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1.
Crit Care Resusc ; 22(1): 26-34, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32102640

RESUMEN

BACKGROUND: Patients with prolonged cardiac arrest that is not responsive to conventional cardiopulmonary resuscitation have poor outcomes. The use of extracorporeal membrane oxygenation (ECMO) in refractory cardiac arrest has shown promising results in carefully selected cases. We sought to validate the results from an earlier extracorporeal cardiopulmonary resuscitation (ECPR) study (the CHEER trial). METHODS: Prospective, consecutive patients with refractory in-hospital (IHCA) or out-of-hospital cardiac arrest (OHCA) who met predefined inclusion criteria received protocolised care, including mechanical cardiopulmonary resuscitation, initiation of ECMO, and early coronary angiography (if an acute coronary syndrome was suspected). RESULTS: Twenty-five patients were enrolled in the study (11 OHCA, 14 IHCA); the median age was 57 years (interquartile range [IQR], 39-65 years), and 17 patients (68%) were male. ECMO was established in all patients, with a median time from arrest to ECMO support of 57 minutes (IQR, 38-73 min). Percutaneous coronary intervention was performed on 18 patients (72%). The median duration of ECMO support was 52 hours (IQR, 24-108 h). Survival to hospital discharge with favourable neurological recovery occurred in 11/25 patients (44%, of which 72% had IHCA and 27% had OHCA). When adjusting for lactate, arrest to ECMO flow time was predictive of survival (odds ratio, 0.904; P = 0.035). CONCLUSION: ECMO for refractory cardiac arrest shows promising survival rates if protocolised care is applied in conjunction with predefined selection criteria.


Asunto(s)
Reanimación Cardiopulmonar/métodos , Oxigenación por Membrana Extracorpórea , Paro Cardíaco/terapia , Reperfusión Miocárdica , Paro Cardíaco Extrahospitalario/terapia , Adulto , Anciano , Reanimación Cardiopulmonar/mortalidad , Oxigenación por Membrana Extracorpórea/efectos adversos , Femenino , Paro Cardíaco/diagnóstico , Humanos , Masculino , Persona de Mediana Edad , Paro Cardíaco Extrahospitalario/mortalidad , Estudios Prospectivos , Estudios Retrospectivos , Tasa de Supervivencia , Resultado del Tratamiento
2.
Crit Care ; 24(1): 61, 2020 02 22.
Artículo en Inglés | MEDLINE | ID: mdl-32087741

RESUMEN

BACKGROUND: To quantitatively summarize the available epidemiological evidence on the survival rate of out-of-hospital cardiac arrest (OHCA) patients who received cardiopulmonary resuscitation (CPR). METHODS: We systematically searched the PubMed, Embase, and Web of Science databases, and the references of retrieved articles were manually reviewed to identify studies reporting the outcome of OHCA patients who received CPR. The overall incidence and outcome of OHCA were assessed using a random-effects meta-analysis. RESULTS: A total of 141 eligible studies were included in this meta-analysis. The pooled incidence of return of spontaneous circulation (ROSC) was 29.7% (95% CI 27.6-31.7%), the rate of survival to hospital admission was 22.0% (95% CI 20.7-23.4%), the rate of survival to hospital discharge was 8.8% (95% CI 8.2-9.4%), the pooled 1-month survival rate was 10.7% (95% CI 9.1-13.3%), and the 1-year survival rate was 7.7% (95% CI 5.8-9.5%). Subgroup analysis showed that survival to hospital discharge was more likely among OHCA patients whose cardiac arrest was witnessed by a bystander or emergency medical services (EMS) (10.5%; 95% CI 9.2-11.7%), who received bystander CPR (11.3%, 95% CI 9.3-13.2%), and who were living in Europe and North America (Europe 11.7%; 95% CI 10.5-13.0%; North America: 7.7%; 95% CI 6.9-8.6%). The survival to discharge (8.6% in 1976-1999 vs. 9.9% in 2010-2019), 1-month survival (8.0% in 2000-2009 vs. 13.3% in 2010-2019), and 1-year survival (8.0% in 2000-2009 vs. 13.3% in 2010-2019) rates of OHCA patients who underwent CPR significantly increased throughout the study period. The Egger's test did not indicate evidence of publication bias for the outcomes of OHCA patients who underwent CPR. CONCLUSIONS: The global survival rate of OHCA patients who received CPR has increased in the past 40 years. A higher survival rate post-OHCA is more likely among patients who receive bystander CPR and who live in Western countries.


Asunto(s)
Reanimación Cardiopulmonar , Servicios Médicos de Urgencia , Paro Cardíaco Extrahospitalario , Adulto , Anciano , Femenino , Hospitalización , Humanos , Masculino , Persona de Mediana Edad , Paro Cardíaco Extrahospitalario/mortalidad , Paro Cardíaco Extrahospitalario/terapia , Alta del Paciente , Tasa de Supervivencia
3.
Crit Care ; 24(1): 60, 2020 Feb 22.
Artículo en Inglés | MEDLINE | ID: mdl-32087761

RESUMEN

BACKGROUND: The knowledge of new prognostic factors in out-of-hospital cardiac arrest (OHCA) that can be evaluated since the beginning of cardiopulmonary resuscitation (CPR) manoeuvres could be helpful in the decision-making process of prehospital care. We aim to identify metabolic variables at the start of advanced CPR at the scene that may be associated with two main outcomes of CPR (recovery of spontaneous circulation (ROSC) and neurological outcome). METHODS: Prospective observational study of all non-traumatic OHCA in patients older than 17 years assisted by emergency medical services (EMS), with doctor and nurse on board, between January 2012 and December 2017. Venous blood gases were sampled upon initially obtaining venous access to determine the initial values of pH, pCO2, HCO3-, base excess (BE), Na+, K+, Ca2+ and lactate. ROSC upon arrival at the hospital and neurological status 30 days later (Cerebral Performance Categories (CPC) scale) were recorded. RESULTS: We included 1552 patients with OHCA with blood test data in a 6-year period. ROSC was achieved in 906 cases (58.4%), and good neurological recovery at 30 days (CPC I-II) occurred in 383 cases (24.68%). In multivariate analysis, we found a significant relationship between non-recovery of spontaneous circulation (no-ROSC) and low pH levels (adjusted odds ratio (OR) 0.03 (0.002-0.59), p = 0.020), high pCO2 levels (adjusted OR 1.03 [1.01-1.05], p = 0.008) and high potassium levels (adjusted OR 2.28 [1.43-3.61], p = 0.008). Poor neurological outcomes were associated with low pH levels (adjusted OR 0.06 [0.02-0.18], p < 0.001), high pCO2 (adjusted OR 1.05 [1.03-1.08], p < 0.001), low HCO3- (adjusted OR 0.97 [0.94-0.999], p = 0.044), low BE (adjusted OR 0.96 [0.93-0.98], p < 0.001) and high potassium levels (adjusted OR 1.37 [1.16-1.60], p < 0.001). CONCLUSION: There is a significant relationship between severe alterations of venous blood-gas variables and potassium at the start of CPR of non-traumatic OHCA and low-ROSC rate and neurological prognosis.


Asunto(s)
Análisis de los Gases de la Sangre , Reanimación Cardiopulmonar , Servicios Médicos de Urgencia , Paro Cardíaco Extrahospitalario , Anciano , Anciano de 80 o más Años , Pruebas Hematológicas , Humanos , Persona de Mediana Edad , Oportunidad Relativa , Paro Cardíaco Extrahospitalario/diagnóstico , Paro Cardíaco Extrahospitalario/terapia , Pronóstico , Estudios Prospectivos
4.
Medicine (Baltimore) ; 99(2): e18658, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31914051

RESUMEN

RATIONALE: Despite increasing number of left ventricular assist device (LVAD) implantation, standardized cardiopulmonary resuscitation (CPR) protocol for patients with LVAD, especially in out-of-hospital settings are not well known. PATIENT CONCERNS: A 41-year-old LVAD implanted man became cardiac arrest in an out-of-hospital setting. Bystander CPR was started and the patient was brought to our hospital without noticing LVAD. Upon arrival, the medical staff noted the LVAD and that the battery of the LVAD was exhausted. DIAGNOSIS: Cardiac arrest on LVAD. INTERVENTIONS: It took 50 minutes to change the battery, then the patient has become ventricular fibrillation; hence, we introduced extracorporeal membranous oxygenation and defibrillated the patient. After the sinus rhythm was restored, the LVAD started working uneventfully. OUTCOMES: The patient became brain dead. LESSONS: There are several difficulties in treating these patients. First, hemodynamic collapse is difficult to diagnose. Second, chest compression for LVAD implanted patients remains controversial. Third, education to first responders who are not familiar with LVAD are not enough. Appropriate education for those issues is needed.


Asunto(s)
Reanimación Cardiopulmonar/métodos , Corazón Auxiliar , Paro Cardíaco Extrahospitalario/terapia , Adulto , Cardioversión Eléctrica , Suministros de Energía Eléctrica , Oxigenación por Membrana Extracorpórea , Humanos , Masculino , Paro Cardíaco Extrahospitalario/complicaciones , Fibrilación Ventricular/etiología , Fibrilación Ventricular/terapia
5.
Int Heart J ; 61(1): 46-53, 2020 Jan 31.
Artículo en Inglés | MEDLINE | ID: mdl-31956145

RESUMEN

We investigated the impact of bystander-initiated cardiopulmonary resuscitation (CPR), dispatcher assistance (DA), and location of arrest on survival and outcomes after out-of-hospital cardiac arrest (OHCA).From a nationwide population-based registry of OHCA patients in Japan, we enrolled adult patients with bystander-witnessed OHCA of medical origin between 2013 and 2015. The primary outcome measure was a neurologically favorable outcome, defined by cerebral performance category 1 or 2. Multivariable logistic regression analysis was used to assess the effects of bystander CPR and DA by location of arrest. A total of 104,621 cases were included (15,984 bystander CPR without DA [15.3%], 40,087 bystander CPR with DA [38.3%], and 48,550 no bystander CPR [46.4%]). In public locations, both the bystander-CPR-with-DA group (22.9% [1,068/4,665]; adjusted odds ratio (AOR), 1.62; 95% confidence interval (CI), 1.43-1.85) and the bystander-CPR-without-DA group (25.8% [918/3,557]; AOR, 1.43; 95% CI, 1.24-1.65) had neurologically favorable outcomes compared with the no-bystander-CPR group (9.9% [610/6,133]). In residential locations, the AORs were 1.44 (95% CI, 1.22-1.70) in the bystander-CPR-without-DA group and 1.60 (95% CI, 1.45-1.77) in the bystander-CPR-with-DA group. However, in nursing homes, bystander CPR was not associated with improved outcomes of OHCA, regardless of the implementation of DA.Bystander CPR with or without DA had better outcomes after OHCA in residential and public locations but not in nursing homes.


Asunto(s)
Reanimación Cardiopulmonar/métodos , Paro Cardíaco Extrahospitalario/terapia , Anciano , Anciano de 80 o más Años , Servicios Médicos de Urgencia , Femenino , Humanos , Japón , Modelos Logísticos , Masculino , Casas de Salud , Análisis de Supervivencia , Resultado del Tratamiento
6.
Rev Esp Cardiol (Engl Ed) ; 73(1): 53-68, 2020 Jan.
Artículo en Inglés, Español | MEDLINE | ID: mdl-30808611

RESUMEN

INTRODUCTION AND OBJECTIVES: Bystander assistance is decisive to enhance the outcomes of out-of-hospital cardiac arrest. Despite an increasing number of basic life support (BLS) training methods, the most effective formula remains undefined. To identify a gold standard, we performed a systematic review describing reported BLS training methods for laypeople and analyzed their effectiveness. METHODS: We reviewed the MEDLINE database from January 2006 to July 2018 using predefined inclusion and exclusion criteria, considering all studies training adult laypeople in BLS and performing practical skill assessment. Two reviewers independently extracted data and evaluated the quality of the studies using the MERSQI (Medical Education Research Study Quality Instrument) scale. RESULTS: Of the 1263 studies identified, 27 were included. Most of them were nonrandomized controlled trials and the mean quality score was 13 out of 18, with substantial agreement between reviewers. The wide heterogeneity of contents, methods and assessment tools precluded pooling of data. Nevertheless, there was an apparent advantage of instructor-led methods, with feedback-supported hands-on practice, and retraining seemed to enhance retention. Training also improved attitudinal aspects. CONCLUSIONS: While there were insufficiently consistent data to establish a gold standard, instructor-led formulas, hands-on training with feedback devices and frequent retraining seemed to yield better results. Further research on adult BLS training may need to seek standardized quality criteria and validated evaluation instruments to ensure consistency.


Asunto(s)
Reanimación Cardiopulmonar/educación , Paro Cardíaco Extrahospitalario/terapia , Adulto , Evaluación Educacional , Humanos
7.
Med Klin Intensivmed Notfmed ; 115(1): 43-51, 2020 Feb.
Artículo en Alemán | MEDLINE | ID: mdl-30397762

RESUMEN

BACKGROUND: According to ILCOR (International Liaison Committee on Resuscitation) recommendations (released in 2003), use of therapeutic hypothermia is recommended for unconscious adult patients who have survived a cardiac arrest regardless of the initial monitored cardiac rhythm. Thereby, the treatment goal is to achieve and maintain a body temperature of 32-34 °C for a period of 12-24 h. According to the October 2015 recommendations of the European Resuscitation Council (ERC), targeted temperature management (TTM) remains part of treatment, but, as an option, it is advised that the targeted body temperature be 36 °C rather than 32-34 °C. PATIENT POPULATION AND METHODS: For a non-randomized retrospective observational study, a total of 149 patients were treated with cardiopulmonary resuscitation (CPR) between May 1999 and September 2009. For the first 4 days after CPR, data associated with demography, resuscitation, therapy (temperature course, neuron-specific enolase [NSE]) and clinical-neurological development (Glasgow Outcome Scale [GOS]) were collected. In the study, patients receiving mild hyperthermia were compared with those who did not receive hypothermia. RESULTS: Of the 149 patients included, 90 were treated with mild hypothermia (as decided by the attending physician), while 59 received no hypothermia therapy. Assessment reveals that mild hypothermia positively influences clinical-neurological progression, but not survival. On day three and four, patients with an unfavorable neurological progression exhibited significantly increased serum levels of NSE (day 4: 108.7 ± 137.3 ng/ml versus 25.5 ± 15.4 ng/ml). Patients receiving hypothermia showed lower average NSE levels compared with persons not receiving hypothermia. Furthermore, during the first 4 days, their NSE values tended to increase slower (NSE value at day 4: 55.9 ± 64.9 ng/ml versus 129.9 ± 174.9 ng/ml). The best cut-off-value for an unfavorable neurological result was 74.2 ng/ml at day four (specificity 100%, sensitivity 48.6%). For the group of patients who received hypothermia, the best cut-off-value was 74.2 ng/ml at day four (specificity 100%, sensitivity 40.9%), and, for the comparison group, best cut-off-value was 25.5 ng/ml at day three (specificity 100%, sensitivity 88.2%). CONCLUSION: After out-of-hospital resuscitation, there is a trend for improved clinical-neurological progression with mild hypothermia but it does not influence the prognostic significance of serum NSE. After assessment of available data, it is not possible to recommend uniform cut-off values for patients who received mild therapeutic hypothermia and for those who did not receive hypothermia treatment.


Asunto(s)
Reanimación Cardiopulmonar , Hipotermia Inducida , Paro Cardíaco Extrahospitalario , Fosfopiruvato Hidratasa , Adulto , Humanos , Paro Cardíaco Extrahospitalario/diagnóstico , Paro Cardíaco Extrahospitalario/terapia , Fosfopiruvato Hidratasa/análisis , Pronóstico , Estudios Retrospectivos
8.
Lancet ; 394(10216): 2255-2262, 2020 12 21.
Artículo en Inglés | MEDLINE | ID: mdl-31862250

RESUMEN

BACKGROUND: More than 80% of public-access defibrillation attempts do not result in sustained return of spontaneous circulation in patients who have had an out-of-hospital cardiac arrest (OHCA) and a shockable heart rhythm before arrival of emergency medical service (EMS) personnel. Neurological and survival outcomes in such patients have not been evaluated. We aimed to assess the neurological status and survival outcomes in such patients. METHODS: This is a retropective analysis of a cohort study from a prospective, nationwide, population-based registry of 1 299 784 patients who had an OHCA event between Jan 1, 2005, and Dec 31, 2015 in Japan. The primary outcome was favourable neurological outcome (Cerebral Performance Category of 1 or 2) at 30 days after the OHCA and the secondary outcome was survival at 30 days following the OHCA. This study is registered with the University Hospital Medical Information Network Clinical Trials Registry, UMIN000009918. FINDINGS: We identified 28 019 patients with bystander-witnessed OHCA and shockable heart rhythm who had received CPR from a bystander. Of these, 2242 (8·0%) patients did not achieve return of spontaneous circulation with CPR plus public-access defibrillation, and 25 087 (89·5%) patients did not achieve return of spontaneous circulation with CPR alone before EMS arrival. The proportion of patients with a favourable neurological outcome was significantly higher in those who received public-access defibrillation than those who did not (845 [37·7%] vs 5676 [22·6%]; adjusted odds ratio [OR] after propensity score-matching, 1·45 [95% CI 1·24-1·69], p<0·0001). The proportion of patients who survived at 30 days after the OHCA was also significantly higher in those who received public-access defibrillation than those who did not (987 [44·0%] vs 7976 [31·8%]; adjusted OR after propensity score-matching, 1·31 [95% CI 1·13-1·52], p<0·0001). INTERPRETATION: Our findings support the benefits of public-access defibrillation and greater accessibility and availability of automated external defibrillators in the community. FUNDING: None.


Asunto(s)
Reanimación Cardiopulmonar/instrumentación , Cardioversión Eléctrica/instrumentación , Enfermedades del Sistema Nervioso/etiología , Paro Cardíaco Extrahospitalario/terapia , Adulto , Anciano , Anciano de 80 o más Años , Reanimación Cardiopulmonar/métodos , Desfibriladores , Cardioversión Eléctrica/métodos , Servicios Médicos de Urgencia , Femenino , Humanos , Japón/epidemiología , Masculino , Persona de Mediana Edad , Enfermedades del Sistema Nervioso/epidemiología , Oportunidad Relativa , Paro Cardíaco Extrahospitalario/complicaciones , Paro Cardíaco Extrahospitalario/mortalidad , Puntaje de Propensión , Estudios Prospectivos , Instalaciones Públicas , Recuperación de la Función , Sistema de Registros , Estudios Retrospectivos
10.
Scand J Trauma Resusc Emerg Med ; 27(1): 112, 2019 Dec 16.
Artículo en Inglés | MEDLINE | ID: mdl-31842928

RESUMEN

BACKGROUND: In Europe, survival rates after out-of-hospital cardiac arrest (OHCA) vary widely. Presence/absence and differences in implementation of systems dispatching First Responders (FR) in order to arrive before Emergency Medical Services (EMS) may contribute to this variation. A comprehensive overview of the different types of FR-systems used across Europe is lacking. METHODS: A mixed-method survey and information retrieved from national resuscitation councils and national EMS services were used as a basis for an inventory. The survey was sent to 51 OHCA experts across 29 European countries. RESULTS: Forty-seven (92%) OHCA experts from 29 countries responded to the survey. More than half of European countries had at least one region with a FR-system. Four categories of FR types were identified: (1) firefighters (professional/voluntary); (2) police officers; (3) citizen-responders; (4) others including off-duty EMS personnel (nurses, medical doctors), taxi drivers. Three main roles for FRs were identified: (a) complementary to EMS; (b) part of EMS; (c) instead of EMS. A wide variation in FR-systems was observed, both between and within countries. CONCLUSIONS: Policies relating to FRs are commonly implemented on a regional level, leading to a wide variation in FR-systems between and within countries. Future research should focus on identifying the FR-systems that most strongly influence survival. The large variation in local circumstances across regions suggests that it is unlikely that there will be a 'one-size fits all' FR-system for Europe, but examining the role of FRs in the Chain of Survival is likely to become an increasingly important aspect of OHCA research.


Asunto(s)
Servicios Médicos de Urgencia , Socorristas , Paro Cardíaco Extrahospitalario/terapia , Anciano , Reanimación Cardiopulmonar , Bases de Datos Factuales , Servicios Médicos de Urgencia/estadística & datos numéricos , Europa (Continente) , Femenino , Humanos , Masculino , Persona de Mediana Edad , Encuestas y Cuestionarios , Tasa de Supervivencia
11.
Emergencias (Sant Vicenç dels Horts) ; 31(6): 417-418, dic. 2019. tab, graf
Artículo en Español | IBECS | ID: ibc-185141

RESUMEN

En la actualidad, el uso de los dispositivos supraglóticos (DSG) para el manejo de la vía aérea está ampliamente extendido en urgencias y emergencias por su fácil manejo. El objetivo de la presente revisión es comparar los dispositivos supraglóticos para el manejo de la vía aérea, tubo laríngeo (TL) y máscara laríngea (ML), en sus diferentes versiones, para determinar cuál de ellos reúne las mejores condiciones para un uso eficiente en la atención a urgencias y emergencias. Se realiza una revisión sistemática de la literatura a través de la consulta en 9 bases de datos bibliográficas: Biblioteca Cochrane Plus, Medline, CINAHL, Dialnet, Global Health, Nursing & Allied Health Database, CUIDEN, Web of Science y ScienceDirect. Fueron seleccionados registros que estaban comprendidos entre los años 2014 y 2019, en español, inglés, francés y portugués, donde se realizara una comparación entre los DSG, TL y ML, en sus diferentes versiones. Se identificaron un total de 18 estudios válidos tras la lectura crítica. En la mayoría de aspectos evaluados, no se apreciaron diferencias significativas entre ambos dispositivos. Destancaba una presión de sellado orofaríngeo y velocidad de inserción superior en determinados contextos en la utilización del TL, y existía además una visión menor de la glotis mediante la utilización del broncoscopio. Los diferentes contextos en que se puede presentar la utilización de los DSG y la escasez de registros que comparan el TL con las ML en sus diferentes versiones no permite una clara diferenciación en cuanto a eficacia. No obstante, sí parece evidenciarse una visión menor de la glotis en la utilización del TL tras ser valorado con el fibroscopio, factor a tener en cuenta si se tiene presente que en la atención secundaria la intubación selectiva mediante la intubación traqueal, considerada el "patrón oro", puede llegar a ser una necesidad


Various supraglottic devices are currently available for airway management and are used widely in emergency situations because they are easy to position. We undertook a systematic review of the literature comparing laryngeal tubes and various laryngeal mask airway devices (LMAs) to determine which ones can be used most efficiently in emergencies. Nine databases were searched, as follows: Cochrane Library Plus, MEDLINE, CINAHL (Cumulative Index to Nursing and Allied Health Literature), Dialnet, Global Health, Nursing & Allied Health Database, CUIDEN, the Web of Science, and ScienceDirect. We collected studies published between 2014 and 2019 in Spanish, English, French, and Portuguese that compared laryngeal tubes to LMAs of different types for supraglottic airway management. Eighteen studies were selected for analysis after critical reading. Significant differences were not seen between tubes and LMAs with respect to most variables, but in certain contexts the oropharyngeal seal and speed of insertion were superior with laryngeal tubes; however, when fiberoptic bronchoscopes were then inserted the view of the glottis was poor. The different contexts in which these devices are used and the scarcity of studies comparing laryngeal tubes to LMAs does not allow us to identify clear differences among them with respect to efficiency. However, tubes seem to offer poorer visibility of the glottis according to evaluation with fiberoptic scopes, a factor to bear in mind if tracheal intubation, which is considered the gold standard, might become necessary


Asunto(s)
Humanos , Paro Cardíaco Extrahospitalario/terapia , Manejo de la Vía Aérea/instrumentación , Máscaras Laríngeas , Intubación Intratraqueal/instrumentación , Manejo de la Vía Aérea/métodos , Intubación Intratraqueal/métodos , Diseño de Equipo
12.
Emergencias (Sant Vicenç dels Horts) ; 31(6): 429-434, dic. 2019. tab, mapas
Artículo en Español | IBECS | ID: ibc-185142

RESUMEN

El objetivo de este trabajo es comparar las legislaciones autonómicas españolas en materia de formación, utilización y obligatoriedad de la instalación de desfibriladores externos automatizados (DEA) fuera del ámbito sanitario y analizar la variabilidad territorial con que se han desarrollado las regulaciones. Llevamos a cabo una revisión de las normativas publicadas en los boletines oficiales de las 17 comunidades autónomas y las 2 ciudades autónomas de España hasta mayo de 2019, extrayendo datos referidos a la regulación de la formación, el uso y la instalación de los DEA fuera del ámbito sanitario. Observamos que médicos y enfermeros están autorizados a utilizar los DEA, salvo en Murcia, donde únicamente tienen autorizado su uso los médicos. En 14 comunidades autónomas también se consideran habilitados los técnicos en emergencias sanitarias. Excepto en el País Vasco, donde cualquier ciudadano puede utilizar un DEA previa alerta a los servicios de emergencia, es necesario realizar un curso inicial acreditado para estar habilitado en el uso de estos dispositivos (cuya duración varía, según la comunidad, entre 4 y 9 horas) y debe ser renovado con una periodicidad que oscila entre uno y 3 años. Sin embargo, 11 comunidades permiten que, en caso de emergencia y en ausencia de personal habilitado, cualquier ciudadano pueda utilizar un DEA, previa alerta a los servicios de emergencia. Once autonomías regulan la obligación de instalar DEA fuera del ámbito sanitario. Se concluye que si bien todas las comunidades autónomas de España disponen de una normativa reguladora del uso y la acreditación de DEA, el mapa legislativo es muy diverso, por lo que sería deseable una política armonizadora para unificar criterios e incentivar el uso de estos dispositivos en caso de necesidad


We compared Spanish autonomous communities' regulations affecting the use of semiautomatic external defibrillators (semi-AEDs), including requirements for training and providing devices outside health care settings. We analyzed differences in the development of regulations across the different geographic areas. Regulations published in the official bulletins of Spain’s 17 autonomous communities and 2 autonomous cities in effect in May 2019 were reviewed to extract directives affecting training, authorized use, and the provision of semi-AEDs outside health care centers. We found that both doctors and nurses are authorized to use the devices in most communities, with the exception of Murcia, where only doctors may use them. Fourteen communities also authorize emergency responders to operate semi-AEDs. Other individuals must call for emergency help before using one, and specific rules vary by community. In the Basque Country anyone may use them, but in other communities, only individuals who have taken a training course on how to use a semi-AED may. The duration of training programs varies from 4 to 9 hours in different parts of Spain, and retraining is required at intervals that vary from 1 to 3 years. However, in 11 communities any citizen may use a semi-AED in an emergency in which authorized persons are not present (after first calling for emergency responders). Eleven autonomous communities regulate the required provision of semi-AEDs outside health care centers. We conclude that although Spain’s autonomous communities have regulations in place for the use of these devices, the regulatory map is highly diverse. Therefore, we think that harmonization is desirable in the interest of unifying criteria and encouraging the use of semi-AEDs when they are needed


Asunto(s)
Humanos , Desfibriladores/normas , Paro Cardíaco Extrahospitalario/terapia , Reanimación Cardiopulmonar/instrumentación , Servicios Médicos de Urgencia/legislación & jurisprudencia , Servicios Médicos de Urgencia/normas
13.
Orv Hetil ; 160(46): 1826-1831, 2019 Nov.
Artículo en Húngaro | MEDLINE | ID: mdl-31707821

RESUMEN

Out-of-hospital cardiac arrest (OHCA) presents a great challenge for the health care systems even in the highly developed countries. For several decades, our greatest efforts have been directed toward the improvement of the prehospital management, including promotion of lay resuscitation and deployment of public access automated defibrillators. Recently, the importance of the hospital phase of the OHCA-management has been also emphasized. Attention has been paid to targeted temperature management and also to early coronary intervention. For those patients who present with ST-elevation on their post-resuscitation ECG, our approach is straightforward: urgent coronary angiography is indicated. The optimal management of those survivors of OHCA who present without ST-elevation is, however, still debated. Although up to 30% of these subjects also suffer from acute occlusive epicardial coronary disease, the clear benefit of urgent coronary angiography for the whole group is yet to be documented. Several large-scale randomized studies are under way to resolve this question. In our present review we detail the above controversies and outline the future directions. Orv Hetil. 2019; 160(46): 1826-1831.


Asunto(s)
Reanimación Cardiopulmonar , Angiografía Coronaria/métodos , Hipotermia Inducida , Paro Cardíaco Extrahospitalario/diagnóstico por imagen , Intervención Coronaria Percutánea/métodos , Humanos , Paro Cardíaco Extrahospitalario/terapia , Paro Cardíaco Extrahospitalario/orina , Intervención Coronaria Percutánea/efectos adversos , Infarto del Miocardio con Elevación del ST
14.
Pan Afr Med J ; 33: 289, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31692808

RESUMEN

Introduction: This study explores why resuscitation is withheld when mobile emergency medical team arrive at the scene of a cardiac arrest. Methods: We conducted a prospective, observational study in pre hospital emergency services. We included adults' patients, with a suspicion of non-traumatic cardiac arrest (CA) in an out of hospital environment, who received or not cardiopulmonary resuscitation (CPR) by our mobile emergency medical service teams. An analytic study was conducted in order to identify independent factors that could influence the decision to resuscitate OHCA. Results: During study, 228 patients were enrolled, the mean age was 64 +/- 14 years and 59% were men. Eighteen patients (8%) received bystander CPR by witnesses. The median time elapsed to arrive at the scene was 13 [8-25] min. The median "noflow" was 22 [10-34] min. The resuscitation decision was taken by the mobile EMS staff for 106 patients (46.5%). For other patients, the decision not to resuscitate was motivated solely by the finding of a confirmed state of death in an elderly patient (p = 0.045). The predictive decision factor for resuscitation was the no flow time less than 18.5 min, Odds Ratio adjusted with 95% confidence interval to: 1.38 (1.24 - 3.55) (p <0.001). Overall out of hospital survival rate was 17% of resuscitated patients. Conclusion: The decision to resuscitate a cardiac arrest outside of the hospital depends more on the "no flow" time than on the presumed etiologies.


Asunto(s)
Reanimación Cardiopulmonar/métodos , Toma de Decisiones , Servicios Médicos de Urgencia/estadística & datos numéricos , Paro Cardíaco Extrahospitalario/terapia , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Tasa de Supervivencia , Factores de Tiempo
15.
Medicine (Baltimore) ; 98(45): e17881, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31702660

RESUMEN

This study aimed to investigate the prognostic difference between AUTOPULSE and LUCAS for out-of-hospital cardiac arrest (OHCA) adult patients.A retrospective observational study was performed nationwide. Adult OHCA patients after receiving in-hospital mechanical chest compression from 2012 to 2016 were included. The primary outcomes were sustained return of spontaneous circulation (ROSC) of more than 20 minutes and survival to discharge.Among 142,906 OHCA patients, 820 patients were finally included. In multivariate analysis, female (OR, 0.57; 95% CI, 0.33-0.99), witnessed arrest (OR, 2.10; 95% CI, 1.20-3.69), and arrest cause of non-cardiac origin (OR, 0.25; 95% CI, 0.10-0.62) were significantly associated with the increase in ROSC. LUCAS showed a lower survival than AUTOPULSE (OR, 0.23; 95% CI, 0.06-0.84), although it showed no significant association with ROSC. Percutaneous coronary intervention (OR, 6.30; 95% CI, 1.53-25.95) and target temperature management (TTM; OR, 7.30; 95% CI, 2.27-23.49) were the independent factors for survival. We categorized mechanical CPR recipients by witness to compare prognostic effectiveness of AUTOPULSE and LUCAS. In the witnessed subgroup, female (OR, 0.46; 95% CI, 0.24-0.89) was a prognostic factor for ROSC and shockable rhythm (OR, 5.04; 95% CI, 1.00-25.30), percutaneous coronary intervention (OR, 12.42; 95% CI, 2.04-75.53), and TTM (OR, 9.03; 95% CI, 1.86-43.78) for survival. In the unwitnessed subgroup, no prognostic factors were found for ROSC, and TTM (OR, 99.00; 95% CI, 8.9-1100.62) was found to be an independent factor for survival. LUCAS showed no significant increase in ROSC or survival in comparison with AUTOPULSE in both subgroups.The in-hospital use of LUCAS may have a deleterious effect for survival compared with AUTOPULSE.


Asunto(s)
Reanimación Cardiopulmonar/instrumentación , Masaje Cardíaco/instrumentación , Paro Cardíaco Extrahospitalario/terapia , Anciano , Anciano de 80 o más Años , Reanimación Cardiopulmonar/mortalidad , Servicios Médicos de Urgencia/estadística & datos numéricos , Femenino , Masaje Cardíaco/mortalidad , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Paro Cardíaco Extrahospitalario/mortalidad , República de Corea/epidemiología , Estudios Retrospectivos , Resultado del Tratamiento
16.
Scand J Trauma Resusc Emerg Med ; 27(1): 97, 2019 Nov 01.
Artículo en Inglés | MEDLINE | ID: mdl-31675978

RESUMEN

BACKGROUND: Resuscitation efforts for traumatic patients with out-of-hospital cardiac arrest (OHCA) are not always futile. Dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) during emergency calls could increase the rate of bystander cardiopulmonary resuscitation (CPR) and thus may enhance survival and neurologic outcomes of non-traumatic OHCA. This study aimed to examine the effectiveness of DA-CPR for traumatic OHCA. METHODS: A retrospective cohort study was conducted using an Utstein-style population database with data from January 1, 2014, to December 31, 2016, in Tainan City, Taiwan. Voice recordings of emergency calls were retrospectively retrieved and reviewed. The primary outcome was an achievement of sustained (≥2 h) return of spontaneous circulation (ROSC); the secondary outcomes were prehospital ROSC, ever ROSC, survival at discharge and favourable neurologic status at discharge. Statistical significance was set at a p-value of less than 0.05. RESULTS: A total of 4526 OHCA cases were enrolled. Traumatic OHCA cases (n = 560, 12.4%), compared to medical OHCA cases (n = 3966, 87.6%), were less likely to have bystander CPR (10.7% vs. 31.7%, p < 0.001) and initially shockable rhythms (7.1% vs. 12.5%, p < 0.001). Regarding DA-CPR performance, traumatic OHCA cases were less likely to have dispatcher recognition of cardiac arrest (6.3% vs. 42.0%, p < 0.001), dispatcher initiation of bystander CPR (5.4% vs. 37.6%, p < 0.001), or any dispatcher delivery of CPR instructions (2.7% vs. 20.3%, p < 0.001). Stepwise logistic regression analysis showed that witnessed cardiac arrests (aOR 1.70, 95% CI 1.10-2.62; p = 0.017) and transportation to level 1 centers (aOR 1.99, 95% CI 1.27-3.13; p = 0.003) were significantly associated with achievement of sustained ROSC in traumatic OHCA cases, while DA-CPR-related variables were not (All p > 0.05). CONCLUSIONS: DA-CPR was not associated with better outcomes for traumatic OHCA in achieving a sustained ROSC. The DA-CPR program for traumatic OHCAs needs further studies to validate its effectiveness and practicability, especially in the communities where rules for the termination of resuscitation in prehospital settings do not exist.


Asunto(s)
Reanimación Cardiopulmonar/métodos , Servicios Médicos de Urgencia/organización & administración , Paro Cardíaco Extrahospitalario/terapia , Heridas y Traumatismos/complicaciones , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Paro Cardíaco Extrahospitalario/etiología , Paro Cardíaco Extrahospitalario/mortalidad , Estudios Retrospectivos , Tasa de Supervivencia/tendencias , Taiwán/epidemiología , Heridas y Traumatismos/mortalidad , Heridas y Traumatismos/terapia
17.
Medicine (Baltimore) ; 98(44): e17550, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31689757

RESUMEN

BACKGROUND: Cardiac arrest (CA) is a serious threat to human health. Cardiopulmonary resuscitation (CPR) is an effective treatment for CA. Early and high-quality CPR is closely related to the survival rate of patients with CA. But manual chest compression has a lot of defects. To solve the defects and improve the quality of CPR, mechanical CPR device was invented. However, it has still controversy whether manual chest compression or mechanical chest compression is better. This systematic review was aimed to investigate the difference in clinical outcomes between manual chest compression and Lund University Cardiac Assist System (LUCAS) assisted CPR in patients with out-hospital CA. METHODS: Original research studies, conducted on adult out-of-hospital CA, were included. PubMed/Medline, EMBASE, Scopus, Cochrane Library, CNKI, and Wanfang database were searched from the setting to February 21, 2019. Odds ratio (OR) with 95% confidence interval (CI) was selected as effect scale index for evaluation of the difference in return of spontaneous circulation (ROSC), survival to hospital admission, survival to hospital discharge, and survival to 30 days. Random effects model was used in this study to estimate overall mean effects. RESULTS: A total of 6 articles, including 4 randomized controlled trials and 2 nonrandomized controlled trials, were selected. And 8501 subjects were involved to analyze the clinical outcomes of LUCAS and manual chest compression for patients with out-hospital CA. Comparisons of ROSC (33.3% vs 33.0%, P = .98; OR = 1; 95% CI: [0.89,1.13]), survival to hospital admission (22.7% vs 24.3%, P = .32; OR = 0.86; 95% CI: [0.65,1.15]), survival to hospital discharge (8.6% vs 10.7%, P = .50; OR = 0.92; 95% CI: [0.73,1.17]), and survival to 30 days (7.5% vs 8.5%, P = .50; OR = 0.92; 95% CI: [0.73,1.17]) were made. No significant difference was found. CONCLUSION: The synthesis of available evidence does not support that mechanical chest compression with LUCAS device improves clinical outcome in out-of-hospital CA patients compared with manual chest compression. Large scale studies with improved designs are still needed in the future.


Asunto(s)
Reanimación Cardiopulmonar/instrumentación , Reanimación Cardiopulmonar/métodos , Paro Cardíaco Extrahospitalario/mortalidad , Paro Cardíaco Extrahospitalario/terapia , Ensayos Clínicos como Asunto , Hospitalización/estadística & datos numéricos , Humanos , Análisis de Supervivencia
18.
Medicine (Baltimore) ; 98(44): e17752, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31689831

RESUMEN

Dispatcher assisted cardiopulmonary resuscitation (DACPR) by Emergency medical services has been shown to improve rates of early out of hospital cardiac arrest (OHCA) recognition and early cardiopulmonary resuscitation (CPR) for OHCA. This study measures the impact of introducing DACPR on OHCA recognition, CPR rates and on patient outcomes in a pilot region in Kuwait.EMS treated OHCA data over 10 months period (February 21-December 31, 2017) before and after the intervention was prospectively collected and analyzed.Comprehensive DACPR in the form of: a standardized dispatch protocol, 1-day training package and quality assurance and improvement measures were applied to Kuwait EMS central Dispatch unit only for pilot region. Primary outcomes: OHCA recognition rate, CPR instruction rate, and Bystander CPR rate. Secondary outcome: survival to hospital discharge.A total of 332 OHCA cases from the EMS archived data were extracted and after exclusion 176 total OHCA cases remain. After DACPR implementation OHCA recognition rate increased from 2% to 12.9% (P = .037), CPR instruction rate increased from 0% to 10.4% (P = .022); however, no significant change was noted for bystander CPR rates or prehospital return of spontaneous circulation. Also, survival to hospital discharge rate did not change significantly (0% before, and 0.8% after, P = .53)In summary, DACPR implementation had positive impacts on Kuwait EMS system operational outcomes; early OHCA recognition and CPR instruction rates in a pilot region of Kuwait. Expanding this initiative to other regions in Kuwait and coupling it with other OHCA system of care interventions are needed to improve OHCA survival rates.


Asunto(s)
Reanimación Cardiopulmonar/educación , Operador de Emergencias Médicas/educación , Servicios Médicos de Urgencia/métodos , Paro Cardíaco Extrahospitalario/terapia , Anciano , Reanimación Cardiopulmonar/métodos , Femenino , Implementación de Plan de Salud , Humanos , Kuwait , Masculino , Persona de Mediana Edad , Alta del Paciente/estadística & datos numéricos , Proyectos Piloto , Evaluación de Programas y Proyectos de Salud , Estudios Prospectivos , Resultado del Tratamiento
19.
Crit Care Resusc ; 21(4): 287-98, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31778636

RESUMEN

OBJECTIVE: Therapeutic hypothermia (TH) is defined as the designed reduction of the human body's core temperature to 32°C-35°C for a period of 24-48 hours. TH has been studied extensively in many diseases related to critical care illness. This meta-analysis assesses the effect of TH on mortality across different indications in medical, neurological and cardiothoracic care. DATA SOURCES: The online databases Embase, Ovid MEDLINE, TRIP and CINAHL were searched for eligible studies published between 1940 and October 2018. STUDY SELECTION: Randomised clinical trials of induced TH in adults for any indication. DATA EXTRACTION: Information about baseline characteristics of patients, mortality outcomes, cooling strategy and target temperature achieved in hypothermia and normothermia groups was collected. DATA SYNTHESIS: Eighty studies, with a total of 13 418 patients, were included in this meta-analysis: 22 studies for traumatic brain injury, six studies for stroke, five studies for out-of-hospital cardiac arrest (OHCA), 34 studies for intraoperative cardiopulmonary bypass, and 13 studies for other diseases. A total of 6901 patients (51.4%) were randomly allocated to the TH group and 6517 patients (48.6%) were randomised to the normothermia control group. The unadjusted analysis showed no significant difference in mortality across different critical care illnesses. However, after adjusting for population, gender, age and temperature, only the OHCA group showed a small statistically significant difference favouring TH, but this had a questionable clinical significance. CONCLUSIONS: This meta-analysis suggests that after decades of extensive research, TH has yet to show a beneficial effect on mortality across different critical care diseases.


Asunto(s)
Hipotermia Inducida/métodos , Unidades de Cuidados Intensivos/estadística & datos numéricos , Paro Cardíaco Extrahospitalario/terapia , Adulto , Temperatura Corporal , Humanos , Hipotermia Inducida/mortalidad , Paro Cardíaco Extrahospitalario/mortalidad , Resultado del Tratamiento
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