Proyecto Girona Territori Cardioprotegit: evaluación del funcionamiento de los desfibriladores públicos / The Girona Territori Cardioprotegit project: performance evaluation of public defibrillators

Introducción y objetivos: La desfibrilación pública ha potenciado la difusión y el uso de los desfibriladores externos automáticos (DEA) de manera exponencial, pero se carece de datos recientes sobre su uso en nuestro medio. Se realizó un análisis descriptivo del funcionamiento de los DEA desde el despliegue de un programa de desfibrilación pública. Métodos: Análisis retrospectivo de los trazados electrocardiográficos registrados y del funcionamiento de los desfibriladores, en el marco de un programa de desfibrilación pública en la provincia de Girona, desde su inicio en junio de 2011 hasta junio de 2015. Resultados: De 231 activaciones, se dispuso de información completa en 188, entre dispositivos móviles (82%) y fijos (18%). La asistolia fue el ritmo más prevalente (42%), mientras que un 23% de los ritmos fueron fibrilación ventricular. La especificidad de los dispositivos identificando ritmos desfibrilables fue del 100%, pero hubo 8 falsos negativos (sensibilidad del 83%). En el caso de los 47 ritmos desfibrilables, la tasa de recuperación de la circulación espontánea fue del 49% (23 casos). No hubo ningún accidente relacionado con el uso del dispositivo. Conclusiones: Casi la mitad de los ritmos registrados fueron asistolias. Los DEA analizados presentaron excelentes seguridad y especificidad, con una sensibilidad moderada. El DEA trató con éxito a la mitad de los pacientes que presentaron ritmo desfibrilable (AU)

Introduction and objectives: In recent years, public access defibrillation programs have exponentially increased the availability of automatic external defibrillators (AED) in public spaces but there are no data on their performance in our setting. We conducted a descriptive analysis of the performance of AED since the launch of a public defibrillation program in our region. Methods: A retrospective analysis was conducted of electrocardiographic tracings and the performance of AED in a public defibrillation program from June 2011 to June 2015 in the province of Girona, Spain. Results: There were 231 AED activations. Full information was available on 188 activations, of which 82% corresponded to mobile devices and 18% to permanent devices. Asystole was the most prevalent rhythm (42%), while ventricular fibrillation accounted for 23%. The specificity of the device in identifying a shockable rhythm was 100%, but there were 8 false negatives (sensitivity 83%). There were 47 shockable rhythms, with a spontaneous circulation recovery rate of 49% (23 cases). There were no accidents related to the use of the device (AU)

The Girona Territori Cardioprotegit Project: Performance Evaluation of Public Defibrillators.

INTRODUCTION AND OBJECTIVES: In recent years, public access defibrillation programs have exponentially increased the availability of automatic external defibrillators (AED) in public spaces but there are no data on their performance in our setting. We conducted a descriptive analysis of the performance of AED since the launch of a public defibrillation program in our region. METHODS: A retrospective analysis was conducted of electrocardiographic tracings and the performance of AED in a public defibrillation program from June 2011 to June 2015 in the province of Girona, Spain. RESULTS: There were 231 AED activations. Full information was available on 188 activations, of which 82% corresponded to mobile devices and 18% to permanent devices. Asystole was the most prevalent rhythm (42%), while ventricular fibrillation accounted for 23%. The specificity of the device in identifying a shockable rhythm was 100%, but there were 8 false negatives (sensitivity 83%). There were 47 shockable rhythms, with a spontaneous circulation recovery rate of 49% (23 cases). There were no accidents related to the use of the device. CONCLUSIONS: Nearly half of the recorded rhythms were asystole. The AED analyzed showed excellent safety and specificity, with moderate sensitivity. Half the patients with a shockable rhythm were successfully treated by the AED.

The effect of cephalosporin resistance on mortality in adult patients with nonmeningeal systemic pneumococcal infections.

PURPOSE: To evaluate the clinical relevance of cephalosporin (ceftriaxone/cefotaxime) resistance among patients with nonmeningeal systemic pneumococcal infection. SUBJECTS AND METHODS: From January 1994 to October 2000, we prospectively studied 522 episodes of nonmeningeal systemic pneumococcal infections (448 pneumonias) in 499 adults who were treated according to hospital guidelines. In vitro antibiotic susceptibility, as the minimum inhibitory concentration (MIC), was determined by microdilution method. The MIC methods and breakpoints (cutoffs) were established by the National Committee for Clinical Laboratory Standards. RESULTS: Of the 522 pneumococcal strains, 413 strains (79%) were susceptible to ceftriaxone/cefotaxime, MIC < or =0.5 microg/mL; 79 (15%) were intermediate, MIC = 1 microg/mL; and 30 (6%) were resistant, MIC = 2 microg/mL. After adjusting for several variables, including pneumococcal serogroups/serotypes, infections due to nonsusceptible (intermediate and resistant) pneumococcal strains were independently associated with prior antibiotic therapy, with an odds ratio of 5.9 (95% confidence interval: 2.6 to 13.6). Thirty-day mortality among the 185 patients who were treated with ceftriaxone (1 g/d) or cefotaxime (1.5 g every 8 hours) did not differ by cephalosporin susceptibility: 18% (26/148) among those with susceptible organisms, 13% (3/24) with intermediate organisms, and 15% (2/13) in resistant cases (P = 0.81). CONCLUSION: Ceftriaxone or cefotaxime were effective in treating patients with nonmeningeal systemic pneumococcal infections caused by strains with MIC < or =2 microg/mL. These results support the newly established ceftriaxone/cefotaxime MIC breakpoints (cutoffs) for nonmeningeal pneumococcal infections.