Prognostic value of venous blood analysis at the start of CPR in non-traumatic out-of-hospital cardiac arrest: association with ROSC and the neurological outcome.

BACKGROUND: The knowledge of new prognostic factors in out-of-hospital cardiac arrest (OHCA) that can be evaluated since the beginning of cardiopulmonary resuscitation (CPR) manoeuvres could be helpful in the decision-making process of prehospital care. We aim to identify metabolic variables at the start of advanced CPR at the scene that may be associated with two main outcomes of CPR (recovery of spontaneous circulation (ROSC) and neurological outcome). METHODS: Prospective observational study of all non-traumatic OHCA in patients older than 17 years assisted by emergency medical services (EMS), with doctor and nurse on board, between January 2012 and December 2017. Venous blood gases were sampled upon initially obtaining venous access to determine the initial values of pH, pCO2, HCO3-, base excess (BE), Na+, K+, Ca2+ and lactate. ROSC upon arrival at the hospital and neurological status 30 days later (Cerebral Performance Categories (CPC) scale) were recorded. RESULTS: We included 1552 patients with OHCA with blood test data in a 6-year period. ROSC was achieved in 906 cases (58.4%), and good neurological recovery at 30 days (CPC I-II) occurred in 383 cases (24.68%). In multivariate analysis, we found a significant relationship between non-recovery of spontaneous circulation (no-ROSC) and low pH levels (adjusted odds ratio (OR) 0.03 (0.002-0.59), p = 0.020), high pCO2 levels (adjusted OR 1.03 [1.01-1.05], p = 0.008) and high potassium levels (adjusted OR 2.28 [1.43-3.61], p = 0.008). Poor neurological outcomes were associated with low pH levels (adjusted OR 0.06 [0.02-0.18], p < 0.001), high pCO2 (adjusted OR 1.05 [1.03-1.08], p < 0.001), low HCO3- (adjusted OR 0.97 [0.94-0.999], p = 0.044), low BE (adjusted OR 0.96 [0.93-0.98], p < 0.001) and high potassium levels (adjusted OR 1.37 [1.16-1.60], p < 0.001). CONCLUSION: There is a significant relationship between severe alterations of venous blood-gas variables and potassium at the start of CPR of non-traumatic OHCA and low-ROSC rate and neurological prognosis.

Hidroxocobalamina y niveles séricos de lactato en la sospecha de intoxicación por cianuro en el síndrome de inhalación de humos / Hydroxocobalamin and lactate concentration in patients suspected of having cyanuric acid poisoning related to smoke inhalation syndrome

Objectives: To measure blood lactate concentrations before and after administration of hydroxocobalamin outside the hospital in patients suspected of having cyanuric acid poisoning due to fire-related smoke inhalation and to assess the metabolic efficacy of hydroxocobalamin as an antidote. Methods: Prospective, observational, single-group longitudinal study analyzing the percentage decrease in lactate concentration after administration of hydroxocobalamin and the time elapsed until the reduction in concentration. Patients had been injured in fires attended by the Madrid municipal citizen protection emergency service (SAMURCitizen Protection), had signs of smoke inhalation from fires in confined spaces and blood lactate concentration sexceeding 7.5 mmol/L on the scene. Patients with signs of hemodynamic instability were excluded. Hydroxocobalamin was administered immediately after the results of the first blood test had been obtained. A second measurement of blood lactate concentration was performed with the same analyzer on arrival at the hospital. Results: Twenty-eight patients were included. The mean (SD) time between the 2 lactate measurements was 31.9 (9.1)minutes. The mean (SD) lactate concentration was 10.2 (2.2) mmol/L initially and 6.7 (2.1) mmol/L at the second (..) (AU)

Objetivos: Conocer la variabilidad de los niveles de lactato en sangre antes y después de la administración extrahospitalaria de hidroxocobalamina, en pacientes con sospecha de intoxicación por derivados del cianuro debida a inhalación de humos en el curso de un incendio, así como valorar la efectividad metabólica que, como antídoto, tiene la hidroxocobalamina. Método: Estudio prospectivo, observacional y longitudinal, sin grupo control, que analiza el porcentaje de disminución de los niveles de lactato tras la administración de hidroxocobalamina y el periodo de tiempo en el que se produce ese descenso. Se incluyeron pacientes víctimas de un incendio atendidos por el Servicio de Emergencias del Ayuntamiento de Madrid (SAMUR-Protección Civil) que presentaban signos de inhalación de humo en el curso de incendios en espacios confinados y en quienes los niveles de lactato en sangre en la escena eran mayores de 7,5 mmol/l. Se descartaron todos aquellos pacientes con signos de inestabilidad hemodinámica. La hidroxocobalamina fue administrada inmediatamente tras el resultado del primer análisis. Una segunda medida de lactato en sangre fue realizada a la llegada al hospital con el mismo analizador. Resultados: Se incluyeron 28 pacientes. La media de tiempo entre las dos mediciones de lactato fue de 31,9 ± 9,1 min. El lactato inicial fue de 10,2 ± 2,2 nmol/L y el final fue de 6,7 ± 2,1 nmol/l, lo cual supuso un descenso medio de 3,4 ± 1,7 mmol/L (IC al95% de 2,7-4,1) que equivale a una diferencia porcentual entre ambas mediciones del 33% (p < 0,001). No se observaron diferencias entre el descenso observado para los (..) (AU)

Efectividad de la implementación de la desfibrilación semiautomática en las Unidades de Soporte Vital Básico / Effectiveness of the use of semiautomatic defibrillation in basic life support services

Objetivo: Evaluar la importancia de la aplicación de la desfibrilación semiautomática en el tratamiento de paradas cardiorrespiratorias (PCR) no presenciadas, de cualquier etiología, atendidas inicialmente por unidades de Soporte Vital Básico (SVB), mediante el análisis de la supervivencia y valoración neurológica a los 7 días del suceso. Método: Estudio prospectivo, descriptivo transversal/longitudinal, que analiza la supervivencia y el estado neurológico mediante la Escala de Glasgow-Pittsburg a los 7 días de la PCR de 233 pacientes atendidos durante un periodo de 5 años por el servicio urbano de emergencias extrahospitalarias de doble escalón de Madrid (SAMUR-PC).Resultados: La supervivencia “ad integrum” tras una PCR no presenciada fue de7,29%, muy próxima a los resultados globales de recuperación en nuestro servicio(12%), en los que se incluyen las PCR atendidas inicialmente por unidades de Soporte Vital Avanzado (SVA). Se constata una diferencia significativa entre los pacientes desfibrilados precozmente por SVB y aquéllos que por su ritmo inicial no lo habían sido. La demanda inicial de asistencia sólo hizo prever una PCR en el 37,7% de todos los casos. Conclusiones: La primera respuesta a la PCR con unidades de SVB con desfibrilador semiautomático(DEA) puede alcanzar niveles de supervivencia similares a la asistencia inicial por SVA (AU)

Objective: The objective of this study was to determine the importance of the use of semiautomatic defibrillation for the treatment of out-of-hospital cardio respiratory arrest of any etiology attended initially by basic life support ambulance services. The analysis was based on survival and neurological evaluation 7 days after the event. Design: A prospective, descriptive, transverse, longitudinal study that analyzed survival and the neurological status using the Glasgow-Pittsburgh scale 7 days after cardio respiratory arrest in 233 patients attended over a 5-year period by a twotier, urban, out-of-hospital emergency service based in Madrid, Spain (SAMUR-PC).Results: Survival with complete recovery observed after out-of-hospital cardio respiratory arrest was 7.29%, a figure very similar to the results for recovery in our department (12%), which included the arrests attended directly by advanced life-support services. There was a significant difference between the patients given early defibrillation by the basic life-support team and those in whom this was not performed based on the initial rhythm. It was also found that the initial call for assistance specified cardio respiratory arrest or unconsciousness in only 37.7% of cases. Conclusions: The primary response to cardio respiratory arrest by basic life support ambulance services with semiautomatic external defibrillators can achieve survivals similar to those in patients attended directly by advanced life-support services (AU)