Plan de desfibrilación externa semiautomática en Galicia. Resultados finales de su implantación / Semiautomatic external defibrillation plan for Galicia: results of implementation

Objetivo: Conocer los resultados del plan de implantación de un programa de desfibriladores semiautomáticos (DESA) en Galicia y valorar su eficacia. Método: Se estudian las paradas cardiorrespiratorias (PCR) atendidas por las ambulancias de la red de transporte sanitario urgente (RTSU) con DESA durante los años 2001,2002 y 2003, la recuperación de constantes en el punto de la atención inicial por los sistémicas médicos de emergencias (SEM), los factores que influyen en la supervivencia y la eficacia del DESA. Se analizó la hoja de registro DESA de los técnicos en transporte sanitario (TTS) de las ambulancias de la RTSU y la hoja DESA informatizada de la Central de Coordinación de Urgencias Sanitarias-061 (CCUS-061).Resultados: 958 PCR atendidas con DESA (26,6 PCR/mes). El 25,1% se encontraban en un ritmo desfibrilable. Se recuperaron el 11,3% del total. El 50,4% de las PCR fueron presenciadas y se inició resucitación cardiopulmonar (RCP) por testigo en el 18,9%.Los intervalos temporales desde la PCR hasta la recepción de la llamada, primer intento de RCP, retorno de circulación y primera desfibrilación en general han tendido a disminuir con los años, aunque el descenso sólo resultó significativo para el intervalo desde la PCR hasta la recepción de la llamada en la CCUS-061.Conclusiones: El programa de implantación del DESA, desarrollado y puesto en marcha por la Fundación Pública Urxencias Sanitarias de Galicia (FPUS-061), ha demostrado estar adaptado a las necesidades de nuestra comunidad. Aunque se ha observado una mejoría en los últimos años, aún deben acortarse más los tiempos de alerta, respuesta y desfibrilación, así como aumentar la tasa de RCP por testigos. (AU)

Objective: To evaluate the effectiveness of a plan for implementing the use of semiautomatic external defibrillators in Galicia. Methods: Cardiorespiratory arrests treated by ambulance attendants with semiautomatic external defibrillators in 2001,2002 and 2003 were studied. Recovery of vital constants at the point of initial emergency service care was noted, and factors affecting survival and the efficacy of defibrillation were analyzed. Data were extracted from the ambulance attendants’ defibrillation records and the computer records of the ambulance service dispatch center. Results: Nine hundred fifty-eight cardio respiratory arrests were treated with semiautomatic external defibrillators (26.61arrests/month). Ambulance attendants found a shock able rhythm in 25.15%; ventricular fibrillation was restored in11.27%. Arrests were witnessed in 50.41% of the cases, and cardiopulmonary resuscitation (CPR) was initiated by a bystander in 18.95%. Times between the arrest and reception of a call to the emergency service, first attempt at resuscitation, restoration of circulation, and first shock decreased from year to year. Conclusions: To improve the results of cardiopulmonary resuscitation in Galicia, it is necessary to shorten the time between the arrest and the call to the emergency service, the ambulance response time, and time until the first shock. The frequency of bystander CPR is low, but has tended to rise in recent years. Basic CPR training in the general population should be improved. The plan for use of semiautomatic external defibrillators that was developed and put into practice by the ambulance service has been shown to meet the needs of our community. To improve outcomes in emergency cases, ambulance response times should be shortened (AU)

Cost-efficiency assessment of Advanced Life Support (ALS) courses based on the comparison of advanced simulators with conventional manikins.

BACKGROUND: Simulation is an essential tool in modern medical education. The object of this study was to assess, in cost-effective measures, the introduction of new generation simulators in an adult life support (ALS) education program. METHODS: Two hundred fifty primary care physicians and nurses were admitted to ten ALS courses (25 students per course). Students were distributed at random in two groups (125 each). Group A candidates were trained and tested with standard ALS manikins and Group B ones with new generation emergency and life support integrated simulator systems. RESULTS: In group A, 98 (78%) candidates passed the course, compared with 110 (88%) in group B (p < 0.01). The total cost of conventional courses was euro 7689 per course and the cost of the advanced simulator courses was euro 29034 per course (p < 0.001). Cost per passed student was euro 392 in group A and euro 1320 in group B (p < 0.001). CONCLUSION: Although ALS advanced simulator systems may slightly increase the rate of students who pass the course, the cost-effectiveness of ALS courses with standard manikins is clearly superior.

Paediatric out-of-hospital resuscitation in an area with scattered population (Galicia-Spain).

BACKGROUND: Cardiorespiratory arrest (CRA) is a rare event in childhood. Our objective was to determine the characteristics of paediatric CRA and the immediate results of cardiopulmonary resuscitation (CPR) in Galicia, a community with a very scattered population. METHODS: All children (aged from newborn to 16 years old) who suffered an out-of-hospital CRA in Galicia and were assisted by the Public Foundation Medical Emergencies of Galicia-061 staff, from June 2002 to February 2005, were included in the study. Data were prospectively recorded following the Utstein's style guidelines. RESULTS: Thirty-one cases were analyzed (3.4 CRA annual cases per 100,000 paediatric population). The arrest was respiratory in 16.1% and cardiac in 83.9% of cases. CRA occurred at home in 58.1% of instances. Time CRA to initiation of CPR was shorter than 10 minutes in 32.2% and longer than 20 minutes in 29.0% of cases. 22.6% of children received bystander CPR. The first recorded rhythm was asystole in 67.7% of cases. Bag-mask ventilation was used in 67.7% and in 83.8% oro-tracheal intubation was done. A peripheral venous access was achieved in 67.7% and intraosseous access was used in 16.1% of patients. 93.5% of children were treated with adrenaline. After initial CPR, sustained restoration of spontaneous circulation was achieved in 38.7% of cases. Six children (19.4%) survived until hospital discharge. Four of 5 children with respiratory arrest survived, whereas only 2 of 26 children with cardiac arrest survived until hospital discharge. CONCLUSION: Despite the handicap of a highly disseminated population, paediatric CRA characteristics and CPR results in Galicia are comparable to references from other communities. Programs to increase bystander CPR, equip laypeople with basic CPR skills and to update life support knowledge of health staff are needed to improve outcomes.