[Teaching basic life support to the general population. Alumni intervention analysis]. / Enseñando soporte vital básico a la población general. Análisis de las intervenciones de los alumnos.

OBJECTIVES: The aim of this study was to investigate the rate at which the alumni of basic life support courses witnessed and intervened in out-of-hospital emergency situations, and to identify the variables characterizing those alumni associated with a greater number of witnessing events and interventions. An analysis of the efficiency of the courses was also carried out. DESIGN: A descriptive, cross-sectional study was made. SETTING: A district in the province of Almería (Spain). PATIENTS: Alumni of a mass basic life support training program targeted to the general population «Plan Salvavidas¼ conducted between 2003-2009. INTERVENTIONS: In 2010 the alumni were administered a telephone survey asking whether they had witnessed an emergency situation since attending the program, with the collection of information related to this emergency situation. MAIN VARIABLES OF INTEREST: Rate of out-of-hospital emergencies witnessed by the alumni. Rate of intervention of the alumni in emergency situations. Variables characterizing alumni with a greater likelihood of witnessing an emergency situation. RESULTS: A total of 3,864 trained alumni were contacted by telephone. Of 1,098 respondents, 63.9% were women, and the mean age was 26.61±10.6 years. Of these alumni, 11.75% had witnessed emergency situations, an average of three years after completing the course. Of these emergencies, 23.3% were identified as cardiac arrest. The alumni intervened in 98% of the possible cases. In 63% of the cases, there was no connection between the alumni and the victim. The majority of the emergency situations occurred in the street and in public spaces. A greater likelihood of witnessing an emergency situation was associated with being a healthcare worker and with being over 18 years of age. CONCLUSIONS: The rate of out-of-hospital emergencies witnessed by these alumni after the course was 11.75%. The level of intervention among the alumni was high. The most efficient target population consisted of healthcare workers.

Evaluación del contenido y funcionamiento de los carros de reanimación cardiopulmonar de un hospital / Evaluation of the content and functioning of cardiopulmonary resuscitation trolleys in a hospital

Fundamento. En la atención a la parada cardiorrespiratoria hospitalaria se utilizan carros de paro cardíaco ubicados en las diferentes áreas del centro. No obstante, ni su contenido ni su revisión suelen depender de la unidad responsable de la atención en estas situaciones de emergencia, y su mantenimiento puede no estar bien definido. Objetivo. Evaluar si el contenido y el funcionamiento de los equipos de los carros de paro cardíaco de nuestro centro aseguran la ejecución eficaz de los protocolos de soporte vital avanzado cardiológico. Métodos. Un grupo de expertos elaboró un listado de material necesario y se evaluó la adecuación del contenido de los carros con las recomendaciones del grupo de expertos. Resultados. Un 40 por ciento de los carros evaluados presentaban deficiencias que podían comprometer o dificultar la eficacia de la reanimación. Sólo un 20 por ciento no presentaba deficiencias. Conclusiones. Debe establecerse un circuito que asegure el óptimo equipamiento de los carros, y esta coordinación debe recaer en la unidad responsable de la asistencia a estas situaciones emergentes (AU)

Thrombolysis with recombinant tissue plasminogen activator during cardiopulmonary resuscitation in fulminant pulmonary embolism. A case series.

OBJECTIVE: To describe our outcomes using thrombolysis during the cardiopulmonary resuscitation (CPR) of patients in cardiorespiratory arrest (CA) caused by fulminant pulmonary embolism (FPE). DESIGN: A case series. SETTING: Intensive care units of a district hospital and a referral centre. PATIENTS: Six patients that suffered CA secondary to an FPE. INTERVENTIONS: Administration of recombinant tissue plasminogen activator during usual CPR manoeuvres when there was a strong suspicion of FPE. Permission for the thrombolytic therapy was sought from family members in all cases. RESULTS: Four out of the six patients survived and remain symptom-free. The thrombolysis was not associated with any fatal complications. CONCLUSIONS: Early thrombolysis during CPR manoeuvres for CA apparently caused by an FPE may reduce the mortality rate among these patients.

Efficacy of thrombolysis in patients with acute myocardial infarction requiring cardiopulmonary resuscitation.

OBJECTIVE: To evaluate the efficacy and safety of systemic thrombolysis administered to resuscitated patients after cardiac arrest (CA) due to an acute myocardial infarction (AMI), through a study of their mortality and haemorrhagic complications. DESIGN: We studied a retrospective cohort of patients with ischaemic heart disease gathered from the database of the Spanish multi-centre project "Analysis of Delay in AMI" (ARIAM). SETTING: Intensive care (ICU) and coronary care (CCU) units of 77 Spanish hospitals. PATIENTS AND PARTICIPANTS: The study period was from 1 January 1995 to 1 January 2000, when 22,922 patients were included in the ARIAM database register; 13,704 were diagnosed with AMI and we studied 303 of these AMI patients admitted after resuscitation for CA. MEASUREMENTS AND RESULTS: Of the 303 patients studied, 228 were male (75.25%); the mean age was 64.57 +/- 12.48 years. Systemic thrombolysis was administered to 67 patients (group I) and the remaining 236 patients were managed without this treatment (group II). The ICU/CCU mortality rate of the series was 39.93 % (121 patients); that of group I was 17.91% (12 patients) and that of group II 46.18% (109 patients) (P < 0.00001). Group I required less mechanical ventilation (group I, 42.85% vs group II, 80.76 %; P < 0.00001) and fewer cardiopulmonary resuscitation attempts (33.34% vs 60.98%, P < 0.0001). Group I also showed a lower incidence of cardiogenic shock (14.28% vs 39.01%, P < 0.0001) and anoxic encephalopathy (8.62% vs 39.89% P = 0.006). There were no fatal haemorrhagic complications in either group. Logistic regression analysis showed the administration of thrombolysis to be an independent variable that protected against mortality. CONCLUSIONS: The administration of thrombolysis to patients with AMI who require resuscitation may be efficacious in reducing mortality and is safe, with no increase in haemorrhagic complications.

Peripartum cardiomyopathy: a case series.

OBJECTIVES: We describe our experience with peripartum cardiomyopathy. DESIGN AND SETTING: A case series in intensive care units (ICU) of a district hospital and a referral center. PATIENTS: Six patients who required admission to an ICU after the onset of peripartum cardiomyopathy. RESULTS: Five of the six patients survived, with total recovery of ventricular function. After 1 year of follow-up all five survivors were symptom free with a normal ventricular function. CONCLUSIONS: There is a low rate of ICU admissions for peripartum cardiomyopathy, which has a potentially fatal prognosis. However, this disease can be detected by echocardiography among patients without the semiology.

Miniexamen neurológico en el traumatismo craneoencefálico grave / Neurologic mini-examination in severe cranio-encephalic trauma

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[Antilymphocytic sera versus azathioprine, combined with cyclosporin and steroids, in liver transplant. Comparison of the results at the intensive care unit and 2 years' follow-up]. / Sueros antilinfocitarios frente a azatioprina, en asociación con ciclosporina y esteroides, en el trasplante hepático. Comparación de resultados en UCI y seguimiento de dos años.

The use of anti-lymphocyte globulins (ATG, ALG, OKT3) for the control or organ rejection in humans, has been of major importance both in preventing and treating organ rejection resistant to other treatments. We present here the results of our immunosuppression protocol using two different therapeutic associations. To the first group consisting of 29 patients, low doses of cyclosporine, steroids and anti-lymphocyte globulins were given, and to another group of 11 patients azathioprine was given together with cyclosporine and steroids at the same doses as in the first group. We want to point out that the incidence of acute rejections was similar in both groups (17.2% vs 18.1%) immediately after surgery and a greater incidence of rejections at a later time during the follow up period in the group treated with azathioprine (34.4% vs 54.6%). The incidence of chronic rejections was similar in both groups (10.3% vs 8.9%). During the follow up period, the incidence of infections was higher in the group treated with azathioprine (13.7% vs 36.4%) as well as bacteremia episodes (17.2% vs 45.4%) (p less than 0.1). We also want to highlight that patients with graft complications (primary graft rejection) suffered infections (p less than 0,001) and had a higher mortality rate (p less than 0,05) in association to the infection.

Myocardial infarct extension. Identification of subgroups by the pattern of the serum CKMB level.

To examine the clinical course of patients with acute myocardial infarction complicated by "extension", we studied prospectively 141 patients who had been diagnosed as having acute myocardial infarction. The serum CKMB level of these patients was determined at 8-h intervals during the first 5 days following admission. The patients were classified into 3 groups. Group A (early extension): patients who showed CKMB re-elevation before the CKMB values reached normal levels (28%). Group B (late extension): patients who showed CKMB re-elevation after the normalization of serum CKMB levels (21%). Group C (control group): patients without CKMB re-elevation (51%). Patients in group A showed the most unfavourable clinical course with a greater rate of haemodynamic deterioration compared with patients in the B or C groups, and a higher rate of recurrent ischemic pain. We found no significant differences in these parameters between the B and C groups. We were unable to find any risk factor associated with the development of extension. The pattern of the serum CKMB curve may allow a separation of two different subgroups of patients with acute myocardial infarct extension: patients with early extension, who show a high prevalence of haemodynamic deterioration, and patients with late extension, characterized by small infarcts and a benign clinical course.