Midterm outcomes of emergency surgery for acute type A aortic dissection in octogenarians.

OBJECTIVE: The incidence of elderly patients with acute type A aortic dissection is increasing. A recent analysis of the International Registry of Acute Aortic Dissection failed to show a mortality benefit with surgery compared with medical management in octogenarians. Therefore, we compared our institutional outcomes of emergency surgery for acute type A aortic dissection in octogenarians versus septuagenarians to understand the outcomes of surgical intervention in elderly patients. METHODS: From 2002 to 2017, 70 octogenarians (aged ≥80 years) and 165 septuagenarians (70-79 years) underwent surgery for acute type A aortic dissection (N = 235, total). Quality of life was assessed by the RAND Short Form-36 quality of life survey. Midterm clinical and functional data were obtained retrospectively. RESULTS: At baseline, septuagenarians had a higher prevalence of diabetes (20.6% vs 5.7%, P = .01). The prevalence of cardiopulmonary resuscitation was 4.8% versus 10.0% (P = .24) in septuagenarians and octogenarians. The prevalence of cardiogenic shock was 18.2% versus 27.1% (P = .17). Thirty-day/in-hospital mortality was 21.2% versus 28.6% (P = .29). Multivariable logistic regression identified cardiogenic shock as an independent risk factor for in-hospital mortality (odds ratio, 10.07; 95% confidence interval, 2.30-44.03) in octogenarians. Survival at 5 years was 49.7% (42.1%-58.6%) versus 34.2% (23.9%-48.8%) in septuagenarians and octogenarians, respectively. Responses to the quality of life survey were no different between septuagenarians and octogenarians across all 8 quality of life categories. CONCLUSIONS: Clinical outcomes after surgery for acute type A aortic dissection are similar in octogenarians and septuagenarians. For discharged survivors, quality of life remains favorable and does not differ between the 2 groups.

Cardiopulmonary resuscitation in television medical dramas: Results of the TVMD2 study.

INTRODUCTION: Television medical dramas (TVMDs) use cardiopulmonary resuscitation (CPR) as a mean of achieving higher viewing rates. TVMDs portrayal of CPR can be used to teach laypersons attempting to perform CPR and to form a shared professional and layperson mental model for CPR decisions. We studied the portrayal of CPR across a wide range of TVMDs to see whether newer series fulfill this promise. MATERIALS AND METHODS: Advanced cardiac life support (ACLS) certified healthcare providers underwent training in the use of a unique instrument based on the AHA (American Heart Association) guidelines to assess TVMD CPR scenarios. Components of the assessment included the adequacy of CPR techniques, gender distribution in CPR scenes, performance quality by different healthcare providers, and CPR outcomes. Thirty-one TVMDs created between 2010 and 2018 underwent review. RESULTS: Among 836 TVMD episodes reviewed, we identified 216 CPR attempts. CPR techniques were mostly portrayed inaccurately. The recommended compressions depth was shown in only 32.0% of the attempts (n = 62). The recommended rate was shown in only 44.3% of the attempts (n = 86). Survival to hospital discharge was portrayed as twice higher in male patients (67.6%, n = 71) than in female patients (32.4%, n = 29) (p < 0.05). Paramedics were portrayed as having better performance than physicians or nurses; compression rates were shown to be within the recommendations in only 42% (n = 73) of the CPR attempts performed by physicians, 44% (n = 8) of those performed by nurses, and 64% (n = 9) of those performed by paramedics. Complete chest recoil after compression was shown in only 34% (n = 58) of the CPR attempts performed by physicians, 38% (n = 7) of those performed by nurses, and 64% (n = 9) of those performed by paramedics. Outcomes were better on the screen than in real life; among the episodes showing outcome (n = 202), the overall rate of survival from CPR was 61.9% (n = 125). CONCLUSION: Portrayal of CPR in TVMDs remains a missed opportunity for improving performance and communication on CPR.

Pediatric Palliative Care During End of Life: A Privilege of a Few in a Tertiary Referral Hospital From Colombia.

BACKGROUND: We aim to describe the access to palliative care (PC) in hospitalized children during end-of-life care and compare the circumstances surrounding the deaths of hospitalized children as a basis for implementing a pediatric PC program at our institution. METHODS: We performed a retrospective chart review of deceased pediatric patients at a tertiary referral hospital in Colombia. The study group was selected by randomly drawing a sample of 100 observations from the 737 deceased children from 2013 to 2016. A 1:1 propensity score (PS) matching was performed to compare the characteristics and outcomes between PC and non-PC treated patients. RESULTS: We included 87 patients. After PS matching, we found that patients under the care of non-PC physicians were more likely to die in the pediatric intensive care unit (non-PC: 6/10 vs PC: 1/10; P = .02), to be on vasopressor agents and mechanical ventilation (non-PC: 7/10 vs PC: 1/10; P = .02), and to receive cardiopulmonary resuscitation at the end of life (non-PC: 5/10 vs PC: 0/10; P = .03). In contrast, a significantly higher proportion of patients under the care of the pediatric PC team died with comfort measures (non-PC: 2/10 vs 8/10; P = .02) and nonescalation of care in physician orders (non-PC: 5/10 vs PC: 10/10; 0.03). CONCLUSION: In this study, only 10 of 87 patients were treated by the pediatric PC team at the end of life. The latter finding is concerning and is a call to action to improve access to pediatric PC at our institution.

Avaliação do impacto das superfícies de compreensão na força necessária para compreensão torácica de alta qualidade / Impact evaluation of compression surfaces on the force required for high-quality chest compression

Introdução: A ressuscitação cardiopulmonar (RCP), em especial, a compressão torácica de alta qualidade é fundamental para a sobrevivência de pacientes vítimas de parada cardiorrespiratória (PCR) intra e extra-hospitalar. Um ponto importante a ser considerado é que não existem recomendações relativas às especificidades da execução das manobras de RCP em condições hospitalares, onde os pacientes estão alocados em superfícies que podem interferir na qualidade das compressões torácicas. Estudos experimentais mostram que a qualidade das compressões torácicas pode variar em cenários da vida real devido a diferenças ambientais e características das superfícies. São consideradas superfícies de compressão o colchão onde o paciente estiver deitado, o chão, a cama/maca e a superfície rígida/ prancha. Essas superfícies de compressão apresentam variáveis que podem impactar o atingimento (alcance) da profundidade adequada na compressão torácica. Objetivos: Mensurar o impacto das diferentes superfícies de compressão (cama/maca, colchão e prancha rígida) sobre a força necessária para realizar compressão torácica de alta qualidade; correlacionar as características das superfícies de compressão (cama/maca, colchão e prancha rígida) com a força necessária para realizar compressão torácica de alta qualidade e identificar um modelo de regressão que possa relacionar, conjunta ou isoladamente, as diferentes superfícies de compressão com a força necessária para realizar compressão torácica de alta qualidade. Metodologia: Trata-se de um estudo experimental, de abordagem quantitativa, onde foi investigado o impacto das características das superfícies de compressão na força necessária para uma compressão torácica de alta qualidade realizado com manequim do tipo Little Anne e um equipamento construído para execução das compressões torácicas. Resultados: Foram realizados 230 testes experimentais que mediram a força necessária para uma compressão torácica de alta qualidade incluindo a variação de 2 fatores: conjunto de cama/maca + colchão e presença ou ausência de prancha rígida. Cinco destes testes foram realizados numa mesa de mármore, simulando o chão, que foi usada como padrão ouro para este estudo. A prancha de madeira apresentou o melhor resultado estatístico para força necessária para uma compressão torácica de alta qualidade, comparada às de acrílico, cabeceira removível do leito e sem a utilização da prancha rígida. As dimensões da cama e, principalmente, as características dos colchões estão correlacionadas estatisticamente com a força necessária para a compressão torácica de alta qualidade, indicando que maiores dimensões da cama e de colchões estão relacionadas à maior força necessária para a compressão torácica ideal e vice-versa. Conclusão: Este estudo atingiu seu objetivo permitindo medir o impacto das superfícies de compressão sobre a força necessária para atingir uma compressão torácica ideal, assim como correlacionar com as dimensões e características das camas/macas, colchões e pranchas rígidas, possibilitando a reflexão das equipes de saúde sobre um atendimento de RCP no que tange ao impacto dessas superfícies sobre a força necessária para se alcançar uma compressão torácica de alta qualidade. Os resultados da análise de regressão confirmam que nenhuma das medidas da prancha rígida é significativa para a força necessária para compressão torácica de alta qualidade. Foram investigados 8.190 modelos de regressão com as possíveis combinações das variáveis da cama/maca, colchão e prancha rígida e não foi possível modelar a força necessária para a compressão torácica de alta qualidade com as dimensões estudadas utilizadas neste trabalho.

Introduction: Cardiopulmonary resuscitation (CPR), particularly the high-quality chest compression, is essential for patient's survival who are victims of cardiopulmonary arrest (CPA) inside and outside hospitals. An important point to be considered is that there are no recommendations regarding specifics CPR maneuvers in hospital conditions, where patients are placed on surfaces that can interfere in the quality of chest compressions. Experimental studies show that the quality of chest compressions can vary in real-life settings due to environmental differences and surface characteristics. Compression surfaces considered are the mattress where the patient is lying, the floor, the bed / stretcher, and the rigid surface / board. These compression surfaces have variables that can impact reaching (reach) the appropriate depth in chest compression. Objectives: Measure the impact of the different compression surfaces (bed / stretcher, mattress and rigid board) on the force required to perform high-quality chest compression; correlate the characteristics of the compression surfaces (bed / stretcher, mattress and rigid board) with necessary strength to perform high- quality chest compression and identify a regression model that can relate, jointly or separately, the different compression surfaces to the necessary force to perform high-quality chest compression. Methodology: This is an experimental study, with a quantitative approach, in which the impact of the compression surfaces' characteristics on the necessary force for high-quality chest compression performed with a Little Anne mannequin and equipment built to perform compressions was investigated. Results: 230 experimental tests were carried out to measure the strength required for high-quality chest compression including the variation of 2 factors: bed / stretcher set + mattress and the presence or absence of a rigid board. Five tests were performed on a marble table, simulating the floor, which was used as the gold standard for this study. The wooden plank presented the best statistical result for the necessary strength for a high-quality chest compression, compared to acrylic, removable headboard and without the use of the rigid plank. The bed's dimensions and, mainly, the mattresses' characteristics are statistically correlated with the necessary force for high-quality chest compression, indicating that larger dimensions of bed and mattresses are related to the greater force necessary for the ideal compression and vice- versa. Conclusion: This study achieved its objective allowing to measure the impact of the compression surfaces on the necessary force to achieve an ideal chest compression, as well as to correlate with the dimensions and characteristics of the beds / stretchers, mattresses and rigid boards, allowing the reflection for the health teams on a CPR service regarding the impact of these surfaces on the necessary force to achieve high-quality chest compression. The regression analysis' results confirm that none of the rigid board's measurements is significant to the strength required for high-quality chest compression. 8,190 regression models were investigated with the possible combinations of bed / stretcher, mattress, and rigid board variables, and it was not possible to model the strength required for high-quality chest compression with the studied dimensions used in this work.

Early prediction of critical events for infants with single-ventricle physiology in critical care using routinely collected data.

OBJECTIVE: Critical events are common and difficult to predict among infants with congenital heart disease and are associated with mortality and long-term sequelae. We aimed to achieve early prediction of critical events, that is, cardiopulmonary resuscitation, emergency endotracheal intubation, and extracorporeal membrane oxygenation in infants with single-ventricle physiology before second-stage surgery. We hypothesized that naïve Bayesian models learned from expert knowledge and clinical data can predict critical events early and accurately. METHODS: We collected 93 patients with single-ventricle physiology admitted to intensive care units in a single tertiary pediatric hospital between 2014 and 2017. Using knowledge elicited from experienced cardiac-intensive-care-unit providers and machine-learning techniques, we developed and evaluated the Cardiac-intensive-care Warning INdex (C-WIN) system, consisting of a set of naïve Bayesian models that leverage routinely collected data. We evaluated predictive performance using the area under the receiver operating characteristic curve, sensitivity, and specificity. We performed the evaluation at 5 different prediction horizons: 1, 2, 4, 6, and 8 hours before the onset of critical events. RESULTS: The area under the receiver operating characteristic curves of the C-WIN models ranged between 0.73 and 0.88 at different prediction horizons. At 1 hour before critical events, C-WIN was able to detect events with an area under the receiver operating characteristic curve of 0.88 (95% confidence interval, 0.84-0.92) and a sensitivity of 84% at the 81% specificity level. CONCLUSIONS: Predictive models may enhance clinicians' ability to identify infants with single-ventricle physiology at high risk of critical events. Early prediction of critical events may indicate the need to perform timely interventions, potentially reducing morbidity, mortality, and health care costs.

Cambios morfofisiológicos celulares durante la reanimación cardiopulmocerebral / Morph-physiological cellular changes during cardiac-pulmonary-cerebral resuscitation

Las células realizan transformaciones estructurales y metabólicas ante situaciones de estrés, lo que les permite mantener una adecuada homeostasis y evitar la muerte. La presente revisión bibliográfica tuvo como objetivo describir los principales cambios morfofisiológicos celulares que acontecen en la parada cardiaca y reanimación cardiopulmocerebral. El método incluyó una revisión documental (bases de datos SciELO Regional, PubMed, Cochrane e Infomed), realizada durante el primer semestre del 2018. Fueron seleccionadas 28 referencias. Se concluye que existen cambios celulares durante el cese circulatorio, las maniobras de resucitación y en la reperfusión. En la parada cardiaca, los cambios celulares se expresan en todos los organelos y puede llevar a muerte por necrosis. Durante la reperfusión se producen nuevos cambios estructurales, por entrada de calcio, alteraciones en sodio, producción de radicales libres e inflamación. Los cambios morfofisiológicos dependerán del estado metabólico previo, el tiempo de parada cardiaca y la instauración eficaz de medidas de resucitación.

Cell suffer structural and metabolic changes in stress situations,which allow them to maintain an adequate homeostasis and avoid death . This bibliographic review had the objective of describing the main morph-physiological changes which occur in cardiac failure and cardiac-pulmonary-cerebral resuscitation. The method was documentary reviewing (database Regional SciELO, PubMed, Cochrane and Infomed), developed during the first semester of 2018. Twenty eight references were selected. It was concluded that there are cellular changes during circulatory stop, the procedures of resuscitation and re-perfusion. In cardiac failure, cellular changes are expressed in all the organelles. And may cause death due to necroses. During re-perfusion new structural changes occur, for calcium entrance, sodium disturbances, production of free radicals and swelling. Morph.physiological changes depend on previous metabolic condition, time of cardiac failure and the successful establishment of resuscitation measures.

Results of the implementation of integrated care after cardiorespiratory arrest in a university hospital.

OBJECTIVES: to identify the care measures performed after cardiorespiratory arrest (CRA) and to relate them to the neurological status and survival at four moments: within the first 24 hours, at the discharge, six months after discharge, and one year after discharge. METHOD: retrospective, analytical and quantitative study performed at the Emergency Department of a university hospital in São Paulo. Eighty-eight medical records of CRA patients who had a return of spontaneous circulation sustained for more than 20 minutes were included and the post-CRA care measures performed in the first 24 hours were identified, as well as its relationship with survival and neurological status. RESULTS: the most frequent post-CRA care measures were use of advanced airway access techniques and indwelling bladder catheterization. Patients who had maintained good breathing and circulation, temperature control and who were transferred to intensive care unit had a better survival in the first 24 hours, after six months and one year after discharge. Good neurological status at six months and one year after discharge was associated with non-use of vasoactive drugs and investigation of the causes of the CRA. CONCLUSION: the identification of good practices in post-CRA care may help to reduce the mortality of these individuals and to improve their quality of life.

Characterization of Pediatric In-Hospital Cardiopulmonary Resuscitation Quality Metrics Across an International Resuscitation Collaborative.

OBJECTIVES: Pediatric in-hospital cardiac arrest cardiopulmonary resuscitation quality metrics have been reported in few children less than 8 years. Our objective was to characterize chest compression fraction, rate, depth, and compliance with 2015 American Heart Association guidelines across multiple pediatric hospitals. DESIGN: Retrospective observational study of data from a multicenter resuscitation quality collaborative from October 2015 to April 2017. SETTING: Twelve pediatric hospitals across United States, Canada, and Europe. PATIENTS: In-hospital cardiac arrest patients (age < 18 yr) with quantitative cardiopulmonary resuscitation data recordings. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: There were 112 events yielding 2,046 evaluable 60-second epochs of cardiopulmonary resuscitation (196,669 chest compression). Event cardiopulmonary resuscitation metric summaries (median [interquartile range]) by age: less than 1 year (38/112): chest compression fraction 0.88 (0.61-0.98), chest compression rate 119/min (110-129), and chest compression depth 2.3 cm (1.9-3.0 cm); for 1 to less than 8 years (42/112): chest compression fraction 0.94 (0.79-1.00), chest compression rate 117/min (110-124), and chest compression depth 3.8 cm (2.9-4.6 cm); for 8 to less than 18 years (32/112): chest compression fraction 0.94 (0.85-1.00), chest compression rate 117/min (110-123), chest compression depth 5.5 cm (4.0-6.5 cm). "Compliance" with guideline targets for 60-second chest compression "epochs" was predefined: chest compression fraction greater than 0.80, chest compression rate 100-120/min, and chest compression depth: greater than or equal to 3.4 cm in less than 1 year, greater than or equal to 4.4 cm in 1 to less than 8 years, and 4.5 to less than 6.6 cm in 8 to less than 18 years. Proportion of less than 1 year, 1 to less than 8 years, and 8 to less than 18 years events with greater than or equal to 60% of 60-second epochs meeting compliance (respectively): chest compression fraction was 53%, 81%, and 78%; chest compression rate was 32%, 50%, and 63%; chest compression depth was 13%, 19%, and 44%. For all events combined, total compliance (meeting all three guideline targets) was 10% (11/112). CONCLUSIONS: Across an international pediatric resuscitation collaborative, we characterized the landscape of pediatric in-hospital cardiac arrest chest compression quality metrics and found that they often do not meet 2015 American Heart Association guidelines. Guideline compliance for rate and depth in children less than 18 years is poor, with the greatest difficulty in achieving chest compression depth targets in younger children.

Delivery Room Resuscitation and Short-Term Outcomes in Moderately Preterm Infants.

OBJECTIVES: To describe the frequency and extent of delivery room resuscitation and evaluate the association of delivery room resuscitation with neonatal outcomes in moderately preterm (MPT) infants. STUDY DESIGN: This was an observational cohort study of MPT infants delivered at 290/7 to 336/7 weeks' gestational age (GA) enrolled in the Neonatal Research Network MPT registry. Infants were categorized into 5 groups based on the highest level of delivery room intervention: routine care, oxygen and/or continuous positive airway pressure, bag and mask ventilation, endotracheal intubation, and cardiopulmonary resuscitation including chest compressions and/or epinephrine use. The association of antepartum and intrapartum risk factors and discharge outcomes with the intensity of resuscitation was evaluated. RESULTS: Of 7014 included infants, 1684 (24.0%) received routine care and no additional resuscitation, 2279 (32.5%) received oxygen or continuous positive airway pressure, 1831 (26.1%) received bag and mask ventilation, 1034 (14.7%) underwent endotracheal intubation, and 186 (2.7%) received cardiopulmonary resuscitation. Among the antepartum and intrapartum factors, increasing GA, any exposure to antenatal steroids and prolonged rupture of membranes decreased the likelihood of receipt of all levels of resuscitation. Infants who were small for GA (SGA) had increased risk of delivery room resuscitation. Among the neonatal outcomes, respiratory support at 28 days, days to full oral feeds and length of stay were significantly associated with the intensity of delivery room resuscitation. Higher intensity of resuscitation was associated with increased risk of mortality. CONCLUSIONS: The majority of MPT infants receive some level of delivery room resuscitation. Increased intensity of delivery room interventions was associated with prolonged respiratory and nutritional support, increased mortality, and a longer length of stay.

Results of the implementation of integrated care after cardiorespiratory arrest in a university hospital / Resultados da implementação dos cuidados integrados pós-parada cardiorrespiratória em um hospital universitário / Resultados de la implementación de los cuidados integrados pos-parada cardiorrespiratoria en un hospital universitario

ABSTRACT Objectives: to identify the care measures performed after cardiorespiratory arrest (CRA) and to relate them to the neurological status and survival at four moments: within the first 24 hours, at the discharge, six months after discharge, and one year after discharge. Method: retrospective, analytical and quantitative study performed at the Emergency Department of a university hospital in São Paulo. Eighty-eight medical records of CRA patients who had a return of spontaneous circulation sustained for more than 20 minutes were included and the post-CRA care measures performed in the first 24 hours were identified, as well as its relationship with survival and neurological status. Results: the most frequent post-CRA care measures were use of advanced airway access techniques and indwelling bladder catheterization. Patients who had maintained good breathing and circulation, temperature control and who were transferred to intensive care unit had a better survival in the first 24 hours, after six months and one year after discharge. Good neurological status at six months and one year after discharge was associated with non-use of vasoactive drugs and investigation of the causes of the CRA. Conclusion: the identification of good practices in post-CRA care may help to reduce the mortality of these individuals and to improve their quality of life.

RESUMO Objetivos: identificar os cuidados pós-parada cardiorrespiratória (PCR) realizados e relacioná-los com o estado neurológico e a sobrevida nas primeiras 24 horas, na alta, após seis meses e um ano. Método: estudo retrospectivo, analítico e quantitativo, realizado no Serviço de Emergência de um hospital universitário em São Paulo. Foram incluídos 88 prontuários de pacientes atendidos em PCR, que apresentaram retorno da circulação espontânea sustentado por mais de 20 minutos e identificados os cuidados pós-PCR realizados nas primeiras 24 horas, como também a relação com a sobrevida e estado neurológico. Resultados: os cuidados pós-PCR realizados com maior frequência foram a obtenção de uma via área avançada e passagem de sonda vesical de demora. Para os pacientes que tiveram manutenção de boa respiração e circulação, controle da temperatura e transferência para unidade de terapia intensiva, a sobrevida foi maior nas primeiras 24 horas, após seis meses e um ano da alta. O bom estado neurológico em seis meses e um ano após a alta associou-se a não utilização de drogas vasoativas e à investigação das causas da PCR. Conclusão: a identificação das boas práticas em relação aos cuidados pós-PCR pode auxiliar na diminuição da mortalidade destes indivíduos e na melhora da sua qualidade de vida.

RESUMEN Objetivos: identificar los cuidados pos-parada cardiorrespiratoria (PCR) realizados y relacionarlos con el estado neurológico y la sobrevida en las primeras 24 horas en el alta, después de seis meses y un año. Método: estudio retrospectivo, analítico y cuantitativo, realizado en el Servicio de Emergencia, de un hospital universitario en São Paulo. Fueron incluidos 88 prontuarios de pacientes atendidos en PCR, que presentaron retorno de la circulación espontánea sustentado por más de 20 minutos e identificados los cuidados pos-PCR realizados en las primeras 24 horas y la relación con la sobrevida y estado neurológico. Resultados: los cuidados pos-PCR realizados con mayor frecuencia fueron la obtención de una vía área avanzada y pasaje de sonda vesical de demora. Los pacientes que tuvieron mantenimiento de buena respiración y circulación, control de la temperatura y transferencia para unidad de terapia intensiva a sobrevida fue mayor en las primeras 24 horas, después de seis meses y un año del alta. El buen estado neurológico en seis meses y un año después del alta se asoció a la no utilización de drogas vasoactivas y la investigación de las causas de la PCR. Conclusión: la identificación de las buenas prácticas en relación a los cuidados pos-PCR puede auxiliar en la disminución de la mortalidad de estos individuos y en la mejoría de su calidad de vida.

Semantic validation of the short versions of the Empathy-Systemizing Quotient Scales / Validação semântica das versões curtas das Escalas de Medição do Quociente de Empatia/Sistematização / Validación semántica de las versiones cortas de las Escalas de Medición del Cociente de Empatía/Sistematización

ABSTRACT Objective: to perform the semantic validation of the short versions of the Empathy-Systemizing Quotient Scales, intended to measure the empathetic and systemizing profiles of individuals. The scales originated in Cambridge and were validated in Portugal, and were assessed for their psychometric properties. Method: methodological study included the scales' semantic validation (content validity) and verification of their psychometric properties (internal consistency). Five judges participated in the semantic validation. The Content Validity Index was calculated, a pretest was conducted with 18 undergraduate nursing students, and, finally, the scales were applied to a sample. Results: the sample was composed of 215 undergraduate nursing students, 186 (86.51%) of whom were women aged 21 years old, on average. The scales presented good internal consistency with global Cronbach's alphas equal to 0.83 and 0.79 for the Empathy Quotient and the Systemizing Quotient, respectively. Correlations between the scales and subscales of the Empathy Quotient and Systemizing Quotient were all positive and significant according to the Pearson correlation coefficient. Conclusion: the scales are reliable and valid to measure the empathetic and systemizing profile of undergraduate nursing students and the final version was named "versões curtas das Escalas de Medição do Quociente de Empatia/Sistematização - Brasil" [short versions of the Empathy-Systemizing Quotient Scales - Brazil].

RESUMO Objetivo: realizar a validação semântica e avaliar as propriedades psicométricas das versões curtas das Escalas de Medição do Quociente de Empatia/Sistematização, originadas em Cambridge e validadas em Portugal, para mensurar o perfil empático e sistemático dos indivíduos. Método: estudo metodológico no qual foram compreendidas a validação semântica (validade de conteúdo) e a verificação das propriedades psicométricas (consistência interna) das escalas. Cinco juízes participaram da validação semântica. Foi calculado o Índice de Validade de Conteúdo, seguido de pré-teste, com 18 graduandos em enfermagem e posterior aplicação a uma amostra. Resultados: a amostra foi composta de 215 graduandos em enfermagem, sendo 186 (86,51%) do sexo feminino, com idade média de 21 anos. As escalas apresentaram boa consistência interna, com valores de Alfa de Cronbach global de 0,83 para o Quociente de Empatia e 0,79 para o Quociente de Sistematização. As correlações entre as escalas e subescalas do Quociente de Empatia e Quociente de Sistematização foram todas positivas e significantes, resultantes do teste de correlação de Pearson. Conclusão: as escalas foram consideradas confiáveis e válidas para mensurar o perfil empático e sistemático de graduandos em enfermagem e a versão final foi denominada versões curtas das Escalas de Medição do Quociente de Empatia/Sistematização - Brasil.

RESUMEN Objetivo: realizar la validación semántica y evaluar las propiedades psicométricas de las versiones cortas de las Escalas de Medición del Cociente de Empatía/Sistematización, originadas en Cambridge y validadas en Portugal, para medir el perfil empático y sistemático de los individuos. Método: estudio metodológico que comprendió la validación semántica (validez de contenido) y verificación de las propiedades psicométricas (consistencia interna) de las escalas. Cinco jueces participaron de la validación semántica. Después de calculado el Índice de Validez de Contenido, se realizó el pretest con dieciocho estudiantes de enfermería y posteriormente se aplicó a una muestra. Resultados: la muestra estuvo compuesta por 215 estudiantes de enfermería, siendo 186 (86,51%) del sexo femenino, con edad media de 21 años. Las escalas presentaron buena consistencia interna con valores de Alpha de Cronbach Global de 0,83 para el Cociente de Empatía y 0,79 para el Cociente de Sistematización. Las correlaciones entre las escalas y subescalas del Cociente de Empatía y Cociente de Sistematización fueron todas positivas y significativas, las que fueron resultado del test de correlación de Pearson. Conclusión: las escalas fueron consideradas confiables y válidas para medir el perfil empático y sistemático de estudiantes de enfermería; la versión final fue denominada de "versiones cortas de las Escalas de Medición del Cociente de Empatía/Sistematización - Brasil".

La reanimación cardiopulmonar desde la experiencia del estudiante: estudio de caso / Cardiopulmonary Resuscitation Experience from Student: Case Study / Ressuscitação cardiopulmonar desde a experiência do estudante: estudo de caso

Introducción: la reanimación es un momento de cuidado que en el profesional de enfermería genera sentimientos y emociones para los cuales no se está preparado, debido a que la formación está centrada en el componente teórico-práctico. Esta situación es similar a la del estudiante. Objetivo: describir la experiencia del estudiante durante la reanimación cardiopulmonar, a fin de reconocer aspectos esenciales para la formación profesional. Materiales y método: abordaje cualitativo, fenomenológico, mediante un estudio de caso. Para recolectar y analizar la información se utilizó la entrevista semiestructurada y la observación, que se registró en notas de campo. Resultados: las categorías que surgieron del análisis se denominaron: conciencia de la subjetividad, apoyo del docente, cuestionamiento frente a la cotidianidad de la muerte en el equipo de salud, la vida como motivación y el resignificado de la muerte. Se contrastaron los resultados de la investigación a la luz de la literatura. Conclusiones: el estudiante experimenta vivencias en las cuales aflora la subjetividad; la muerte es una de ellas y tiene mayor significado cuando se asume por primera vez, puesto que no se está preparado para abordarla. Ayudar a morir con dignidad y acompañar en el sufrimiento requiere formación, conocimiento y madurez, en el futuro profesional, dada la implicación emocional que genera. Por tanto, se deben propiciar espacios de reflexión en torno a estas situaciones críticas, preferiblemente desde las experiencias de los mismos estudiantes, para fortalecer los aspectos que hacen de esta una experiencia enriquecedora.

Introduction: Cardiopulmonary CPR resuscitation is a moment of care generated in the professional nursing feelings and emotions for which you are not prepared, because the training is focused on the theoretical and practical component; this situation is similar to the student. Aim: To describe the student experience during CPR, to recognize essential aspects for vocational training. Materials and Methods: A qualitative approach, phenomenological, through a case study. To collect and analyze information through semistructured interviews and observation was recorded in field notes was used. Results: The categories that emerged from the analysis were named: Awareness of subjectivity, teacher support, questioning face death every day in the health team, life as motivation and redefined death. The results of research in the light of the literature were contrasted. Conclusions: The student experiences where subjectivity comes out, death is one of them and has more meaning when it is assumed for the first time, since you are not prepared to address it. Helping to die with dignity and accompany suffering requires training, knowledge and maturity in the professional future, given the emotional involvement it generates. Therefore, should promote opportunities for reflection on these critical situations, preferably from the experiences of these students in order to strengthen the aspects that make this an enriching experience.

Introdução: a ressuscitação cardiopulmonar (RCP) é um momento de cuidado que no professional de enfermagem gera sentimentos e emoções para as quais não está preparado, porque o treinamento é focado na teória e na prática. Objetivo: descrever a experiência do estudante durante a RCP, para reconhecer aspectos essenciais para a formação profissional. Materiais e métodos: abordagem qualitativa, fenomenológica, através de um estudo de caso. Para recolher e analisar a informação, nós usamos entrevistas e observação semi-estruturada que foi gravada em notas de campo. Resultados: as categorias que emergiram da análise foram nomeados: a consciência da subjetividade, apoio dos professores, questionando diante a cotidianidade da morte na equipe de saúde, a vida como motivação e o entendimento da morte. Os resultados da pesquisa foram comparados à luz da literatura. Conclusões: o estudante tem experiências onde a subjetividade emerge, a morte é uma delas e tem mais significado quando e assumida pela primeira vez, porque a pessoa não está preparada para enfrentá-lo. Ajudar a morrer com dignidade e acompanhar no sofrimento que exige formação, conhecimento e maturidade, no futuro profissional, dado o envolvimento emocional que ele gera. Portanto, ele deve promover espaços para a reflexão sobre estas situações críticas, de preferência a partir das experiências dos próprios alunos, a fim de reforçar os aspectos que tornam esta uma experiência enriquecedora.

Incidence and Risk Factors for Cardiovascular Collapse After Unplanned Extubations in the Pediatric ICU.

BACKGROUND: Cardiovascular collapse is a life-threatening event after unplanned extubations (UEs) in the pediatric ICU (PICU). However, there is a paucity of pediatric studies assessing this complication. We sought to assess the incidence, risk factors, and outcome of cardiovascular collapse after UEs in PICU patients. METHODS: All children who had been mechanically ventilated for ≥12 h were prospectively tracked for UEs over an 8-y period. Subjects were included in the study if they were between ages 1 month and 16 y and had experienced UE. They were analyzed in 2 groups: those with cardiovascular collapse (defined as the need for cardiopulmonary resuscitation or circulatory dysfunction immediately after UE) and those with no cardiovascular collapse. RESULTS: Of the 847 subjects, 109 UEs occurred in 14,293 intubation days (0.76 UEs/100 intubation days), with 21 subjects (19.2%) experiencing cardiovascular collapse, of which 10 required cardiopulmonary resuscitation. Compared with subjects without cardiovascular collapse after UE, children with cardiovascular collapse were younger (<6 months old), with respiratory failure from lower respiratory tract diseases, lower PaO2/FIO2 (218 vs 282 mm Hg), and higher oxygenation indices (5.5 vs 3.5) before UE events. Logistic regression revealed that only an age ≤6 months old was strongly associated with cardiovascular collapse (odds ratio 3.4, P = .03). There were no differences between cardiovascular collapse and non-cardiovascular collapse subjects regarding the length of hospital stay, ventilator-associated pneumonia rate, and mortality. CONCLUSIONS: Cardiovascular collapse is a frequent complication of UEs, particularly in the youngest children. Specific bundles to prevent UEs may reduce morbidity related to these events.

Capnography Use During Intubation and Cardiopulmonary Resuscitation in the Pediatric Emergency Department.

OBJECTIVE: Capnography is indicated as a guide to assess and monitor both endotracheal intubation and cardiopulmonary resuscitation (CPR). Our primary objective was to determine the effect of the 2010 American Heart Association (AHA) guidelines on the frequency of capnography use during critical events in children in the emergency department (ED). Our secondary objective was to examine associations between patient characteristics and capnography use among these patients. METHODS: A retrospective chart review was performed on children aged 0 to 21 years who were intubated or received CPR in 2 academic children's hospital EDs between January 2009 and December 2012. Age, sex, time of arrival, medical or traumatic cause, length of CPR, return of spontaneous circulation (ROSC), documented use of capnography and colorimetry, capnography values, and adverse events were recorded. RESULTS: Two hundred ninety-two patients were identified and analyzed. Intubation occurred in 95% of cases and CPR in 30% of cases. Capnography was documented in only 38% of intubated patients and 13% of patients requiring CPR. There was an overall decrease in capnography use after publication of the 2010 AHA recommendations (P = 0.05). Capnography use was associated with a longer duration of CPR and return of spontaneous circulation. CONCLUSIONS: Despite the 2010 AHA recommendations, a minority of critically ill children are being monitored with capnography and an unexpected decrease in documented use occurred among our sample. Further education and implementation of capnography should take place to improve the use of this monitoring device for critically ill pediatric patients in the ED.

Limitation to Advanced Life Support in patients admitted to intensive care unit with integrated palliative care. / Limitação de Suporte Avançado de Vida em pacientes admitidos em unidade de terapia intensiva com cuidados paliativos integrados.

OBJECTIVE: To estimate the incidence of limitations to Advanced Life Support in critically ill patients admitted to an intensive care unit with integrated palliative care. METHODS: This retrospective cohort study included patients in the palliative care program of the intensive care unit of Hospital Paulistano over 18 years of age from May 1, 2011, to January 31, 2014. The limitations to Advanced Life Support that were analyzed included do-not-resuscitate orders, mechanical ventilation, dialysis and vasoactive drugs. Central tendency measures were calculated for quantitative variables. The chi-squared test was used to compare the characteristics of patients with or without limits to Advanced Life Support, and the Wilcoxon test was used to compare length of stay after Advanced Life Support. Confidence intervals reflecting p ≤ 0.05 were considered for statistical significance. RESULTS: A total of 3,487 patients were admitted to the intensive care unit, of whom 342 were included in the palliative care program. It was observed that after entering the palliative care program, it took a median of 2 (1 - 4) days for death to occur in the intensive care unit and 4 (2 - 11) days for hospital death to occur. Many of the limitations to Advanced Life Support (42.7%) took place on the first day of hospitalization. Cardiopulmonary resuscitation (96.8%) and ventilatory support (73.6%) were the most adopted limitations. CONCLUSION: The contribution of palliative care integrated into the intensive care unit was important for the practice of orthothanasia, i.e., the non-extension of the life of a critically ill patient by artificial means.

Limitação de Suporte Avançado de Vida em pacientes admitidos em unidade de terapia intensiva com cuidados paliativos integrados / Limitation to Advanced Life Support in patients admitted to intensive care unit with integrated palliative care

RESUMO Objetivo: Estimar a incidência de limitação de Suporte Avançado de Vida em pacientes graves internados em unidade de terapia intensiva com cuidados paliativos integrados. Métodos: Estudo de coorte retrospectivo, no qual foram incluídos os pacientes inseridos no programa de cuidados paliativos da unidade de terapia intensiva do Hospital Paulistano, maiores de 18 anos de idade, no período de 1º de maio de 2011 a 31 de janeiro de 2014. As limitações de Suporte Avançado de Vida analisadas foram: ordem para não ressuscitar, ventilação mecânica, hemodiálise e droga vasoativa. Para as variáveis quantitativas, foram calculadas medidas de tendência central. O teste qui quadrado foi utilizado para comparar características dos pacientes com ou sem limitação de Suporte Avançado de Vida e teste de Wilcoxon, para comparar o tempo de internação após Suporte Avançado de Vida. Para significância estatística, consideraram-se o intervalo de confiança e p ≤ 0,05. Resultados: Foram internados na unidade de terapia intensiva 3.487 pacientes, sendo 342 inseridos no programa de cuidados paliativos. Observou-se que, após entrada no programa de cuidados paliativos, demorou uma mediana de 2 (1 - 4) dias para o óbito na unidade de terapia intensiva e 4 (2 - 11) dias para óbito hospitalar. Boa parte das limitações de Suporte Avançado de Vida (42,7%) aconteceu no primeiro dia de internação. A ressuscitação cardiopulmonar (96,8%) e o suporte ventilatório (73,6%) foram as limitações mais adotadas. Conclusão: Foi relevante a contribuição dos cuidados paliativos integrados à unidade de terapia intensiva para a prática da ortotanásia, ou seja, o não prolongamento da vida de um paciente terminal por meios artificiais.

ABSTRACT Objective: To estimate the incidence of limitations to Advanced Life Support in critically ill patients admitted to an intensive care unit with integrated palliative care. Methods: This retrospective cohort study included patients in the palliative care program of the intensive care unit of Hospital Paulistano over 18 years of age from May 1, 2011, to January 31, 2014. The limitations to Advanced Life Support that were analyzed included do-not-resuscitate orders, mechanical ventilation, dialysis and vasoactive drugs. Central tendency measures were calculated for quantitative variables. The chi-squared test was used to compare the characteristics of patients with or without limits to Advanced Life Support, and the Wilcoxon test was used to compare length of stay after Advanced Life Support. Confidence intervals reflecting p ≤ 0.05 were considered for statistical significance. Results: A total of 3,487 patients were admitted to the intensive care unit, of whom 342 were included in the palliative care program. It was observed that after entering the palliative care program, it took a median of 2 (1 - 4) days for death to occur in the intensive care unit and 4 (2 - 11) days for hospital death to occur. Many of the limitations to Advanced Life Support (42.7%) took place on the first day of hospitalization. Cardiopulmonary resuscitation (96.8%) and ventilatory support (73.6%) were the most adopted limitations. Conclusion: The contribution of palliative care integrated into the intensive care unit was important for the practice of orthothanasia, i.e., the non-extension of the life of a critically ill patient by artificial means.

Assessing the efficacy of rescue equipment in lifeguard resuscitation efforts for drowning.

PURPOSE: The whole drowning process usually occurs within seconds to a few minutes. An early rescue may stop and/or prevent most medical complications. Fins, rescue tube, and rescue board (RB) are the equipment most frequently used by lifeguards. Our objective was to compare, in a water rescue quasiexperimental trial, these different pieces of rescue equipment to define the safest and with the lower rescue time as well as to assess their effects on the lifeguards' physiological state and cardiopulmonary resuscitation (CPR) performance. METHOD: A controlled trial was conducted to study the time effect of 4 different rescue techniques and assess CPR quality, along with the physiological effects of each rescue technique (blood lactate and subjective Borg's scale effort perception) on 35 lifeguards. RESULTS: Among the final sample subjects (n = 23), a total of 92 rescues were completed. Total water rescue time was longer without equipment (NE). The total rescue time was significantly lower using RB (P < .001). Similar good quality of CPR before and after water rescue was observed in all trials (P > .05), although correct ventilations represented less than 50% of total in all trials. Blood lactate increased after all rescues. The subjective effort Borg's scale showed significantly less effort using RB vs without equipment, fins, and fins and rescue tube. CONCLUSION: The use of propelling and/or floating equipment saves precious time with repercussions in the reduction of drowning mortality and morbidity. The RB offers a significant advantage. Lifeguards need more CPR training, especially considering the importance of efficient ventilations for drowning victims.

One-year follow-up of neurological status of patients after cardiac arrest seen at the emergency room of a teaching hospital.

OBJECTIVE: To describe neurological status and associated factors of survivors after cardiac arrest, upon discharge, and at 6 and 12 month follow-up. METHODS: A cohort, prospective, descriptive study conducted in an emergency room. Patients who suffered cardiac arrest and survived were included. A one-year consecutive sample, comprising 285 patients and survivors (n=16) followed up for one year after discharge. Neurological status was assessed by the Cerebral Performance Category before the cardiac arrest, upon discharge, and at 6 and 12 months after discharge. The following factors were investigated: comorbidities, presence of consciousness upon admission, previous cardiac arrest, witnessed cardiac arrest, location, cause and initial rhythm of cardiac arrest, number of cardiac arrests, interval between collapse and start of cardiopulmonary resuscitation, and between collapse and end of cardiopulmonary resuscitation, and duration of cardiopulmonary resuscitation. RESULTS: Of the patients treated, 4.5% (n=13) survived after 6 and 12 months follow-up. Upon discharge, 50% of patients remained with previous Cerebral Performance Category of the cardiac arrest and 50% had worsening of Cerebral Performance Category. After 6 months, 53.8% remained in the same Cerebral Performance Category and 46.2% improved as compared to discharge. After 12 months, all patients remained in the same Cerebral Performance Category of the previous 6 months. There was no statistically significant association between neurological outcome during follow-up and the variables assessed. CONCLUSION: There was neurological worsening at discharge but improvement or stabilization in the course of a year. There was no association between Cerebral Performance Category and the variables assessed.

One-year follow-up of neurological status of patients after cardiac arrest seen at the emergency room of a teaching hospital / Um ano de seguimento da condição neurológica de pacientes pós-parada cardiorrespiratória atendidos no pronto-socorro de um hospital universitário

ABSTRACT Objective: To describe neurological status and associated factors of survivors after cardiac arrest, upon discharge, and at 6 and 12 month follow-up. Methods: A cohort, prospective, descriptive study conducted in an emergency room. Patients who suffered cardiac arrest and survived were included. A one-year consecutive sample, comprising 285 patients and survivors (n=16) followed up for one year after discharge. Neurological status was assessed by the Cerebral Performance Category before the cardiac arrest, upon discharge, and at 6 and 12 months after discharge. The following factors were investigated: comorbidities, presence of consciousness upon admission, previous cardiac arrest, witnessed cardiac arrest, location, cause and initial rhythm of cardiac arrest, number of cardiac arrests, interval between collapse and start of cardiopulmonary resuscitation, and between collapse and end of cardiopulmonary resuscitation, and duration of cardiopulmonary resuscitation. Results: Of the patients treated, 4.5% (n=13) survived after 6 and 12 months follow-up. Upon discharge, 50% of patients remained with previous Cerebral Performance Category of the cardiac arrest and 50% had worsening of Cerebral Performance Category. After 6 months, 53.8% remained in the same Cerebral Performance Category and 46.2% improved as compared to discharge. After 12 months, all patients remained in the same Cerebral Performance Category of the previous 6 months. There was no statistically significant association between neurological outcome during follow-up and the variables assessed. Conclusion: There was neurological worsening at discharge but improvement or stabilization in the course of a year. There was no association between Cerebral Performance Category and the variables assessed. .

RESUMO Objetivo: Identificar a condição neurológica e os fatores associados de sobreviventes pós-parada cardiorrespiratória na alta hospitalar, após 6 e 12 meses de seguimento. Métodos: Estudo de coorte, prospectivo e descritivo, realizado em um pronto-socorro. Foram incluídos pacientes em parada cardiorrespiratória que sobreviveram à alta. A amostra foi consecutiva por um ano, sendo composta por 285 pacientes, e os sobreviventes (n=16) foram acompanhados por um ano após alta. O estado neurológico foi avaliado pela Categoria de Performance Cerebral antes da parada, na alta, 6 e 12 meses após alta. Foram investigados os seguintes fatores: comorbidades, presença de consciência na admissão, parada cardiorrespiratória prévia, parada cardiorrespiratória testemunhada, local, causa e ritmo inicial da parada, número de paradas, intervalo entre colapso e início da ressuscitação cardiopulmonar, e entre colapso e término da ressuscitação, e duração da ressuscitação. Resultados: Dos pacientes atendidos, 4,5% (n=13) sobreviveram após 6 e 12 meses de seguimento. Na alta, 50% dos pacientes permaneceram com Categoria de Performance Cerebral prévia à parada, e 50% tiveram piora da mesma. Após 6 meses, 53,8% permaneceram com mesma Categoria de Performance Cerebral, e 46,2% tiveram melhora em relação à alta. Após 12 meses, a totalidade dos pacientes permaneceu com mesma Categoria de Performance Cerebral em relação aos 6 meses anteriores. Não houve associação estatisticamente significativa entre evolução neurológica durante o seguimento e variáveis de interesse. Conclusão: Observou-se piora neurológica na alta, mas houve melhora ou estabilização no decorrer de 1 ano. Não foi encontrada associação entre Categoria de Performance Cerebral e variáveis de interesse. .