Supervivencia y factores asociados a la práctica de reanimación cardiopulmonar en curso entre los pacientes con parada cardiaca extrahospitalaria / Ambulance cardiopulmonary resuscitation: outcomes and associated factors in out-of-hospital cardiac arrest

OBJETIVO: Conocer la supervivencia y los factores asociados a la realización de reanimación cardiopulmonar (RCP) en curso entre los pacientes con parada cardiaca extrahospitalaria (PCR). MÉTODO: Análisis retrospectivo de un registro de casos de PCR entre 2008 y 2014. Se incluyeron los pacientes con PCR sin recuperación espontánea de pulso en el momento de la toma de decisión del traslado hospitalario y que fueron desestimados para donación en asistolia. Se realizó un análisis multivariante para determinar las variables que se asociaron al uso de una estrategia de reanimación en curso y se determinó la supervivencia y el resultado neurológico en dicho grupo de casos. RESULTADOS: Se incluyeron 7.241 pacientes, de los cuales 259 (3,6%) fueron trasladados al hospital con RCP en curso. La edad media fue 51,6 (DE 23,6) años, de los cuales 27 (10,1%) casos tenían 16 años. Las variables que se asociaron con el uso de RCP en curso fueron: edad 16 años [OR 6,48 (IC95% 3,91-10,76); p < 0,001)], PCR presenciada [OR 1,62 (IC95% 1,16-2,26); p = 0,004], PCR ocurrida fuera del domicilio [OR 3,17 (IC95% 2,38-4,21); p < 0,001)]; etiología no cardiaca [OR 1,47 (IC95%1,07-2,02); p = 0,019], ritmo inicial desfibrilable [OR 1,67 (IC95% 1,17-2,37); p = 0,004], no existencia de soporte vital previo (SVp) [OR 3,48 (IC95% 2,58-4,70); p < 0,001] y realización de intubación orotraqueal (IOT) [OR 1,93 (IC95% 1,24-2,99); p = 0,003]. Un paciente (0,38%) sobrevivió al alta con buen estado neurológico. CONCLUSIONES: La RCP en curso en servicios de emergencias con médico a bordo es una estrategia poco frecuente en casos de PCR. La juventud del paciente, que la PCR suceda fuera del domicilio, sea presenciada, no exista soporte vital previo, tenga un ritmo inicial desfibrilable, una etiología no cardiaca y que se consiga IOT se asocian con esta estrategia cuyo resultado final puede considerarse fútil

OBJECTIVE: To assess factors associated with survival of out-of-hospital cardiac arrest (OHCA) in patients who underwent cardiopulmonary resuscitation (CPR) during ambulance transport. METHODS: Retrospective analysis of a registry of OHCA cases treated between 2008 and 2014. We included patients who had not recovered circulation at the time it was decided to transport to a hospital and who were rejected as non-heart-beating donors. Multivariate analysis was used to explore factors associated with the use of ambulance CPR, survival, and neurologic outcome. RESULTS: Out of a total of 7241 cases, 259 (3.6%) were given CPR during emergency transport. The mean (SD) age was 51.6 (23.6) years; 27 (10.1%) were aged 16 years or younger. The following variables were associated with the use of CPR during transport: age 16 years or under (odds ratio [OR], 6.48; 95% CI, 3.91-10.76); P

Ambulance cardiopulmonary resuscitation: outcomes and associated factors in out-of-hospital cardiac arrest. / Supervivencia y factores asociados a la práctica de reanimación cardiopulmonar en curso entre los pacientes con parada cardiaca extrahospitalaria.

OBJECTIVES: To assess factors associated with survival of out-of-hospital cardiac arrest (OHCA) in patients who underwent cardiopulmonary resuscitation (CPR) during ambulance transport. MATERIAL AND METHODS: Retrospective analysis of a registry of OHCA cases treated between 2008 and 2014. We included patients who had not recovered circulation at the time it was decided to transport to a hospital and who were rejected as non-heart-beating donors. Multivariate analysis was used to explore factors associated with the use of ambulance CPR, survival, and neurologic outcome. RESULTS: Out of a total of 7241 cases, 259 (3.6%) were given CPR during emergency transport. The mean (SD) age was 51.6 (23.6) years; 27 (10.1%) were aged 16 years or younger. The following variables were associated with the use of CPR during transport: age 16 years or under (odds ratio [OR], 6.48; 95% CI, 3.91-10.76); P<.001)], witnessed OHCA (OR, 1.62; 95% CI, 1.16-2.26; P=.004), cardiac arrest outside the home (OR, 3.17; 95% CI, 2.38-4.21; P<.001), noncardiac cause (OR, 1.47; 95% CI, 1.07-2.02; P=.019], initially shockable rhythm (OR, 1.67; 95% CI, 1.17-2.37; P=.004), no prior basic life support (OR, 3.48; 95% CI, 2.58-4.70; P<.001), and orotracheal intubation (OR, 1.93; 95% CI, 1.24-2.99; P=.003). One patient (0.38%) survived to discharge with good neurologic outcome. CONCLUSION: Ambulance CPR by a physician on board is applied in few OHCA cases. Young patient age, cardiac arrest outside the home, the presence of a witness, lack of a shockable rhythm on responder arrival, lack of basic life support prior to responder arrival, noncardiac cause, and orotracheal intubation are associated with the use of ambulance CPR, a strategy that can be considered futile.

OBJETIVO: Conocer la supervivencia y los factores asociados a la realización de reanimación cardiopulmonar (RCP) en curso entre los pacientes con parada cardiaca extrahospitalaria (PCR). METODO: Análisis retrospectivo de un registro de casos de PCR entre 2008 y 2014. Se incluyeron los pacientes con PCR sin recuperación espontánea de pulso en el momento de la toma de decisión del traslado hospitalario y que fueron desestimados para donación en asistolia. Se realizó un análisis multivariante para determinar las variables que se asociaron al uso de una estrategia de reanimación en curso y se determinó la supervivencia y el resultado neurológico en dicho grupo de casos. RESULTADOS: Se incluyeron 7.241 pacientes, de los cuales 259 (3,6%) fueron trasladados al hospital con RCP en curso. La edad media fue 51,6 (DE 23,6) años, de los cuales 27 (10,1%) casos tenían <= 16 años. Las variables que se asociaron con el uso de RCP en curso fueron: edad <= 16 años [OR 6,48 (IC95% 3,91-10,76); p < 0,001)], PCR presenciada [OR 1,62 (IC95% 1,16-2,26); p = 0,004], PCR ocurrida fuera del domicilio [OR 3,17 (IC95% 2,38-4,21); p < 0,001)]; etiología no cardiaca [OR 1,47 (IC95%1,07-2,02); p = 0,019], ritmo inicial desfibrilable [OR 1,67 (IC95% 1,17-2,37); p = 0,004], no existencia de soporte vital previo (SVp) [OR 3,48 (IC95% 2,58-4,70); p < 0,001] y realización de intubación orotraqueal (IOT) [OR 1,93 (IC95% 1,24-2,99); p = 0,003]. Un paciente (0,38%) sobrevivió al alta con buen estado neurológico. CONCLUSIONES: La RCP en curso en servicios de emergencias con médico a bordo es una estrategia poco frecuente en casos de PCR. La juventud del paciente, que la PCR suceda fuera del domicilio, sea presenciada, no exista soporte vital previo, tenga un ritmo inicial desfibrilable, una etiología no cardiaca y que se consiga IOT se asocian con esta estrategia cuyo resultado final puede considerarse fútil.

Supervivencia y estado neurológico tras muerte súbita cardiaca extrahospitalaria. Resultados del Registro Andaluz de Parada Cardiorrespiratoria Extrahospitalaria / Survival and neurologic outcome after out-of-hospital cardiac arrest. Results of the andalusian out-of-hospital cardiopulmonary arrest registry

Introducción y objetivos: No hay demasiados datos sobre la muerte súbita prehospitalaria en España. El objetivo es describir su incidencia, las características de los pacientes y los resultados de su atención por un servicio de emergencias extrahospitalario. Métodos: Análisis retrospectivo de un registro prospectivo de parada cardiorrespiratoria atendida por un servicio de emergencias extrahospitalario entre enero de 2008 y diciembre de 2012. Se incluyó a todos los pacientes con estimación de etiología cardiaca como causa de la parada. Se realizó análisis descriptivo de las características generales de los pacientes y de los factores asociados con alta hospitalaria con buen estado neurológico. Resultados: Se incluyó a 4.072 pacientes, con una incidencia estimada de 14,6 eventos por 100.000 habitantes y año, el 72,6% varones. La media de edad era 62,0 ± 15,8 años. El 58,6% de los casos ocurrieron en domicilio. El 25% de los pacientes tenían un ritmo inicial desfibrilable. El 28,8% de los pacientes llegaron con pulso al hospital, el 58,3% del grupo con ritmo desfibrilable. El 10,2% recibió el alta en buen estado neurológico. Las variables asociadas con esta recuperación fueron: parada presenciada (p = 0,04), parada presenciada por el equipo de emergencias (p = 0,005), realización previa de soporte vital (p = 0,04), ritmo inicial desfibrilable (p = 0,0001) y realización de intervencionismo coronario (p = 0,0001). Conclusiones: Más de la mitad de los casos de muerte súbita ocurren en el domicilio. Afectan a una población relativamente joven. Aunque 1 de cada 10 pacientes tuvo una recuperación satisfactoria, la fase previa a la llegada de los equipos de emergencias debe mejorar. El intervencionismo coronario tuvo gran impacto en el pronóstico de los pacientes (AU)

Introduction and objectives: There is a paucity of data on prehospital cardiac arrest in Spain. Our aim was to describe the incidence, patient characteristics, and outcomes of out-of-hospital emergency care for this event. Methods: We conducted a retrospective analysis of a prospective registry of cardiopulmonary arrest handled by an out-of-hospital emergency service between January 2008 and December 2012. The registry included all patients considered to have a cardiac etiology as the cause of arrest, with a descriptive analysis performed of general patient characteristics and factors associated with good neurologic outcome at hospital discharge. Results: A total of 4072 patients were included, with an estimated incidence of 14.6 events per 100 000 inhabitants and year; 72.6% were men. The mean age was 62.0 ± 15.8 years, 58.6% of cases occurred in the home, 25% of patients had initial defibrillable rhythm, 28.8% of patients arrived with a pulse at the hospital (58.3% of the group with defibrillable rhythm), and 10.2% were discharged with good neurologic outcome. The variables associated with this recovery were: witnessed arrest (P = .04), arrest witnessed by emergency team (P = .005), previous life support (P = .04), initial defibrillable rhythm (P = .0001), and performance of a coronary interventional procedure (P = .0001). Conclusions: More than half the cases of sudden cardiac arrest occur at home, and the population was found to be relatively young. Although recovery was satisfactory in 1 out of every 10 patients, there is a need for improvement in the phase prior to emergency team arrival. Coronary interventional procedures had an impact on patient prognosis (AU)

Survival and Neurologic Outcome After Out-of-hospital Cardiac Arrest. Results of the Andalusian Out-of-hospital Cardiopulmonary Arrest Registry.

INTRODUCTION AND OBJECTIVES: There is a paucity of data on prehospital cardiac arrest in Spain. Our aim was to describe the incidence, patient characteristics, and outcomes of out-of-hospital emergency care for this event. METHODS: We conducted a retrospective analysis of a prospective registry of cardiopulmonary arrest handled by an out-of-hospital emergency service between January 2008 and December 2012. The registry included all patients considered to have a cardiac etiology as the cause of arrest, with a descriptive analysis performed of general patient characteristics and factors associated with good neurologic outcome at hospital discharge. RESULTS: A total of 4072 patients were included, with an estimated incidence of 14.6 events per 100000 inhabitants and year; 72.6% were men. The mean age was 62.0 ± 15.8 years, 58.6% of cases occurred in the home, 25% of patients had initial defibrillable rhythm, 28.8% of patients arrived with a pulse at the hospital (58.3% of the group with defibrillable rhythm), and 10.2% were discharged with good neurologic outcome. The variables associated with this recovery were: witnessed arrest (P=.04), arrest witnessed by emergency team (P=.005), previous life support (P=.04), initial defibrillable rhythm (P=.0001), and performance of a coronary interventional procedure (P=.0001). CONCLUSIONS: More than half the cases of sudden cardiac arrest occur at home, and the population was found to be relatively young. Although recovery was satisfactory in 1 out of every 10 patients, there is a need for improvement in the phase prior to emergency team arrival. Coronary interventional procedures had an impact on patient prognosis.

Safety and efficacy of in-hospital clopidogrel-to-prasugrel switching in patients with acute coronary syndrome. An analysis from the 'real world'.

Antiplatelet switching in the management of acute coronary syndrome (ACS) seems to be safe, but prospective data are limited. This retrospective study assessed the safety and efficacy of in-hospital clopidogrel-to-prasugrel switching in patients with ACS. We analysed 525 consecutive patients with ACS admitted to our coronary care unit. We assessed the prevalence and the short-term outcomes of in-hospital clopidogrel-to-prasugrel switching. Bleeding and thrombotic events were assessed using propensity score matching analysis. A total of 468 patients received acetylsalicylic acid and a P2Y12 ADP receptor inhibitor. Medication switching occurred in 117 patients (25 %). Compared with the clopidogrel group, the switching group consisted preferentially of younger males with STEMI, exhibited fewer comorbidities, and had lower ischaemic risk. We found no differences between the switching group and the clopidogrel group in the bleeding rate [3.6 vs. 2.3 %, odds ratio (OR):1.59 95 % confidence interval (CI): 0.26-9.7, p NS], and in adverse cardiac or cerebrovascular events (MACCE) (5 vs. 8.4 %, OR: 0.57 95 % CI 0.16-2, p NS). In-hospital switching from clopidogrel to prasugrel in a selected high-risk ACS population resulted in a similar incidence of in-hospital haemorrhagic and thrombotic events. This strategy should be clarified in further randomised studies.