facility accreditation were strongly recommended but often not required for office-based surgery. The American Society of Plastic Surgeons and the American Society for Aesthetic Plastic Surgery have taken steps to increase patient safety, mandating that outpatient plastic surgery only be performed at accredited facilities. Many credentialing organizations are now escalating the requirements for Advanced Cardiac Life Support/Basic Life Support certification.

[Assessment of physicians employed in emergency medical services about their level of knowledge on basic life support, advanced cardiac life support and medicolegal responsibilities]. / 112 Acil Saglik Hizmetleri'nde görevli doktorlarin temel yasam destegi, ileri kardiyak yasam destegi ve doktorun adli sorumluluklari konularindaki bilgi düzeylerinin degerlendirilmesi.

BACKGROUND: We aimed to determine the level of knowledge of Emergency Medical Services (EMS) physicians on Basic Life Support (BLS), Advanced Cardiac Life Support (ACLS) and medicolegal responsibilities in conjunction with related factors. METHODS: Fifty-three physicians (43 male, 10 females; mean age 39 years; range 28 to 50 years) employed in EMS were required to respond a questionnaire consisting of demographic data and educational background. They also answered 25 multiple-choice questions about BLS, ACLS and medicolegal responsibilities of physicians in a face-to-face manner. The data were analyzed using Mann-Whitney U-test and Kruskal-Wallis Analysis of Variance test. RESULTS: Mean level of knowledge was 45.4 on a hundred-point scale. Attendance to courses covering emergency aid and working as an ambulance physician for more than one year were associated with higher levels of knowledge (p=0.012; p=0.015). CONCLUSION: In-service training should be undertaken to raise the level of knowledge of the physicians employed in rural EMS and to improve the quality of field care.