Respuesta de los autores: El papel clave de los equipos de emergencias extrahospitalarias en los programas de donación en asistolia no controlada en Andalucía / Authors' reply: Key role for out-of-hospital emergency teams in non-heart-beating donor programs in Andalusia

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Supervivencia y factores asociados a la práctica de reanimación cardiopulmonar en curso entre los pacientes con parada cardiaca extrahospitalaria / Ambulance cardiopulmonary resuscitation: outcomes and associated factors in out-of-hospital cardiac arrest

OBJETIVO: Conocer la supervivencia y los factores asociados a la realización de reanimación cardiopulmonar (RCP) en curso entre los pacientes con parada cardiaca extrahospitalaria (PCR). MÉTODO: Análisis retrospectivo de un registro de casos de PCR entre 2008 y 2014. Se incluyeron los pacientes con PCR sin recuperación espontánea de pulso en el momento de la toma de decisión del traslado hospitalario y que fueron desestimados para donación en asistolia. Se realizó un análisis multivariante para determinar las variables que se asociaron al uso de una estrategia de reanimación en curso y se determinó la supervivencia y el resultado neurológico en dicho grupo de casos. RESULTADOS: Se incluyeron 7.241 pacientes, de los cuales 259 (3,6%) fueron trasladados al hospital con RCP en curso. La edad media fue 51,6 (DE 23,6) años, de los cuales 27 (10,1%) casos tenían 16 años. Las variables que se asociaron con el uso de RCP en curso fueron: edad 16 años [OR 6,48 (IC95% 3,91-10,76); p < 0,001)], PCR presenciada [OR 1,62 (IC95% 1,16-2,26); p = 0,004], PCR ocurrida fuera del domicilio [OR 3,17 (IC95% 2,38-4,21); p < 0,001)]; etiología no cardiaca [OR 1,47 (IC95%1,07-2,02); p = 0,019], ritmo inicial desfibrilable [OR 1,67 (IC95% 1,17-2,37); p = 0,004], no existencia de soporte vital previo (SVp) [OR 3,48 (IC95% 2,58-4,70); p < 0,001] y realización de intubación orotraqueal (IOT) [OR 1,93 (IC95% 1,24-2,99); p = 0,003]. Un paciente (0,38%) sobrevivió al alta con buen estado neurológico. CONCLUSIONES: La RCP en curso en servicios de emergencias con médico a bordo es una estrategia poco frecuente en casos de PCR. La juventud del paciente, que la PCR suceda fuera del domicilio, sea presenciada, no exista soporte vital previo, tenga un ritmo inicial desfibrilable, una etiología no cardiaca y que se consiga IOT se asocian con esta estrategia cuyo resultado final puede considerarse fútil

OBJECTIVE: To assess factors associated with survival of out-of-hospital cardiac arrest (OHCA) in patients who underwent cardiopulmonary resuscitation (CPR) during ambulance transport. METHODS: Retrospective analysis of a registry of OHCA cases treated between 2008 and 2014. We included patients who had not recovered circulation at the time it was decided to transport to a hospital and who were rejected as non-heart-beating donors. Multivariate analysis was used to explore factors associated with the use of ambulance CPR, survival, and neurologic outcome. RESULTS: Out of a total of 7241 cases, 259 (3.6%) were given CPR during emergency transport. The mean (SD) age was 51.6 (23.6) years; 27 (10.1%) were aged 16 years or younger. The following variables were associated with the use of CPR during transport: age 16 years or under (odds ratio [OR], 6.48; 95% CI, 3.91-10.76); P

La valoración de la calidad de la resucitación cardiopulmonar con soporte telefónico realizada por testigos como elemento de evaluación del desempeño de un servicio de emergencias médicas / Quality assessment of bystander cardiopulmonary resuscitation during telephone assistance, a potential quality indicator of emergency medical service performance

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Ambulance cardiopulmonary resuscitation: outcomes and associated factors in out-of-hospital cardiac arrest. / Supervivencia y factores asociados a la práctica de reanimación cardiopulmonar en curso entre los pacientes con parada cardiaca extrahospitalaria.

OBJECTIVES: To assess factors associated with survival of out-of-hospital cardiac arrest (OHCA) in patients who underwent cardiopulmonary resuscitation (CPR) during ambulance transport. MATERIAL AND METHODS: Retrospective analysis of a registry of OHCA cases treated between 2008 and 2014. We included patients who had not recovered circulation at the time it was decided to transport to a hospital and who were rejected as non-heart-beating donors. Multivariate analysis was used to explore factors associated with the use of ambulance CPR, survival, and neurologic outcome. RESULTS: Out of a total of 7241 cases, 259 (3.6%) were given CPR during emergency transport. The mean (SD) age was 51.6 (23.6) years; 27 (10.1%) were aged 16 years or younger. The following variables were associated with the use of CPR during transport: age 16 years or under (odds ratio [OR], 6.48; 95% CI, 3.91-10.76); P<.001)], witnessed OHCA (OR, 1.62; 95% CI, 1.16-2.26; P=.004), cardiac arrest outside the home (OR, 3.17; 95% CI, 2.38-4.21; P<.001), noncardiac cause (OR, 1.47; 95% CI, 1.07-2.02; P=.019], initially shockable rhythm (OR, 1.67; 95% CI, 1.17-2.37; P=.004), no prior basic life support (OR, 3.48; 95% CI, 2.58-4.70; P<.001), and orotracheal intubation (OR, 1.93; 95% CI, 1.24-2.99; P=.003). One patient (0.38%) survived to discharge with good neurologic outcome. CONCLUSION: Ambulance CPR by a physician on board is applied in few OHCA cases. Young patient age, cardiac arrest outside the home, the presence of a witness, lack of a shockable rhythm on responder arrival, lack of basic life support prior to responder arrival, noncardiac cause, and orotracheal intubation are associated with the use of ambulance CPR, a strategy that can be considered futile.

OBJETIVO: Conocer la supervivencia y los factores asociados a la realización de reanimación cardiopulmonar (RCP) en curso entre los pacientes con parada cardiaca extrahospitalaria (PCR). METODO: Análisis retrospectivo de un registro de casos de PCR entre 2008 y 2014. Se incluyeron los pacientes con PCR sin recuperación espontánea de pulso en el momento de la toma de decisión del traslado hospitalario y que fueron desestimados para donación en asistolia. Se realizó un análisis multivariante para determinar las variables que se asociaron al uso de una estrategia de reanimación en curso y se determinó la supervivencia y el resultado neurológico en dicho grupo de casos. RESULTADOS: Se incluyeron 7.241 pacientes, de los cuales 259 (3,6%) fueron trasladados al hospital con RCP en curso. La edad media fue 51,6 (DE 23,6) años, de los cuales 27 (10,1%) casos tenían <= 16 años. Las variables que se asociaron con el uso de RCP en curso fueron: edad <= 16 años [OR 6,48 (IC95% 3,91-10,76); p < 0,001)], PCR presenciada [OR 1,62 (IC95% 1,16-2,26); p = 0,004], PCR ocurrida fuera del domicilio [OR 3,17 (IC95% 2,38-4,21); p < 0,001)]; etiología no cardiaca [OR 1,47 (IC95%1,07-2,02); p = 0,019], ritmo inicial desfibrilable [OR 1,67 (IC95% 1,17-2,37); p = 0,004], no existencia de soporte vital previo (SVp) [OR 3,48 (IC95% 2,58-4,70); p < 0,001] y realización de intubación orotraqueal (IOT) [OR 1,93 (IC95% 1,24-2,99); p = 0,003]. Un paciente (0,38%) sobrevivió al alta con buen estado neurológico. CONCLUSIONES: La RCP en curso en servicios de emergencias con médico a bordo es una estrategia poco frecuente en casos de PCR. La juventud del paciente, que la PCR suceda fuera del domicilio, sea presenciada, no exista soporte vital previo, tenga un ritmo inicial desfibrilable, una etiología no cardiaca y que se consiga IOT se asocian con esta estrategia cuyo resultado final puede considerarse fútil.

Estrategias de reperfusión en hospitales sin intervención coronaria percutánea primaria / Reperfusion strategies in hospitals without primary percutaneous coronary intervention

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Out-of-hospital cardiac arrest (OHCA) attended by mobile emergency teams with a physician on board. Results of the Spanish OHCA Registry (OSHCAR).

Most survival outcomes in out-of-hospital cardiac arrest (OHCA) are provided by emergency medical services (EMS) without a doctor on board. Our objective was to determine such outcomes in a whole country with public physician-led EMS. METHODS: We analyzed data from a nationwide prospective registry of OHCA cases attended by 19 public EMS in Spain, covering the period from 1-October 2013 to 30-October 2014. RESULTS: Advanced life support (ALS) was initiated in 9347 cases (incidence 18.6 cases/105 inhabitants per year). Resuscitation was considered futile in 558 cases (5.9%), and ALS was continued in 8789 cases (94.1%); mean age 63.5±17 years, 72.1% men. Initial rhythm was shockable in 22.1% of cases. Basic life support (BLS) was provided by bystanders in 1602 (24%) cases (635 of them with telephone assistance from the dispatch center). Of 8789 patients receiving ALS, 72.1% men, 2669 (30.4%) patients had return of spontaneous circulation on hospital arrival, 50.6% when the initial rhythm was shockable. Hospital discharge with good neurological status (CPC1-2) was found in 11.1% of the study population and in 27.6% when considering the Utstein comparator group of patients. A total of 216 (2.5%) patients arrived at the hospital with ongoing resuscitation, of whom only one survived with CPC1-2, and 165 (1.9%) patients were included in non-heart-beating donation programs. CONCLUSIONS: In Spain with physician-led EMS, OHCA survival with CPC1-2 reached a reasonable percentage despite only a modest contribution of bystander BLS. Ongoing resuscitation strategy seems to be futile except when considering non-heart beating donation programs.

Supervivencia y estado neurológico tras muerte súbita cardiaca extrahospitalaria. Resultados del Registro Andaluz de Parada Cardiorrespiratoria Extrahospitalaria / Survival and neurologic outcome after out-of-hospital cardiac arrest. Results of the andalusian out-of-hospital cardiopulmonary arrest registry

Introducción y objetivos: No hay demasiados datos sobre la muerte súbita prehospitalaria en España. El objetivo es describir su incidencia, las características de los pacientes y los resultados de su atención por un servicio de emergencias extrahospitalario. Métodos: Análisis retrospectivo de un registro prospectivo de parada cardiorrespiratoria atendida por un servicio de emergencias extrahospitalario entre enero de 2008 y diciembre de 2012. Se incluyó a todos los pacientes con estimación de etiología cardiaca como causa de la parada. Se realizó análisis descriptivo de las características generales de los pacientes y de los factores asociados con alta hospitalaria con buen estado neurológico. Resultados: Se incluyó a 4.072 pacientes, con una incidencia estimada de 14,6 eventos por 100.000 habitantes y año, el 72,6% varones. La media de edad era 62,0 ± 15,8 años. El 58,6% de los casos ocurrieron en domicilio. El 25% de los pacientes tenían un ritmo inicial desfibrilable. El 28,8% de los pacientes llegaron con pulso al hospital, el 58,3% del grupo con ritmo desfibrilable. El 10,2% recibió el alta en buen estado neurológico. Las variables asociadas con esta recuperación fueron: parada presenciada (p = 0,04), parada presenciada por el equipo de emergencias (p = 0,005), realización previa de soporte vital (p = 0,04), ritmo inicial desfibrilable (p = 0,0001) y realización de intervencionismo coronario (p = 0,0001). Conclusiones: Más de la mitad de los casos de muerte súbita ocurren en el domicilio. Afectan a una población relativamente joven. Aunque 1 de cada 10 pacientes tuvo una recuperación satisfactoria, la fase previa a la llegada de los equipos de emergencias debe mejorar. El intervencionismo coronario tuvo gran impacto en el pronóstico de los pacientes (AU)

Introduction and objectives: There is a paucity of data on prehospital cardiac arrest in Spain. Our aim was to describe the incidence, patient characteristics, and outcomes of out-of-hospital emergency care for this event. Methods: We conducted a retrospective analysis of a prospective registry of cardiopulmonary arrest handled by an out-of-hospital emergency service between January 2008 and December 2012. The registry included all patients considered to have a cardiac etiology as the cause of arrest, with a descriptive analysis performed of general patient characteristics and factors associated with good neurologic outcome at hospital discharge. Results: A total of 4072 patients were included, with an estimated incidence of 14.6 events per 100 000 inhabitants and year; 72.6% were men. The mean age was 62.0 ± 15.8 years, 58.6% of cases occurred in the home, 25% of patients had initial defibrillable rhythm, 28.8% of patients arrived with a pulse at the hospital (58.3% of the group with defibrillable rhythm), and 10.2% were discharged with good neurologic outcome. The variables associated with this recovery were: witnessed arrest (P = .04), arrest witnessed by emergency team (P = .005), previous life support (P = .04), initial defibrillable rhythm (P = .0001), and performance of a coronary interventional procedure (P = .0001). Conclusions: More than half the cases of sudden cardiac arrest occur at home, and the population was found to be relatively young. Although recovery was satisfactory in 1 out of every 10 patients, there is a need for improvement in the phase prior to emergency team arrival. Coronary interventional procedures had an impact on patient prognosis (AU)

Survival and Neurologic Outcome After Out-of-hospital Cardiac Arrest. Results of the Andalusian Out-of-hospital Cardiopulmonary Arrest Registry.

INTRODUCTION AND OBJECTIVES: There is a paucity of data on prehospital cardiac arrest in Spain. Our aim was to describe the incidence, patient characteristics, and outcomes of out-of-hospital emergency care for this event. METHODS: We conducted a retrospective analysis of a prospective registry of cardiopulmonary arrest handled by an out-of-hospital emergency service between January 2008 and December 2012. The registry included all patients considered to have a cardiac etiology as the cause of arrest, with a descriptive analysis performed of general patient characteristics and factors associated with good neurologic outcome at hospital discharge. RESULTS: A total of 4072 patients were included, with an estimated incidence of 14.6 events per 100000 inhabitants and year; 72.6% were men. The mean age was 62.0 ± 15.8 years, 58.6% of cases occurred in the home, 25% of patients had initial defibrillable rhythm, 28.8% of patients arrived with a pulse at the hospital (58.3% of the group with defibrillable rhythm), and 10.2% were discharged with good neurologic outcome. The variables associated with this recovery were: witnessed arrest (P=.04), arrest witnessed by emergency team (P=.005), previous life support (P=.04), initial defibrillable rhythm (P=.0001), and performance of a coronary interventional procedure (P=.0001). CONCLUSIONS: More than half the cases of sudden cardiac arrest occur at home, and the population was found to be relatively young. Although recovery was satisfactory in 1 out of every 10 patients, there is a need for improvement in the phase prior to emergency team arrival. Coronary interventional procedures had an impact on patient prognosis.

DIOCLES: Algunos matices y nuevas preguntas / DIOCLES: some caveats and new questions

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Initial complications and factors related to prehospital mortality in acute myocardial infarction with ST segment elevation.

OBJECTIVE: Hospital mortality in myocardial infarction ST-elevation myocardial infarction has decreased in recent years, in contrast to prehospital mortality. Our objective was to determine initial complications and factors related to prehospital mortality in patients with acute myocardial infarction with ST segment elevation (STEMI). METHODS: Observational study based on a prospective continuous register of patients of any age attended by out-of-hospital emergency teams in Andalusia between January 2006 and June 2009. This includes patients with acute coronary syndrome-like symptoms whose initial ECG showed ST elevation or presumably new left bundle branch block (LBBB). Epidemiological, prehospital data and final diagnostic were recorded. The study included all patients with STEMI on the register, without age restrictions. Forward stepwise logistic regression analysis was performed to control for confounders. RESULTS: A total of 2528 patients were included, 24% were women. Mean age 63.4±13.4 years; 16.7% presented atypical clinical symptoms. Initial complications: ventricular fibrillation (VF) 8.4%, severe bradycardia 5.8%, third-degree atrial-ventricular (AV) block 2.4% and hypotension 13.5%. Fifty-two (2.1%) patients died before reaching hospital. Factors associated with prehospital mortality were female sex (OR 2.36, CI 1.28 to 4.33), atypical clinical picture (OR 2.31, CI 1.21 to 4.41), hypotension (OR 4.95, CI 2.60 to 9.20), LBBB (OR 4.29, CI 1.71 to 10.74), extensive infarction (ST elevation in ≥5 leads) (OR 2.53, CI 1.28 to 5.01) and VF (OR 2.82, CI 1.38 to 5.78). CONCLUSIONS: A significant proportion of patients with STEMI present early complications in the prehospital setting, and some die before reaching hospital. Prehospital mortality was associated with female sex and atypical presentation, as pre-existing conditions, and hypotension, extensive infarction, LBBB and VF on emergency team attendance.