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1.
Emergencias (Sant Vicenç dels Horts) ; 31(6): 429-434, dic. 2019. tab, mapas
Artigo em Espanhol | IBECS | ID: ibc-185142

RESUMO

El objetivo de este trabajo es comparar las legislaciones autonómicas españolas en materia de formación, utilización y obligatoriedad de la instalación de desfibriladores externos automatizados (DEA) fuera del ámbito sanitario y analizar la variabilidad territorial con que se han desarrollado las regulaciones. Llevamos a cabo una revisión de las normativas publicadas en los boletines oficiales de las 17 comunidades autónomas y las 2 ciudades autónomas de España hasta mayo de 2019, extrayendo datos referidos a la regulación de la formación, el uso y la instalación de los DEA fuera del ámbito sanitario. Observamos que médicos y enfermeros están autorizados a utilizar los DEA, salvo en Murcia, donde únicamente tienen autorizado su uso los médicos. En 14 comunidades autónomas también se consideran habilitados los técnicos en emergencias sanitarias. Excepto en el País Vasco, donde cualquier ciudadano puede utilizar un DEA previa alerta a los servicios de emergencia, es necesario realizar un curso inicial acreditado para estar habilitado en el uso de estos dispositivos (cuya duración varía, según la comunidad, entre 4 y 9 horas) y debe ser renovado con una periodicidad que oscila entre uno y 3 años. Sin embargo, 11 comunidades permiten que, en caso de emergencia y en ausencia de personal habilitado, cualquier ciudadano pueda utilizar un DEA, previa alerta a los servicios de emergencia. Once autonomías regulan la obligación de instalar DEA fuera del ámbito sanitario. Se concluye que si bien todas las comunidades autónomas de España disponen de una normativa reguladora del uso y la acreditación de DEA, el mapa legislativo es muy diverso, por lo que sería deseable una política armonizadora para unificar criterios e incentivar el uso de estos dispositivos en caso de necesidad


We compared Spanish autonomous communities' regulations affecting the use of semiautomatic external defibrillators (semi-AEDs), including requirements for training and providing devices outside health care settings. We analyzed differences in the development of regulations across the different geographic areas. Regulations published in the official bulletins of Spain’s 17 autonomous communities and 2 autonomous cities in effect in May 2019 were reviewed to extract directives affecting training, authorized use, and the provision of semi-AEDs outside health care centers. We found that both doctors and nurses are authorized to use the devices in most communities, with the exception of Murcia, where only doctors may use them. Fourteen communities also authorize emergency responders to operate semi-AEDs. Other individuals must call for emergency help before using one, and specific rules vary by community. In the Basque Country anyone may use them, but in other communities, only individuals who have taken a training course on how to use a semi-AED may. The duration of training programs varies from 4 to 9 hours in different parts of Spain, and retraining is required at intervals that vary from 1 to 3 years. However, in 11 communities any citizen may use a semi-AED in an emergency in which authorized persons are not present (after first calling for emergency responders). Eleven autonomous communities regulate the required provision of semi-AEDs outside health care centers. We conclude that although Spain’s autonomous communities have regulations in place for the use of these devices, the regulatory map is highly diverse. Therefore, we think that harmonization is desirable in the interest of unifying criteria and encouraging the use of semi-AEDs when they are needed


Assuntos
Humanos , Desfibriladores/normas , Parada Cardíaca Extra-Hospitalar/terapia , Reanimação Cardiopulmonar/instrumentação , Serviços Médicos de Emergência/legislação & jurisprudência , Serviços Médicos de Emergência/normas
2.
Medicine (Baltimore) ; 98(13): e14418, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30921176

RESUMO

Effectiveness of bystander cardiopulmonary resuscitation (CPR) is known to provide emergency medical services which reduce the number of deaths in patients with out-of-hospital cardiac arrest. The survival at these patients is affected by the training level of the bystander, but the best format of CPR training is unclear. In this pilot study, we aimed to examine whether the sequence of CPR instruction improves learning retention on the course materials.A total of 95 participants were recruited and divided into 2 groups; Group 1: 49 participants were taught firstly how to recognize a cardiac arrest and activate the emergency response system, and Group 2: 46 participants were taught chest compression first. The performance of participants was observed and evaluated, the results from 1 pre-test and 2 post-tests between 2 groups were then compared.There was a significantly better improvement of participants in Group 2 regarding the recognition of a cardiac arrest and the activation of the emergency response system than of those in Group 1. At the post-test, participants in Group 2 had an improvement in chest compression compared to those in Group 1, but the difference was not statistically significant.Our study had revealed that teaching CPR first in a standardized public education program had improved the ability of participants to recognize cardiac arrest and to activate the emergency response system.


Assuntos
Reanimação Cardiopulmonar/educação , Serviços Médicos de Emergência/normas , Parada Cardíaca Extra-Hospitalar/terapia , Adulto , Reanimação Cardiopulmonar/normas , Desfibriladores/normas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Parada Cardíaca Extra-Hospitalar/epidemiologia , Parada Cardíaca Extra-Hospitalar/mortalidade , Pressão , Tórax/fisiologia
3.
Int J Cardiol ; 272: 179-184, 2018 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-30121177

RESUMO

OBJECTIVES: To evaluate the effectiveness of wearable cardioverter defibrillator (WCD) use in protecting patients from sudden cardiac arrest (SCA) while they were treated in nonhospital settings until re-implantation of an Implantable cardioverter-defibrillator (ICD) was feasible. We sought to determine whether the WCD could be successfully utilized long term (≥1 year) after ICD extraction in patients at continued risk of SCD in which ICD re-implantation was not practical. BACKGROUND: ICDs have proven to improve mortality in patients for both secondary and primary prevention of SCA. Increased ICD implantation in older patients with comorbid conditions has resulted in higher rates of cardiac device infections. Currently, a wearable cardioverter defibrillator (WCD) is an alternative management for SCA prevention in specific cases. METHODS: This a retrospective analysis based on consecutive WCD patients who underwent ICD explant due to device-related infections or mechanical reasons between April 2007 and July 2014. A total of 102 patients were identified from the national database maintained by ZOLL (Pittsburgh, PA, USA). We analyzed the reason for WCD use, demographic information, device data, compliance and duration of WCD use, detected arrhythmias and therapies, and reason for discontinuing WCD use. RESULTS: In these long term WCD users, average length of WCD use was 638 ±â€¯361 days. Nine patients (8.8%) had a sustained ventricular arrhythmia that was successfully resuscitated by the WCD. Six patients (5.8%) experienced inappropriate shocks. Two patients (1.9%) died of asystole events while wearing the WCD and an additional 10 patients died while not monitored by the WCD. Thirty-nine patients (38.2%) ended WCD use when a new ICD was implanted and 15 patients (14.7%) were still wearing the WCD at the time of analysis. CONCLUSIONS: We found that extending use of the WCD to ≥1 year is a safe and effective alternative treatment for patients with explanted ICDs who are not pacemaker dependent.


Assuntos
Morte Súbita Cardíaca/prevenção & controle , Desfibriladores/tendências , Cardioversão Elétrica/instrumentação , Cardioversão Elétrica/tendências , Dispositivos Eletrônicos Vestíveis/tendências , Adulto , Idoso , Desfibriladores/normas , Cardioversão Elétrica/normas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Dispositivos Eletrônicos Vestíveis/normas
4.
Resuscitation ; 130: 41-43, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29883678

RESUMO

INTRODUCTION: Modern automated external defibrillators (AEDs) are designed to prevent shock delivery when excessive motion produces rhythm disturbances mimicking ventricular fibrillation (VF). This has been reported as a safety issue in airline operations, where turbulent motion is commonplace. We aimed to evaluate whether all seven AEDs can deliver shock appropriately in a flight simulator under turbulent conditions. METHODS: The study was performed in a Boeing 747-400 full motion flight simulator in Hong Kong. An advanced life support manikin and arrhythmia generator were used to produce sinus rhythm (SR), asystole, and five amplitudes of VF, with a programmed change to SR in the event of an effective shock being delivered. All rhythms were tested at rest (no turbulence) and at four levels of motion (ground taxi vibration, and mild, moderate and severe in-flight turbulence). Success was defined as: 1. effective shock being delivered where the rhythm was VF successfully converted to SR; 2. no inappropriate shock being delivered for asystole or SR. RESULTS: Five AEDs produced acceptable results at all levels of turbulence. Another was satisfactory for VF except at very fine amplitudes. One model was deemed unsatisfactory for in-flight use as its motion detector inhibited shocks at all levels of turbulence. CONCLUSION: Some AEDs designed primarily for ground use may not perform well under turbulent in-flight conditions. AEDs for possible in-flight or other non-terrestrial use should be fully evaluated by manufacturers or end-users before introduction to service.


Assuntos
Desfibriladores , Cardioversão Elétrica , Fibrilação Ventricular/prevenção & controle , Medicina Aeroespacial/métodos , Aeronaves , Desfibriladores/efeitos adversos , Desfibriladores/normas , Cardioversão Elétrica/métodos , Cardioversão Elétrica/normas , Humanos , Manequins , Teste de Materiais/métodos , Projetos de Pesquisa
5.
South Med J ; 111(6): 349-352, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29863224

RESUMO

OBJECTIVES: Sudden cardiac arrest (SCA) remains a significant cause of morbidity and mortality, and the key to increased survival is emergent bystander intervention. A growing body of evidence has shown that timely bystander-initiated cardiopulmonary resuscitation (CPR) and defibrillation are significantly correlated with an increased likelihood of survival. Despite these demonstrated benefits, bystanders perform these interventions in less than half of witnessed SCA cases. We hypothesized that the level of public CPR and automated external defibrillator (AED) knowledge may be limited and may play a role in the likelihood of intervening. METHODS: A convenience survey of potential bystanders to SCA was conducted in a high-traffic shopping center to estimate the overall knowledge level of CPR and AED usage and determine general attitudes toward intervening in the setting of SCA. Concurrently with the survey, professional emergency responders offered free bystander compression-only CPR and AED training on location. RESULTS: The majority of survey respondents expressed a willingness to perform the aforementioned interventions when asked directly. Results, however, indicate that although 69% of respondents consider themselves to have a general knowledge of CPR, only 18% spontaneously mentioned CPR when presented with a hypothetical SCA scenario. In addition, only 2.2% mentioned defibrillation, and 63% indicated that they would not know how to locate a public access AED when needed. Of the individuals who participated in both the survey and the training, all of them indicated that they were more likely to intervene in an SCA after receiving the training. CONCLUSIONS: Our findings suggest that future public outreach efforts should target the current CPR and AED knowledge gap. They also indicate that free, brief trainings offered at public events are a feasible way to increase the knowledge and skills of potential bystanders to SCA.


Assuntos
Reanimação Cardiopulmonar/normas , Desfibriladores/normas , Conhecimentos, Atitudes e Prática em Saúde , Idoso , Feminino , Promoção da Saúde/métodos , Promoção da Saúde/normas , Humanos , Masculino , Pessoa de Meia-Idade , Parada Cardíaca Extra-Hospitalar/epidemiologia , Parada Cardíaca Extra-Hospitalar/terapia , South Carolina/epidemiologia , Inquéritos e Questionários , Análise de Sobrevida
6.
Resuscitation ; 127: 132-146, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29706236

RESUMO

Despite significant advances in the field of resuscitation science, important knowledge gaps persist. Current guidelines for resuscitation are based on the International Liaison Committee on Resuscitation 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations, which includes treatment recommendations supported by the available evidence. The writing group developed this consensus statement with the goal of focusing future research by addressing the knowledge gaps identified during and after the 2015 International Liaison Committee on Resuscitation evidence evaluation process. Key publications since the 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations are referenced, along with known ongoing clinical trials that are likely to affect future guidelines. © 2018 European Resuscitation Council and American Heart Association, Inc. Published by Elsevier B.V. All rights reserved.


Assuntos
Reanimação Cardiopulmonar/normas , Consenso , Desfibriladores/normas , Serviços Médicos de Emergência/normas , Parada Cardíaca Extra-Hospitalar/terapia , Fatores Etários , Reanimação Cardiopulmonar/educação , Humanos , Parada Cardíaca Extra-Hospitalar/diagnóstico , Parada Cardíaca Extra-Hospitalar/mortalidade , Recuperação de Função Fisiológica , Tempo para o Tratamento
7.
BMJ Case Rep ; 20182018 Apr 24.
Artigo em Inglês | MEDLINE | ID: mdl-29691271

RESUMO

A previously asymptomatic young female with no previous medical or cardiac history collapsed during indoor exercise. A portable automatic external defibrillator showed a shockable rhythm. She received multiple electrical shocks with return to normal sinus rhythm without ischaemic ECG changes. Her troponin level was mildly elevated. A transthoracic echocardiogram revealed moderately reduced left ventricular ejection fraction with global hypokinesis. During emergent coronary angiography, the left main coronary artery could not be found. The right coronary artery was normal with robust collaterals to the entire left coronary circulation extending to the left main coronary artery, but did not fill the ostium. Coronary CT angiogram confirmed nearly complete absence of the left main coronary artery ostium. A diagnosis of left main coronary artery atresia was made. Patient underwent successful two vessel coronary artery bypass grafting. She continues to do well 1 year postoperatively.


Assuntos
Anormalidades Cardiovasculares/diagnóstico por imagem , Anomalias dos Vasos Coronários/diagnóstico por imagem , Vasos Coronários/diagnóstico por imagem , Morte Súbita Cardíaca/etiologia , Adulto , Anormalidades Cardiovasculares/patologia , Angiografia Coronária/métodos , Ponte de Artéria Coronária/métodos , Anomalias dos Vasos Coronários/complicações , Anomalias dos Vasos Coronários/patologia , Anomalias dos Vasos Coronários/cirurgia , Vasos Coronários/cirurgia , Desfibriladores/normas , Desfibriladores/estatística & dados numéricos , Diagnóstico Diferencial , Ecocardiografia/métodos , Eletrocardiografia/métodos , Feminino , Humanos , Doenças Raras , Volume Sistólico/fisiologia , Resultado do Tratamento , Troponina/sangue
8.
Circ J ; 82(6): 1481-1486, 2018 05 25.
Artigo em Inglês | MEDLINE | ID: mdl-29445060

RESUMO

Prevention of sudden cardiac death (SCD) has become an important issue in today's cardiovascular field, together with various developments in secondary prevention of basic cardiac diseases. The importance of the implantable cardioverter defibrillator (ICD) is now widely accepted because it has exhibited significant improvement in patients' prognoses in ischemic and non-ischemic cardiovascular diseases. However, there is an unignorable gap between the ICD indication in the guidelines and real-world high-risk patients for SCD, especially in the acute recovery phase of cardiac injury. Although various studies have demonstrated a clinical benefit of defibrillation devices, the studies of immediate ICD use in the acute recovery phase have failed to exhibit a benefit in patients from the point of the view of a decrease in total deaths. To bridge this gap, the wearable cardioverter defibrillator (WCD) provides a safer observation period in the acute phase and eliminates inappropriate overuse of ICD in the subacute phase. Here, we discuss the usefulness of the WCD and current understanding of its indications based on various clinical data. In conclusion, WCD is a feasible bridge to therapy and/or safe observation for patients at high risk of SCD, especially in the acute recovery phase of cardiac diseases.


Assuntos
Morte Súbita Cardíaca/prevenção & controle , Desfibriladores/normas , Dispositivos Eletrônicos Vestíveis , Doenças Cardiovasculares/terapia , Desfibriladores/tendências , Humanos , Japão
9.
Resuscitation ; 120: 108-112, 2017 11.
Artigo em Inglês | MEDLINE | ID: mdl-28923243

RESUMO

AIM: The aim was to investigate the clinical performance of two different types of automated external defibrillators (AEDs). METHODS: Three investigators reviewed 2938 rhythm analyses performed by AEDs in 240 consecutive patients (median age 72, q1-q3=62-83) who had suffered cardiac arrest between January 2011 and March 2015. Two different AEDs were used (AED A n=105, AED B n=135) in-hospital (n=91) and out-of-hospital (n=149). RESULTS: Among 194 shockable rhythms, 17 (8.8%) were not recognized by AED A, while AED B recognized 100% (n=135) of shockable episodes (sensitivity 91.2 vs 100%, p<0.01). In AED A, 8 (47.1%) of these episodes were judged to be algorithm errors while 9 (52.9%) were caused by external artifacts. Among 1039 non-shockable rhythms, AED A recommended shock in 11 (1.0%), while AED B recommended shock in 63 (4.1%) of 1523 episodes (specificity 98.9 vs 95.9, p<0.001). In AED A, 2 (18.2%) of these episodes were judged to be algorithm errors (AED B, n=40, 63.5%), while 9 (81.8%) were caused by external artifacts (AED B, n=23, 36.5%). CONCLUSIONS: There were significant differences in sensitivity and specificity between the two different AEDs. A higher sensitivity of AED B was associated with a lower specificity while a higher specificity of AED A was associated with a lower sensitivity. AED manufacturers should work to improve the algorithms. In addition, AED use should always be reviewed with a routine for giving feedback, and medical personnel should be aware of the specific strengths and shortcomings of the device they are using.


Assuntos
Desfibriladores/normas , Cardioversão Elétrica/instrumentação , Parada Cardíaca/terapia , Fibrilação Ventricular/terapia , Suporte Vital Cardíaco Avançado , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Feminino , Parada Cardíaca/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Sensibilidade e Especificidade , Fibrilação Ventricular/complicações
10.
Singapore Med J ; 58(7): 354-359, 2017 07.
Artigo em Inglês | MEDLINE | ID: mdl-28741000

RESUMO

The most common initial rhythm in a sudden cardiac arrest is ventricular fibrillation or pulseless ventricular tachycardia. This is potentially treatable with defibrillation, especially if provided early. However, any delay in defibrillation will result in a decline in survival. Defibrillation requires coordination with the cardiopulmonary resuscitation component for effective resuscitation. These two components, which form the key links in the chain of survival, have to be brought to the cardiac victim in a timely fashion. An effective chain of survival is needed in both the institution and community settings.


Assuntos
Cardioversão Elétrica/normas , Reanimação Cardiopulmonar/normas , Desfibriladores/normas , Serviços Médicos de Emergência/normas , Humanos , Singapura
11.
Resuscitation ; 118: 140-146, 2017 09.
Artigo em Inglês | MEDLINE | ID: mdl-28526495

RESUMO

AIM: An increasing number of failing automated external defibrillators (AEDs) is reported: AEDs not giving a shock or other malfunction. We assessed to what extent AEDs are 'failing' and whether this had a device-related or operator-related cause. METHODS: We studied analysis periods from AEDs used between January 2012 and December 2014. For each analysis period we assessed the correctness of the (no)-shock advice (sensitivity/specificity) and reasons for an incorrect (no)-shock advice. If no shock was delivered after a shock advice, we assessed the reason for no-shock delivery. RESULTS: We analyzed 1114 AED recordings with 3310 analysis periods (1091 shock advices; 2219 no-shock advices). Sensitivity for coarse ventricular fibrillation was 99% and specificity for non-shockable rhythm detection 98%. The AED gave an incorrect shock advice in 4% (44/1091) of all shock advices, due to device-related (n=15) and operator-related errors (n=28) (one unknown). Of these 44 shock advices, only 2 shocks caused a rhythm change. One percent (26/2219) of all no-shock advices was incorrect due to device-related (n=20) and operator-related errors (n=6). In 5% (59/1091) of all shock advices, no shock was delivered: operator failed to deliver shock (n=33), AED was removed (n=17), operator pushed 'off' button (n=8) and other (n=1). Of the 1073 analysis periods with a shockable rhythm, 67 (6%) did not receive an AED shock. CONCLUSION: Errors associated with AED use are rare (4%) and when occurring are in 72% caused by the operator or circumstances of use. Fully automatic AEDs may prevent the majority of these errors.


Assuntos
Reanimação Cardiopulmonar/métodos , Desfibriladores/normas , Cardioversão Elétrica/instrumentação , Análise de Falha de Equipamento , Parada Cardíaca Extra-Hospitalar/terapia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Parada Cardíaca Extra-Hospitalar/mortalidade , Fibrilação Ventricular/diagnóstico , Fibrilação Ventricular/terapia
12.
Int Emerg Nurs ; 33: 7-13, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28256337

RESUMO

INTRODUCTION: Nurses are often the first responders to in-hospital cardiac emergencies. A positive attitude towards cardiopulmonary resuscitation with defibrillation may contribute to early cardiopulmonary resuscitation and rapid defibrillation, which are associated with enhanced long-term survival. The aim of this study was to translate and adapt the 31-item attitudes towards cardiopulmonary resuscitation with defibrillation and the national resuscitation guidelines (ACPRD) instrument into Chinese and to evaluate its psychometric properties in a sample of Taiwanese hospital nurses. METHODS: The ACPRD instrument was translated into Chinese using professional translation services. Content validity index based on five experts to refine the translated instrument. The final instrument was applied to a sample of 290 female nurses, recruited from a regional hospital in southern Taiwan, to assess its internal consistency, factor structure, and discriminative validity. RESULTS: The Chinese ACPRD instrument showed good internal consistency (Cronbach's alpha=0.87). Seven factors emerged from the factor analysis. The instrument showed good discriminative validity and were able to differentiate the attitudes of nurses with more experience of defibrillation or cardiopulmonary resuscitation from those with less experience. Nurses working in emergency ward or intensive care unit also showed significantly higher overall scores compared to those working in other units. CONCLUSION: The Chinese ACPRD demonstrated adequate content validity, internal consistency, sensible factor structure, and good discriminative validity. Among Chinese-speaking nurses, it may be used as a tool for assessing the effectiveness of educational programs that aim to improve their confidence in performing cardiopulmonary resuscitation with defibrillation.


Assuntos
Atitude do Pessoal de Saúde , Reanimação Cardiopulmonar/psicologia , Desfibriladores/psicologia , Enfermeiras e Enfermeiros/psicologia , Psicometria/normas , Adulto , Reanimação Cardiopulmonar/normas , Reanimação Cardiopulmonar/estatística & dados numéricos , Desfibriladores/normas , Desfibriladores/estatística & dados numéricos , Feminino , Humanos , Enfermeiras e Enfermeiros/estatística & dados numéricos , Psicometria/métodos , Reprodutibilidade dos Testes , Inquéritos e Questionários , Taiwan
13.
Circulation ; 135(25): 2454-2465, 2017 Jun 20.
Artigo em Inglês | MEDLINE | ID: mdl-28254836

RESUMO

BACKGROUND: Public access defibrillation programs can improve survival after out-of-hospital cardiac arrest, but automated external defibrillators (AEDs) are rarely available for bystander use at the scene. Drones are an emerging technology that can deliver an AED to the scene of an out-of-hospital cardiac arrest for bystander use. We hypothesize that a drone network designed with the aid of a mathematical model combining both optimization and queuing can reduce the time to AED arrival. METHODS: We applied our model to 53 702 out-of-hospital cardiac arrests that occurred in the 8 regions of the Toronto Regional RescuNET between January 1, 2006, and December 31, 2014. Our primary analysis quantified the drone network size required to deliver an AED 1, 2, or 3 minutes faster than historical median 911 response times for each region independently. A secondary analysis quantified the reduction in drone resources required if RescuNET was treated as a large coordinated region. RESULTS: The region-specific analysis determined that 81 bases and 100 drones would be required to deliver an AED ahead of median 911 response times by 3 minutes. In the most urban region, the 90th percentile of the AED arrival time was reduced by 6 minutes and 43 seconds relative to historical 911 response times in the region. In the most rural region, the 90th percentile was reduced by 10 minutes and 34 seconds. A single coordinated drone network across all regions required 39.5% fewer bases and 30.0% fewer drones to achieve similar AED delivery times. CONCLUSIONS: An optimized drone network designed with the aid of a novel mathematical model can substantially reduce the AED delivery time to an out-of-hospital cardiac arrest event.


Assuntos
Reanimação Cardiopulmonar/normas , Desfibriladores/normas , Serviços Médicos de Emergência/normas , Modelos Teóricos , Parada Cardíaca Extra-Hospitalar/terapia , Tempo para o Tratamento/normas , Idoso , Reanimação Cardiopulmonar/métodos , Reanimação Cardiopulmonar/tendências , Desfibriladores/tendências , Serviços Médicos de Emergência/métodos , Serviços Médicos de Emergência/tendências , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ontário/epidemiologia , Parada Cardíaca Extra-Hospitalar/epidemiologia , Tempo para o Tratamento/tendências
14.
Resuscitation ; 110: 12-17, 2017 01.
Artigo em Inglês | MEDLINE | ID: mdl-27780740

RESUMO

PURPOSE: Early and good quality cardiopulmonary resuscitation (CPR) and the use of automated external defibrillators (AEDs) improve cardiac arrest patients' survival. However, AED peri- and post-shock/analysis pauses may reduce CPR effectiveness. METHODS: The time performance of 12 different commercially available AEDs was tested in a manikin based scenario; then the AEDs recordings from the same tested models following the clinical use both in Pavia and Ticino were analyzed to evaluate the post-shock and post-analysis time. RESULTS: None of the AEDs was able to complete the analysis and to charge the capacitors in less than 10s and the mean post-shock pause was 6.7±2.4s. For non-shockable rhythms, the mean analysis time was 10.3±2s and the mean post-analysis time was 6.2±2.2s. We analyzed 154 AED records [104 by Emergency Medical Service (EMS) rescuers; 50 by lay rescuers]. EMS rescuers were faster in resuming CPR than lay rescuers [5.3s (95%CI 5-5.7) vs 8.6s (95%CI 7.3-10). CONCLUSIONS: AEDs showed different performances that may reduce CPR quality mostly for those rescuers following AED instructions. Both technological improvements and better lay rescuers training might be needed.


Assuntos
Reanimação Cardiopulmonar , Desfibriladores , Cardioversão Elétrica , Serviços Médicos de Emergência , Primeiros Socorros , Parada Cardíaca Extra-Hospitalar/terapia , Reanimação Cardiopulmonar/instrumentação , Reanimação Cardiopulmonar/métodos , Reanimação Cardiopulmonar/normas , Simulação por Computador , Desfibriladores/classificação , Desfibriladores/normas , Cardioversão Elétrica/instrumentação , Cardioversão Elétrica/métodos , Serviços Médicos de Emergência/métodos , Serviços Médicos de Emergência/normas , Primeiros Socorros/instrumentação , Primeiros Socorros/métodos , Primeiros Socorros/normas , Humanos , Itália , Manequins , Teste de Materiais , Análise e Desempenho de Tarefas , Fatores de Tempo , Tempo para o Tratamento
16.
Zhongguo Yi Liao Qi Xie Za Zhi ; 40(1): 17-21, 2016 Jan.
Artigo em Chinês | MEDLINE | ID: mdl-27197490

RESUMO

This paper introduces a new method which controls discharge energy accurately. It is achieved by calculating target voltage based on transthoracic impedance and accurately controlling charging voltage and discharge pulse width. A new defibrillator is designed and programmed using this method. The test results show that this method is valid and applicable to all kinds of external defibrillators.


Assuntos
Desfibriladores/normas , Desenho de Equipamento
17.
Artigo em Alemão | MEDLINE | ID: mdl-27022697

RESUMO

Witnesses of a sudden cardiac arrest play a key-role in resuscitation. Lay-persons should therefore be trained to recognize that a collapsed person who is not breathing at all or breathing normally might suffer from cardiac arrest. Information of professional emergency medical staff by lay-persons and their initiation of cardio-pulmonary-resuscitation-measures are of great importance for cardiac-arrest victims. Ambulance-dispatchers have to support lay-rescuers via telephone. This support includes the localisation of the nearest Automatic External Defibrillator (AED). Presentation of agonal breathing or convulsions due to brain-hypoxia need to be recognized as potential early signs of cardiac arrest. In any case of cardiac arrest chest-compressions need to be started. There is insufficiant data to recommend "chest-compression-only"-CPR as being equally sufficient as cardio-pulmonary-resuscitation including ventilation. Rescuers trained in ventilation should therefore combine compressions and ventilations at a 30:2-ratio. Movement of the chest is being used as a sign of sufficient ventilation. High-quality chest-compressions of at least 5 cm of depth, not exceeding 6 cm, are recommended at a ratio of 100-120 chest conpressions/min. Interruption of chest-compression should be avoided. At busy public places AED should be available to enable lay-rescuers to apply early defibrillation.


Assuntos
Procedimentos Clínicos/normas , Morte Súbita Cardíaca/prevenção & controle , Desfibriladores/normas , Cuidados para Prolongar a Vida/normas , Equipe de Assistência ao Paciente/normas , Ressuscitação/normas , Cuidados Críticos/normas , Serviços Médicos de Emergência/normas , Alemanha , Humanos , Guias de Prática Clínica como Assunto
18.
Artigo em Alemão | MEDLINE | ID: mdl-26754534

RESUMO

In October 2015, new guidelines for cardiopulmonary resuscitation (CPR) were published, which represent a revision of the guidelines 2010. The new recommendations are based on an update of knowledge on resuscitation, which was evaluated for the first time by GRADE (Grading of Recommendations Assessment, Development and Evaluation). The key messages of the guidelines 2010 were retained in 2015. Adult basic life support consists of a sequence of 30 chest compressions at a rate of 100-120/min with a depth of 5 to maximally 6 cm and 2 ventilations. As soon as possible, an automated external defibrillator (AED) should be applied. Interruptions of chest compressions should be minimized. To improve bystander CPR emergency medical dispatchers should diagnose cardiac arrest when informed about unconscious persons not breathing normally. In this case, emergency medical staff should inform bystanders to resuscitate with compression only CPR until the arrival of an emergency team. In postresuscitation care, mild hypothermia (body temperature 32-34 °C) has been replaced by targeted temperature management in unconscious patients. Now, the guidelines recommend a constant body temperature between 32-36 °C for at least 24 h. Fever should be prevented or treated.


Assuntos
Reanimação Cardiopulmonar/normas , Morte Súbita Cardíaca/prevenção & controle , Desfibriladores/normas , Serviços Médicos de Emergência/normas , Hipotermia Induzida/normas , Guias de Prática Clínica como Assunto , Adulto , Reanimação Cardiopulmonar/métodos , Reanimação Cardiopulmonar/tendências , Terapia Combinada/métodos , Terapia Combinada/normas , Terapia Combinada/tendências , Serviços Médicos de Emergência/métodos , Serviços Médicos de Emergência/tendências , Medicina Baseada em Evidências , Feminino , Alemanha , Humanos , Hipotermia Induzida/tendências , Masculino , Terapia Respiratória/métodos , Terapia Respiratória/normas , Terapia Respiratória/tendências , Resultado do Tratamento
19.
J Formos Med Assoc ; 115(8): 628-38, 2016 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-26596689

RESUMO

BACKGROUND/PURPOSE: Protocols for managing patients with out-of-hospital cardiac arrest (OHCA) may vary due to legal, cultural, or socioeconomic concerns. We sought to assess international variation in policies and protocols related to OHCA. METHODS: A brief survey was developed by consensus. Elicited information included protocols for managing patients with nontraumatic OHCA or traumatic OHCA, policies for using automated external defibrillators (AEDs) during transportation of patients with ongoing resuscitation, and application of terminations of resuscitation (TOR) rules in prehospital settings in the respondent's city or country. The populations of interest were emergency physicians, medical directors of emergency medical services (EMS), and policy makers. RESULTS: Responses were obtained from eight cities in six Asian countries. Only one (12.5%) city applied TOR rules for OHCAs. Do-not-resuscitate (DNR) orders were valid in prehospital settings in five (62.5%) cities. All cities used AEDs for nontraumatic OHCAs; seven (87.5%) cities did not routinely use AEDs for traumatic OHCAs. For nontraumatic OHCAs, four (50%) cities performed 2 minutes of on-scene cardiopulmonary resuscitation (CPR) and then transported the patients with ongoing resuscitation to hospitals; three (37.5%) cities performed 4 minutes of on-scene CPR; one (12.5%) city allowed variation in the duration of on-scene CPR. CONCLUSION: International variation in practices and polices related to OHCAs do exist. Concerns regarding prehospital TOR rules include medical evidence, legal considerations, EMS manpower, public perception, medical oversight, education, EMS characteristics, and cost-effectiveness analysis. Further research is needed to achieve consensus regarding management protocols, especially for EMS that perform resuscitation during transportation of OHCA patients.


Assuntos
Reanimação Cardiopulmonar/normas , Desfibriladores/normas , Serviços Médicos de Emergência , Parada Cardíaca Extra-Hospitalar/terapia , Ordens quanto à Conduta (Ética Médica) , Ásia , Cidades , Protocolos Clínicos , Análise Custo-Benefício , Humanos , Médicos , Inquéritos e Questionários
20.
Occup Health Saf ; 85(10): 94, 96-7, 2016 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30280872

RESUMO

The new tool is an innovative, standardized method of determining the most effective placement of these necessary devices.


Assuntos
Desfibriladores/normas , Parada Cardíaca Extra-Hospitalar/terapia , Local de Trabalho , Humanos
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