Novedades en métodos formativos en resucitación / Novelities in resuscitation training methods

La importancia de la parada cardiaca como problema sanitario hace que la formación en las técnicas de resucitación constituya un tema de gran interés. Es necesario potenciarla formación en resucitación de todos los ciudadanos y que ésta se inicie en las escuelas y en los institutos, siendo dianas de la formación para convertirse en futuros instructores los maestros y los enfermeros. Parece demostrado que el modelo de cursos cortos con video instrucción y utilización de maniquíes es de gran utilidad para la difusión de las técnicas de resucitación. Parece conveniente la liberalización de la utilización de los desfibriladores externos automáticos (DEA) y la reducción de las exigencias formativas en soporte vital básico y DEA para aquellos profesionales no sanitarios que puedan utilizarlos. La formación a nivel sanitario debe mejorarse en las escuelas de medicina y enfermería a nivel de pregrado. Los profesionales sanitarios deberán recibir una formación acorde a sus necesidades y deberá destacarse el desarrollo de habilidades no técnicas, como el liderazgo y el trabajo en equipo. El modelo formativo con la utilización de instructores y maniquíes de baja fidelidad sigue siendo un elemento básico y fundamental en la formación. La formación mediante la evaluación del desempeño es una técnica que debe implantarse en todas aquellas áreas donde se presenten casos de parada cardiaca y el equipo de profesionales sanitarios haya intervenido. La simulación parece orientarse como la técnica actual y futura para la formación en distintos ámbitos sanitarios y, cómo no, dentro de este importante campo como es el de la resucitación. Finalmente, la investigación en formación en resucitación debe ser considerada como un claro ejemplo de ciencia translacional, en la que estudios rigurosos de adquisición de habilidades con medida de resultados, trasladen las mismas al entorno clínico, para el análisis de su repercusión sobre la atención de los pacientes (AU)

Abstract The importance of cardiac arrest as a health problem makes training in resuscitationa topic of great interest. It is necessary to enhance resuscitation training for all citizens,starting in schools and institutes, targeting teachers and nurses for training, to in turn become future trainers. The model of short courses with video-instruction and the use of mannequins isuseful for the dissemination of resuscitation techniques. Liberalization of the use of automated external defibrillators (AED) and reduction of the training requirements in basic life support and AED for those non-health professionals who can use them, seems appropriate. Training must be improved in schools of medicine and nursing schools at undergraduate level. Health professionals should be trained according to their needs, with emphasis on non-technical skills such as leadership and teamwork. The model based on the use of trainers and low-fidelity mannequinsremains a basic and fundamental element in training. Training through performance evaluationis a technique that should be implemented in all areas where cases of cardiac arrest are seen and the healthcare team has intervened. Simulation appears to be defined as the current and future modality for training in various medical areas, including of course the important field of resuscitation. Lastly, research in resuscitation training should be considered an example of translational science, where rigorous studies of skill acquisition with outcome measures serveto transfer the results to the clinical environment for analysis of their impact upon patient care(AU)

[Novelities in resuscitation training methods]. / Novedades en métodos formativos en resucitación.

The importance of cardiac arrest as a health problem makes training in resuscitation a topic of great interest. It is necessary to enhance resuscitation training for all citizens, starting in schools and institutes, targeting teachers and nurses for training, to in turn become future trainers. The model of short courses with video-instruction and the use of mannequins is useful for the dissemination of resuscitation techniques. Liberalization of the use of automated external defibrillators (AED) and reduction of the training requirements in basic life support and AED for those non-health professionals who can use them, seems appropriate. Training must be improved in schools of medicine and nursing schools at undergraduate level. Health professionals should be trained according to their needs, with emphasis on non-technical skills such as leadership and teamwork. The model based on the use of trainers and low-fidelity mannequins remains a basic and fundamental element in training. Training through performance evaluation is a technique that should be implemented in all areas where cases of cardiac arrest are seen and the healthcare team has intervened. Simulation appears to be defined as the current and future modality for training in various medical areas, including of course the important field of resuscitation. Lastly, research in resuscitation training should be considered an example of translational science, where rigorous studies of skill acquisition with outcome measures serve to transfer the results to the clinical environment for analysis of their impact upon patient care.

Manejo del síndrome posparada cardíaca / Managing the post-cardiac arrest syndrome

Desde el advenimiento de la resucitación cardiopulmonar (RCP), hace más de 40 años, se ha conseguido que cada vez una mayor proporción de pacientes con parada cardiorrespiratoria logren la recuperación de la circulación espontánea (RCE). Sin embargo, la mayoría de estos pacientes fallecen en los primeros días tras su ingreso en las unidades de cuidados intensivos (UCI), y esta situación no ha mejorado en estos años. La mortalidad de estos pacientes se asocia en gran medida a daño cerebral. Posiblemente, el reconocimiento de que la RCP no se acaba con la RCE, sino con el retorno de la función cerebral normal y la estabilización total del paciente, nos ayudará a mejorar el tratamiento terapéutico de estos pacientes en las UCI. En este sentido, parece más apropiado el término «resucitación cardiocerebral», como proponen algunos autores. Recientemente, el Internacional Liaison Committee on Resuscitation (ILCOR) ha publicado un documento de consenso sobre el «síndrome posparada cardíaca» y diversos autores han propuesto que los cuidados posparada se integren como un quinto eslabón de la cadena de supervivencia, tras la alerta precoz, la RCP precoz por testigos, la desfibrilación precoz y el soporte vital avanzado precoz. El manejo terapéutico de los pacientes que recuperan la circulación espontánea tras las maniobras de RCP basada en medidas de soporte vital y una serie de actuaciones improvisadas basadas en el «juicio clínico» puede que no sea la mejor forma de tratar a los pacientes con «síndrome posparada cardíaca». Estudios recientes indican que el tratamiento de estos pacientes mediante protocolos guiados por objetivos -incluyendo las medidas terapéuticas que han demostrado su eficacia, como la hipotermia terapéutica inducida leve y la revascularización precoz, cuando esté indicada- puede mejorar notablemente el pronóstico de éstos. Dado que en el momento actual no existe un protocolo basado en la evidencia universalmente aceptado, el Comité Directivo del Plan Nacional de RCP de la Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (SEMICYUC), tras una revisión exhaustiva de la literatura científica sobre el tema, seguida de una discusión en línea entre todos los miembros del comité y una reunión de consenso, ha elaborado el presente documento con la intención de que pueda servir como base para el desarrollo de protocolos locales en las diferentes UCI de nuestro país, teniendo en cuenta sus medios y sus características propias (AU)

Since the advent of cardiopulmonary resuscitation more than 40 years ago, we have achieved a return to spontaneous circulation in a growing proportion of patients with cardiac arrest. Nevertheless, most of these patients die in the first few days after admission to the intensive care unit (ICU), and this situation has not improved over the years. Mortality in these patients is mainly associated to brain damage. Perhaps recognizing that cardiopulmonary resuscitation does not end with the return of spontaneous circulation but rather with the return of normal brain function and total stabilization of the patient would help improve the therapeutic management of these patients in the ICU. In this sense, the term cardiocerebral resuscitation proposed by some authors might be more appropriate. The International Liaison Committee on Resuscitation recently published a consensus document on the «Post-Cardiac Arrest Syndrome» and diverse authors have proposed that post-arrest care be integrated as the fifth link in the survival chain, after early warning, early cardiopulmonary resuscitation by witnesses, early defibrillation, and early advanced life support. The therapeutic management of patients that recover spontaneous circulation after cardiopulmonary resuscitation maneuvers based on life support measures and a series of improvised actions based on «clinical judgment» might not be the best way to treat patients with post-cardiac arrest syndrome. Recent studies indicate that using goal-guided protocols to manage these patients including therapeutic measures of proven efficacy, such as inducing mild therapeutic hypothermia and early revascularization, when indicated, can improve the prognosis considerably in these patients. Given that there is no current protocol based on universally accepted evidence, the Steering Committee of the National Cardiopulmonary Resuscitation Plan of the Spanish Society of Intensive Medicine and Cardiac Units has elaborated this document after a thorough review of the literature and an online discussion involving all the members of the committee and a consensus meeting with the aim of providing a platform for the development of local protocols in different ICSs in our country to fit their own means and characteristics (AU)

[Managing the post-cardiac arrest syndrome. Directing Committee of the National Cardiopulmonary Resuscitation Plan (PNRCP) of the Spanish Society for Intensive Medicine, Critical Care and Coronary Units (SEMICYUC)]. / Manejo del síndrome posparada cardíaca. Comité Directivo del Plan Nacional de Resuscitación Cardiopulmonary de la SEMICYUC (Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias).

Since the advent of cardiopulmonary resuscitation more than 40 years ago, we have achieved a return to spontaneous circulation in a growing proportion of patients with cardiac arrest. Nevertheless, most of these patients die in the first few days after admission to the intensive care unit (ICU), and this situation has not improved over the years. Mortality in these patients is mainly associated to brain damage. Perhaps recognizing that cardiopulmonary resuscitation does not end with the return of spontaneous circulation but rather with the return of normal brain function and total stabilization of the patient would help improve the therapeutic management of these patients in the ICU. In this sense, the term cardiocerebral resuscitation proposed by some authors might be more appropriate. The International Liaison Committee on Resuscitation recently published a consensus document on the "Post-Cardiac Arrest Syndrome" and diverse authors have proposed that post-arrest care be integrated as the fifth link in the survival chain, after early warning, early cardiopulmonary resuscitation by witnesses, early defibrillation, and early advanced life support. The therapeutic management of patients that recover spontaneous circulation after cardiopulmonary resuscitation maneuvers based on life support measures and a series of improvised actions based on "clinical judgment" might not be the best way to treat patients with post-cardiac arrest syndrome. Recent studies indicate that using goal-guided protocols to manage these patients including therapeutic measures of proven efficacy, such as inducing mild therapeutic hypothermia and early revascularization, when indicated, can improve the prognosis considerably in these patients. Given that there is no current protocol based on universally accepted evidence, the Steering Committee of the National Cardiopulmonary Resuscitation Plan of the Spanish Society of Intensive Medicine and Cardiac Units has elaborated this document after a thorough review of the literature and an online discussion involving all the members of the committee and a consensus meeting with the aim of providing a platform for the development of local protocols in different ICSs in our country to fit their own means and characteristics.

[An evaluation of blood cultures obtained via a central venous catheter]. / Valoración de los cultivos de sangre obtenidos mediante catéter venoso central.

BACKGROUND: The aim of this study was to determine the use of blood samples obtained through central venous catheters (CVC) in the diagnosis of bacteremias in patients admitted to an intensive care unit (ICU). METHODS: A prospective randomized study was carried out in which 125 blood samples obtained by CVC were compared with 125 samples simultaneously obtained by venipuncture. RESULTS: In 105 sample pairs (84%) the results of both samples were in agreement (Kappa index 0.61). The sensitivity of the technique in the diagnosis of bacteremia was 76.5%, specificity 86.8% positive predictive value 68.4% and negative predictive value 90.8%. No differences were found in the efficacy of the technique carried out by venous punction or that of the samples obtained through catheters inserted in subclavian, femoral and antecubital veins (p = 0.99). CONCLUSIONS: Blood cultures obtained through central venous catheters constitute a technical alternative for the diagnosis of bacteremia in cases in which venipuncture is difficult or of doubtful asepsis.