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1.
Med. intensiva (Madr., Ed. impr.) ; 43(6): 346-351, ago.-sept. 2019. ilus, graf, tab
Artigo em Espanhol | IBECS | ID: ibc-183253

RESUMO

Objetivo: Comparar en un maniquí de lactante la calidad de las compresiones torácicas según el método tradicional (MT) o según la nueva técnica de 2pulgares con puños cerrados (NM). Diseño: Estudio controlado, aleatorizado y cruzado en profesionales. Ámbito: Hospital Universitario con UCI Pediátrica del norte de España. Participantes: Residentes y enfermeros de Pediatría, habiendo superado un curso de RCP básica y avanzada pediátrica. Intervenciones: Análisis cuantitativo de calidad de compresiones torácicas en escenario de RCP en lactante durante 2 min, mediante el sistema SimPad(R) con SkillReporter(TM) de Laerdal. Variables de interés principales: Frecuencia media y porcentaje de compresiones en rango recomendada, profundidad media y porcentaje de compresiones en rango recomendado, porcentaje de compresiones con descompresión adecuada y porcentaje de compresiones realizadas con los dedos en el centro del tórax. Resultados: La calidad global de las compresiones (NM: 84,2±23,7% vs. MT: 80,1±25,4% [p=0,25; no sig.]), el porcentaje de compresiones con profundidad correcta (NM: 59,9±35,8% vs. MT: 59,5±35,7% [p=0,76; no sig.]), la profundidad media alcanzada (NM: 37,3±3,8mm vs. MT: 36±5,3mm [p=0,06; no sig.]), el porcentaje de reexpansión completa de la caja torácica (NM: 94,4±9,3% vs. MT: 92,4±18,3% [p=0,58; no sig.]) y el porcentaje de compresiones con la frecuencia recomendada (NM: 62,2±34,6% vs. MT: 51±37,2% [p=0,13; no sig.]) fueron similares con los 2métodos. Conclusiones: La calidad de compresiones torácicas con el nuevo método (pulgares con los puños cerrados) es similar a la obtenida con el método tradicional


Objective: To compare the quality of chest compressions performed according to the classical technique (MT) versus a new technique (NM) (compression with 2thumbs with closed fists) in an infant manikin. Design: A controlled, randomized cross-over study was carried out in professionals assisting pediatric patients. Setting: A University Hospital with a Pediatric ICU in the north of Spain. Participants: Residents and nurses in Pediatrics who had completed a basic and an advanced pediatric cardiopulmonary resuscitation course. Interventions: Quantitative analysis of the variables referred to chest compression quality in a 2-minute cardiopulmonary resuscitation scenario in infants. Laerdal's SimPad(R) with SkillReporter(TM) system was used. Main variables of interest: Mean rate and percentage of compressions in the recommended rate range, mean depth and percentage of compressions within the depth range of recommendations, percentage of compressions with adequate decompression, and percentage of compressions performed with the fingers in the center of the chest. Results: Global quality of the compressions (NM: 84.2±23.7% vs. MT: 80.1±25.4% [p=0.25; p=ns]), percentage of compressions with correct depth (NM: 59.9±35.8% vs. MT: 59.5±35.7% [p=0.76; p=ns]), mean depth reached (NM: 37.3±3.8mm vs. MT: 36±5.3mm [p=0.06; p=ns]), percentage of complete re-expansion of the chest (NM: 94.4±9.3% vs. MT: 92.4±18.3% [p=0.58; p=ns]), and percentage of compressions with the recommended rate (NM: 62.2±34.6% vs. MT: 51±37.2% [p=0.13; p=ns]) proved similar with both methods. Conclusions: The quality of chest compressions with the new method (thumbs with closed fists) is similar to that afforded by the traditional method


Assuntos
Humanos , Masculino , Feminino , Adulto , Reanimação Cardiopulmonar/educação , Reanimação Cardiopulmonar/métodos , Simulação de Paciente , Manequins , Massagem Cardíaca/métodos , Reanimação Cardiopulmonar/instrumentação , Pessoal de Saúde/educação , Educação em Enfermagem/métodos , Internato e Residência , Análise Quantitativa , Massagem Cardíaca/instrumentação , Massagem Cardíaca/enfermagem , Unidades de Terapia Intensiva Pediátrica/estatística & dados numéricos
2.
Pediatr Cardiol ; 40(6): 1217-1223, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31218374

RESUMO

We designed the newly developed flexed two-finger chest compression technique for cardiopulmonary resuscitation (CPR) in infants to increase the quality of chest compression by considering the advantages and disadvantages of the two-thumb encircling hand technique and conventional two-finger technique. The aim of the study is to compare the performance of the flexed two-finger technique and the currently used two-thumb technique or two-finger technique for infant CPR. A total of 42 doctors conducted 2-min single-rescuer CPR on a cardiac arrest infant model using the two-thumb technique followed, in a random order, by the two-finger technique and the flexed two-finger technique. Although the ratio of the adequate compression depth was highest in the two-thumb technique, followed by the flexed two-finger technique and two-finger technique (100% [98-100] vs. 99% [80-100] vs. 76% [42-95], respectively, P < 0.001), the hand-off time of the two-thumb technique was significantly longer than in the two-finger technique and flexed two-finger technique (31 s [28-35] vs. 29 s [27-32] vs. 29 s [26-32], respectively, P < 0.001). The number of total chest compressions of the two-thumb technique was significantly lower than in the two-finger technique and flexed two-finger technique (150 [148-159] vs. 159 [149-173] vs. 162 [150-172], respectively, P < 0.001). The newly developed chest compression technique could provide adequate compression depth without increasing the hand-off time during single-rescuer infant CPR.Trial registration: Clinical Research Information Service, KCT0002730.


Assuntos
Reanimação Cardiopulmonar/métodos , Massagem Cardíaca/métodos , Adulto , Estudos Cross-Over , Feminino , Dedos , Parada Cardíaca/terapia , Humanos , Lactente , Masculino , Manequins
3.
Eur J Pediatr ; 178(6): 937-945, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30976922

RESUMO

With different videolaryngoscopes for pediatric patients available, UEScope can be used in all age groups. The aim of this study was to compare the Miller laryngoscope and UEScope in pediatric intubation by paramedics in different scenarios. Overall, 93 paramedics with no experience in pediatric intubation or videolaryngoscopy performed endotracheal intubation in scenarios: (A) normal airway without chest compressions, (B) difficult airway without chest compressions, (C) normal airway with uninterrupted chest compressions, (D) difficult airway with uninterrupted chest compressions. Scenario A. Total intubation success with both laryngoscopes: 100%. First-attempt success: 100% for UEScope, 96.8% for Miller. Median intubation time for UEScope: 13 s [IQR, 12.5-17], statistically significantly lower than for Miller: 14 s [IQR, 12-19.5] (p = 0.044). Scenario B. Total efficacy: 81.7% for Miller, 100% for UEScope (p = 0.012). First-attempt success: 48.4% for Miller, 87.1% for UEScope (p = 0.001). Median intubation time: 27 s [IQR, 21-33] with Miller, 15 s [IQR, 14-21] with UEScope (p = 0.001). Scenario C. Total efficiency: 91.4% with Miller, 100% with UEScope (p = 0.018); first-attempt success: 67.7 vs. 90.3% (p = 0.003), respectively. Intubation time: 21 s [IQR, 18-28] for Miller, 15 s [IQR, 12-19.5] for UEScope. Scenario D. Total efficiency: 65.6% with Miller, 98.9% with UEScope (p < 0.001); first-attempt success: 29.1 vs. 72% (p = 0.001), respectively. Intubation time: 38 s [IQR, 23-46] for Miller, 21 s [IQR, 17-25.5] for UEScope.Conclusion: In pediatric normal airway without chest compressions, UEScope is comparable with Miller. In difficult pediatric airways without chest compressions, UEScope offers better first-attempt success, shorted median intubation time, and improved glottic visualization. With uninterrupted chest compressions in normal or difficult airway, UEScope provides a higher first-attempt success, a shorter median intubation time, and a better glottic visualization than Miller laryngoscope. What is Known: • Endotracheal intubation is the gold standard for adult and children airway management. • More than two direct laryngoscopy attempts in children with difficult airways are associated with a high failure rate and increased incidence of severe complications. What is New: • In difficult pediatric airways with or without chest compressions, UEScope in inexperienced providers in simulated settings provides better first-attempt efficiency, median intubation time, and glottic visualization.


Assuntos
Intubação Intratraqueal/instrumentação , Laringoscópios/normas , Adulto , Pessoal Técnico de Saúde/educação , Reanimação Cardiopulmonar/métodos , Pré-Escolar , Estudos Cross-Over , Medicina de Emergência/educação , Feminino , Massagem Cardíaca/métodos , Humanos , Masculino , Manequins , Estudos Prospectivos , Treinamento por Simulação
4.
Am J Cardiol ; 123(10): 1626-1627, 2019 05 15.
Artigo em Inglês | MEDLINE | ID: mdl-30879607

RESUMO

Out-of-hospital cardiac arrest is a major public health concern. Research has shown that initiation of cardiopulmonary resuscitation (CPR) by lay bystanders increases survival rates. Evidence also shows that CPR training, delivered in various ways, is successful in a wide age range of children. This study was conducted to assess if children (average age of 12) were able to perform high quality chest compressions and whether this can be achieved by supplementing CPR instructional video with other methods to time delivery of compressions. A total of 160 study subjects were divided into 3 groups. The CPR instructional video was played for all 3 groups. One group (n = 53) was instructed to time their compressions with a popular music. Another group (n = 56) was assigned to a specially designed video game whereby they practiced how to time chest compressions. The control group (n = 51) consisted of those who only watched the video. Each group was divided in teams of 3 and observed for successful delivery of chest compressions on the little Anne Adult CPR training manikins. The control group performed a mean of 88 compressions per minute (CPM) out of which a mean of 72 clicks were appreciated. The music group performed 104 CPM with 74 clicks. Meanwhile, the video game group performed 102 CPM with 78 clicks. This study demonstrated sixth graders are capable of learning and performing effective hands only bystander CPR and this can and should be taught in schools even as young as the sixth grade level.


Assuntos
Reanimação Cardiopulmonar/educação , Massagem Cardíaca/métodos , Manequins , Parada Cardíaca Extra-Hospitalar/terapia , Educação de Pacientes como Assunto/métodos , Criança , Feminino , Humanos , Masculino
5.
Eur J Pediatr ; 178(6): 795-801, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30850868

RESUMO

This study was conducted to investigate the effect of metronome guidance on the performance of infant cardiopulmonary resuscitation (CPR). A total of 36 medical doctors conducted a 2-min single rescuer CPR with the two-finger technique (TFT) or two-thumb encircling hands technique (TT) on an infant manikin without metronome guidance (baseline test). After completing the baseline test, the participants were assigned to either a "guidance group" or "non-guidance group." The guidance group performed CPR with a high-pitched sound at 110 beats/min from a metronome (test 2), while the non-guidance group performed 2-min CPR without metronome guidance (test 1). Comparison between the results of tests 1 and 2 showed that the ratio of adequate chest compression rate was significantly different in both the TFT (73% [34-93] vs. 98% [95-99], P < 0.001) and the TT (53% [32-79] vs. 99% [98-100], P = 0.010). Other parameters including average depth and the ratio of adequate depth were not significantly different between tests 1 and 2 in both the TFT and TT.Conclusion: Metronome guidance improves the adequacy of chest compression rate during infant CPR without affecting chest compression depth in both the TFT and TT.Trial registration: Clinical Research Information Service, KCT0002735 What is Known: • The rate of chest compressions can be optimized by the use of metronome guidance in pediatric cardiopulmonary resuscitation (CPR). • An adverse effect of deteriorating chest compression depth was found while using a metronome guidance during adult CPR simulations. What is New: • The metronome guidance improved the adequacy of the chest compression rate during infant CPR without affecting other parameters including average depth and the ratio of adequate depth in both the two-finger chest compression technique and two-thumb encircling hand technique.


Assuntos
Reanimação Cardiopulmonar/métodos , Massagem Cardíaca/métodos , Adulto , Feminino , Dedos , Parada Cardíaca/terapia , Humanos , Lactente , Masculino , Manequins , Estudos Prospectivos , Fatores de Tempo , Resultado do Tratamento
6.
Crit Care Med ; 47(3): 449-455, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30768501

RESUMO

OBJECTIVES: Combined with devices that enhance venous return out of the brain and into the thorax, preclinical outcomes are improved significantly using a synergistic bundled approach involving mild elevation of the head and chest during cardiopulmonary resuscitation. The objective here was to confirm clinical safety/feasibility of this bundled approach including use of mechanical cardiopulmonary resuscitation provided at a head-up angle. DESIGN: Quarterly tracking of the frequency of successful resuscitation before, during, and after the clinical introduction of a bundled head-up/torso-up cardiopulmonary resuscitation strategy. SETTING: 9-1-1 response system for a culturally diverse, geographically expansive, populous jurisdiction. PATIENTS: All 2,322 consecutive out-of-hospital cardiac arrest cases (all presenting cardiac rhythms) were followed over 3.5 years (January 1, 2014, to June 30, 2017). INTERVENTIONS: In 2014, 9-1-1 crews used LUCAS (Physio-Control Corporation, Redmond, WA) mechanical cardiopulmonary resuscitation and impedance threshold devices for out-of-hospital cardiac arrest. After April 2015, they also 1) applied oxygen but deferred positive pressure ventilation several minutes, 2) solidified a pit-crew approach for rapid LUCAS placement, and 3) subsequently placed the patient in a reverse Trendelenburg position (~20°). MEASUREMENTS AND MAIN RESULTS: No problems were observed with head-up/torso-up positioning (n = 1,489), but resuscitation rates rose significantly during the transition period (April to June 2015) with an ensuing sustained doubling of those rates over the next 2 years (mean, 34.22%; range, 29.76-39.42%; n = 1,356 vs 17.87%; range, 14.81-20.13%, for 806 patients treated prior to the transition; p < 0.0001). Outcomes improved across all subgroups. Response intervals, clinical presentations and indications for attempting resuscitation remained unchanged. Resuscitation rates in 2015-2017 remained proportional to neurologically intact survival (~35-40%) wherever tracked. CONCLUSIONS: The head-up/torso-up cardiopulmonary resuscitation bundle was feasible and associated with an immediate, steady rise in resuscitation rates during implementation followed by a sustained doubling of the number of out-of-hospital cardiac arrest patients being resuscitated. These findings make a compelling case that this bundled technique will improve out-of-hospital cardiac arrest outcomes significantly in other clinical evaluations.


Assuntos
Reanimação Cardiopulmonar/métodos , Massagem Cardíaca/métodos , Parada Cardíaca Extra-Hospitalar/terapia , Posicionamento do Paciente/métodos , Reanimação Cardiopulmonar/efeitos adversos , Estudos de Viabilidade , Feminino , Massagem Cardíaca/efeitos adversos , Humanos , Masculino , Posicionamento do Paciente/efeitos adversos
7.
J Am Heart Assoc ; 8(1): e009436, 2019 01 08.
Artigo em Inglês | MEDLINE | ID: mdl-30612478

RESUMO

Background Little is known about whether cardiopulmonary resuscitation ( CPR ) training can increase bystander CPR in the community or the appropriate target number of CPR trainings. Herein, we aimed to demonstrate community-wide aggressive dissemination of CPR training and evaluate temporal trends in bystander CPR . Methods and Results We provided CPR training (45-minute chest compression-only CPR plus automated external defibrillator use training or the conventional CPR training), targeting 16% of residents. All emergency medical service-treated out-of-hospital cardiac arrests of medical origin were included. Data on patients experiencing out-of-hospital cardiac arrest and bystander CPR quality were prospectively collected from September 2010 to December 2015. The primary outcome was the proportion of high-quality bystander CPR . During the study period, 57 173 residents (14.7%) completed the chest compression-only CPR training and 32 423 (8.3%) completed conventional CPR training. The proportion of bystander CPR performed did not change (from 43.3% in 2010 to 42.0% in 2015; P for trend=0.915), but the proportion of high-quality bystander CPR delivery increased from 11.7% in 2010 to 20.7% in 2015 ( P for trend=0.015). The 1-year increment was associated with high-quality bystander CPR (adjusted odds ratio, 1.461; 95% CI, 1.055-2.024). Bystanders who previously experienced CPR training were 3.432 times (95% CI, 1.170-10.071) more likely to perform high-quality CPR than those who did not. Conclusions We trained 23.0% of the residents in the medium-sized city of Osaka, Japan, and demonstrated that the proportion of high-quality CPR performed on the scene increased gradually, whereas that of bystander CPR delivered overall remained stable.


Assuntos
Reanimação Cardiopulmonar/educação , Desfibriladores , Serviços Médicos de Emergência/métodos , Massagem Cardíaca/métodos , Parada Cardíaca Extra-Hospitalar/terapia , Sistema de Registros , Idoso , Reanimação Cardiopulmonar/métodos , Feminino , Seguimentos , Humanos , Japão/epidemiologia , Masculino , Parada Cardíaca Extra-Hospitalar/mortalidade , Pressão , Estudos Retrospectivos , Taxa de Sobrevida/tendências
8.
Am J Emerg Med ; 37(5): 913-920, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30119989

RESUMO

OBJECTIVE: To compare OHCA outcomes in patients managed with mechanical versus manual CPR in an EMS system with a "pit crew" approach to resuscitation and a scripted sequence for the initiation of mechanical CPR. METHODS: Through a year-long quality improvement effort we standardized the initial resuscitative efforts for OHCA, prioritizing a "pit crew" approach to high quality manual CPR, early defibrillation and basic airway management ahead of a scripted sequence for initiating mechanical CPR. We then analyzed outcomes for adult, non-traumatic OHCA attended in the following year (2016). We used a propensity score matched analysis to compare ROSC, survival to discharge, and neurologic status among patients managed with manual versus mechanical CPR while controlling for patient demographics and arrest characteristics. RESULTS: Of 444 eligible OHCAs, 217 received manual and 227 received mechanical CPR. Crude ROSC (39.2% vs. 29.1%) and survival to discharge (13.8% vs. 5.7%) were higher with manual CPR. In the propensity matched analysis (n = 176 manual CPR; 176 mechanical CPR), both ROSC (38.6% vs. 28.4%; difference: 10.2%; CI: 0.4% to 20.0%) and survival to discharge (13.6% vs. 6.8%; difference: 6.8%; CI: 0.5% to 13.3%) remained significantly higher for patients receiving manual CPR. CONCLUSIONS: In this EMS system with a standardized, "pit crew" approach to OHCA that prioritized initial high-quality initial resuscitative efforts and scripted the sequence for initiating mechanical CPR, use of mechanical CPR was associated with decreased ROSC and decreased survival to discharge.


Assuntos
Reanimação Cardiopulmonar/métodos , Massagem Cardíaca/métodos , Parada Cardíaca Extra-Hospitalar/terapia , Idoso , Manuseio das Vias Aéreas/métodos , Cardioversão Elétrica , Serviços Médicos de Emergência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Padrões de Referência , Estudos Retrospectivos , Taxa de Sobrevida , Fatores de Tempo
10.
J Am Heart Assoc ; 8(1): e011189, 2019 01 08.
Artigo em Inglês | MEDLINE | ID: mdl-30590977

RESUMO

Background Mechanical chest compression (CC) is currently suggested to deliver sustained high-quality CC in a moving ambulance. This study compared the hemodynamic support provided by a mechanical piston device or manual CC during ambulance transport in a porcine model of cardiopulmonary resuscitation. Methods and Results In a simulated urban ambulance transport, 16 pigs in cardiac arrest were randomized to 18 minutes of mechanical CC with the LUCAS (n=8) or manual CC (n=8). ECG, arterial and right atrial pressure, together with end-tidal CO2 and transthoracic impedance curve were continuously recorded. Arterial lactate was assessed during cardiopulmonary resuscitation and after resuscitation. During the initial 3 minutes of cardiopulmonary resuscitation, the ambulance was stationary, while then proceeded along a predefined itinerary. When the ambulance was stationary, CC-generated hemodynamics were equivalent in the 2 groups. However, during ambulance transport, arterial and coronary perfusion pressure, and end-tidal CO2 were significantly higher with mechanical CC compared with manual CC (coronary perfusion pressure: 43±4 versus 18±4 mmHg; end-tidal CO2: 31±2 versus 19±2 mmHg, P<0.01 at 18 minutes). During cardiopulmonary resuscitation, arterial lactate was lower with mechanical CC compared with manual CC (6.6±0.4 versus 8.2±0.5 mmol/L, P<0.01). During transport, mechanical CC showed greater constancy compared with the manual CC, as represented by a higher CC fraction and a lower transthoracic impedance curve variability ( P<0.01). All animals in the mechanical CC group and 6 (75%) in the manual one were successfully resuscitated. Conclusions This model adds evidence in favor of the use of mechanical devices to provide ongoing high-quality CC and tissue perfusion during ambulance transport.


Assuntos
Ambulâncias , Serviços Médicos de Emergência/métodos , Massagem Cardíaca/métodos , Hemodinâmica/fisiologia , Parada Cardíaca Extra-Hospitalar/terapia , Animais , Reanimação Cardiopulmonar/métodos , Modelos Animais de Doenças , Masculino , Parada Cardíaca Extra-Hospitalar/fisiopatologia , Pressão , Suínos
11.
Pediatr Crit Care Med ; 19(11): e576-e584, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30395117

RESUMO

OBJECTIVES: The optimum chest compression site (P_optimum) in children is debated: European Resuscitation Council recommends one finger breadth above the xiphisternal joint, whereas American Heart Association proposes the lower sternal half. Using a coordinate system imposed on CT, we aimed to determine the pediatric P_optimum to maximize stroke volume, the key point for successful cardiopulmonary resuscitation, while minimizing hepatic injury. DESIGN: Retrospective, cross-sectional study. SETTING: University hospital. PATIENTS: Children 1-15 years old who underwent chest CT. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We defined zero point (0, 0) as the center of the xiphisternal joint designating leftward and upward directions of the patients as positive on each axis. P_optimum (x_max. left ventricle, y_max. left ventricle) was defined as the center of the maximum diameter of the left ventricle, whereas P_aorta (x_aorta, y_aorta) as that of the aortic annulus. To compress the left ventricle exclusively, y_max. left ventricle should range above the y coordinate of hepatic dome (y_liver_dome) and below y_aorta. Data were presented as median (interquartile range) and compared among age groups 1.0-5.0, 5.1-10.0, and 10.1-15.0 years using Kruskal-Wallis test. For universal application regardless of age, y coordinates were converted into relative ones with unit of sternal top: 1 unit of sternal top was the y coordinate of the sternal top. A total of 163 patients were enrolled, median age 8.8 year (4.2-14.3 yr). Among age groups, no significant difference was observed in y_max. left ventricle, relative y_max. left ventricle, y_aorta, and y_liver_dome: 1.0 cm (0.1-1.9 cm), 0.10 unit of sternal top (0.01-0.18 unit of sternal top), 0.39 unit of sternal top (0.30-0.47 unit of sternal top), and -0.14 unit of sternal top (-0.25 to -0.03 unit of sternal top), respectively. The probability to compress the left ventricle exclusively was greater than or equal to 96% when placing hand at 0.05-0.20 unit of sternal top. Subgroup analysis demonstrated the following regression equation: x_max. left ventricle (mm) = 0.173 × (height in cm) + 13 (n = 106; p < 0.001; R = 0.278). CONCLUSIONS: Theoretically, pediatric P_optimum is located 1 cm (or 0.1 unit of sternal top) above the xiphisternal joint.


Assuntos
Reanimação Cardiopulmonar/métodos , Parada Cardíaca/terapia , Massagem Cardíaca/métodos , Adolescente , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Lactente , Masculino , Estudos Retrospectivos , Esterno/anatomia & histologia , Esterno/diagnóstico por imagem , Volume Sistólico/fisiologia , Tomografia Computadorizada por Raios X
12.
J Am Heart Assoc ; 7(19): e009728, 2018 10 02.
Artigo em Inglês | MEDLINE | ID: mdl-30371318

RESUMO

Background The American Heart Association recommends use of physiologic feedback when available to optimize chest compression delivery. We compared hemodynamic parameters during cardiopulmonary resuscitation in which either end-tidal carbon dioxide ( ETCO 2) or diastolic blood pressure ( DBP ) levels were used to guide chest compression delivery after asphyxial cardiac arrest. Methods and Results One- to 2-week-old swine underwent a 17-minute asphyxial-fibrillatory cardiac arrest followed by alternating 2-minute periods of ETCO 2-guided and DBP -guided chest compressions during 10 minutes of basic life support and 10 minutes of advanced life support. Ten animals underwent resuscitation. We found significant changes to ETCO 2 and DBP levels within 30 s of switching chest compression delivery methods. The overall mean ETCO 2 level was greater during ETCO 2-guided cardiopulmonary resuscitation (26.4±5.6 versus 22.5±5.2 mm Hg; P=0.003), whereas the overall mean DBP was greater during DBP -guided cardiopulmonary resuscitation (13.9±2.3 versus 9.4±2.6 mm Hg; P=0.003). ETCO 2-guided chest compressions resulted in a faster compression rate (149±3 versus 120±5 compressions/min; P=0.0001) and a higher intracranial pressure (21.7±2.3 versus 16.0±1.1 mm Hg; P=0.002). DBP -guided chest compressions were associated with a higher myocardial perfusion pressure (6.0±2.8 versus 2.4±3.2; P=0.02) and cerebral perfusion pressure (9.0±3.0 versus 5.5±4.3; P=0.047). Conclusions Using the ETCO 2 or DBP level to optimize chest compression delivery results in physiologic changes that are method-specific and occur within 30 s. Additional studies are needed to develop protocols for the use of these potentially conflicting physiologic targets to improve outcomes of prolonged cardiopulmonary resuscitation.


Assuntos
Asfixia Neonatal/complicações , Pressão Sanguínea/fisiologia , Dióxido de Carbono/metabolismo , Reanimação Cardiopulmonar/métodos , Parada Cardíaca/terapia , Massagem Cardíaca/métodos , Monitorização Fisiológica/métodos , Animais , Animais Recém-Nascidos , Asfixia Neonatal/fisiopatologia , Diástole , Modelos Animais de Doenças , Parada Cardíaca/etiologia , Parada Cardíaca/fisiopatologia , Masculino , Projetos Piloto , Suínos
13.
Zhongguo Yi Xue Ke Xue Yuan Xue Bao ; 40(4): 473-480, 2018 Aug 30.
Artigo em Chinês | MEDLINE | ID: mdl-30193600

RESUMO

Objective To compare the clinical outcomes of continuous chest compressions (CCP) or interrupt chest compression (ICP) for the cardiac arrest patients. Methods Totally 114 adult patients with out-of-hospital non-trauma-related cardiac arrest that needed cardiopulmonary resuscitation (CPR) in Quzhou People's Hospital from January 2014 to January 2017 were enrolled in this study. Patients who divided into CCP group (n=70) and ICP group (n=44) according to the maneuvers. The clinical data of these two groups were collected and compared. Results The chest-compression fraction was higher in CCP group than in ICP group (0.85±0.05 vs. 0.75±0.06,t=9.868,P=0.000),and the rate of chest-compression pause per minute was significantly lower in CCP group (3.5±1.6 vs. 6.9±3.8,t=-10.669,P=0.000). The interval from arrival at a first aid location to CPR,duration of CPR,electric defibrillation frequency,airway establishment,intubation time,and use of first-aid drugs were not statistically significant (all P>0.05). Significantly lower proportion of patients in CCP group were transported to a hospital (42.8% vs. 56.8%,Χ2=0.198,P=0.032). The proportion of patients achieving recovery of spontaneous circulation (ROSC) in CCP group were significantly lower than in ICP group (28.5% vs.47.7%,Χ2=0.191,P=0.038). The proportion of patients who got successful resuscitation in CCP group was significantly lower than in ICP group (20.0% vs. 38.6%,Χ2=4.470,P=0.029). The proportion of patients who survived and were discharged was significantly lower in CCP group than in ICP group (8.6% vs.22.7%,Χ2=0.487,P=0.041). There was no significant difference between these two groups in ROSC time,proportion of survivors one month after discharge,proportion of survivors six months after discharges,and neurological outcomes (all P>0.05). Among the survivors,2 patients had ST-elevation myocardial infarction,1 had rheumatic heart disease,2 had non-ST segment elevations myocardial infarction,and 1 had dilated cardiomyopathy. Multivariate Cox proportional hazard regression analysis was used to analyze the independent factor of prognosis. The time from cardiac arrest to CPR (HR=1.047,95% CI=1.003-1.093,P=0.034),the time from CPR to ROSC (HR=1.021,95% CI=1.003-1.038,P=0.020),and Glasgow Coma Scale (GCS) 1 score (HR=1.551,95% CI=1.022-2.355,P=0.039) were the independent risk factor for deaths within 180 days after discharge. Conclusion Long interval from cardiac arrest to CPR,long interval from CPR to ROSC,and a Glasgow Coma Scale score of>1 are the independent risk factors of deaths within 180 days after discharge. Therefore,the survival outcomes of CCP may not be superior to ICP in patients with out-of-hospital cardiac arrest.


Assuntos
Reanimação Cardiopulmonar/métodos , Massagem Cardíaca/métodos , Parada Cardíaca Extra-Hospitalar/terapia , Adulto , Cardioversão Elétrica , Humanos , Taxa de Sobrevida , Resultado do Tratamento
14.
Resuscitation ; 133: 187-192, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30172693

RESUMO

AIM: The cardiopulmonary resuscitation (CPR) guidelines recommend that endotracheal intubation (ETI) should be performed only by highly skilled rescuers. However, the definition of 'highly skilled' is unclear. This study evaluated how much experience with ETI is required for rescuers to perform successful ETI quickly without complications including serious chest compression interruption (interruption time <10 s) or oesophageal intubation during CPR. METHODS: This was a clinical observation study using review of CPR video clips in an urban emergency department (ED) over 2 years. Accumulated ETI experience and performance of ETI were analysed. Main outcomes were 1) 'qualified ETI': successful ETI within 60 s without complications and 2) 'highly qualified ETI': successful ETI within 30 s without complications. RESULTS: We analysed 110 ETIs using direct laryngoscopy during CPR. The success rate improved and the time to successful ETI decreased with increasing experience; however, the total interruption time of chest compression did not decrease. A 90% success rate for qualified ETI required 137 experiences of ETIs (1218 days of training). A 90% success rate for highly qualified ETI required at least 243 experiences of ETIs (1973 days of training). CONCLUSIONS: Accumulated experience can improve the ETI success rate and time to successful ETI during CPR. Because ETI must be performed quickly without serious interruption of chest compression during CPR, becoming proficient at ETI requires more experience than that required for non-arrest patients. In our analysis, more than 240 experiences were required to achieve a 90% success rate of highly qualified ETI.


Assuntos
Reanimação Cardiopulmonar/estatística & dados numéricos , Intubação Intratraqueal/normas , Reanimação Cardiopulmonar/educação , Competência Clínica , Medicina de Emergência/educação , Serviço Hospitalar de Emergência/estatística & dados numéricos , Massagem Cardíaca/métodos , Massagem Cardíaca/normas , Humanos , Internato e Residência , Intubação Intratraqueal/métodos , Intubação Intratraqueal/estatística & dados numéricos , Parada Cardíaca Extra-Hospitalar/terapia , Estudos Retrospectivos , Fatores de Tempo , Gravação em Vídeo
15.
Life Sci Space Res (Amst) ; 18: 72-79, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30100150

RESUMO

INTRODUCTION: 2015 UK resuscitation guidelines aim for 50-60 mm depth when giving external chest compressions (ECCs). This is achievable in hypogravity if the rescuer flexes and extends their arms during CPR, or using a new method trialed; the 'Mackaill-Russomano' (MR CPR) method. METHODS: 10 participants performed 3 sets of 30 ECCs in accordance with 2015 guidelines. A control was used at 1Gz, with eight further conditions using Mars and Moon simulations, with and without braces in the terrestrial position and using the MR CPR method. The MR CPR method involved straddling the mannequin, using its legs for stabilization. A body suspension device, with counterweights, simulated hypogravity environments. ECC depth, rate, angle of arm flexion and heart rate (HR) were measured. RESULTS: Participants completed all conditions, and ECC rate was achieved throughout. Mean (±â€¯SD) ECC depth using the MR CPR method at 0.38Gz was 54.1 ±â€¯0.55 mm with braces; 50.5 ±â€¯1.7 mm without. ECCs were below 50 mm at 0.17Gz using the MR CPR method (47.5 ±â€¯1.47 mm with braces; 47.4 ±â€¯0.87 mm without). In the terrestrial position, ECCs were more effective without braces (49.4 ±â€¯0.26 mm at 0.38Gz; 43.9 ±â€¯0.87 mm at 0.17Gz) than with braces (48.5 ±â€¯0.28 mm at 0.38Gz; 42.4 ±â€¯0.3 mm at 0.17Gz). Flexion increased from approximately 2° - 8° with and without braces respectively. HR did not change significantly from control. DISCUSSION: 2015 guidelines were achieved using the MR CPR method at 0.38Gz, with no significant difference with and without braces. Participants were closer to achieving the required ECC depth in the terrestrial position without braces. ECC depth was not achieved at 0.17Gz, due to a greater reduction in effective body weight.


Assuntos
Medicina Aeroespacial , Reanimação Cardiopulmonar/métodos , Massagem Cardíaca/métodos , Hipogravidade , Simulação de Ausência de Peso , Adulto , Feminino , Frequência Cardíaca , Humanos , Masculino , Pressão , Voo Espacial , Adulto Jovem
16.
Resuscitation ; 132: 41-46, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30121201

RESUMO

BACKGROUND: Devices that measure ventilation in the pre-hospital setting are deficient especially during early cardiopulmonary resuscitation (CPR) before placement of an advanced airway. Consequently, evidence is limited regarding the role of ventilation during early CPR and its effect on outcomes. OBJECTIVE: To develop software that automatically identifies ventilation waveforms recorded by defibrillators based on changes in transthoracic impedance during standard CPR. METHODS: This was an observational, retrospective analysis of non-traumatic pre-hospital cardiac arrest patients who received 30:2 CPR by emergency medical service rescuers. Data was collected from 550 cases recorded by the bioimpedance channel of defibrillators. Two expert clinicians independently assessed all episodes from the time of initial CPR until placement of an advanced airway, defined acceptable ventilation waveforms, and annotated the pauses between compressions with ventilation waveforms. We then developed software that incorporated the expert criteria and automatically annotated pauses with acceptable ventilations. RESULTS: A total of 7396 pauses were analyzed, mean(SD) duration of 30:2 CPR was 13 (8) min, with 13 (10) pauses/patient, and mean pause duration of 6 (3) s. Reviewer 1 and reviewer 2 identified 2375 and 2249 pauses with any acceptable ventilation, respectively, with an inter-rater reliability of 0.94. The novel software program reproduced expert annotation with excellent agreement (>0.8) and high accuracy, both sensitivity and specificity above 90%, compared to two reviewers. The software presented a substantial agreement with the reviewers (κ > 0.73) for ventilation counts in the pauses. CONCLUSION: We developed a novel and reliable strategy that enables investigation of ventilation quality during standard CPR using thoracic bioimpedance. This strategy would allow a timely and reliable automatic annotation of large scale resuscitation datasets.


Assuntos
Cardiografia de Impedância/instrumentação , Reanimação Cardiopulmonar/métodos , Massagem Cardíaca/métodos , Parada Cardíaca Extra-Hospitalar/terapia , Respiração , Desfibriladores , Serviços Médicos de Emergência/métodos , Humanos , Reprodutibilidade dos Testes , Estudos Retrospectivos , Fatores de Tempo
17.
Cochrane Database Syst Rev ; 8: CD007260, 2018 08 20.
Artigo em Inglês | MEDLINE | ID: mdl-30125048

RESUMO

BACKGROUND: Mechanical chest compression devices have been proposed to improve the effectiveness of cardiopulmonary resuscitation (CPR). OBJECTIVES: To assess the effectiveness of resuscitation strategies using mechanical chest compressions versus resuscitation strategies using standard manual chest compressions with respect to neurologically intact survival in patients who suffer cardiac arrest. SEARCH METHODS: On 19 August 2017 we searched the Cochrane Central Register of Controlled Studies (CENTRAL), MEDLINE, Embase, Science Citation Index-Expanded (SCI-EXPANDED) and Conference Proceedings Citation Index-Science databases. Biotechnology and Bioengineering Abstracts and Science Citation abstracts had been searched up to November 2009 for prior versions of this review. We also searched two clinical trials registries for any ongoing trials not captured by our search of databases containing published works: Clinicaltrials.gov (August 2017) and the World Health Organization International Clinical Trials Registry Platform portal (January 2018). We applied no language restrictions. We contacted experts in the field of mechanical chest compression devices and manufacturers. SELECTION CRITERIA: We included randomised controlled trials (RCTs), cluster-RCTs and quasi-randomised studies comparing mechanical chest compressions versus manual chest compressions during CPR for patients with cardiac arrest. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. MAIN RESULTS: We included five new studies in this update. In total, we included 11 trials in the review, including data from 12,944 adult participants, who suffered either out-of-hospital cardiac arrest (OHCA) or in-hospital cardiac arrest (IHCA). We excluded studies explicitly including patients with cardiac arrest caused by trauma, drowning, hypothermia and toxic substances. These conditions are routinely excluded from cardiac arrest intervention studies because they have a different underlying pathophysiology, require a variety of interventions specific to the underlying condition and are known to have a prognosis different from that of cardiac arrest with no obvious cause. The exclusions were meant to reduce heterogeneity in the population while maintaining generalisability to most patients with sudden cardiac death.The overall quality of evidence for the outcomes of included studies was moderate to low due to considerable risk of bias. Three studies (N = 7587) reported on the designated primary outcome of survival to hospital discharge with good neurologic function (defined as a Cerebral Performance Category (CPC) score of one or two), which had moderate quality evidence. One study showed no difference with mechanical chest compressions (risk ratio (RR) 1.07, 95% confidence interval (CI) 0.82 to 1.39), one study demonstrated equivalence (RR 0.79, 95% CI 0.60 to 1.04), and one study demonstrated reduced survival (RR 0.41, CI 0.21 to 0.79). Two other secondary outcomes, survival to hospital admission (N = 7224) and survival to hospital discharge (N = 8067), also had moderate quality level of evidence. No studies reported a difference in survival to hospital admission. For survival to hospital discharge, two studies showed benefit, four studies showed no difference, and one study showed harm associated with mechanical compressions. No studies demonstrated a difference in adverse events or injury patterns between comparison groups but the quality of data was low. Marked clinical and statistical heterogeneity between studies precluded any pooled estimates of effect. AUTHORS' CONCLUSIONS: The evidence does not suggest that CPR protocols involving mechanical chest compression devices are superior to conventional therapy involving manual chest compressions only. We conclude on the balance of evidence that mechanical chest compression devices used by trained individuals are a reasonable alternative to manual chest compressions in settings where consistent, high-quality manual chest compressions are not possible or dangerous for the provider (eg, limited rescuers available, prolonged CPR, during hypothermic cardiac arrest, in a moving ambulance, in the angiography suite, during preparation for extracorporeal CPR [ECPR], etc.). Systems choosing to incorporate mechanical chest compression devices should be closely monitored because some data identified in this review suggested harm. Special attention should be paid to minimising time without compressions and delays to defibrillation during device deployment.


Assuntos
Reanimação Cardiopulmonar/métodos , Parada Cardíaca/terapia , Massagem Cardíaca/métodos , Circulação Sanguínea , Reanimação Cardiopulmonar/instrumentação , Reanimação Cardiopulmonar/mortalidade , Parada Cardíaca/mortalidade , Massagem Cardíaca/instrumentação , Massagem Cardíaca/mortalidade , Hospitalização , Humanos , Alta do Paciente , Ensaios Clínicos Controlados Aleatórios como Assunto
19.
Resuscitation ; 132: 33-40, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30149088

RESUMO

AIM: To determine if integrating a trained CPR Coach into resuscitation teams can improve CPR quality during simulated pediatric cardiopulmonary arrest (CPA). METHODS: We conducted a multicenter, prospective, randomized trial. An 18-minute simulated CPA scenario was run for resuscitation teams comprised of CPR-certified professionals from four International Network for Simulation-based Pediatric Innovation, Research & Education (INSPIRE) institutions. Forty teams (200 participants) were randomized to having a trained CPR Coach vs. no CPR Coach. CPR Coaches were responsible for providing real-time verbal feedback of CPR performance to compressors. All teams utilized CPR feedback technology. We report the proportion of overall excellent CPR, proportion of chest compressions (CC) with depth 50-60 mm, the proportion of CC with rate 100-120 per minute, CC fraction, and pre-, post-, and peri-shock pause duration. RESULTS: CPR coached teams compared with teams without a CPR Coach resulted in an absolute improvements in overall excellent CPR by 31.8% (95% CI, 17.7, 35.9; p < 0.001), mean CC depth compliance by 31.5% (15.7, 47.4; p < 0.001), mean CC depth by 4.6 mm (1.6, 7.5; p < 0.001), mean CC fraction by 5.4% (0.2, 10.6; p = 0.04), and mean pre-, post- and peri-shock pause duration by -2.7 s (-5.1, -0.4; p = 0.02), -1.0 s (-1.8, -0.2; p = 0.01); and -3.8 (-6.6, -1.0; p = 0.008), respectively. Changes in mean CC rate compliance and mean CC rate were not statistically significant. CONCLUSIONS: In the presence of CPR feedback technology, the integration of a trained CPR coach into resuscitation teams enhances CPRquality metrics associated with improved survival outcomes from pediatric cardiac arrest.


Assuntos
Reanimação Cardiopulmonar/educação , Parada Cardíaca/terapia , Reanimação Cardiopulmonar/métodos , Criança , Retroalimentação , Feminino , Fidelidade a Diretrizes , Massagem Cardíaca/métodos , Humanos , Masculino , Tutoria , Estudos Prospectivos , Treinamento por Simulação , Resultado do Tratamento
20.
Resuscitation ; 131: 55-62, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30092277

RESUMO

BACKGROUND: Chest compression (CC) research primarily focuses on finding the 'optimum' compression waveform using a variety of compression efficacy metrics. Blood flow is rarely measured systematically with high fidelity. Using a programmable mechanical chest compression device, we studied the effect of inter-compression pauses in a swine model of cardiac arrest, testing the hypothesis that a single 'optimal' CC waveform exists based on measurements of resulting blood flow. METHODS: Hemodynamics were studied in 9 domestic swine (∼30 kg) using multiple flow probes and standard physiological monitoring. After 10 min of ventricular fibrillation, five mechanical chest compression waveforms (5.1 cm, varying inter-compression pauses) were delivered for 2 min each in a semi-random pattern, totaling 50 compression minutes. Linear Mixed Models were used to estimate the effect of compression waveform on hemodynamics. RESULTS: Blood flow and pressure decayed significantly with time in both arteries and veins. No waveform maximized blood flow in all vessels simultaneously and the waveform generating maximal blood flow in a specific vessel changed over time in all vessels. A flow mismatch between paired arteries and veins, e.g. abdominal aorta and inferior vena cava, also developed over time. The waveform with the slowest rate and shortest duty cycle had the smallest mismatch between flows after about 30 min of CPR. CONCLUSIONS: This data challenges the concept of a single optimal CC waveform. Time dependent physiological response to compressions and no single compression waveform optimizing flow in all vessels indicate that current descriptions of CPR don't reflect patient physiology.


Assuntos
Pressão Arterial , Reanimação Cardiopulmonar/métodos , Circulação Cerebrovascular , Parada Cardíaca/fisiopatologia , Massagem Cardíaca/métodos , Animais , Feminino , Parada Cardíaca/terapia , Hemodinâmica , Modelos Lineares , Suínos
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