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Am J Cardiol ; 2020 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-33007308


Bystander training in cardiopulmonary resuscitation (CPR) is crucial to improve the victims' survival and quality of life after sudden cardiac arrest. This observational study aimed to determine the success rate of 2 different programs of CPR training for children, adolescents, and adults in school communities. We assessed the development and acquisition of the following CPR skills: checking local safety, assessing victim's responsiveness, calling for help, assessing victim's breathing, and performing chest compression (hands and straight arms placement on the chest, compression velocity, depth, and chest release) using a 40-minute program with handmade manikins or the 120-minute program using intermediate-fidelity manikins. There were 1,630 learners (mean age 16 years, 38% male) in the 40-minute program, and 347 learners (mean age 27 years, 32% male) in the 120-minute program. The lowest successful pass rate of learners that developed CPR skills was 89.4% in the 40-minute program and 84.5% in the 120-minute program. The chances of success increased with age in the same program (compression rate and depth). The success rate also increased with the more extended and intermediate-cost program at the same age (assessing victim's responsiveness, calling for help, and assessing the victim's respiration). In conclusion, a 40-minute and cheaper (low-cost handmade manikin) CPR program was adequate to develop and acquire the overall CPR skills for ≥89% at school communities, independently of gender. However, some individual CPR skills can be further improved with increasing age and using the longer and intermediate-cost program.

Braz J Anesthesiol ; 2020 Jun 13.
Artigo em Inglês | MEDLINE | ID: mdl-32836520


The care for patients suffering from cardiopulmonary arrest in a context of a COVID-19 pandemic has particularities that should be highlighted. The following recommendations from the Brazilian Association of Emergency Medicine (ABRAMEDE), the Brazilian Society of Cardiology (SBC) and the Brazilian Association of Intensive Medicine (AMIB) and the Brazilian Society of Anesthesiology (SBA), associations and societies official representatives of specialties affiliated to the Brazilian Medical Association (AMB), aim to guide the various assistant teams, in a context of little solid evidence, maximizing the protection of teams and patients. It is essential to wear full Personal Protective Equipment (PPE) for aerosols during the care of Cardiopulmonary Resuscitation (CPR) and it is imperative to consider and treat the potential causes in these patients, especially hypoxia and arrhythmias caused by changes in the QT interval or myocarditis. The installation of an advanced invasive airway must be obtained early and the use of High Efficiency Particulate Arrestance (HEPA) filters at the interface with the valve bag is mandatory; situations of occurrence of CPR during mechanical ventilation and in a prone position demand peculiarities that are different from the conventional CPR pattern. Faced with the care of a patient diagnosed or suspected of COVID-19, the care follows the national and international protocols and guidelines 2015 ILCOR (International Alliance of Resuscitation Committees), AHA 2019 Guidelines (American Heart Association) and the Update of the Cardiopulmonary Resuscitation and Emergency Care Directive of the Brazilian Society of Cardiology 2019.

Arq Bras Cardiol ; 114(6): 1078-1087, 2020 06.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32638902


Care for patients with cardiac arrest in the context of the coronavirus disease 2019 (COVID-19) pandemic has several unique aspects that warrant particular attention. This joint position statement by the Brazilian Association of Emergency Medicine (ABRAMEDE), Brazilian Society of Cardiology (SBC), Brazilian Association of Intensive Care Medicine (AMIB), and Brazilian Society of Anesthesiology (SBA), all official societies representing the corresponding medical specialties affiliated with the Brazilian Medical Association (AMB), provides recommendations to guide health care workers in the current context of limited robust evidence, aiming to maximize the protection of staff and patients alike. It is essential that full aerosol precautions, which include wearing appropriate personal protective equipment, be followed during resuscitation. It is also imperative that potential causes of cardiac arrest of particular interest in this patient population, especially hypoxia, cardiac arrhythmias associated with QT prolongation, and myocarditis, be considered and addressed. An advanced invasive airway device should be placed early. Use of HEPA filters at the bag-valve interface is mandatory. Management of cardiac arrest occurring during mechanical ventilation or during prone positioning demands particular ventilator settings and rescuer positioning for chest compressions which deviate from standard cardiopulmonary resuscitation techniques. Apart from these logistical issues, care should otherwise follow national and international protocols and guidelines, namely the 2015 International Liaison Committee on Resuscitation (ILCOR) and 2019 American Heart Association (AHA) guidelines and the 2019 Update to the Brazilian Society of Cardiology Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Guideline.

Reanimação Cardiopulmonar/normas , Infecções por Coronavirus/terapia , Coronavirus , Pandemias , Pneumonia Viral/terapia , Guias de Prática Clínica como Assunto , Comitês Consultivos , Betacoronavirus , Brasil/epidemiologia , Reanimação Cardiopulmonar/métodos , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Humanos , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Sociedades Médicas , Estados Unidos
Artigo em Inglês | MEDLINE | ID: mdl-32552523


Endovascular Therapeutic hypothermia (ETH) reduces the damage caused by postischemia reperfusion injury syndrome in cardiopulmonary arrest and has already established its role in patients with sudden death; however, its role in ST-segment elevation myocardial infarction (STEMI) remains controversial. The objectives of this study were to investigate the safety, feasibility, and 30-day efficacy of rapid induction of therapeutic hypothermia as adjunctive therapy to percutaneous coronary intervention (PCI) in patients with anterior and inferior STEMIs. This was a prospective, controlled, randomized, two-arm, prospective, interventional study of patients admitted to the emergency department within 6 hours of angina onset, with anterior or inferior STEMI eligible for PCI. Subjects were randomized to the hypothermia group (primary PCI+ETH) or to the control group (primary PCI) at a 4:1 ratio. The ETH was induced by 1 L cold saline (1-4°C) associated with the Proteus™ System, by cooling for at least 18 minutes before coronary reperfusion with a target temperature of 32°C ± 1°C. Maintenance of ETH was conducted for 1-3 hours, and active reheating was done at a rate of 1°C/h for 4 hours. Primary safety outcomes were the feasibility of ETH in the absence of (1) door-to-balloon (DTB) delay; (2) major adverse cardiac events (MACE) within 30 days after randomization. The primary outcomes of effectiveness were infarct size (IS) and left ventricular ejection fraction (LVEF) at 30 days. An as-treated statistical analysis was performed. Fifty patients were included: 35 (70%) randomized to the hypothermia group and 15 (30%) to the control group. The mean age was 58 ± 12 years; 78% were men; and associated diseases were 60% hypertension, 42% diabetes, and 72% dyslipidemia. The compromised myocardial wall was anterior in 38% and inferior in 62%, and the culprit vessels were left anterior descending artery (LAD) (40%), right coronary artery (38%), and left circumflex (18%). All 35 patients who attempted ETH (100%) had successful cooling, with a mean endovascular coronary reperfusion temperature of 33.1°C ± 0.9°C. The mean ischemic time was 375 ± 89.4 minutes in the hypothermia group and 359.5 ± 99.4 minutes in the control group. The mean DTB was 92.1 ± 20.5 minutes in the hypothermia group and 87 ± 24.4 minutes in the control group. The absolute difference of 5.1 minutes was not statistically significant (p = 0.509). The MACE rates were similar between both groups (21.7% vs. 20% respectively, p = 0.237). In the comparison between the hypothermia and control groups, no statistically significant differences were observed at 30 days between mean IS (13.9% ± 8% vs. 13.8% ± 10.8%, respectively, p = 0.801) and mean final LVEF (43.3% ± 11.2% vs. 48.3 ± 10.9%, respectively; p = 0.194). Hypothermia as an adjunctive therapy to primary PCI in STEMI is feasible and can be implemented without delay in coronary reperfusion. Hypothermia was safe regarding the incidence of MACE at 30 days. However, there was a higher incidence of arrhythmia and in-hospital infection in the hypothermia group, with no increase in mortality. Regarding efficacy, there was no difference in IS or LVEF at 30 days that would suggest additional myocardial protection with ETH. NCT02664194.

Arq Bras Cardiol ; 113(3): 449-663, 2019 10 10.
Artigo em Português | MEDLINE | ID: mdl-31621787
Sci Rep ; 9(1): 14975, 2019 10 18.
Artigo em Inglês | MEDLINE | ID: mdl-31628390


Data on predictors of intraoperative cardiac arrest (ICA) outcomes are scarce in the literature. This study analysed predictors of poor outcome and their prognostic value after an ICA. Clinical and laboratory data before and 24 hours (h) after ICA were analysed as predictors for no return of spontaneous circulation (ROSC) and 24 h and 1-year mortality. Receiver operating characteristic curves for each predictor and sensitivity, specificity, positive and negative likelihood ratios, and post-test probability were calculated. A total of 167,574 anaesthetic procedures were performed, including 158 cases of ICAs. Based on the predictors for no ROSC, a threshold of 13 minutes of ICA yielded the highest area under curve (AUC) (0.867[0.80-0.93]), with a sensitivity and specificity of 78.4% [69.6-86.3%] and 89.3% [80.4-96.4%], respectively. For the 1-year mortality, the GCS without the verbal component 24 h after an ICA had the highest AUC (0.616 [0.792-0.956]), with a sensitivity of 79.3% [65.5-93.1%] and specificity of 86.1 [74.4-95.4]. ICA duration and GCS 24 h after the event had the best prognostic value for no ROSC and 1-year mortality. For 24 h mortality, no predictors had prognostic value.

Parada Cardíaca/epidemiologia , Parada Cardíaca/mortalidade , Complicações Intraoperatórias/epidemiologia , Complicações Intraoperatórias/mortalidade , Adulto , Idoso , Anestesia Geral , Área Sob a Curva , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Prevalência , Probabilidade , Prognóstico , Curva ROC , Estudos Retrospectivos , Fatores de Risco , Sensibilidade e Especificidade
Bernoche, Claudia; Timerman, Sergio; Polastri, Thatiane Facholi; Giannetti, Natali Schiavo; Siqueira, Adailson Wagner da Silva; Piscopo, Agnaldo; Soeiro, Alexandre de Matos; Reis, Amélia Gorete Afonso da Costa; Tanaka, Ana Cristina Sayuri; Thomaz, Ana Maria; Quilici, Ana Paula; Catarino, Andrei Hilário; Ribeiro, Anna Christina de Lima; Barreto, Antonio Carlos Pereira; Azevedo, Antonio Fernando Barros de Filho; Pazin, Antonio Filho; Timerman, Ari; Scarpa, Bruna Romanelli; Timerman, Bruno; Tavares, Caio de Assis Moura; Martins, Cantidio Soares Lemos; Serrano, Carlos Vicente Junior; Malaque, Ceila Maria Sant'Ana; Pisani, Cristiano Faria; Batista, Daniel Valente; Leandro, Daniela Luana Fernandes; Szpilman, David; Gonçalves, Diego Manoel; Paiva, Edison Ferreira de; Osawa, Eduardo Atsushi; Lima, Eduardo Gomes; Adam, Eduardo Leal; Peixoto, Elaine; Evaristo, Eli Faria; Azeka, Estela; Silva, Fabio Bruno da; Wen, Fan Hui; Ferreira, Fatima Gil; Lima, Felipe Gallego; Fernandes, Felipe Lourenço; Ganem, Fernando; Galas, Filomena Regina Barbosa Gomes; Tarasoutchi, Flavio; Souza, Germano Emilio Conceição; Feitosa, Gilson Soares Filho; Foronda, Gustavo; Guimarães, Helio Penna; Abud, Isabela Cristina Kirnew; Leite, Ivanhoé Stuart Lima; Linhares, Jaime Paula Pessoa Filho; Moraes, Junior João Batista de Moura Xavier; Falcão, João Luiz Alencar de Araripe; Ramires, Jose Antônio Franchini; Cavalini, José Fernando; Saraiva, José Francisco Kerr; Abrão, Karen Cristine; Pinto, Lecio Figueira; Bianchi, Leonardo Luís Torres; Lopes, Leonardo Nícolau Geisler Daud; Piegas, Leopoldo Soares; Kopel, Liliane; Godoy, Lucas Colombo; Tobase, Lucia; Hajjar, Ludhmila Abrahão; Dallan, Luís Augusto Palma; Caneo, Luiz Fernando; Cardoso, Luiz Francisco; Canesin, Manoel Fernandes; Park, Marcelo; Rabelo, Marcia Maria Noya; Malachias, Marcus Vinícius Bolívar; Gonçalves, Maria Aparecida Batistão; Almeida, Maria Fernanda Branco de; Souza, Maria Francilene Silva; Favarato, Maria Helena Sampaio; Carrion, Maria Julia Machline; Gonzalez, Maria Margarita; Bortolotto, Maria Rita de Figueiredo Lemos; Macatrão-Costa, Milena Frota; Shimoda, Mônica Satsuki; Oliveira-Junior, Mucio Tavares de; Ikari, Nana Miura; Dutra, Oscar Pereira; Berwanger, Otávio; Pinheiro, Patricia Ana Paiva Corrêa; Reis, Patrícia Feitosa Frota dos; Cellia, Pedro Henrique Moraes; Santos Filho, Raul Dias dos; Gianotto-Oliveira, Renan; Kalil Filho, Roberto; Guinsburg, Ruth; Managini, Sandrigo; Lage, Silvia Helena Gelas; Yeu, So Pei; Franchi, Sonia Meiken; Shimoda-Sakano, Tania; Accorsi, Tarso Duenhas; Leal, Tatiana de Carvalho Andreucci; Guimarães, Vanessa; Sallai, Vanessa Santos; Ávila, Walkiria Samuel; Sako, Yara Kimiko.
Arq. bras. cardiol ; 113(3): 449-663, Sept. 2019. tab, graf
Artigo em Português | LILACS, Sec. Est. Saúde SP, SESSP-IDPCPROD, Sec. Est. Saúde SP | ID: biblio-1038561
Rev. Soc. Cardiol. Estado de Säo Paulo ; 28(3)jul.-ago. 2018. tab, graf
Artigo em Português | LILACS | ID: biblio-916551


Evitar novos episódios de parada cardiorrespiratória (PCR). Identificar e tratar as causas que levaram o paciente à PCR. Oferecer suportes ventilatório, hemodinâmico, neurológico e metabólico. Realizar a modulação terapêutica de temperatura para todos os pacientes que retornaram à circulação espontânea. Indicação de cateterismo cardíaco para pacientes sem causa estabelecida de PCR quando a causa pode ser um evento coronariano

Avoid further episodes of cardiopulmonary arrest (CPA). Identify and treat the causes of the patient's CPA. Provide ventilatory, hemodynamic, neurological and metabolic support. Perform therapeutic temperature modulation for all patients who have resumed spontaneous circulation. Indication of cardiac catheterization for patients with no established cause of CPA when the cause may be a coronary event

Humanos , Masculino , Feminino , Emergências , Parada Cardíaca/terapia , Cateterismo Cardíaco , Dopamina/uso terapêutico , Epinefrina/uso terapêutico , Isquemia , Cetose/complicações , Norepinefrina/uso terapêutico , Reperfusão , Ressuscitação/métodos , Terapêutica
Int J Med Educ ; 8: 309-313, 2017 Aug 25.
Artigo em Inglês | MEDLINE | ID: mdl-28850944


Objectives: To describe learning outcomes of undergraduate nursing students following an online basic life support course (BLS). Methods: An online BLS course was developed and administered to 94 nursing students. Pre- and post-tests were used to assess theoretical learning. Checklist simulations and feedback devices were used to assess the cardiopulmonary resuscitation (CPR) skills of the 62 students who completed the course. Results: A paired t-test revealed a significant increase in learning [pre-test (6.4 ± 1.61), post-test (9.3 ± 0.82), p < 0.001]. The increase in the average grade after taking the online course was significant (p<0.001). No learning differences (p=0.475) had been observed between 1st and 2nd year (9.20 ± 1.60), and between 3rd and 4th year (9.67 ± 0.61) students. A CPR simulation was performed after completing the course: students checked for a response (90%), exposed the chest (98%), checked for breathing (97%), called emergency services (76%), requested for a defibrillator (92%), checked for a pulse (77%), positioned their hands properly (87%), performed 30 compressions/cycle (95%), performed compressions of at least 5 cm depth (89%), released the chest (90%), applied two breaths (97%), used the automated external defibrillator (97%), and positioned the pads (100%). Conclusions: The online course was an effective method for teaching and learning key BLS skills wherein students were able to accurately apply BLS procedures during the CPR simulation. This short-term online training, which likely improves learning and self-efficacy in BLS providers, can be used for the continuing education of health professionals.

Reanimação Cardiopulmonar/educação , Educação em Enfermagem/métodos , Treinamento por Simulação/métodos , Estudantes de Enfermagem , Competência Clínica , Instrução por Computador/métodos , Avaliação Educacional , Feminino , Humanos , Internet , Aprendizagem , Masculino , Autoeficácia , Adulto Jovem
Rev. Soc. Cardiol. Estado de Säo Paulo ; 26(1): 27-33, jan.-mar.2016. tab, ilus
Artigo em Português | LILACS | ID: lil-789773


O processo fisiopatológico secundário à parada cardiorrespiratória (PCR) com retorno da circulação espontânea (RCE), determina a síndrome pós-PCR, com lesão cerebral, disfunção miocárdica e reperfusão, em resposta à isquemia orgânica. A terapia do controle da temperatura (TCT) oferece mecanismos neuroprotetores, limitação da lesão miocárdica e redução da resposta inflamatória sistêmica. Dúvidas existem em relação aos benefícios, início e duração da TCT, porém, há evidências que apoiam a melhora da sobrevida e do prognóstico neurológico em populações selecionadas. Recomenda-se a TCT por 24 horas, com controle da temperatura na faixa de 32 °C a 36 °C para adultos que sobrevivem à PCR extra-hospitalar e permanecem em coma com ritmos iniciais de fibrilação/taquicardia ventricular, o que também é sugerido para os sobreviventes de PCR extra-hospitalar com ritmo inicial não chocável e de PCR intra-hospitalar em qualquer ritmo inicial. O início do resfriamento deve ser feito o mais precocemente possível, depreferência, até 12 horas após o RCE. O controle da temperatura corpórea deve ser incorporado aos cuidados dos pacientes críticos pós-PCR, a fim de reduzir as taxas de mortalidade e de sequelas neurológicas...

The secondary pathophysiological process to cardiorespiratory arrest (CRA) with return of spontaneous circulation (ROSC), determines the post-cardiorespiratory arrest syndrome with brain injury, myocardial reperfusion and dysfunction in response to systemic ischemia. The temperature control therapy (TCT) provides neuroprotective mechanisms, limitation of myocardial injury and reduction of systemic inflammatory response. There are still some questions regarding the benefits, timing and duration of TCT, however, there is evidence supporting improved survival and neurological outcome in selected populations. TCT is recommended for 24 hours, with temperature control in the range of 32 to 36 °C for comatose adults who survive after out-of-hospital cardiorespiratory arrest with initial rates of fibrillation/ ventricular tachycardia, which is also suggested for extra-hospital cardiorespiratory arrest survivors with early pace not shockable and intra-hospital cardiorespiratory arrest in any initial rate. The beginning of the cooling should be done as early as possible, ideally up to12 hours after ROSC. The control of body temperature should be incorporated into the careof the post-CRA critically ill patients in order to reduce mortality and neurological sequelae...

Humanos , Masculino , Feminino , Hipotermia/complicações , Hipotermia/terapia , Parada Cardíaca/fisiopatologia , Parada Cardíaca/terapia , Temperatura Corporal , Eletrocardiografia/métodos , Qualidade de Vida , Fatores de Risco , Reperfusão Miocárdica/métodos , Sobrevida , Sistema Nervoso Central/fisiopatologia
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-1029988


Objetivo: descrever a experiência do projeto Viva Coração na cidade de Salvador, Bahia, Brasil. Método: trata-sede um relato de experiência sobre o projeto Viva Coração desenvolvido pelo SAMU 192, no qual foi realizadotreinamento da população em reanimação cardiopulmonar e distribuição de aparelho de desfibrilação para espaçosde atendimento à saúde. Resultados: foram treinadas 6.287 pessoas vinculadas a cenários como: serviços de saúde,repartições públicas, estações de transbordo e ponto turístico. O conteúdo abordado nas atividades teórico-práticas,com duração de 4 horas, baseou-se nos protocolos de ressuscitação cardiorrespiratória da American Heart Association.Foram distribuídos 200 desfibriladores para as unidades de saúde participantes. Conclusões: a experiência favoreceuo treinamento da população para atuar em situações de parada cardiorrespiratória, conhecimento que amplia aschances de intervenção e sobrevida sem sequelas e poderá subsidiar novas capacitações.

Objective: the main objective of this study was to relate the experience of the Heart Rescue Project, in the city ofSalvador, Bahia state, in Brazil. Method: the report is about an experience with the Heart Rescue Project developedby SAMU 192, in which the population was trained in cardiopulmonary resuscitation. Also, through the projectwere distributed defibrillation equipments for health care spaces. Results: were trained 6,287 people linked to placeslike health services, public agencies, transfer stations and tourist sites. The addressed content, in the theoretical andpractical activities, was based on the American Heart Association protocols for cardiopulmonary resuscitation. Tothe health units that participated in the training, 200 defibrillators were distributed. Conclusions: the populationthat received the training was stimulated to act in situations of cardiac arrest. The knowledge imparted increasesthe probability of obtaining a survival without sequelae, therefore it is believed that this would help new courses oftraining

Objetivo: el estudio tuvo por objetivo describir la experiencia del proyecto Reanimación del Corazón en la ciudad deSalvador, estado de Bahía, en Brasil. Método: se trata de un relato de la experiencia sobre el proyecto Reanimación delCorazón desarrollado por el SAMU 192, en el cual fue realizado un entrenamiento de la población en reanimacióncardiopulmonar y se distribuyeron aparatos de desfibrilación para espacios de atención a la salud. Resultados: fueron entrenadas 6.287 personas vinculadas a escenarios como: servicios de salud, reparticiones públicas, estacionesde transbordo y puntos turísticos. El contenido abordado en las actividades teórico prácticas, con duración de4 horas, se basó en los protocolos de resucitación cardiorrespiratoria de la American Heart Association. Fuerondistribuidos 200 desfibriladores para las unidades de salud participantes. Conclusiones: la experiencia favoreció elentrenamiento de la población para actuar en situaciones de parada cardiorrespiratoria, conocimiento que amplíalas probabilidades de intervención y supervivencia sin secuelas, pudiendo así auxiliar nuevas capacitaciones.

Humanos , Educação em Saúde , Parada Cardíaca , Primeiros Socorros , Reanimação Cardiopulmonar
Int J Med Educ ; 6: 166-71, 2015 Nov 22.
Artigo em Inglês | MEDLINE | ID: mdl-26590951


OBJECTIVE: To identify faculty perceptions of simulation insertion in the undergraduate program, considering the advantages and challenges posed by this resource. METHODS: We conducted a qualitative study with intentional sampling according to pre-defined criteria, following a semi-structured outline regarding data saturation. We have interviewed 14 healthcare instructors from a teaching institution that employs simulation in its syllabi. RESULTS: The majority of the faculty interviewed considered the use of scenario, followed by debriefing, as an excellent teaching tool. However, the faculty also noted a number of difficulties, such as the workload necessary to assemble the scenario, the correlation between scenario goals and the competences of the program, the time spent with the simulation, and the ratio of students to faculty members. CONCLUSIONS: Faculties consider simulation an effective tool in the healthcare program and maintain that the main obstacle faced by them is the logistical demand.

Atitude , Educação Médica/métodos , Educação em Enfermagem/métodos , Docentes , Treinamento por Simulação , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
J Am Heart Assoc ; 4(10): e002185, 2015 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-26452987


BACKGROUND: Targeted automated external defibrillator (AED) programs have improved survival rates among patients who have an out-of-hospital cardiac arrest (OHCA) in US airports, as well as European and Japanese railways. The Sao Paulo (Brazil) Metro subway carries 4.5 million people per day. A targeted AED program was begun in the Sao Paulo Metro with the objective to improve survival from cardiac arrest. METHODS AND RESULTS: A prospective, longitudinal, observational study of all cardiac arrests in the Sao Paulo Metro was performed from September 2006 through November 2012. This study focused on cardiac arrest by ventricular arrhythmias, and the primary endpoint was survival to hospital discharge with minimal neurological impairment. A total of 62 patients had an initial cardiac rhythm of ventricular fibrillation. Because no data on cardiac arrest treatment or outcomes existed before beginning this project, the first 16 months of the implementation was used as the initial experience and compared with the subsequent 5 years of full operation. Return of spontaneous circulation was not different between the initial 16 months and the subsequent 5 years (6 of 8 [75%] vs. 39 of 54 [72%]; P=0.88). However, survival to discharge was significantly different once the full program was instituted (0 of 8 vs. 23 of 54 [43%]; P=0.001). CONCLUSIONS: Implementation of a targeted AED program in the Sao Paulo Metro subway system saved lives. A short interval between arrest and defibrillation was key for good long-term, neurologically intact survival. These results support strategic expansion of targeted AED programs in other large Latin American cities.

Reanimação Cardiopulmonar/instrumentação , Morte Súbita Cardíaca/prevenção & controle , Desfibriladores , Cardioversão Elétrica/instrumentação , Parada Cardíaca Extra-Hospitalar/terapia , Ferrovias , Serviços Urbanos de Saúde , Fibrilação Ventricular/terapia , Idoso , Brasil , Reanimação Cardiopulmonar/efeitos adversos , Reanimação Cardiopulmonar/mortalidade , Cardioversão Elétrica/efeitos adversos , Cardioversão Elétrica/mortalidade , Serviços Médicos de Emergência , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Parada Cardíaca Extra-Hospitalar/diagnóstico , Parada Cardíaca Extra-Hospitalar/mortalidade , Parada Cardíaca Extra-Hospitalar/fisiopatologia , Admissão do Paciente , Alta do Paciente , Avaliação de Programas e Projetos de Saúde , Estudos Prospectivos , Recuperação de Função Fisiológica , Fatores de Risco , Fatores de Tempo , Tempo para o Tratamento , Transporte de Pacientes , Resultado do Tratamento , Fibrilação Ventricular/diagnóstico , Fibrilação Ventricular/mortalidade , Fibrilação Ventricular/fisiopatologia