Survival and neurological status after out-of-hospital cardiac arrest in the pediatric population in Andalusia.

OBJECTIVE: Little is known about the evolution and long-term neurological status of pediatric patients who survive out-of-hospital cardiac arrest. Our aim is to describe long-term survival and neurological status. DESIGN: Retrospective observational study, based on the Andalusian Register of out-of-hospital Cardiac Arrest. SETTING: Pre-hospital Care. PATIENTS: The study included patients aged 0-15 years between January 2008 and December 2012. INTERVENTIONS: Patients follow up. VARIABLES: Prehospital and hospital care variables were analyzed and one-year follow-up was performed, along with a specific follow-up of survivors in June 2014. RESULTS: Of 5069 patients included in the register, 125 (2.5%) were aged ≤15 years. Cardiac arrest was witnessed in 52.8% of cases and resuscitation was performed in 65.6%. The initial rhythm was shockable in 7 (5.2%) cases. Nearly half (48.8%) the patients reached the hospital alive, of whom 20% did so while receiving resuscitation maneuvers. Only 9 (7.2%) patients survived to hospital discharge; 5 showed ad integrum recovery and 4 showed significant neurological impairment. The 5 patients with complete recovery continued their long-term situation. The remaining 4 patients, although slight improvement, were maintained in situation of neurological disability. CONCLUSIONS: Survival after out-of-hospital cardiac arrest in pediatric patients was low. The long-term prognosis of survivors with good neurological recovery remains, although improvement in the rest was minimal.

[Results of an artificial airway management protocol in critical patients subjected to mechanical ventilation]. / Resultados de un protocolo de manejo sobre la vía aérea artificial en pacientes críticos sometidos a ventilación mecánica.

OBJECTIVE: To determine the results of the implementation of a protocol in an intensive care unit (ICU) referred to critically ill patients requiring a prolonged artificial airway. DESIGN: A prospective, observational cohort study was carried out. INTERVENTION: Management strategies were established on the airway by endotracheal intubation (ETI) or tracheostomy, and guidelines were developed for action in the decannulation process. SETTING: A polyvalent ICU. PATIENTS: We studied 169 patients subjected to mechanical ventilation (MV), 67 with ETI ≥ 10 days of MV and 102 with percutaneous (PT) or surgical tracheostomy (TQ). VARIABLES OF INTEREST: ICU and hospital stays, days of ETI and MV, mortality, tracheostomy, anatomical risk factors, surgical complications, and postoperative decannulation period. RESULTS: ETI versus tracheotomy involved fewer days of MV (17 vs. 30 days, p<0.001), a shorter ICU stay (20 vs. 35 days, p<0.001), and a shorter hospital stay (34 vs. 51 days, p<0.001).There were more TQ procedures in patients with risk factors (47% TP vs. 89% TQ, p<0.001). Intraoperative minor bleeding was the most common complication, being associated with TQ (31% vs. 11%, p = 0.03). TP was associated with a shorter cannulationperiod (25 days vs. 34 days, p<0.04). CONCLUSIONS: The protocol variants showed no differences in terms of complications and mortality, when orienting application to patients with similar characteristics.

Ritmo circadiano y variaciones temporales en el paro cardiaco súbito extrahospitalario / Circadian rhythm and time variations in out-hospital sudden cardiac arrest

Objetivos: Analizar las características cronobiológicas y las variaciones temporales del paro cardiaco extrahospitalario (PCEH). Diseño: Estudio descriptivo retrospectivo. Pacientes: Todos los casos de PCEH de origen cardíaco registrados en la base de datos del servicio de emergencias médicas (SEM) de la Comunidad Autónoma de Castilla y León (España) durante 18 meses. Variables de interés principales: Edad, sexo, recuperación de la circulación espontánea, primer ritmo monitorizado (desfibrilable /no desfibrilable), lugar de alerta [(hogar, lugar público, centro atención primaria (AP)], testigo (familiar, transeúnte, fuerzas de seguridad, personal AP), hora de alerta (0-8; 8-16; 16-24), hora de activación del equipo de emergencias, hora de atención y día de la semana. Análisis univariante mediante Chi2, varianza y tests no paramétricos. Análisis cronobiológico mediante transformada rápida de Fourier y test Cosinor. Resultados: Se estudiaron 1.286 casos registrados entre enero 2007 y junio 2008. Se observaron diferencias estadísticas significativas en menor edad (p<0,05), mayor incidencia en el hogar (p<0,001) y mayor frecuencia de familiares-convivientes como testigos (p<0,001) en el periodo de 0-8h. El análisis cronobiológico mostró ritmo diario (circadiano) con acrofase a las 11:16h (p<0,001) y ritmo semanal (circaseptano) con acrofase en miércoles (p<0,05). Las medianas de intervalos alerta-atención y activación-atención fueron respectivamente 11,7min y 8,0min, sin diferencias entre periodos horarios. Conclusiones: Se demuestra la presencia de un ritmo diario de aparición del PCEH con pico matinal y un ritmo semanal con pico en miércoles. Estos resultados orientan al ajuste preventivo y a la planificación de recursos y mejoras en la respuesta, en determinados periodos horarios (AU)

Objectives: To analyze the chronobiological and time variations of out- hospital cardiac arrest (OHCA). Design: A retrospective descriptive study was made. Patients: All cases of OHCA of cardiac origin registered over 18 months in the database of the emergency medical service (EMS) of the Autonomous Community of Castilla y León (Spain) were evaluated. Variables analyzed: Age, sex, recovery of spontaneous circulation (ROSC), first monitored rhythm (amenable / not amenable to defibrillation), alert site [(home, public place, primary care (PC) center], alerting person (family, witness, law enforcement member, PC center staff), alert time (0-8; 8-16; 16-24), emergency team activation time, care time and day of the week. Univariate analysis (chi-squared), variance, and nonparametric tests comparing the variables in three periods of 8hours. Chronobiological analysis by fast Fourier transform and Cosinor testing. Results: We studied 1286 cases reported between January 2007 and June 2008. Statistically significant differences were observed in terms of younger age, higher incidence in the victim's home, and greater frequency of family-cohabiting persons as witnesses in the period between 0 and 8hours. Chronobiological analysis found daily rhythm (circadian) with acrophase at 11.16h (p<0.001) and weekly rhythm (circaseptan) with acrophase on Wednesday (p<0.05). The median alert time-care time interval and emergency team activation time-care time were 11.7min and 8.0min, respectively, without differences between periods. Conclusions: We have demonstrated the presence of a daily rhythm of emergence of OHCA with a morning peak and a weekly rhythm with a peak on Wednesdays. These results can guide the planning of resources and improvements in response in certain time periods (AU)

Características generales de la parada cardiaca extrahospitalaria registrada por un servicio de emergencias médicas / General characteristics out of hospital cardiac arrest of cardiac origin recorded by an emergency medical service

Objetivo: Analizar las características generales de la parada cardiaca extrahospitalaria(PCEH) en una comunidad autónoma y los factores asociados a la recuperación de la circulación espontánea (RCE).Método: Estudio descriptivo retrospectivo de las PCEH de origen cardiaco incluidas en la base de datos del servicio de emergencias (SEM) de Castilla y León en un periodo de18 meses. El objetivo primario fue la RCE. Las variables analizadas fueron la edad, sexo, ritmo desfibrilable (DF), lugar del paro, testigo, intervalo alerta-atención inicial e intervalo despacho SEM-atención inicial. Resultados: Se estudiaron 1.286 PCEH, que representan 0,34 casos/1.000 habitantes/año. La mediana de edad fue de 73,0 años (rango intercuartílico 21,0), y el66,5% fueron hombres. Se consiguió RCE en el 22,2%. Las características de la PCEH fueron: ritmo DF 15,3%; en el hogar 72,2%, en un lugar público 21,3%, en un centro atención primaria (AP) 6,5%; presenciada por un familiar 49,1%, por un transeúnte 31,6%, por fuerzas seguridad 2,6% y por personal AP 15,7%. Fueron variables independientes asociadas a la RCE: edad inferior a 50 años [OR 1,6 (IC 95%: 1,03; 2,4)],ritmo DF [OR 3,8 (IC 95%: 2,7; 5,3)], lugar del paro en centro AP [OR 2,7 (IC 95%:1,4; 4,9)] y en lugar público [OR 1,8 (IC 95%: 1,2; 2,7)].Conclusiones: La incidencia de PCEH fue similar a otras series europeas. Destaca el bajo porcentaje de ritmos DF. Se confirma el hogar como lugar de más frecuente presentación, y una menor edad, la presencia de ritmos DF y la presentación en lugares públicos o centros sanitarios, como factores independientes asociados a RCE (AU)

Objective: To analyze the general characteristics out of hospital cardiac arrest (OHCA) including the frecuency of return of spontaneous circulation and related factors. Methods: Retrospective descriptive analysis of cases of OHCA in the records of the emergency medical service of Castile-Leon covering a period of 18 months. The main independent outcome analyzed was return of spontaneous circulation. Independent variables analyzed were age, sex, presence of shockable rhythm, location of cardiac arrest, witness, time between emergency call and initiation of care, and time between ambulance dispatch and initiation of care. Results: The EMS attended a total of 1286 cases of OHCA, representing an annual incidence of 0.34 cases per 1000 population. The median age (interquartile range) was 73.0 (21.0) years; 66.5% of the patients were men, spontaneous circulation returned in 22.2%, and a shockable rhythm was present in 15.3%. Cardiac arrest occurred in the home in72.2% of the cases, in a public place in 21.3%, and at a primary health care clinic in 6.5%. Witnesses were a familymember (49.1%), a passer-by (31.6%), a member of a security force (2.6%), and a primary care staff member (15.7%).Independent variables related to return of spontaneous circulation were age under 50 years (odds ratio [OR], 1.6; 95% confidence interval [CI], 1.03-2.4), presence of a shockable rhythm (OR, 3.8; 95% CI, 2.7-5.3); cardiac arrest at a primary health care clinic (OR, 2.7; 95% CI, 1.4-4.9) or in a public place (OR, 1.8; 95% CI, 1.2-2.7).Conclusions: The incidence of OHCA was similar to that reported for other European series. The low percentage of shockable rhythm was noteworthy. The home was confirmed as the most common setting for cardiac arrest; lower age, presence of shockable rhythm, occurrence of cardiac arrest in a public place or at a primary care clinic were confirmed as variables independently associated with return of spontaneous circulation (AU)

[Circadian rhythm and time variations in out-hospital sudden cardiac arrest]. / Ritmo circadiano y variaciones temporales en el paro cardiaco súbito extrahospitalario.

OBJECTIVES: To analyze the chronobiological and time variations of out- hospital cardiac arrest (OHCA). DESIGN: A retrospective descriptive study was made. PATIENTS: All cases of OHCA of cardiac origin registered over 18 months in the database of the emergency medical service (EMS) of the Autonomous Community of Castilla y León (Spain) were evaluated. VARIABLES ANALYZED: Age, sex, recovery of spontaneous circulation (ROSC), first monitored rhythm (amenable / not amenable to defibrillation), alert site [(home, public place, primary care (PC) center], alerting person (family, witness, law enforcement member, PC center staff), alert time (0-8; 8-16; 16-24), emergency team activation time, care time and day of the week. Univariate analysis (chi-squared), variance, and nonparametric tests comparing the variables in three periods of 8 hours. Chronobiological analysis by fast Fourier transform and Cosinor testing. RESULTS: We studied 1286 cases reported between January 2007 and June 2008. Statistically significant differences were observed in terms of younger age, higher incidence in the victim's home, and greater frequency of family-cohabiting persons as witnesses in the period between 0 and 8 hours. Chronobiological analysis found daily rhythm (circadian) with acrophase at 11.16 h (p<0.001) and weekly rhythm (circaseptan) with acrophase on Wednesday (p<0.05). The median alert time-care time interval and emergency team activation time-care time were 11.7 min and 8.0 min, respectively, without differences between periods. CONCLUSIONS: We have demonstrated the presence of a daily rhythm of emergence of OHCA with a morning peak and a weekly rhythm with a peak on Wednesdays. These results can guide the planning of resources and improvements in response in certain time periods.

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

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

[Novelties in advanced life support]. / Novedades en soporte vital avanzado.

We present some of the most important developments in advanced life support incorporating the new international recommendations for resuscitation 2010. The study highlights aspects related to prevention and early detection of in-hospital cardiac arrest, resuscitation in the hospital, the new advanced life support algorithm, the techniques and devices for cardiopulmonary resuscitation, post-resuscitation care, assessment of the prognosis of patients who survive initially, and specific aspects of non-beating heart organ donation and the creation of cardiac arrest referral centers.

[ILCOR 2010 recommendations. The evidence evaluation process in resuscitation]. / Recomendaciones ILCOR 2010. El proceso de evaluación de la evidencia en resucitación.

The consensus document on the Science of Resuscitation and Emergency Cardiac Care with ILCOR Treatment Recommendations is an invaluable tool for quickly, simply and rigorously establishing the evidence on which the Resuscitation Guidelines 2010 are fundamented. We present a method that has been used in the review process according to evidence-based medicine, which can be considered a role model for both individual and collective use in clinical practice, not only in the field of resuscitation but also in other areas of medicine.

[News in basic life support and semi-automated external defibrillation]. / Novedades en soporte vital básico y desfibrilación externa semiautomática.

During resuscitation, basic life support (BLS) and automated external defibrillation refer to maneuvers designed to maintain airway patency and support breathing and circulation without equipment other than a barrier device and the use of an automated external defibrillator (AED). We present some of the most important developments incorporated to the new international recommendations for resuscitation 2010. Aspects related to prevention and early detection of cardiac arrest are highlighted, along with the important role of dispatchers of emergency medical services, the importance of high quality CPR and programs of public access defibrillation. We likewise describe sequences of action and basic life support algorithms, and semi-automated external defibrillation.

Paro cardíaco hospitalario. Señales de cambio / In-hospital cardiac arrest. Signs of change

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