Should We Prolong the Observation Period for Neurological Recovery After Cardiac Arrest?

OBJECTIVES: To evaluate whether the recommended observation period of 7 days for cardiac arrest survivors is sufficient for conscious recovery and to identify the variables associated with eventual neurologic recovery among patients with delayed awakening. DESIGN: A retrospective cohort study. SETTING: A single tertiary medical center. PATIENTS: Five-hundred twenty-nine nontraumatic adult cardiac arrest survivors with prearrest favorable neurologic function (Cerebral Performance Category 1-2) who survived to hospital discharge during 2011-2019. INTERVENTIONS: The enrolled patients were classified into favorable (Cerebral Performance Category 1-2) and poor (Cerebral Performance Category 3-4) neurologic recovery according to their neurologic function at hospital discharge. Among patients with favorable neurologic recovery, those who recovered within 7 days were assigned to the early recovery group or after 7 days as the late recovery group. MEASUREMENTS AND MAIN RESULTS: There were 395 patients exhibiting favorable neurologic recovery (n = 357 in the early group, n = 38 in late group) and 134 patients exhibiting poor neurologic recovery (poor recovery group). Among patients who remained unconscious on day 7, delayed awakening was associated with male sex (odds ratio [OR], 3.905; 95% CI, 1.153-13.221), prehospital return of spontaneous circulation (OR, 7.628; 95% CI, 2.084-27.922), therapeutic hypothermia (OR, 4.320; 95% CI, 1.624-11.488), and extracorporeal cardiopulmonary resuscitation (OR, 4.508; 95% CI, 1.414-14.371). Being transferred from another hospital, however, was less likely to be associated with delayed awakening (OR, 0.061; 95% CI, 0.009-0.431). The median duration for patients to regain clear consciousness in the late recovery group was 12.12 days. No patient who recovered consciousness had an unfavorable electroencephalography pattern, however, in patients with poor recovery, the 7-day electroencephalography showed 45 patients with generalized suppression (33.6%), two with burst suppression (1.5%), 14 with seizure/epileptic discharge (10.5%), and one with status epilepticus (0.7%). CONCLUSIONS: Up to 9.6% of cardiac arrest patients with favorable outcomes recover consciousness after the recommended 7 days of observation, indicating the observation time of 7 days seems justified but longer duration may be needed. The results of the culturally and clinically isolated population may limit the application to other population.

Preclinical neurorehabilitation with environmental enrichment confers cognitive and histological benefits in a model of pediatric asphyxial cardiac arrest.

Pediatric asphyxial cardiac arrest (ACA) often leaves children with physical, cognitive, and emotional disabilities that affect overall quality of life, yet rehabilitation is neither routinely nor systematically provided. Environmental enrichment (EE) is considered a preclinical model of neurorehabilitation and thus we sought to investigate its efficacy in our established model of pediatric ACA. Male Sprague-Dawley rat pups (post-natal day 16-18) were randomly assigned to ACA (9.5 min) or Sham injury. After resuscitation, the rats were assigned to 21 days of EE or standard (STD) housing during which time motor, cognitive, and anxiety-like (i.e., affective) outcomes were assessed. Hippocampal CA1 cells were quantified on post-operative day-22. Both ACA + STD and ACA + EE performed worse on beam-balance vs. Sham controls (p < 0.05) and did not differ from one another overall (p > 0.05); however, a single day analysis on the last day of testing revealed that the ACA + EE group performed better than the ACA + STD group (p < 0.05) and did not differ from the Sham controls (p > 0.05). Both Sham groups performed better than ACA + STD (p < 0.05) but did not differ from ACA + EE (p > 0.05) in the open field test. Spatial learning and declarative memory were improved and CA1 neuronal loss was attenuated in the ACA + EE vs. ACA + STD group (p < 0.05). Collectively, the data suggest that providing rehabilitation after pediatric ACA can reduce histopathology and improve motor and cognitive ability.

Parada cardiorrespiratória na pandemia por coronavírus: revisão compreensiva da literatura / Cardiorespiratory arrest in a coronavirus pandemic: comprehensive literature review / Paro cardiorrespiratorio en una pandemia de coronavirus: revisión exhaustiva de la literatura

Objetivo: apresentar atualizações para a ressuscitação cardiopulmonar em pacientes suspeitos e confirmados com COVID-19. Método: revisão compreensiva da literatura, com síntese narrativa das evidências de diretrizes e recomendações da Organização Mundial de Saúde, Associação de Medicina Intensiva Brasileira, American Heart Association, Resuscitation Council UK, American College of Surgions Committee on Trauma e National Association of Emergency Medical Technicians. Resultados: as principais atualizações trazem informações sobre especificidades das manobras de ressuscitação cardiopulmonar; preparação do ambiente, recursos humanos e materiais, reconhecimento da parada cardiorrespiratória e ações iniciais; estratégias de ventilação e acesso invasivo da via aérea; ajustes do ventilador mecânico e manobras de ressuscitação cardiopulmonar em pacientes pronados. Considerações finais: profissionais de saúde envolvidos no atendimento à parada cardiorrespiratória de pacientes suspeitos e/ou confirmados com COVID-19 podem encontrar inúmeros desafios, portanto devem seguir com rigor o protocolo estabelecido para maximizar a efetividade das manobras de ressuscitação e minimizar o risco de contágio pelo vírus e sua disseminação.

Objective: to present updates for cardiopulmonary resuscitation in suspected and confirmed patients with COVID-19. Method: comprehensive literature review with narrative synthesis of the evidence of guidelines and recommendations from World Health Organization, Associação de Medicina Intensiva Brasileira, American Heart Association, Resuscitation Council UK, American College of Surgions Committee on Trauma and National Association of Emergency Medical Technicians. Results: the main updates bring information about the specifics of cardiopulmonary resuscitation maneuvers; preparation of the environment and human and material resources, recognition of cardiorespiratory arrest and initial actions; ventilation and invasive airway access strategies; mechanical ventilator adjustments and cardiopulmonary resuscitation maneuvers in patients in the prone position. Final considerations: health professionals involved in the care of cardiorespiratory arrest of suspected and/or confirmed patients with COVID-19 can face numerous challenges, so they must strictly follow the protocol established to maximize the effectiveness of resuscitation maneuvers and minimize the risk of contagion by the virus and its spread.

Objetivo: apresentar actualizaciones para la reanimación cardiopulmonar en pacientes sospechos os y confirmados con COVID-19. Método: revisión exhaustiva de la literatura con síntesis narrativa de la evidencia de guías y recomendaciones de la Organización Mundial de la Salud, Associação de Medicina Intensiva Brasileira, American Heart Association, Resuscitation Council UK, American College of Surgions Committee on Trauma and National Association of Emergency Medical Technicians. Resultados: las principales actualizaciones aportan información sobre los detalles de las maniobras de reanimación cardiopulmonar; preparación del medio ambiente y recursos humanos y materiales, reconocimiento de paro cardiorrespiratorio y acciones iniciales; estrategias de ventilación y acceso invasivo a las vías aéreas; ajustes del ventilador mecánico y maniobras de reanimación cardiopulmonar en pacientes en decúbito prono. Consideraciones finales: los profesionales de la salud involucrados en la atención del paro cardiorrespiratorio de pacientes sospechosos y/o confirmados con COVID-19 pueden enfrentar numerosos desafíos, por lo que deben seguir estrictamente el protocolo establecido para maximizar la efectividad de las maniobras de reanimación y minimizar el riesgo de contagio por el virus y supropagación.

Desafios no manejo da parada cardiorrespiratória durante a pandemia da COVID-19: um estudo de reflexão / Challenges in the management of cardiopulmonary arrest during the COVID-19 pandemic: a reflection study / Desafíos en el manejo del paro cardiorrespiratorio durante la pandemia de COVID-19: un estudio de reflexión

Introdução: Com o início da pandemia, inquietações quanto à condução da parada cardiorrespiratória em casos suspeitos e confirmados da COVID-19 surgiram ante as peculiaridades e publicações científicas quanto à temática. Dessa forma, o presente estudo apresenta uma reflexão e demonstra as novas recomendações acerca dos cuidados necessários a serem adotados pela equipe multiprofissional. Método: Trata-se de um estudo de reflexão teórica, de caráter descritivo e abordagem qualitativa com base em documentos convencionais e não convencionais emitidos pelos principais órgãos reguladores e revistas de grande impacto que abordam as temáticas discorridas. Além disso, não houve recorte temporal para a seleção do referencial bibliográfico. Resultados: Os resultados expostos abordaram o cuidado relacionado com os recursos humanos e materiais envolvendo a temática, o manejo da via aérea nesse evento em pacientes que estavam ou não em uso de intubação endotraqueal, assim como em relação aos indivíduos em posição prona. Conclusão e implicações para a prática: Diante das discussões apresentadas, é evidente a necessidade de atualização por parte das instituições de saúde em suas rotinas e dos profissionais que se encontram neste estudo como mecanismo de proteção e manutenção da qualidade do cuidado prestado

Introduction: With the onset of the pandemic, concerns emerged about the management of cardiorespiratory arrest in suspected and confirmed cases of COVID-19 considering its singularities and scientific publications on the subject. Thus, this study presents a reflection about the new recommendations for patient care that must be adopted by multiprofessional teams. Method: This is a theoretical qualitative descriptive study that analyzed conventional and unconventional documents issued by the main regulatory bodies and high impact magazines addressing the study topics. No time frame was considered when selecting the bibliographic references. Results: The results addressed patient care with human and material resources involving the theme, the airway management in patients affected by COVID-19, whether they were using endotracheal intubation or not, and the approach for individuals in prone position. Conclusion and implications for the practice: In view of the discussions presented, health institutions and professionals must update their routines as a mechanism to protect and maintain the quality of care provided

Introducción: Con el inicio de la pandemia, preocupaciones sobre la conducción del paro cardiorrespiratorio en casos sospechosos y confirmados de COVID-19 ante las peculiaridades y publicaciones científicas sobre el tema. Así pues, este estudio presenta una reflexión y demuestra las nuevas recomendaciones sobre los cuidados que deben adoptarse por el equipo. Método: Se trata de un estudio de reflexión teórica, de carácter descriptivo y enfoque cualitativo, basado em documentos convencionales y no convencionales emitidos por los principales organismos reguladores y revistas de alto impacto que abordan los temas tratados. Además, no hubo un recorte temporal para la selección de la referencia bibliográfica. Resultados: Los resultados expuestos abordaron el cuidado relacionado con los recursos humanos y materiales involucrando la temática, el manejo de la vía aérea en este evento, en pacientes que usaban o no intubación endotraqueal, como también en relación de individuos en posición prona. Conclusión e implicaciones para la práctica: Ante las discusiones presentadas, es evidente la necesidad de actualización por las instituciones de salud en sus rutinas y de los profesionales que se encuentran en este estudio, como mecanismo de protección y mantenimiento de la calidad del cuidado ministrado

Reanimación cardiopulmonar en pacientes con coronavirus SARS-CoV-2 en posiciones supino y prono / Cardiopulmonary resuscitation in coronavirus SARS-CoV-2 patients in supine and prone positions

During this Pandemic it has been reported that 5% of cases require an Intensive Care Unit. Certain patients who present hypoxemia, acidosis, electrolyte disorders or adverse effects of drugs such as hydroxychloroquine, may end up in Cardiac Arrest. In these patients, it is recommended to provide high-quality cardiopulmonary resuscitation with all biosecurity measures. What should be done in the event of sudden cardiac arrest? The ethical obligation of health personnel is to resuscitate, but with the responsibility of personal protection, that is, with the precept of the rescuer's safety first. The purpose of this article is to review the protocol on the behavior recommended in the care of patients suffering from cardiac arrest in an environment with a Covid pandemic 19, such as that experienced by the world community today. For care and management protocol, AHA, UK and ILCOR guidelines, as well as publications on prone cardiopulmonary resuscitation, will be considered.

Durante esta Pandemia se ha comunicado que un 5% de los casos requieren de Unidad de Cuidados Intensivos. Determinados pacientes que presentan hipoxemia, acidosis, trastornos electrolíticos o efectos adversos de fármacos como la hidroxicloroquina, pueden terminar en paro cardíaco. En estos pacientes se recomienda proporcionar una reanimación cardiopulmonar de alta calidad con todas las medidas de bioseguridad. ¿Qué se debe hacer frente al caso de un paro cardíaco súbito? La obligación ética del personal de salud es reanimar, pero con la responsabilidad de protección personal, es decir, con el precepto de primero la seguridad del reanimador. El propósito del presente artículo es revisar el protocolo sobre la conducta que se recomienda en la atención del paciente que sufre paro cardíaco en un ambiente con pandemia de Covid-19, como la que vive la comunidad mundial en la actualidad. Para la atención y protocolo de manejo, se tendrán en cuenta las guías de la AHA, del Reino Unido y de la ILCOR, así como las publicaciones de reanimación cardiopulmonar en posición prona.

Eficacia de la enseñanza teórico-práctica en institutos de reanimación cardiopulmonar / Effectiveness of practical theoretical teaching in high-school about cardiopulmonary resuscitation

FUNDAMENTOS: Las enfermedades cardiovasculares constituyen uno de los problemas de salud más importantes para la población. La mayoría de las muertes evitables se deben a enfermedades coronarias en el medio extrahospitalario. Formar a la población sobre la reanimación cardiopulmonar (RCP) supone un aumento de la tasa de supervivencia ante una parada cardiorrespiratoria. MÉTODOS: Se realizó un estudio observacional, prospectivo y analítico, en una muestra de alumnos de cuarto curso de Educación Secundaria Obligatoria a los que se dividió en dos grupos. A un primer grupo se les realizó un curso teórico-práctico sobre RCP; al segundo grupo, un curso solo teórico de RCP. Se realizaron tres cuestionarios sobre conocimiento de RCP: el primero, previo al curso; el segundo, tras el curso; y el tercero, a los dos meses de finalizar el curso. Se compararon los resultados entre los cuestionarios para analizar el grado de adquisición y mantenimiento de conocimientos. RESULTADOS: Se seleccionó una muestra de 326 alumnos, 213 en el grupo teórico-práctico y 113 en el teórico. La edad media fue de 15,6 años (DE=0,7, R 15-17) y el 56% eran niñas. La puntuación media de los cuestionarios fue: primer cuestionario, 5,1 puntos (DE=1,8, R 0-10); segundo cuestionario, en el grupo teórico-práctico 8,2 puntos (DE=1,6, R 3-10) frente al grupo teórico con 7,7 puntos (DE=1,9, R 0-10); y tercer cuestionario, 7,2 puntos (DE=1,8, R 1-10). En el primer cuestionario, un 5,2% conocían la frecuencia de las compresiones torácicas y ventilaciones en la RCP, mejorando al 68,1% en el segundo cuestionario en el grupo teóricopráctico, y un 79,6% en el grupo teórico. CONCLUSIONES: Tras el curso teórico-práctico sobre RCP, aumenta en 3,1 puntos la nota media en los cuestionarios de conocimientos en RCP, y en 2,1 puntos tras dos meses de la realización del curso. El grupo teórico-práctico obtiene una puntuación mejor en la encuesta poscurso (8,2 puntos) respecto al grupo teórico (7,7 puntos)

BACKGROUND: Cardiovascular diseases is one of the most important health problems among population. Most preventable deaths which take place in a context different from the hospital are related to coronary heart diseases. Training the population in cardiopulmonary resuscitation (CPR) may well result in an increase in the survival rate before a cardiorespiratory arrest. METHODS: An observational study - both prospective and analytical - was conducted through a sample of students in the fourth year of compulsory secondary education. They were divided in two groups: a first group was trained with a theoretical-practical course on CPR, the second group only a theoretical course on CPR. Three surveys on CPR knowledge were conducted, the first one prior to a CPR course, the second one after the course and the third carried out two months after completing it. The results were compared between the three surveys to examine the degree of acquisition and maintenance of knowledge. RESULTS: 326 students, 213 theoretical-practical group and 113 theoretical group, whose average age was 15.6 years (DE=0.7, R 15-17) and 56% were girls. The average scores of the questionnaires were: 5.1 points (DE=1.8, R 0-10) on first exam, 8.2 points (DE=1.6, R 3-10) on second exam of the theoretical-practical group versus 7.7 points (DE=1.9, R 0-10) of the theoretical group, and 7.2 points (DE=3.8, R 1-10) on third exam. In the first exam, 5.2% of them knew the frequency of chest compressions and ventilations in CPR, improving to 68.1% in the second questionnaire of the theoretical-practical group, and a 79.6% of the theoretical group. CONCLUSIONS: Increased knowledge in cardiopulmonary resuscitation reflect in an increase of 3.1 points of average after the theoretical-practical sessions and in 2.1 points two months later. The theoretical-practical group obtain a better score in the post-course exam (8.2 points) compared to the theoretical group (7.7 points)

In Hospitals With More Nurses Who Have Baccalaureate Degrees, Better Outcomes For Patients After Cardiac Arrest.

In 2010, prompted by compelling evidence that demonstrated better patient outcomes in hospitals with higher percentages of nurses with a bachelor of science in nursing (BSN), the Institute of Medicine recommended that 80 percent of the nurse workforce be qualified at that level or higher by 2020. Using data from the American Heart Association's Get With the Guidelines-Resuscitation registry (for 2013-18), RN4CAST-US hospital nurse surveys (2015-16), and the American Hospital Association (2015), we found that each 10-percentage-point increase in the hospital share of nurses with a BSN was associated with 24 percent greater odds of surviving to discharge with good cerebral performance among patients who experienced in-hospital cardiac arrest. Lower patient-to-nurse ratios on general medical and surgical units were also associated with significantly greater odds of surviving with good cerebral performance. These findings contribute to the growing body of evidence that supports policies to increase access to baccalaureate-level education and improve hospital nurse staffing.

Pediatric Post-Cardiac Arrest Care: A Scientific Statement From the American Heart Association.

Successful resuscitation from cardiac arrest results in a post-cardiac arrest syndrome, which can evolve in the days to weeks after return of sustained circulation. The components of post-cardiac arrest syndrome are brain injury, myocardial dysfunction, systemic ischemia/reperfusion response, and persistent precipitating pathophysiology. Pediatric post-cardiac arrest care focuses on anticipating, identifying, and treating this complex physiology to improve survival and neurological outcomes. This scientific statement on post-cardiac arrest care is the result of a consensus process that included pediatric and adult emergency medicine, critical care, cardiac critical care, cardiology, neurology, and nursing specialists who analyzed the past 20 years of pediatric cardiac arrest, adult cardiac arrest, and pediatric critical illness peer-reviewed published literature. The statement summarizes the epidemiology, pathophysiology, management, and prognostication after return of sustained circulation after cardiac arrest, and it provides consensus on the current evidence supporting elements of pediatric post-cardiac arrest care.

Formación de escolares en soporte vital básico por sus propios profesores / Teachers' training of schoolchildren in basic life support

Objetivo: Evaluar la formación en soporte vital básico (SVB), en horario escolar, de alumnos de primero de la enseñanza secundaria obligatoria (ESO) por sus propios profesores y su resultado a los seis meses. Método: Estudio observacional prospectivo, con análisis pre y postintervención a los seis meses. Se impartieron cursos de SVB según las recomendaciones del European Resuscitation Council a los profesores y estos a sus alumnos. Los exámenes teóricos y prácticos fueron realizados por los profesores. Resultados: Se formaron 62 profesores que instruyeron a 1.043 alumnos. Hubo un aumento significativo de los conocimientos teóricos [de 4,42 (DE 1,64) a 7,28 (1,85), p < 0,001] aunque descendió a los seis meses [5,15 (3,16), p < 0,001]. Las habilidades prácticas también se mantuvieron a los seis meses, aunque con mayor dificultad las relacionadas con la vía aérea. Conclusiones: La formación en SVB de escolares de primero de la ESO realizada por sus propios profesores en horario modificó la actitud de los escolares ante una posible parada cardiaca y logró un aprendizaje de las técnicas que desciende a los 6 meses

Objective: To assess first-year secondary-school students' knowledge and performance of basic life support (BLS) 6 months after training given by their regular teachers during school hours. Method: Prospective observational study comparing pre-intervention and 6-months post-intervention knowledge and performance. The teachers gave BLS classes according to the guidelines of the European Resuscitation Council and also supervised the tests of BLS knowledge and performance. Results: Sixty-two teachers were trained in BLS instruction. They then instructed 1043 students. The students' knowledge increased significantly from mean (SD) scores of 4.42 (1.64) to 7.28 (1.85) (P< .001) and was maintained at 6 months (mean score, 5.15 [3.16]; P<.001). Performance skills were also maintained at 6 months, although the students had greater difficulty attaining ventilation targets. Conclusions: Teachers' training of their own first-year secondary students during regular school hours led to changes in the students' attitudes toward the possibility of cardiac arrest and to the learning of BLS techniques

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

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

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

Association of extracerebral organ failure with 1-year survival and healthcare-associated costs after cardiac arrest: an observational database study.

BACKGROUND: Organ dysfunction is common after cardiac arrest and associated with worse short-term outcome, but its impact on long-term outcome and treatment costs is unknown. METHODS: We used nationwide registry data from the intensive care units (ICU) of the five Finnish university hospitals to evaluate the association of 24-h extracerebral Sequential Organ Failure Assessment (24h-EC-SOFA) score with 1-year survival and healthcare-associated costs after cardiac arrest. We included adult cardiac arrest patients treated in the participating ICUs between January 1, 2003, and December 31, 2013. We acquired the confirmed date of death from the Finnish Population Register Centre database and gross 1-year healthcare-associated costs from the hospital billing records and the database of the Finnish Social Insurance Institution. RESULTS: A total of 5814 patients were included in the study, and 2401 were alive 1 year after cardiac arrest. Median (interquartile range (IQR)) 24h-EC-SOFA score was 6 (5-8) in 1-year survivors and 7 (5-10) in non-survivors. In multivariate regression analysis, adjusting for age and prior independency in self-care, the 24h-EC-SOFA score had an odds ratio (OR) of 1.16 (95% confidence interval (CI) 1.14-1.18) per point for 1-year mortality. Median (IQR) healthcare-associated costs in the year after cardiac arrest were €47,000 (€28,000-75,000) in 1-year survivors and €12,000 (€6600-25,000) in non-survivors. In a multivariate linear regression model adjusting for age and prior independency in self-care, an increase of one point in the 24h-EC-SOFA score was associated with an increase of €170 (95% CI €150-190) in the cost per day alive in the year after cardiac arrest. In the same model, an increase of one point in the 24h-EC-SOFA score was associated with an increase of €4400 (95% CI €3300-5500) in the total healthcare-associated costs in 1-year survivors. CONCLUSIONS: Extracerebral organ dysfunction is associated with long-term outcome and gross healthcare-associated costs of ICU-treated cardiac arrest patients. It should be considered when assessing interventions to improve outcomes and optimize the use of resources in these patients.

Effects of cardiovascular and cerebrovascular health events on work and earnings: a population-based retrospective cohort study.

BACKGROUND: Survivors of acute health events can experience lasting reductions in functional status and quality of life, as well as reduced ability to work and earn income. We aimed to assess the effect of acute myocardial infarction (MI), cardiac arrest and stroke on work and earning among working-age people. METHODS: For this retrospective cohort study, we used the Canadian Hospitalization and Taxation Database, which contains linked hospital and income tax data, from 2005 to 2013 to perform difference-in-difference analyses. We matched patients admitted to hospital for acute MI, cardiac arrest or stroke with controls who were not admitted to hospital for these indications. Participants were aged 40-61 years, worked in the 2 years before the event and were alive 3 years after the event. Patients were matched to controls for 11 variables. The primary outcome was working status 3 years postevent. We also assessed earnings change attributable to the event. We matched 19 129 particpants who were admitted to hospital with acute MI, 1043 with cardiac arrest and 4395 with stroke to 1 820 644, 307 375 and 888 481 controls, respectively. RESULTS: Fewer of the patients who were admitted to hospital were working 3 years postevent than controls for acute MI (by 5.0 percentage points [pp], 95% confidence interval [CI] 4.5-5.5), cardiac arrest (by 12.9 pp, 95% CI 10.4-15.3) and stroke (by 19.8 pp, 95% CI 18.5-23.5). Mean (95% CI) earnings declines attributable to the events were $3834 (95% CI 3346-4323) for acute MI, $11 143 (95% CI 8962-13 324) for cardiac arrest, and $13 278 (95% CI 12 301-14 255) for stroke. The effects on income were greater for patients who had lower baseline earnings, comorbid disease, longer hospital length of stay or needed mechanical ventilation. Sex, marital status or self-employment status did not affect income declines. INTERPRETATION: Acute MI, cardiac arrest and stroke all resulted in substantial loss in employment and earnings that persisted for at least 3 years after the events. These outcomes have consequences for patients, families, employers and governments. Identification of subgroups at high risk for these losses may assist in targeting interventions, policies and legislation to promote return to work.

De la prevención a la rehabilitación: hacia un manejo integral de la parada cardiaca / From prevention to rehabilitation: toward a comprehensive approach to tackling cardiac arrest

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The impact of psychological distress on long-term recovery perceptions in survivors of cardiac arrest.

PURPOSE: To determine the association of depressive and PTSD symptoms with cardiac arrest survivors' long-term recovery perceptions, after accounting for cognitive status, functional independence, and medical comorbidities. METHODS: Perceived recovery of 78 cardiac arrest survivors at 6-months post-hospital discharge was assessed through the question, "Do you feel that you have made a complete recovery from your arrest?" Psychological symptoms were measured using the Center for Epidemiological Studies-Depression scale (CES-D) and the PTSD Checklist-Specific (PCLS). Logistic regression was utilized to assess the association between psychological symptoms with positive and negative recovery perceptions, adjusting for demographics, cognitive impairment, functional dependence, and medical comorbidities. RESULTS: At 6 months, 53% of patients (n = 41) had negative recovery perceptions. 32.1% (n = 25) of patients screened for depression and 28.2% (n = 22) for PTSD. Patients with higher CES-D scores were significantly more likely to have negative recovery perceptions in both unadjusted and adjusted analyses (OR: 1.10, 95% CI [1.03, 1.16], p < .01). PCL-S scores were significantly associated with negative recovery perceptions in an unadjusted model (OR: 1.05, 95% CI [1.01, 1.10], p < .01), but not after adjustment of covariates. CONCLUSIONS: In contrast with cognitive and functional measures, depressive symptoms were strongly associated with cardiac arrest survivors' negative recovery perceptions at 6-months post-discharge.

¿Qué tan efectivos son los dispositivos de compresión mecánica, en comparación a la compresión torácica manual, en pacientes con paro cardio respiratorio? / How effective are the devices for mechanical compression, compared to manual chest compression, in patients with cardio respiratory arrest?

INTRODUCCIÓN: El paro cardio respiratorio es un cese repentino de la función cardíaca y de la respiración espontánea.La mitad de las muertes por enfermedad cardiovascular ocurren por un paro cardio respiratorio, y un 60% de éstos eventos ocurren fuera de un establecimiento asistencial (1). El inicio inmediato de maniobras de reanimación cardiopulmonar (RCP) y la desfibrilación precoz son las únicas intervenciones que han demostrado mejorar la sobrevida del paro cardiorrespiratorio extra-hospitalario (PCR-EH) de causa cardíaca (1). El área de estudio de la resucitación está en constante evolución desde hace 200 años (2). Dada la repentina naturaleza de estos eventos, realizar estudios para evaluar la efectividad de intervenciones para la RCP, como ensayos controlados aleatorizados es complejo, por lo que la mayoría de las recomendaciones y guías clínicas han sido realizadas basadas en estudios retrospectivos, en animales y en consenso de expertos (3­10). OBJETIVO DE ESTA SÍNTESIS: Informar la toma de decisiones sobre la adquisición e implementación de sistemas de compresión torácica, aportando evidencia sobre efectividad y costo-efectividad. Se presentan los principales hallazgos encontrados en la evidencia recopilada, además de algunas consideraciones sobre la implementación relacionadas a la intervención estudiada. RESUMEN DE HALLAZGOS: Esta síntesis busca aportar evidencia sobre el efecto que tendría la utilización del sistema de compresión torácica en vez de lacompresión manual para la reanimación cardiopulmonar, en el caso de un paro cardio respiratorio por causa no traumática en un ambiente extrahospitalario, en personas adultas. Se incluyeron todas las intervenciones que compararan sistemas de compresión torácica automáticos contra la compresión manual realizada en pacientes adultos que presentaron un paro cardio respiratorio extrahospitalario por causa no traumática. Se excluyeron: intervenciones realizadas dentro del hospital; en población pediátrica; uso de equipos después del fallo de la compresión torácica manual y la comparación de otras intervenciones, como oxigenación de membrana extracorpórea (ECMO) versus RCP. Se priorizó incluir los dispositivos de tipo LUCAS® y AutoPulse®. excluyendo otro tipo de dispositivos como Thumper y pneumatic vest. Luego de realizar la búsqueda, se seleccionaron los títulos y resúmenes por dos revisores independientes, discutiendo cada uno de los disensos encontrados. Se encontraron inicialmente 33 revisiones sistemáticas. De éstas, se excluyeron 18 por disenso o duplicados. En la lectura por texto completo se excluyeron 6 por no ser la población e intervención abordada en este resumen. CONSIDERACIONES DE IMPLEMENTACIÓN: Consideraciones de Aplicabilidad: Los estudios fueron realizados en Austria, Canadá, China, Estados Unidos, Holanda, Reino Unido y Suecia, por lo que se debiera evaluar la pertinencia de los resultados para el contexto de Chile, considerando las particularidades del sistema de salud. Sin embargo, dado que los hallazgos de la síntesis de evidencia no favorecen o muestran un efecto nulo de la intervención (LUCAS y AutoPulse), es importante demostrar por qué los resultados que muestra la evidencia serían distintos y mostrarían un beneficio en el contexto de nuestro país, en caso de implementar este programa. Todos los estudios considerados incluyeron compresión torácica manual en los minutos previos a iniciar la compresión torácica automática, mientras se preparaba el dispositivo. Es importante contemplar que, en caso que se requiera reemplazar la compresión torácica manual por una compresión torácico mecánica, los resultados de esta síntesis contemplan RCP básico previo al uso del dispositivo de compresión torácica, por lo que el reemplazo total no es efectivamente evaluado. CONSIDERACIONES ECONÓMICAS: Durante la búsqueda de literatura de efectividad, se encontró además una evaluación económica realizada por el Sistema Nacional de Salud de Inglaterra (NHS) (35). Esta fue realizada para evaluar la costo-efectividad del uso del dispositivo LUCAS-2 comparado con la compresión manual durante la resucitación mediante equipo clínico luego de un paro cardíaco fuera del hospital. La evaluación económica fue realizada desde la perspectiva del sistema de salud y reportó los costos incrementales por años de vida ajustados por calidad (QALY) para LUCAS-2 comparado con la técnica manual. Los QALYs fueron medidos a los sobrevivientes, a los 3 y 12 meses después del paro cardíaco. Los costos incluidos fueron: los costos de la intervención propiamente tal, del dispositivo LUCAS-2 y costos de ambulancia, junto con los costos de estadía hospitalaria del paciente en UCI, ingresos la unidad de urgencia, visitas posteriores a pacientes y el uso de los servicios de atención primaria utilizados en la recuperación. También se realizó un micro-costeo para obtener el costo del dispositivo por aplicación, la cual incluyó el costo de compra del dispositivo y de sus accesorios para su funcionamiento, el costo de incorporar el equipo a la ambulancia, los costos de mantenimiento y los costos de la capacitación inicial para el equipo clínico operador.En este estudio los efectos fueron observados a 12 meses, por lo tanto, no se requirió tasa de descuento. La incertidumbre se analizó a través de un análisis de sensibilidad probabilístico simulado con 1000 muestras. El resultado mostró que LUCAS-2 no es costo-efectivo, lo cual se mostró robusto en el análisis de sensibilidad. Más aún, se mostró que LUCAS-2, en comparación a la técnica manual, entrega un menor beneficio (no mejoró la sobrevida), a un costo más alto. En nuestro país, el equipo modelo LUCAS-3, tiene un costo de adquisición de $15.000.000 aproximadamente, según cotización de octubre 2018. Consideraciones de Equidad: Dado que los resultados de los estudios no favorecen la intervención (LUCAS y AutoPulse), quizás la implementación de este tipo de tecnología, en el sistema público de salud, no aportaría a disminuir la brecha de equidad existente entre el sistema público y el privado. CONSIDERACIONES DE MONITOREO Y EVALUACIÓN: Considerando que algunos de los desenlaces tienen certeza en la evidencia muy baja, sería importante evaluar la publicación de nueva evidencia que permita mejorar esta certeza, en específico para la sobrevida al egreso de AutoPulse. Del mismo modo, se considera pertinente esperar nueva evidencia sobre los resultados de 2 ensayos en marcha, los cuales comparan los modelos LUCAS-2 y LUCAS-3 con la compresión torácica manual. Se debe considerar que el objetivo de este dispositivo se planteó como un reemplazo para la compresión torácica manual. Sin embargo, es importante evaluar si existen otros usos posibles como por ejemplo, un uso complementario a RCP manual, o en condiciones donde no es posible contar con personal capacitado (15).

Contusión pulmonar tras RCP valorada por ecografía / Ultrasound-assessed pulmonary contusion after CPR

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Soria Cardioprotegida. Primer programa español de prevención y tratamiento integral de la muerte súbita cardiaca / Soria Cardioprotegida. The first Spanish program for the prevention and integral treatment of sudden cardiac death

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Soria Cardioprotegida. Primer programa español de prevención y tratamiento integral de la muerte súbita cardiaca. Respuesta / Soria Cardioprotegida. The First spanish program for the prevention and integral treatment of sudden cardiac death. Response

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