Variabilidad regional en incidencia, características generales y resultados finales de la parada cardiaca extrahospitalaria en España: Registro OHSCAR / Regional variation in the incidence, general characteristics, and outcomes of prehospital cardiac arrest in Spain: the Out-of-Hospital Spanish Cardiac Arrest Registry

OBJETIVOS: Existe gran variabilidad internacional en la incidencia y los resultados en la atención a la parada cardiaca extrahospitalaria (PCRE). El objetivo es conocer si existe variabilidad en la incidencia, características y resultados en supervivencia en la atención a la PCRE por los servicios extrahospitalarios de emergencias (SEM) de España. MÉTODO: Análisis descriptivo, retrospectivo de los datos del registro OHSCAR correspondientes al periodo octubre2013-octubre 2014, que incluye pacientes atendidos por 19 SEM de España con intento de reanimación. Se recogieron los casos atendidos y variables clave sobre la asistencia a una PCRE: incidencia, características del paciente, del evento, de la actuación previa a los equipos de emergencias (EE), de la reanimación realizada, y de los principales tratamientos hospitalarios. Se comparó la situación neurológica al alta hospitalaria de los casos con ingreso hospitalario. RESULTADOS: La incidencia de casos con intento de reanimación y todas las características generales, salvo la distribución por sexo, presentaron diferencias estadísticamente significativas entre los SEM participantes (p < 0,001). Hubo diferencias significativas en los tratamientos hospitalarios recibidos y en los resultados finales, tanto en la proporción de pacientes que llegaron con pulso espontáneo al hospital, 30,5%, rango entre 21,3% y 56,1% (p < 0,001), como en el porcentaje de altas hospitalaria con categoría 1 o 2 de la clasificación Cerebral Perfomance Categories (CPC), sobre el total de ingresados, 31,8%, rango entre 17,2% y 58,3% (p < 0,001). CONCLUSIONES: Existe una importante variabilidad entre los SEM españoles en la incidencia de casos con intento de reanimación, en todas las variables clave y en la supervivencia al alta hospitalaria de la atención a la PCRE

BACKGROUND AND OBJECTIVE: The incidence and outcomes of care for out-of-hospital cardiac arrest (OHCA) vary greatly from country to country. We aimed to study variation in the incidence, characteristics, and outcomes of care for OHCAs given by Spanish prehospital emergency services. METHODS: Descriptive retrospective analysis of data from the Out-of-Hospital Spanish Cardiac Arrest Registry (OHSCAR) from October 2013 to October 2014. Attempts by 19 Spanish emergency services to resuscitate patients were studied. All OHCA cases were reviewed to obtain the following data: incidence, patient and event characteristics, prior emergencies, resuscitation attempts, and the main treatments provided in the hospital. If a patient was admitted, we compared the neurologic status on hospital discharge. RESULTS: Statistically significant differences were detected between emergency services (P< .0001) in the incidence of attempted resuscitation and all general characteristics except sex. Hospital treatments and outcomes also differed significantly: pulse had been restored on arrival of 30.5% of patients (range 21.3% to 56.1%, P< .001), and 31.8% of admitted patients were discharged in cerebral performance categories 1 or 2 (range 17.2% to58.3%,P< .001). CONCLUSION: Differences in the incidence of resuscitation attempts, key variables, and survival at discharge from the hospital are present in OHCA cases attended by prehospital emergency services in different regions of Spain

Regional variation in the incidence, general characteristics, and outcomes of prehospital cardiac arrest in Spain: the Out-of-Hospital Spanish Cardiac Arrest Registry. / Variabilidad regional en incidencia, características generales y resultados finales de la parada cardiaca extrahospitalaria en España: Registro OHSCAR.

OBJECTIVES: The incidence and outcomes of care for out-of-hospital cardiac arrest (OHCA) vary greatly from country to country. We aimed to study variation in the incidence, characteristics, and outcomes of care for OHCAs given by Spanish prehospital emergency services. MATERIAL AND METHODS: Descriptive retrospective analysis of data from the Out-of-Hospital Spanish Cardiac Arrest Registry (OHSCAR) from October 2013 to October 2014. Attempts by 19 Spanish emergency services to resuscitate patients were studied. All OHCA cases were reviewed to obtain the following data: incidence, patient and event characteristics, prior emergencies, resuscitation attempts, and the main treatments provided in the hospital. If a patient was admitted, we compared the neurologic status on hospital discharge. RESULTS: Statistically significant differences were detected between emergency services (P .0001) in the incidence of attempted resuscitation and all general characteristics except sex. Hospital treatments and outcomes also differed significantly: pulse had been restored on arrival of 30.5% of patients (range 21.3% to 56.1%, P .001), and 31.8% of admitted patients were discharged in cerebral performance categories 1 or 2 (range 17.2% to 58.3%, P .001). CONCLUSION: Differences in the incidence of resuscitation attempts, key variables, and survival at discharge from the hospital are present in OHCA cases attended by prehospital emergency services in different regions of Spain.

OBJETIVO: Existe gran variabilidad internacional en la incidencia y los resultados en la atención a la parada cardiaca extrahospitalaria (PCRE). El objetivo es conocer si existe variabilidad en la incidencia, características y resultados en supervivencia en la atención a la PCRE por los servicios extrahospitalarios de emergencias (SEM) de España. METODO: Análisis descriptivo, retrospectivo de los datos del registro OHSCAR correspondientes al periodo octubre 2013-octubre 2014, que incluye pacientes atendidos por 19 SEM de España con intento de reanimación. Se recogieron los casos atendidos y variables clave sobre la asistencia a una PCRE: incidencia, características del paciente, del evento, de la actuación previa a los equipos de emergencias (EE), de la reanimación realizada, y de los principales tratamientos hospitalarios. Se comparó la situación neurológica al alta hospitalaria de los casos con ingreso hospitalario. RESULTADOS: La incidencia de casos con intento de reanimación y todas las características generales, salvo la distribución por sexo, presentaron diferencias estadísticamente significativas entre los SEM participantes (p 0,001). Hubo diferencias significativas en los tratamientos hospitalarios recibidos y en los resultados finales, tanto en la proporción de pacientes que llegaron con pulso espontáneo al hospital, 30,5%, rango entre 21,3% y 56,1% (p 0,001), como en el porcentaje de altas hospitalaria con categoría 1 o 2 de la clasificación Cerebral Perfomance Categories (CPC), sobre el total de ingresados, 31,8%, rango entre 17,2% y 58,3% (p 0,001). CONCLUSIONES: Existe una importante variabilidad entre los SEM españoles en la incidencia de casos con intento de reanimación, en todas las variables clave y en la supervivencia al alta hospitalaria de la atención a la PCRE.

Cardiogenic shock in acute coronary syndrome.

This is a review of current knowledge on cardiogenic shock (CS), with particular attention to recommended management. The bibliography for the study was compiled through a search of different databases between 1966-2008. The references cited in the selected articles were also reviewed. The selection criteria included all reports published on CS, from case reports and case series to controlled studies. Languages used were Spanish, French, Italian, Portuguese, German, and English. Cardiogenic shock is the most frequent cause of in-hospital death as a complication of acute coronary syndrome. The incidence is about 7% and, despite therapeutic advances, it continues to have an ominous prognosis, with mortality rates of over 50%. Coronary reperfusion is fundamental in the management of cardiogenic shock, particularly with the use of percutaneous coronary intervention. However, if this is not available, systemic thrombolysis may be performed together with balloon counterpulsation or the use of pressor drugs. Despite the historical importance of the Swan-Ganz catheter, this would appear to have limited use, with echocardiography nonetheless having a fundamental role in the management of CS. Although patients with cardiogenic shock often present a left ventricular ejection fraction of around 30%, survivors often have a good functional classification one year after the event. Neurohormonal and inflammatory mechanisms play a fundamental role in the pathophysiology of CS. These mechanisms are currently the target of studies looking into developing new therapeutic strategies.