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.

Actividad y asistencia a la parada cardiorrespiratoria en un servicio extrahospitalario de emergencias durante la pandemia COVID-19 / Caseload and cardiopulmonary arrest management by an out-of-hospital emergency service during the COVID-19 pandemic

Objetivos. Conocer las consecuencias de la pandemia COVID-19 en la atención a la parada cardiorrespiratoria (PCR) extrahospitalaria con relación al inicio de las maniobras de resucitación cardiopulmonar (RCP) y su supervivencia. Valorar el impacto de la pandemia por COVID-19 en la actividad asistencial de un servicio de urgencias y emergencias extrahospitalarias en comparación con otros periodos sin enfermedad.Método. Estudio observacional prospectivo, basado en un registro continuo de PCR extrahospitalaria del SUMMA 112 de Madrid, durante el periodo del 1 de marzo al 30 de abril del 2020. Las variables se recogieron siguiendo las recomendaciones Utstein. Se utilizó el periodo de marzo-abril 2019 como control de comparación directa con el periodo de estudio y los periodos de enero-febrero de 2019 y de 2020 para conocer la variabilidad entre dichos años.Resultados. De las 313 PCR atendidas en marzo-abril de 2020, en 146 casos se realizó RCP avanzada. De los 87 pacientes catalogados COVID positivo, llegaron vivos al hospital 33. No se aplicaron maniobras de RCP avanzada en 167 ocasiones, identificando como causa más frecuente el tiempo de colapso excesivo. El 92,7% de las PCR sucedieron en domicilio. Comparado con otros periodos, hubo más llamadas al centro coordinador de urgencias en marzo-abril de 2020, si bien la movilización de recursos fue similar.Conclusiones. Durante la pandemia de COVID-19 hubo más mortalidad en la PCR extrahospitalaria, aumentando el porcentaje de PCR sin RCP avanzada, destacando como principal causa el tiempo de colapso excesivo. Sin embargo, aunque se incrementó significativamente la demanda telefónica, este servicio de emergencias extrahospitalarias no tuvo aumento en la movilización de los recursos móviles asistenciales. (AU)

Objective. To describe the effect of the coronavirus disease 2019 (COVID-19) pandemic on the initiation of cardiopulmonary resuscitation (CPR) in patients with out-of-hospital cardiopulmonary arrest. To compare the cardiopulmonary arrest caseload during the pandemic to the caseloads in other periods.Methods. Observational, prospective study based on the registry of out-of-hospital cardiopulmonary arrest emergencies the SUMMA112 ambulance service responded to between March 1 and April 30, 2020, in the Spanish autonomous community of Madrid. The registry is a Utstein-style database. The period of March–April 2019 was the control period for direct comparison with the 2020 study period and with the January–February periods of 2019 and 2020.Results. The responders undertook advanced CPR in 146 of the 313 cardiopulmonary arrest cases registered during March-April, 2020. Of the 87 patients with COVID-19–positive tests, 33 reached the hospital alive. Advanced CPR was not applied in 167 cases; the most frequent reason was prolonged circulatory collapse. Most cases (92.7%) occurred in the home. The emergency dispatchers received more calls in March and April of 2020, but they sent out a similar number of ambulances.Conclusions. Mortality was higher in cases of cardiopulmonary arrest during the COVID-19 pandemic. The percentage of cases with no application of advanced CPR rose; the main reason was the amount of time between collapse and first response. Even though the number of emergency calls increased significantly, the SUMMA112 service did not dispatch more ambulances. (AU)

Caseload and cardiopulmonary arrest management by an out-of-hospital emergency service during the COVID-19 pandemic. / Actividad y asistencia a la parada cardiorrespiratoria en un servicio extrahospitalario de emergencias durante la pandemia COVID-19.

OBJECTIVES: To describe the effect of the coronavirus disease 2019 (COVID-19) pandemic on the initiation of cardiopulmonary resuscitation (CPR) in patients with out-of-hospital cardiopulmonary arrest. To compare the cardiopulmonary arrest caseload during the pandemic to the caseloads in other periods. MATERIAL AND METHODS: Observational, prospective study based on the registry of out-of-hospital cardiopulmonary arrest emergencies the SUMMA112 ambulance service responded to between March 1 and April 30, 2020, in the Spanish autonomous community of Madrid. The registry is a Utstein-style database. The period of March-April 2019 was the control period for direct comparison with the 2020 study period and with the January-February periods of 2019 and 2020. RESULTS: The responders undertook advanced CPR in 146 of the 313 cardiopulmonary arrest cases registered during March-April, 2020. Of the 87 patients with COVID-19-positive tests, 33 reached the hospital alive. Advanced CPR was not applied in 167 cases; the most frequent reason was prolonged circulatory collapse. Most cases (92.7%) occurred in the home. The emergency dispatchers received more calls in March and April of 2020, but they sent out a similar number of ambulances. CONCLUSION: Mortality was higher in cases of cardiopulmonary arrest during the COVID-19 pandemic. The percentage of cases with no application of advanced CPR rose; the main reason was the amount of time between collapse and first response. Even though the number of emergency calls increased significantly, the SUMMA112 service did not dispatch more ambulances.

OBJETIVO: Conocer las consecuencias de la pandemia COVID-19 en la atención a la parada cardiorrespiratoria (PCR) extrahospitalaria con relación al inicio de las maniobras de resucitación cardiopulmonar (RCP) y su supervivencia. Valorar el impacto de la pandemia por COVID-19 en la actividad asistencial de un servicio de urgencias y emergencias extrahospitalarias en comparación con otros periodos sin enfermedad. METODO: Estudio observacional prospectivo, basado en un registro continuo de PCR extrahospitalaria del SUMMA 112 de Madrid, durante el periodo del 1 de marzo al 30 de abril del 2020. Las variables se recogieron siguiendo las recomendaciones Utstein. Se utilizó el periodo de marzo-abril 2019 como control de comparación directa con el periodo de estudio y los periodos de enero-febrero de 2019 y de 2020 para conocer la variabilidad entre dichos años. RESULTADOS: De las 313 PCR atendidas en marzo-abril de 2020, en 146 casos se realizó RCP avanzada. De los 87 pacientes catalogados COVID positivo, llegaron vivos al hospital 33. No se aplicaron maniobras de RCP avanzada en 167 ocasiones, identificando como causa más frecuente el tiempo de colapso excesivo. El 92,7% de las PCR sucedieron en domicilio. Comparado con otros periodos, hubo más llamadas al centro coordinador de urgencias en marzo-abril de 2020, si bien la movilización de recursos fue similar. CONCLUSIONES: Durante la pandemia de COVID-19 hubo más mortalidad en la PCR extrahospitalaria, aumentando el porcentaje de PCR sin RCP avanzada, estacando como principal causa el tiempo de colapso excesivo. Sin embargo, aunque se incrementó significativamente la demanda telefónica, este servicio de emergencias extrahospitalarias no tuvo aumento en la movilización de los recursos móviles asistenciales.

Uncontrolled donation programs after out-of-hospital cardiac arrest. An estimation of potential donors.

OBJECTIVE: To determine the number of potential deceased organ donors from out-of- hospital cardiac arrest cases (OHCA) attended by public physician-led emergency medical services in Spain, based on data recorded in the nationwide Spanish OHCA Registry (OHSCAR). MATERIAL AND METHODS: We analysed OHSCAR data on deceased OHCA patients in Spain during 13 months (1/10/2013 to 31/10/2014). Variables included age, sex, estimated OHCA time, cardiopulmonary resuscitation (CPR) start time and outcome. Inclusion criteria were: age 16-60 years, witnessed OHCA, no return of spontaneous circulation (ROSC) and time interval <15min between OHCA occurrence and CPR initiation. RESULTS: Of a total 8789 cases, 3290 met the age criteria; of these, CPR was not witnessed in 745 cases. Among the remaining 2545 patients, 141 were included in uncontrolled donation after cardiac death (uDCD) programs, 902 arrived at the hospital with ROSC, 64 arrived with ongoing CPR and 15 cases were lost to follow-up. Of the remaining 1423 without ROSC, CPR initiation time was not recorded in 454 cases and 398 did not meet the time criteria <15min between OHCA and CPR initiation. Finally, 571 met all the criteria and could have been potential donors. There were significant differences in the actual donors percentage from potential donors percentage between provinces with and without donor programs (141/322=43.8% versus 0/390=0%), but there were no differences in ROSC between the two types of provinces (418/1320=31.7% versus 652/1970=33.4%). CONCLUSIONS: Many potential donors are missed in current clinical practice. uDCD programs are few and underused even in a country with high rates of organ transplantation.

Evolución del injerto hepático procendente de donante en asistolia / Evolution of the liver graft from a asystole donor

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Lung transplant of extrahospitalary donor after cardiac death.

Non-heart-beating donors (NHBDs) have to meet the predefined criteria for organ donation including death from irreversible cessation of the beating heart. The Maastricht conference defined 4 NHBD categories to differentiate their viability and ethical-legal support. In Spain, NHBDs who originate from an out-of-hospital setting correspond to type II donors. These are patients who have had a cardiac arrest outside hospital and, after failed CPR attempts, are transferred with hemodynamic support measures to the hospital for organ donation. The Hospital Clínico San Carlos also has a lung donation program in collaboration with the Hospital Puerta de Hierro in Madrid and the Hospital Marques de Valdecilla in Santander. The objective of this study is to describe the results of lung transplantation of after cardiac death program, specifically the section regarding lung extraction donation. Twenty potential lung donors were obtained during the study. Most patients were male (19 cases), with a mean age of 42 years (36.5-49.5 years). A total of 33 lungs were donated (18 right and 15 left lungs). Most extractions were multiorganic (19 cases). One liver, 19 kidneys, 2 pancreas, and 19 corneas were obtained from these donors; bone tissue was obtained from all donors. The transplantation was bipulmonary in 13 cases and unipulmonary in 7. Thirty days after transplantation, 2 recipients died, 1 died of stroke associated with bilateral pneumonia and 1 died of hypovolemic shock resulting from hemothorax. The remaining 18 patients were progressing well at 30 days. Our data suggest that lung transplantation from patients after extrahospitalary cardiac death is feasible.

Out-hospital donors after cardiac death in Madrid, Spain: a 5-year review.

OBJECTIVE: The Medical Emergencies Service of Madrid (Spain) (Servicio de Urgencias Medicas de Madrid), SUMMA112, forms part of an organ donor program involving patients who have suffered out-hospital cardiac arrest and fail to respond to advanced cardiopulmonary resuscitation maneuvers. Subjects meeting the inclusion criteria are moved to a transplant unit under sustained resuscitation maneuvering in order to harvest the organs. This paper presents compliance with the timelines of the program, the proportion of donors, the characteristics of donors and non-donors, and the number of organs obtained. MATERIAL: A retrospective descriptive study was made based on the review of case histories. The SPSS(©) version 16.0 statistical package was used for data analysis. RESULTS: A total of 214 cases were recorded, of which 84% were males. The mean age was 40 years. The mean time to arrival on scene was 13 min and 34 s. The mean time to arrival in hospital was 88 min and 10 s. A total of 522 organs and tissues were harvested (250 kidneys, 33 livers, 123 corneas, 97 bone tissues and 19 lungs), corresponding to 3.2 organs/tissues per patient on average. A total of 21.7% of the patients were not valid. There were no differences between the valid and non-valid patients in terms of age and gender. The causes of non-donation included extracorporeal circuit failure (6.3%), family refusal (15.6%), patient refusal expressed in life (4.7%), legal denial (1.6%), biological causes (51.6%), and others (20.3%). Cardiac compressors were used in 85 cases, yielding 92 kidneys, 41 corneas, 30 bone tissues, 19 livers and 9 lungs, corresponding to 2.1 organs/tissues per patient on average. CONCLUSION: This program affords a very important number of organs for transplantation. Further studies are needed to assess the efficacy of mechanical cardiac compressor use in generating more organs.

Kidney transplant function using organs from non-heart-beating donors maintained by mechanical chest compressions.

OBJECTIVE: This study aims to determine the failure rate of transplanted kidney grafts in recipients of organs from non-heart beating donors (NHBDs) who have had mechanical chest compressions to maintain a circulation before organ retrieval. METHODS: A retrospective observational study based on review of the emergency medical service database and case histories of NHBDs, and information periodically sent by transplant units about donors and organs. The following variables were studied: age, sex, transfer hospital, time to arrival on the scene of cardiopulmonary arrest, time to arrival in hospital, number and type of organs retrieved, use of mechanical chest compression devices, and kidney function in graft recipients. The study covered the period between January 2008 and November 2009. During 2008 standard manual chest compressions were used and during 2009 mechanical chest compression devices were used. RESULTS: In 39 transplanted kidneys from donors receiving mechanical chest compressions primary failure was documented in recipients on two occasions (5.1%). Kidneys transplanted from donors who had manual chest compressions resulted in three primary failures in recipients (9.1%). The difference between the two groups was not significant (p=0.5). Three patients achieved successful return of spontaneous circulation in the mechanical chest compression group after initiation of the NHBD donor protocol. CONCLUSION: We have described our experience and protocol for non-heart beating donation using victims of out-of-hospital cardiac arrest in whom cardiopulmonary resuscitation has been unsuccessful as donors. Primary kidney graft failure rates in organs from non-heart beating donors is similar when manual or mechanical chest compression devices are used during cardiopulmonary resuscitation.