[Differences between Spain's autonomous communities in the availability of semi-automatic external defibrillators outside the healthcare setting]. / Diferencias entre comunidades autónomas de España en la dotación de desfibriladores externos semiautomáticos fuera del ámbito sanitario.

BACKGROUND: Early defibrillation is one of the interventions that can most influence the prognosis of cardiac arrest. The objectives of this study were to determine the number of automatic external defibrillators outside the healthcare setting in each autonomous community in Spain and to compare the legislation of each autonomous community on the mandatory installation of defibrillators outside the healthcare setting. METHODS: A cross-sectional observational study was carried out between December 2021 and January 2022 by consulting official data in the 17 Spanish autonomous communities. RESULTS: Complete data on the number of registered defibrillators were obtained from 15 autonomous communities. The number of defibrillators ranged from 35 to 126 per 100,000 inhabitants. At the global level, differences were observed between communities with mandatory defibrillator installation and those without (92.1 vs. 57.8 defibrillators/100,000 inhabitants). CONCLUSIONS: There is heterogeneity in the provision of defibrillators outside the health care setting, which seems to be related to the diversity of legislation on the mandatory installation of defibrillators.

Reanimación cardiopulmocerebral en la carrera Medicina: diferencias entre los planes de estudios D y E / Cardiopulmonary-cerebral resuscitation in the Medicine career: differences between study plans D and E

Fundamento: la reanimación cardiopulmocerebral básica está presente como curso propio en los planes de estudios "D" y "E" de la carrera de Medicina; aunque en ambos la organización del proceso tiene sus particularidades. Objetivo: precisar las diferencias en cuanto a estructura, proceso docente y resultados académicos en la enseñanza de la reanimación cardiopulmocerebral básica, entre los planes de estudios "D" y "E" de la carrera de Medicina. Métodos: se realizó un estudio descriptivo, prospectivo, transversal, en la Universidad de Ciencias Médicas de Cienfuegos en los años 2017 y 2019. Se utilizaron métodos teóricos y empíricos. Para comparar resultados se utilizó el universo estudiantil en ambos años, para evaluar satisfacción y calidad una muestra aleatoria simple. Se utilizaron técnicas de estadística descriptiva. Para ambos cursos se utilizó similar escenario y claustro de profesores. Resultados: las diferencias entre ambos planes derivan de los componentes no personales del proceso docente; el plan "D" tiene 20 horas y el "E" 40, con lo cual se amplían sus contenidos. Todos los temas y objetivos del plan "D" estuvieron incluidos en el "E". Hubo similitud en las promociones general (80.4 % y 75.2 %) y de calidad (50.6 % y 53.1 %) en ambos años. El cumplimiento de las expectativas, satisfacción y calidad del proceso fue valorado de muy alto y alto (más 98 %) por los estudiantes en ambos cursos. Conclusiones: aunque existieron diferencias en el proceso enseñanza aprendizaje entre ambos planes, no hubo repercusión en la satisfacción de los estudiantes, calidad del proceso docente, ni los resultados académicos. La variante del plan "E" es más integral para la formación básica del apoyo vital.

Background: basic cardiopulmonary-cerebral resuscitation is present as its own course in the "D" and "E" study plans of the Medicine career; although in both the organization of the process has its particularities. Objective: to specify the differences in terms of structure, teaching process and academic results in the teaching of basic cardiopulmonary-cerebral resuscitation, between the "D" and "E" study plans of the Medicine career. Methods: a descriptive, prospective, cross-sectional study was carried out at Cienfuegos University of Medical Sciences from 2017 to 2019. Theoretical and empirical methods were used. To compare results, the student universe was used in both years, to evaluate satisfaction and quality a simple random sample. Descriptive statistical techniques were used. For both courses, a similar scenario and faculty were used. Results: the differences between both plans derive from the non-personal components of the teaching process; plan "D" has 20 hours and plan "E" 40, which expands its contents. All the topics and objectives of plan "D" were included in plan "E". There was similarity in the general (80.4% and 75.2%) and quality (50.6% and 53.1%) school grades in both years. The fulfillment of the expectations, satisfaction and quality of the process was valued as very high and high (more than 98%) by the students in both courses. Conclusions: although there were differences in the teaching-learning process between both plans, there was no impact on student satisfaction, quality of the teaching process, or academic results. The "E" plan variant is more comprehensive for basic life support training.

Avaliação da simulação em parada cardiorrespiratória durante o debriefing entre estudantes de enfermagem na pandemia / Assessment of a simulation in cardiopulmonary arrest during the debriefing among nursing students in the pandemic / Evaluación de la simulación de paro cardiorrespiratorio durante el debriefing entre los estudiantes de enfermería en la pandemia

Objetivo: avaliar a simulação em parada cardiorrespiratória durante o debriefing entre estudantes de enfermagem na pandemia da COVID-19. Método: estudo descritivo de abordagem qualitativa realizado entre 22 estudantes de enfermagem em duas etapas: simulação clínica em parada cardiorrespiratória e debriefing associado à simulação. O corpus textual decorrente dos diálogos foi submetido à análise lexicográfica, com auxílio do software "IRAMUTEQ". Resultados: a maioria dos estudantes nunca havia participado de cenários de simulação clínica no decorrer da graduação. Mediante o debriefing, identificaram-se aspectos facilitadores como a voz do manequim e o realismo da simulação. Como dificultadores, os estudantes atribuíram o nervosismo e a falta de conhecimento no atendimento em parada cardiorrespiratória. Conclusão: na avaliação da simulação durante o debriefing verificou-se a importância desta estratégia de ensino prático para formação acadêmica, impactando positivamente no processo de ensino-aprendizagem do estudante de enfermagem, sobretudo na pandemia da COVID-19.

Objective: to evaluate the simulation in cardiopulmonary arrest during the debriefing among nursing students in the COVID-19 pandemic. Method: a descriptive study with a qualitative approach carried out among 22 nursing students in two stages: clinical simulation in cardiopulmonary arrest and debriefing associated with the simulation. The textual corpus resulting from the dialogues was submitted to lexicographical analysis, with the aid of the "IRAMUTEQ" software. Results: most students had never participated in clinical simulation scenarios during graduation. Through the debriefing, facilitating aspects such as the manikin's voice and the realism of the simulation were identified. As difficulties, the students attributed nervousness and lack of knowledge in cardiopulmonary arrest care. Conclusion: in the evaluation of the simulation during the debriefing, the importance of this practical teaching strategy for academic training was verified, positively impacting the teaching-learning process of the nursing student, especially in the COVID-19 pandemic.

Objetivo: evaluar la simulación en paro cardiorrespiratorio durante el debriefing entre los estudiantes de enfermería en la pandemia de COVID-19. Método: estudio descriptivo con enfoque cualitativo realizado entre 22 estudiantes de enfermería en dos etapas: simulación clínica en paro cardiorrespiratorio y debriefing asociado a la simulación. El corpus textual resultante de los diálogos fue sometido a un análisis lexicográfico, con la ayuda del programa "IRAMUTEQ". Resultados: la mayoría de los estudiantes nunca han participado en escenarios de simulación clínica en el transcurso del pregrado. Mediante el debriefing, se identificaron aspectos facilitadores como la voz del maniquí y el realismo de la simulación. Como dificultadores, los estudiantes atribuyeron el nerviosismo y la falta de conocimiento a la atención en paro cardiorrespiratorio. Conclusión: en la evaluación de la simulación durante el debriefing, se notó la importancia de esta estrategia de enseñanza práctica para la formación académica, impactando positivamente en el proceso de enseñanza-aprendizaje del estudiante de enfermería, sobre todo en la pandemia de COVID-19.

Cardiopulmonary resuscitation during the COVID-19 pandemic in Spain.

OBJECTIVES: The disease COVID-19 produces serious complications that can lead to cardiorespiratory arrest. Quality cardiopulmonary resuscitation (CPR) can improve patient prognosis. The objective of this study is to evaluate the performance of the specialty of Anesthesiology in the management of CPR during the pandemic. METHODS: A survey was carried out with Google Forms consisting of 19 questions. The access link to the questionnaire was sent by email by the Spanish Society of Anesthesia (SEDAR) to all its members. RESULTS: 225 responses were obtained. The regions with the highest participation were: Madrid, Catalonia, Valencia and Andalusia. 68.6%% of the participants work in public hospitals. 32% of the participants habitually work in intensive care units (ICU), however, 62.1% have attended critical COVID-19 in the ICU and 72.6% have anesthetized them in the operating room. 26,3% have attended some cardiac arrest, 16,8% of the participants admitted to lead the manoeuvres, 16,8% detailed that it had been another department, and 66,2% was part of the team, but did not lead the assistance. Most of the CPR was performed in supine, only 5% was done in prone position. 54.6% of participants had not taken any course of Advance Life Support (ALS) in the last 2 years. 97.7% of respondents think that Anesthesia should lead the in-hospital CPR. CONCLUSION: The specialty of Anesthesiology has actively participated in the care of the critically ill patient and in the management of CPR during the COVID-19 pandemic. However, training and/or updating in ALS is required.

Características epidemiológicas y factores asociados a la parada cardiorrespiratoria extrahospitalaria atendida por espectadores antes de la llegada del primer recurso asistencial / Epidemiological characteristics and factors associated with out-of-hospital cardiac arrest attended by bystanders before ambulance arrival

Fundamento:. Comparar las características epidemiológicas de las paradas cardiacas extrahospitalarias enfunción de si fueron o no atendidas por espectadoresantes de la llegada de la ambulancia y describir los factores asociados a la reanimación por testigos. Metodología: Estudio observacional retrospectivo sobre los casos de parada cardiorrespiratoria extrahospitalaria ocurridos en el País Vasco durante cinco años.Se determinaron diferencias epidemiológicas de los casos en función de si la reanimación cardiopulmonar fueiniciada por espectadores. La relación entre la variabledependiente no se inicia reanimación por testigos y distintos factores de exposición se analizó con regresiónlogística multivariable. Resultados: Se revisaron 3278 eventos; en el 61,9 % delos casos no se practicó reanimación por testigos o espectadores y se asoció a inexistencia de instruccionestelefónicas (OR: 6,25; IC95 %: 5,15-7,58; p < 0,001), localización del evento en el domicilio (OR: 2,94; IC95 %: 2,48-3,48; p < 0,001), evento no presenciado (OR: 1,56; IC95 %:1,28-1,89; p < 0,001), víctima con edad superior a 64 años(OR: 1,48; IC95 %: 1,26-1,74; p < 0,001) y ámbito urbano(OR: 1,29; IC95 %: 1,04-1,62; p = 0,023). Conclusiones: Existen diferencias en las paradas cardiacas en función de si han sido o no reanimadas porespectadores y estas características podrían condicionar la decisión del rescatador al respecto de iniciar lareanimación y la evolución de la misma.(AU)

Background: The aim of this study is to analyze thecharacteristics of out of hospital cardiac arrests basedon whether patients received bystander resuscitationbefore ambulance arrival, and to describe the factorsassociated with resuscitation attempts by bystanders. Methods: A retrospective observational study was performed. Clinical data from cardiac arrest patients in theBasque Country (Spain) were collected over a periodof five years. Epidemiological characteristics comparedresuscitation started by bystanders with resuscitationcarried out by ambulance caregivers. The relation between no resuscitation started by bystander and different exposure factors was explored by multiple logisticregression analysis. Results: We analyzed 3,278 cardiac arrests. Of them,61.9 % were not attended by bystanders and this wasassociated with the absence of instructions from Emergency Centre (OR: 6.25, 95 % CI: 5.15-7.58, p < 0.001),home location (OR: 2.94, 95 %CI: 2.48-3.48, p < 0.001),unwitnessed cardiac arrest (OR: 1.56, 95 %CI 1.28-1.89,p < 0.001), victims of 65 years or older (OR: 1.48, 95 %CI:1.26-1.74, p < 0.001) and suburban locations (OR: 1.29,95 %CI: 1.04-1.62, p = 0.023). Conclusion: There are differences in cardiac arrestsdepending on whether they have been resuscitated bybystanders. These characteristics may influence thebystander’s decision to initiate resuscitation maneuvers (or not) and evolution.(AU)

Paro cardiorrespiratorio en la embarazada y cesárea perimortem / Maternal cardiac arrest and perimortem cesarean delivery

Resumen El paro cardiorrespiratorio (PCR) en la mujer embarazada es una situación infrecuente, grave y de manejo multidisciplinario. La reanimación cardiopulmonar requiere consideraciones y particularidades propias de la embarazada, centradas en la fisiología y la anatomía, teniendo especial consideración la compresión aortocava, la intubación-ventilación difícil, la presencia de estómago lleno y el hecho que hay dos vidas involucradas. Las principales causas de PCR son las hemorrágicas, seguidas de las embólicas, cardiovasculares, anestésicas e infecciosas. Las principales acciones incluyen activación del código azul obstétrico con respuesta rápida para una eventual realización de histerotomía de emergencia oportuna en el mismo sitio evitando el traslado al quirófano, compresiones torácicas de buena calidad, desviación manual uterina a la izquierda, intubación endotraqueal y manejo avanzado de la vía aérea, todo esto con el fin de mejorar la sobrevida materno-fetal. La cesárea perimortem es un pilar en el manejo, favoreciendo el desenlace materno y eventualmente el fetal. Se debe realizar a los 4 minutos de una reanimación cardiopulmonar no exitosa. Sin embargo, aún hay retardo a la hora de indicarla, por lo que se debe incentivar el entrenamiento, la simulación en resucitación cardiopulmonar materna y las guías clínicas para todo el personal involucrado en la atención de pacientes obstétricas.

Abstract Cardiopulmonary arrest is a rare event during pregnancy and labor. It involves many subspecialties and allied health providers. Besides it requires knowledge of maternal physiology as it relates to resuscitation, particularly aortocaval compression, difficult airway, full stomach and the fact that there are two lives involved. The most frequent causes of cardiac arrest during pregnancy include bleeding, followed by embolism, infection, anesthesia complications and heart failure. The main steps required are: obstetric code activation with appropriate response for performing timely emergent hysterotomy in the same place avoiding the transfer to operating room; good-quality chest compressions; manual uterine displacement to the left, advanced pharmacological and airway management; and optimal care after resuscitation to improve maternal and fetal outcomes. Although current recommendations for maternal resuscitation include the performance of perimortem cesarean section after four minutes of unsuccessful cardiopulmonary resuscitation, deficits in knowledge about this procedure are common. Therefore, training and available evidence-based guidelines should be put in place for all obstetric caregivers.

Reanimación cardiopulmonar en prono a propósito de un caso / Case report cardiopulmonary resuscitation in prone position

Prone position is necessary for some neurosurgical and othopedic procedures. Cardiopulmonary resuscitation (CPR) in prone position was first described by McNeil in 1989, since then several successful cases have been published. We report the case of a 72-year-old patient with history of stage IV breast cancer who presented acute spinal cord compression due to a vertebral fracture at T10 level. Surgical spinal cord decompression and posterior arthrodesis was performed. After three hours of surgery, cardiorespiratory arrest occur while patient was in prone position. Unestable spine and fixed head made turning the patient into supine position very difficult, consequently prone CPR manoeuvres were started with recovery of spontaneous circulation. In case of cardiorespiratory arrest in prone position, the intense fixation and the extent of the surgical incision make the change to supine a time-consuming and technically complex procedure. If cardiorespiratory arrest occurs in the prone position, CPR in the prone position might be reasonable.

La posición de decúbito prono es necesaria para la realización de algunos procedimientos neuroquirúrgicos y traumatológicos. La reanimación cardiopulmonar (RCP) en prono fue descrita por primera vez por McNeil en 1989, desde entonces se han publicado varios casos de RCP en prono con buen resultado. Presentamos el caso de una paciente de 72 años con antecedentes de carcinoma de mama estadio IV que presenta síndrome de compresión medular por fractura patológica a nivel de T10. Se decide realizar descompresión medular y artrodesis por vía posterior. A las 3 horas de la cirugía se produjo parada cardiorrespiratoria en prono. Dada la inestabilidad espinal y la fijación de la paciente, el cambio a supino era complejo por lo que se iniciaron maniobras de RCP en prono con posterior recuperación de circulación espontánea. En caso de parda cardiorrespiratoria en prono, la intensa fijación y la extensión de la incisión quirúrgica hace que el cambio a supino consuma tiempo y sea técnicamente complejo. Si la PCR ocurre en prono, está justificado iniciar las maniobras de RCP en esta posición.

Conhecimento teórico de graduandos sobre parada cardiorrespiratória no suporte básico de vida / Conocimientos teóricos de los estudiantes universitarios sobre la parada cardiorrespiratoria en soporte vital básico / Theoretical knowledge of undergraduates on cardiorespiratory arrest in basic life support

Objective identificar o conhecimento teórico de graduandos de cursos que não são da saúde sobre parada cardiorrespiratória no suporte básico de vida Method pesquisa descritiva e exploratória de natureza quantitativa realizada com graduandos de universidade pública localizada no Noroeste do Paraná, em 2019. Para coleta dos dados, utilizou-se questionário, contendo caracterização do sujeito e dez questões referentes ao reconhecimento e atendimento de situações de parada cardiorrespiratória e reanimação cardiopulmonar. Os dados foram tabulados e analisados. Results não se consideraram aptos para atendimento de evento de parada cardiorrespiratória 94,0% dos participantes; 92,6% não sabiam detectar essa condição; e 95,5% não souberam qual conduta adotar. Conclusion o conhecimento teórico de graduandos de cursos que não são da saúde sobre parada cardiorrespiratória foi insuficiente e é necessário treinamento para leigos em situações de emergência, para que o atendimento seja iniciado correta e imediatamente, sem postergar acionamento de serviço médico de emergência.

Objetivo identificar los conocimientos teóricos de los estudiantes universitarios de cursos no sanitarios sobre la parada cardiorrespiratoria en soporte vital básico. Método investigación descriptiva y exploratoria de carácter cuantitativo realizada con egresados de universidad pública ubicada en el Noroeste de Paraná, en 2019. Para la recolección de datos se utilizó un cuestionario, que contenía caracterización del sujeto y diez preguntas relacionadas con el reconocimiento y asistencia de situaciones de paro cardiorrespiratorio y reanimación cardiopulmonar. Los datos fueron tabulados y analizados. Resultados el 94,0% de los participantes no se consideraron aptos para el evento de paro cardiorrespiratorio; El 92,6% no sabía cómo detectar esta afección; y el 95,5% no sabía qué conducta adoptar. Conclusión los conocimientos teóricos de los estudiantes universitarios de cursos no sanitarios sobre parada cardiorrespiratoria fueron insuficientes y se requiere capacitación para los laicos en situaciones de emergencia, de modo que la atención se inicie de manera correcta e inmediata, sin posponer la activación del servicio médico de emergencia.

Objective to identify the theoretical knowledge of undergraduates of non-health courses about cardiorespiratory arrest on basic life support. Method descriptive and exploratory research of quantitative nature carried out with graduates of public university located in the Northwest of Paraná, in 2019. For data collection, a questionnaire was used, containing characterization of the subject and ten questions related to the recognition and attendance of situations of cardiorespiratory arrest and cardiopulmonary resuscitation. The data were tabulated and analyzed. Results 94.0% of the participants were not considered fit for cardiorespiratory arrest event; 92.6% did not know how to detect this condition; and 95.5% did not know which conduct to adopt. Conclusion the theoretical knowledge of undergraduates of non-health courses about cardiorespiratory arrest was insufficient and training is required for lay people in emergency situations, so that care is started correctly and immediately, without postponing emergency medical service activation.

Construção e validação de simulação em vídeo para ensino da ressuscitação cardiopulmonar / Construcción y evaluación de una simulación en video para la enseñanza de resucitación cardiopulmonar / Construction and validation of a video simulation for teaching cardiopulmonary resuscitation

RESUMO Objetivo: desenvolver Tecnologia Educacional Digital (vídeo de simulação) sobre Ressuscitação Cardiopulmonar no adulto em Suporte Básico de Vida com o uso do Desfibrilador Externo Automático no ambiente hospitalar. Metodologia: trata-se de uma pesquisa de produção tecnológica, aplicada. Desenvolvida na Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, no período de janeiro de 2017 a março de 2018. Expertises na área de Urgência e Emergência, 16 enfermeiros, participaram do estudo. Estatística AC1 foi utilizada para avaliar a concordância inter-avaliadores. Resultados: o roteiro/script e storyboard foi validado e alcançado 100% da avaliação em "concordo" ou "concordo fortemente". Classificados em "concordância considerável", com AC1 0,70 e p<0,0001, na concordância inter-avaliadores geral. Conclusão: este estudo proporciona contribuição exponencial no processo ensino-aprendizagem sobre o ensino de Ressuscitação Cardiopulmonar no adulto em Suporte Básico de Vida com o uso do Desfibrilador Externo Automático no ambiente hospitalar, pelo desenvolvimento do vídeo de simulação validado.

RESUMEN: Objetivo: desarrollar Tecnología Educativa Digital (video de simulación) sobre Resucitación Cardiopulmonar en adultos en Soporte Vital Básico con el uso del Desfibrilador Externo Automático en el entorno hospitalario. Metodología: se trata de una investigación de producción tecnológica aplicada que se desarrolló en la Universidad de San Pablo, Facultad de Enfermería de Ribeirão Preto, durante el período de enero de 2017 a marzo de 2018. Los participantes del estudio fueron especialistas en el área de Urgencia y Emergencia, específicamente 16 profesionales de Enfermería. Se utilizó la estadística AC1 para evaluar la concordancia entre los evaluadores. Resultados: se validaron el guion y el desarrollo secuencial (storyboard) con un 100% de las evaluaciones calificadas como "De acuerdo" o "Plenamente de acuerdo", clasificadas como "Concordancia considerable", con valores de AC1=0,70 y p<0,0001 en la concordancia general entre evaluadores. Conclusión: este estudio proporciona un aporte exponencial en el proceso de enseñanza-aprendizaje sobre la enseñanza de Resucitación Cardiopulmonar en adultos en Soporte Vital Básico con el uso del Desfibrilador Externo Automático en el entorno hospitalario, mediante el desarrollo del video de simulación validado.

ABSTRACT Objective: to develop Digital Educational Technology (simulation video) on Cardiopulmonary Resuscitation in adults in Basic Life Support with the use of the External Automated Defibrillator in the hospital environment. Methodology: this is an applied technological production research study developed at the University of São Paulo, Ribeirão Preto College of Nursing, from January 2017 to March 2018. Experts in the area of Urgency and Emergency, namely 16 nurses, participated in the study. The AC1 statistics was used to assess inter-rater agreement. Results: the script and storyboard were validated and reached 100% of the evaluation in "I agree" or "I strongly agree", classified as "Considerable agreement", with AC1=0.70 and p<0.0001, in general inter-rater agreement. Conclusion: this study provides an exponential contribution to the teaching-learning process on the teaching of Cardiopulmonary Resuscitation in adults in Basic Life Support with the use of the Automatic External Defibrillator in the hospital environment, through the development of the validated simulation video.

Analysis of a sustained educational intervention to teach cardiopulmonaryresuscitation to schoolchildren. / Análisis de una experiencia perdurable de un proyecto educativo de reanimación cardiopulmonar en un centro escolar.

EN: This project analyzed the feasibility, effectiveness, and sustainability of an educational project to teach cardiopulmonary resuscitation (CPR). This project has been carried out in a publicly subsidized school in a town in Asturias, Spain (population, over 80 000 inhabitants). The enrollment included students in preschool and both primary and secondary education classes. The project had 3 phases: 1) health care experts trained the teachers in CPR and they designed the educational project together; 2) health care experts taught CPR to schoolchildren, and 3) teachers taught CPR to the children. All the children enrolled in preschool and primary school (aged 3 to 12 years) initially participated in the study. Training followed the 2005 guidelines of the International Liaison Committee on Resuscitation (ILCOR) in effect at the time of the study. In the first phase (2006), 19 teachers (79.2% of the faculty) were trained in basic CPR and collaborated with the health care professionals in designing the course, including setting its objectives and developing materials. In the second phase (2006-2011), the health care professionals trained 646 preschool and primary school children and accredited 13 teachers (54.2% of the faculty) in the use of an automated external defibrillator (AED) and to serve as CPR instructional monitors. In the third phase (2012-2014), 7 teachers trained 703 preschool and primary and secondary school students, and 17 teachers (70.8% of the faculty) received training to become CPR monitors and/or to update their knowledge of AED use. A total of 1349 students between the ages of 3 and 15 years received instruction in CPR. The school has had an AED on its premises since 2011. The teachers have made further improvements in the courses, incorporating new teaching materials, updating the objectives, and extending instruction to secondary school students. The implementation of an educational program to teach CPR in a school that enrolls preschool through secondary school students was feasible and sustainable. Teachers have improved the program, extended it to secondary school students, and made the project known in the local media and on the school's web site, thus contributing to the creation of a CPR culture that reached out to the community.

ES: Se analiza la experiencia de un proyecto educativo de reanimación cardiopulmonar básica (RCPB) en un centro escolar valorando si es viable, efectivo y perdurable en el tiempo. Se trata de un proyecto desarrollado en un centro de enseñanza concertada de educación infantil (EI), primaria (EP) y secundaria (ESO), ubicado en un concejo muy poblado de Asturias, de más de 80.000 habitantes, en tres fases: 1) formación de maestros por personal sanitario y diseño conjunto del proyecto; 2) formación de escolares por personal sanitario, y 3) formación de niños por sus profesores. Se incluyeron todos los alumnos matriculados en el colegio en EI y EP (3 a 12 años). La formación impartida siguió las recomendaciones ILCOR (International Liaison Committee on Resuscitation) 2005, vigentes en aquel momento. En la fase 1 (año 2006) 19 profesores (79,2% de la plantilla) recibieron formación en RCPB y diseñaron con el personal sanitario los objetivos y material a emplear para cada curso. En la fase 2 (2006-2011) el personal sanitario formó a 646 escolares de EI y EP, y acreditó a 13 maestros (54,2% de la plantilla) para utilizar un DEA y como monitores de RCPB. En la fase 3 (2012-2014) 7 maestros formaron a 703 alumnos de EI, EP y ESO; 17 profesores (70,8% de la plantilla) recibieron cursos de monitor de RCPB y reciclajes DEA. En total recibieron formación en RCPB 1.349 niños entre 3 y 15 años. Desde el año 2011, el colegio cuenta con un DEA. Los profesores han mejorado el proyecto incorporando nuevos materiales, adelantado objetivos y extendiéndolo a los alumnos de ESO. La implantación de un proyecto educativo en RCPB en un colegio de enseñanza concertada de EI, EP y ESO de Asturias fue viable y ha perdurado. El profesorado ha mejorado el proyecto y lo ha extendido a los alumnos de secundaria, difundiendo la RCPB en medios de comunicación locales y en su página web, creando una cultura de la RCPB y acercándola a toda la comunidad.

Reflection and Updates: Cardiopulmonary Resuscitation -Guidelines 2015 - Contribution to Nursing / Reflexión y actualizaciones: Resucitación cardiopulmonar -Pautas 2015 - Contribución a la enfermería

ABSTRACT The occurrence of cardiac arrest is a stressful and critical event. Despite technological advances in the training of cardiopulmonary resuscitation (CPR) techniques, mortality remains high, and patients survive up to discharge with high levels of neurological complications. The European Resuscitation Council guidelines and the American Heart Association as of 2015 hold the best recommendations in performing CPR.

RESUMEN La ocurrencia de un paro cardíaco es un evento estresante y crítico. A pesar de los avances tecnológicos en la práctica de técnicas de resucitación cardiopulmonar (RCP), la mortalidad sigue siendo alta, y los pacientes sobreviven al alta hospitalaria con altos niveles de complicaciones neurológicas. Las guías del Consejo Europeo de Resucitación y la Asociación Americana del Corazón a partir de 2015, poseen las mejores recomendaciones para realizar RCP.

Guía para la enseñanza del apoyo vital prehospitalario. Consenso para el proyecto de formación e investigación en apoyo vital. Cienfuegos, 2018 / Guideline for teaching pre-hospital life support. Consensus for the project of training and research in life support. Cienfuegos 2018

Fundamento: En el escenario prehospitalario la mortalidad por emergencias médicas es alta, principalmente cuando los episodios se producen antes del arribo al sistema de salud. El personal de salud debe estar entrenado para enfrentar estas emergencias en ese contexto. El proyecto para la formación e investigación en apoyo vital en emergencias y desastres puede ser un marco académico para lograrlo.Objetivo: actualizar para el proyecto, las guías y estrategia docente para la enseñanza del apoyo vital ante emergencias en el ámbito prehospitalario.Métodos: se desarrolló un Taller nacional con ocho expertos y seis informantes clave, los días 10 y 11 de julio del 2018, en Cienfuegos. Además de la revisión documental, fueron aplicadas la técnica de tormenta de ideas, la de grupo nominal y el cuestionario semiestructurado.Desarrollo: los elementos propuestos para la enseñanza del apoyo vital prehospitalario, tanto en el pregrado como el posgrado, fueron los siguientes: objetivos, aspectos didácticos, estrategia docente, contenidos, alcance, habilidades a desarrollar, futuras investigaciones y áreas para la colaboración interinstitucional. Se definió la estructura de un curso prototipo para la enseñanza del tema y las principales consideraciones para su ejecución.Conclusión: las propuestas académicas para el curso Apoyo vital prehospitalario contienen los elementos básicos para la preparación de los profesionales y estudiantes de la salud para brindar asistencia médica en el escenario einstituciones del nivel primario de atención.

Foundation: In the pre hospital scenario mortality due to emergencies is high, mainly because episodes are produced before arriving to the health system. Health personnel should be trained for facing these emergencies in this context. The project for training and researching in life support in emergencies and disasters nay be an academic framework to achieve it.Objective: to update the Project, guidelines and teaching strategy for training life support before emergencies in pre hospital emergencies.Method: qualitative study which had as a starting point the development of a National Workshop with 8 experts and 6 key informers, on July 10th and 11th in Cienfuegos. Besides documentary review, there were applied the techniques of brainstorming, nominal group, semi structured questionnaire.Results: the elements proposed for teaching pre-hospital life support, in under graduate and postgraduate courses were the following: objectives, didactical elements, teaching strategy, content, scope, skills to be developed, future research and areas of inter institutional collaboration. It was defined that the structure of a course model for teaching the topic and the main considerations for its execution.Conclusion: academic proposals for life support contain basic elements for training health professionals and students to provide medical assistance at site and in institutions of firs level of health.

Propuesta de entrenamiento en emergencias y reanimación cardiopulmocerebral para testigos presenciales no profesionales de la salud / Proposal of training in cardio-pulmonary-cerebral emergencies and resuscitation for health non-professional eyewitnesses

Fundamento: La atención a las emergencias y la parada cardiorrespiratoria cerebral constituye una prioridad en los momentos actuales; cuando esta se realiza desde los primeros minutos, por personas no profesionales, presentes en el lugar del suceso, los resultados son favorables para el paciente y la sociedad.Objetivo: describir los resultados de una propuesta de entrenamiento para la formación de habilidades en la atención a las emergencias y la parada cardiorrespiratoria, para testigos presenciales no profesionales de la salud.Métodos: estudio cuasiexperimental, con diseño de antes y después, realizado en la ciudad de Holguín, entre enero y julio del 2018. Fue diseñada una propuesta de capacitación de cinco horas presenciales (curso teórico -práctico) para la enseñanza de la reanimación. Se trabajó con 108 personas, a las cuales se aplicó un diagnóstico antes y después de la intervención educativa.Resultados: el grupo estuvo compuesto principalmente por adolescentes y adultos de nivel medio superior, que desconocían del tema pues no habían recibido capacitación ni información al respecto. La intervención mejoró los conocimientos teóricos y prácticos sobre reanimación, las habilidades para el diagnóstico y la conducta ante las principales alteraciones cardiorrespiratorias que precisan apoyo vital básico.Conclusión: la propuesta de capacitación para la formación de habilidades en la atención a las emergencias y la parada cardiorrespiratoria fue aceptada por los participantes en el curso. El entrenamiento favoreció la adquisición de habilidades y conocimientos sobre resucitación.

Foundation: assisting emergencies and cardio respiratory cerebral failure is currently a priority; when it is performed by non- professionals from the very first minutes present at the moment at the place of event, results are favorable for the patient and the society.Objective: to describe the results of a training proposal for skill development in assisting emergencies and cardio-respiratory failure, for eyewitness non-health professionals.Methods: it is a quasi-experimental study with previous and after design, developed in the Holguin City, between January and July 2018. It was designed a training proposal of 5 hours face to face course (theoretical and practical course) for teaching resuscitation. It was worked with 108 persons, to whom a diagnostic test was applied before and after the educative intervention.Results: the group was composed mainly by teenagers and adults with high school level, who did not know about the topic since they had never been trained nor had information about the topic. The intervention improved theoretical and practical knowledge about resuscitation, skills for the diagnosis and the conduct before main cardio-respiratory disturbances, which require life support.Conclusion: the training proposal for developing skills for assisting emergencies and cardio-respiratory failure was accepted by the participating people in the course. It favored the acquisition of abilities and knowledge about resuscitation.

Publicaciones cubanas sobre reanimación cardiopulmocerebral: una aproximación bibliométrica. 1998 - 2018 / Cuban publications about cardio-pulmonary-cerebral resuscitation: a bibliometric approach from 1998 to 2018

Introducción: A lo largo de los años se han realizado múltiples investigaciones sobre reanimación cardiopulmonar (RCP); aparecen nuevas evidencias y se publican regularmente artículos científicos que muestran su desarrollo. Objetivo: Caracterizar las publicaciones científicas sobre RCP en Cuba. Métodos: Estudio bibliométrico descriptivo, retrospectivo, realizado entre enero de 1998 y noviembre de 2018. Se revisaron todas las publicaciones cubanas en las revistas médicas indexadas en el Scientific Electronic Library Online (Scielo). No se incluyeron editoriales ni cartas al editor. Se diseñó una ficha de registro en Microsoft Office Excel 2010, en la cual se organizó la información de los artículos para su identificación, conteo y análisis de los indicadores bibliométricos. Resultados: De los 83 artículos indexados en Scielo, solo 24 cumplieron los criterios de inclusión; existió un predominio de los artículos originales con 58,3 %, seguido de las revisiones. En cuanto al número de autores por artículo, la categoría de 3 a 6 autores fue la más frecuente. El año de mayor publicación fue 2017, con 5 artículos. Conclusiones: La producción científica relacionada con la reanimación cardiopulmocerebral ha sido inestable y pobre. Los periodos de mayor productividad científica fueron durante los años 2003 y 2017. Se muestra un predominio de los artículos originales seguidos por las revisiones.

Introduction: multiple researches have been developed along the years about cardio-pulmonary (CPR); new evidences appear and scientific articles are published regularly which show its development. Objective: to characterize scientific publications about CPR in Cuba. Methods: descriptive bibliometric, retrospective study done from January 1998 to November 2018. All Cuban publications indexed to Scientific Electronic Library Online (Scielo) were reviewed. Editorials and letters to the editor were not included. It was designed a registration folder in Microsoft Office Excel 2010, in which the information about the articles was organized for their identification, counting and analysis of the bibliometric indicators. Results: from the 83 articles indexed in Scielo, only 24 had the requirements to be included, there was predominance of original articles with 58, 3%, followed by reviews. Regarding the number of authors per article the category 3 to 6 authors was the most frequent, with 5 articles. Conclusion: scientific production related to cardio-pulmonary-cerebral resuscitation has been unstable and poor. The periods of greater scientific production were 2003 and 2017. There is a predominance of original articles followed by reviews.

Caracterización clínica de pacientes con parada cardiorrespiratoria / Clinical characterization of patients with cardiorespiratory arrest

Introducción: El paro cardiorrespiratorio constituye una emergencia médica, con grave peligro de muerte en quien lo sufre. Objetivo: Caracterizar los factores clínicos asociados al paro cardiorrespiratorio en pacientes atendidos en el servicio de urgencias. Método: Estudio observacional transversal. Serie de 108 pacientes. Variables: edad, sexo, presencia de comorbilidad y grado de comorbilidad. Resultados: Los factores que mayores porcentajes mostraron con el riesgo de fallecer fueron: la edad superior a los 50 años (52,9 por ciento), el sexo masculino (57,5 por ciento), los antecedentes de hipertensión arterial (72,4 por ciento), cardiopatía isquémica (37,9 por ciento) y diabetes mellitus (28,2 por ciento), y la presencia de una comorbilidad de por lo menos dos enfermedades (44,8 por ciento). Conclusiones: El conocimiento de las variables clínicas y factores pronósticos identificados resultan de inestimable valor, ya que optimizan el proceso de toma de decisiones en el manejo del paro cardiorrespiratorio y por tanto en la salvación de vidas humanas(AU)

Introduction: Cardiorespiratory arrest constitutes a medical emergency, with serious danger of death in those who suffer it. Objective: To determine the clinical prognostic factors associated with the patient with cardiorespiratory arrest attended in the emergency department. Method: Cross-sectional observational study. Sample of 108 patients. Variables: age, sex, comorbidity and degree of comorbidity. Results: The factors that showed the highest percentages with the risk of dying were: age over 50 years (52.9 percent), male sex (57.5 percent), history of arterial hypertension (72.4 percent), ischemic heart disease (37.9 percent) and diabetes mellitus (28.2 percent), and the presence of a comorbidity of at least two diseases (44.8 percent). Conclusions: The factors that showed the highest percentages in relation to the risk of dying after a CRP episode were age over 50 years, male sex, history of hypertension, ischemic heart disease and diabetes mellitus, and the presence of comorbidity of at least two non-communicable chronic diseases(AU)

Does level D personal protective equipment guard against hazardous biologic agents during cardiopulmonary resuscitation? / ¿Afecta el uso de un equipo de protección individual frente a riesgos biológicos nivel D a la realización de una reanimación cardiopulmonar?

OBJECTIVES: Our aim was to determine the usefulness of level D personal protective equipment (PPE) in safeguarding health care staff who perform cardiopulmonary resuscitation (CPR). MATERIAL AND METHODS: Quasi-experimental, uncontrolled trial in 96 volunteers chosen randomly and stratified by sex, level of training, and professional category. The subjects were selected from a convenience sample of 164 nurses, physicians, and students of nursing and medicine (40 men [41.66%] and 56 women [58.33%]). The mean (SD) age was 31 (11) years. The Conconi test was used to determine heart rate (HR) at the anaerobic threshold on a cycle ergometer. That HR was then compared to each volunteer's maximum HR during performance of CPR while wearing PPE. RESULTS: While the volunteers were performing CPR, 46.9% of them surpassed their maximum recommendable HR recorded during the cycle ergometer test. CONCLUSION: We found that performing CPR while wearing level D PPE requires intense physical effort. Special situations should be taken into consideration when developing protocols for situations that require staff to wear PPE. Staff who must perform CPR under these conditions should be given specific training.

OBJETIVO: Determinar cómo afecta el uso de los equipos de protección individual (EPI) nivel D a los trabajadores de la salud cuando realizan una reanimación. METODO: Estudio cuasiexperimental no controlado sobre 96 voluntarios elegidos mediante un muestreo aleatorio estratificado por sexo, nivel de formación y categoría profesional, de una muestra de oportunidad de 164 voluntarios, 40 hombres (41,66%) y 56 mujeres (58,33%), con una edad media de 31 (DE 11) años, estudiantes de medicina y enfermería y profesionales médicos y enfermeros. Mediante el uso de un protocolo Conconi con cicloergometría se obtuvo la frecuencia cardiaca (FC) del umbral anaeróbico de los voluntarios, y después se comparó con la FC máxima de los voluntarios durante la realización de una reanimación con el EPI colocado. RESULTADOS: Durante los minutos correspondientes a la realización del masaje cardiaco externo durante la reanimación en el caso clínico, un 46,9% de los voluntarios sobrepasan la FC máxima recomendable obtenida mediante la ciclo ergometría. CONCLUSIONES: Nuestro estudio encontró que la realización de una reanimación con un EPI nivel D supone un sobresfuerzo físico muy intenso. Es necesario tener contemplado en los protocolos estas situaciones especiales e implementar un entrenamiento específico para aquellos reanimadores que deban trabajar con este tipo de pacientes.

[Ventilation during cardiopulmonary resuscitation in the infant. Mouth to mouth and nose, or bag-valve-mask? A quasi-experimental study]. / Ventilación durante la reanimación cardiopulmonar en el lactante: ¿boca a boca y nariz o con bolsa autoinflable? Un estudio cuasiexperimental.

INTRODUCTION: It has been observed that health professionals have difficulty performing quality cardiopulmonary resuscitation (CPR). The aim of this study was to compare the quality of ventilations performed by Nursing students on an infant model using different methods (mouth-to-mouth-and-nose or bag-valve-mask). MATERIAL AND METHODS: A quasi-experimental cross-sectional study was performed that included 46 second-year Nursing students. Two quantitative 4-minute tests of paediatric CPR were performed: a) mouth-to-mouth-and-nose ventilations, and b) ventilations with bag-valve-mask. A Resusci Baby QCPR Wireless SkillReporter® mannequin from Laerdal was used. The proportion of ventilations with adequate, excessive, and insufficient volume was recorded and analysed, as well as the overall quality of the CPR (ventilations and chest compressions). RESULTS: The students were able to give a higher number of ventilations with adequate volume using the mouth-to-mouth-and-nose method (55±22%) than with the bag-valve-mask (28±16%, P<.001). The overall quality of the CPR was also significantly higher when using the mouth-to-mouth-and-nose method (60±19 vs. 48±16%, P<.001). CONCLUSIONS: Mouth-to-mouth-and-nose ventilation method is more efficient than bag-valve-mask ventilations in CPR performed by nursing students with a simulated infant model.

Effect of 3basic life support training programs in future primary school teachers. A quasi-experimental design. / Efecto de 3métodos de enseñanza en soporte vital básico en futuros maestros de Educación Primaria. Un diseño cuasiexperimental.

AIM: To evaluate the learning of basic life support (BLS) measures on the part of laypersons after 3different teaching programs. DESIGN: A quasi-experimental before-after study involving a non-probabilistic sample without a control group was carried out. SCOPE: Primary school teacher students from the University of Santiago (Spain). PARTICIPANTS: A total of 124 students (68.8% women and 31.2% men) aged 20-39 years (M=22.23; SD=3.79), with no previous knowledge of BLS, were studied. INTERVENTIONS: Three teaching programs were used: a traditional course, an audio-visual approach and feedback devices. MAIN VARIABLES OF INTEREST: Chest compressions as sole cardiopulmonary resuscitation skill evaluation: average compression depth, compression rate, chest recoil percentage and percentage of correct compressions. Automated external defibrillator: time needed to apply a shock before and after the course. RESULTS: There were significant differences in the results obtained after 2minutes of chest compressions, depending on the training program received, with feedback devices having a clear advantage referred to average compression depth (p<0.001), compression rate (p<0.001), chest recoil percentage (p<0.001) and percentage of correct compressions (p<0.001). Regarding automated external defibrillator, statistically significant differences were found in Tafter (p=0.025). CONCLUSIONS: The teaching course using feedback devices obtained the best results in terms of the quality of chest compressions, followed by the traditional course and audio-visual approach. These favorable results were present in both men and women. All 3teaching methods reached the goal of reducing defibrillation time.

Frecuencia de órdenes de no reanimación en un hospital universitario de cuarto nivel de complejidad / Do-not-resuscitate orders frecuency in a fourth level university Hospital

Las órdenes de no reanimación (ONR) surgen luego de la introducción de la reanimación cardiopulmonar (RCP) en la práctica clínica como una alternativa para los pacientes que, por diferentes motivos, no eran candidatos para recibir este tipo de manejo médico. Con el tiempo se han incrementado las decisiones de no reanimar a los pacientes, posiblemente por el envejecimiento de la población, el aumento en la prevalencia de patologías oncológicas o una mayor sensibilización de los médicos en cuanto a los desenlaces de los pacientes que son llevados a una RCP. De acuerdo con lo anterior, se desarrolló este estudio con el objetivo de conocer y describir la frecuencia de las ONR y RCP en los pacientes que murieron en un hospital de cuarto nivel en la ciudad de Bogotá. Igualmente, se describieron las características demográficas de estos pacientes.

After the introduction of the cardiopulmonary resuscitation into clinical practice, non-resuscitation orders emerged as an alternative for those patients that, for several reasons, were not candidates to receive this type of medical treatment. Over time the non-resuscitation orders have increased in number, possibly due to the aging of the population, an increase in the prevalence of oncological pathologies or greater awareness of the physicians regarding the outcomes of the patients being carried to a CPR. According to the above, this study was developed with the objective of knowing and describing the frequency of ONR and CPR in patients who died in a 4th level hospital in the city of Bogotá. Likewise, the demographic characteristics of these patients were described.

La reanimación cardiopulmonar desde la experiencia del estudiante: estudio de caso / Cardiopulmonary Resuscitation Experience from Student: Case Study / Ressuscitação cardiopulmonar desde a experiência do estudante: estudo de caso

Introducción: la reanimación es un momento de cuidado que en el profesional de enfermería genera sentimientos y emociones para los cuales no se está preparado, debido a que la formación está centrada en el componente teórico-práctico. Esta situación es similar a la del estudiante. Objetivo: describir la experiencia del estudiante durante la reanimación cardiopulmonar, a fin de reconocer aspectos esenciales para la formación profesional. Materiales y método: abordaje cualitativo, fenomenológico, mediante un estudio de caso. Para recolectar y analizar la información se utilizó la entrevista semiestructurada y la observación, que se registró en notas de campo. Resultados: las categorías que surgieron del análisis se denominaron: conciencia de la subjetividad, apoyo del docente, cuestionamiento frente a la cotidianidad de la muerte en el equipo de salud, la vida como motivación y el resignificado de la muerte. Se contrastaron los resultados de la investigación a la luz de la literatura. Conclusiones: el estudiante experimenta vivencias en las cuales aflora la subjetividad; la muerte es una de ellas y tiene mayor significado cuando se asume por primera vez, puesto que no se está preparado para abordarla. Ayudar a morir con dignidad y acompañar en el sufrimiento requiere formación, conocimiento y madurez, en el futuro profesional, dada la implicación emocional que genera. Por tanto, se deben propiciar espacios de reflexión en torno a estas situaciones críticas, preferiblemente desde las experiencias de los mismos estudiantes, para fortalecer los aspectos que hacen de esta una experiencia enriquecedora.

Introduction: Cardiopulmonary CPR resuscitation is a moment of care generated in the professional nursing feelings and emotions for which you are not prepared, because the training is focused on the theoretical and practical component; this situation is similar to the student. Aim: To describe the student experience during CPR, to recognize essential aspects for vocational training. Materials and Methods: A qualitative approach, phenomenological, through a case study. To collect and analyze information through semistructured interviews and observation was recorded in field notes was used. Results: The categories that emerged from the analysis were named: Awareness of subjectivity, teacher support, questioning face death every day in the health team, life as motivation and redefined death. The results of research in the light of the literature were contrasted. Conclusions: The student experiences where subjectivity comes out, death is one of them and has more meaning when it is assumed for the first time, since you are not prepared to address it. Helping to die with dignity and accompany suffering requires training, knowledge and maturity in the professional future, given the emotional involvement it generates. Therefore, should promote opportunities for reflection on these critical situations, preferably from the experiences of these students in order to strengthen the aspects that make this an enriching experience.

Introdução: a ressuscitação cardiopulmonar (RCP) é um momento de cuidado que no professional de enfermagem gera sentimentos e emoções para as quais não está preparado, porque o treinamento é focado na teória e na prática. Objetivo: descrever a experiência do estudante durante a RCP, para reconhecer aspectos essenciais para a formação profissional. Materiais e métodos: abordagem qualitativa, fenomenológica, através de um estudo de caso. Para recolher e analisar a informação, nós usamos entrevistas e observação semi-estruturada que foi gravada em notas de campo. Resultados: as categorias que emergiram da análise foram nomeados: a consciência da subjetividade, apoio dos professores, questionando diante a cotidianidade da morte na equipe de saúde, a vida como motivação e o entendimento da morte. Os resultados da pesquisa foram comparados à luz da literatura. Conclusões: o estudante tem experiências onde a subjetividade emerge, a morte é uma delas e tem mais significado quando e assumida pela primeira vez, porque a pessoa não está preparada para enfrentá-lo. Ajudar a morrer com dignidade e acompanhar no sofrimento que exige formação, conhecimento e maturidade, no futuro profissional, dado o envolvimento emocional que ele gera. Portanto, ele deve promover espaços para a reflexão sobre estas situações críticas, de preferência a partir das experiências dos próprios alunos, a fim de reforçar os aspectos que tornam esta uma experiência enriquecedora.