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1.
Emergencias (Sant Vicenç dels Horts) ; 32(1): 49-56, feb. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-185854

RESUMO

Objetivo. Evaluar la efectividad, en relación al retorno a circulación espontánea, la supervivencia al alta y la supervivencia al alta con buen estado neurológico, del acceso intraóseo frente al acceso venoso en la resucitación en parada cardiaca extrahospitalaria. Método. Se realiza una revisión sistemática y metanálisis en las bases de datos Medline (PubMed), Embase, Web of Science y Cochrane Library. Se incluyeron estudios observacionales y ensayos clínicos registrados en las bases de datos mencionadas desde el 1 de enero de 1950 hasta el 31 de mayo de 2019, en los que la población incluida fueran pacientes adultos en situación de parada cardiaca extrahospitalaria y que tuvieran canalizado un acceso intraóseo o intravenoso. La evaluación del riesgo de sesgo se realizó mediante la herramienta de evaluación de sesgo de Cochrane y la herramienta GRADE. Resultado. Se identificaron 434 referencias de las que 5 se incluyen en la síntesis cualitativa y cuantitativa. El acceso intraóseo se relaciona con una peor tasa de retorno a circulación espontánea [OR 0,69 (IC 95%: 0,57-0,83), p = 0,02, I2 = 65%] y una peor supervivencia al alta hospitalaria [OR 0,65 (IC 95%: 0,51-0,83); p < 0,01, I2 = 30%] en comparación con el acceso venoso. Conclusiones. El acceso intraóseo en pacientes en situación de parada cardiaca extrahospitalaria se relaciona con peores resultados en términos de retorno a circulación espontánea y supervivencia al alta hospitalaria


Objective. To evaluate the efficacy of intraosseous access versus venous access in out-of-hospital cardiac arrest in terms of return of spontaneous circulation (ROSC) and survival to hospital discharge with or without favorable neurologic status. Methods. Systematic review and meta-analysis of articles indexed in MEDLINE (PubMed), Embase, the Web of Science, and the Cochrane Library. Other terms adapted to the language of each index were also used. We included observational studies and clinical trials published from January 1, 1950, to May 31, 2019, if the study population included adult patients in cardiac arrest outside the hospital and in whom an intraosseous or intravenous catheter was inserted. Risk of bias was evaluated with the Cochrane and GRADE (Grading of Recommendations Assessment, Development and Evaluation) tools. Results. We identified 434 papers to include in the qualitative review and 5 studies for meta-analysis. Intraosseous access was related to a lower rate of ROSC (odds ratio [OR], 0.69; 95% CI, 0.57-0.83; P = .02; I2 = 65%) and worse survival to discharge (OR, 0.65; 95% CI, 0.51-0.83); P<.01, I2 = 30%). Conclusion. Intraosseous access in out-of-hospital cardiac arrest is related to poorer outcomes in terms of ROSC and survival at hospital discharge


Assuntos
Humanos , Parada Cardíaca Extra-Hospitalar/epidemiologia , Taxa de Sobrevida , Morte Súbita , Fibrilação Ventricular , Alta do Paciente/tendências , Razão de Chances
2.
PLoS One ; 15(1): e0218634, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31940337

RESUMO

BACKGROUND: Out-of-hospital cardiac arrest (OHCA) is one of the leading causes of death worldwide, with acute coronary syndromes accounting for most of the cases. While the benefit of early revascularization has been clearly demonstrated in patients with ST-segment-elevation myocardial infarction (STEMI), diagnostic pathways remain unclear in the absence of STEMI. We aimed to characterize OHCA patients presenting to 2 tertiary cardiology centers and identify predicting factors associated with survival. METHODS: We retrospectively analyzed 519 patients after OHCA from February 2003 to December 2017 at 2 centers in Munich, Germany. Patients undergoing immediate coronary angiography (CAG) were compared to those without. Multivariate regression analysis and inverse probability treatment weighting (IPTW) were performed to identify predictors for improved outcome in a matched population. RESULTS: Immediate CAG was performed in 385 (74.1%) patients after OHCA with presumed cardiac cause of arrest. As a result of multivariate analysis after propensity score matching, we found that immediate CAG, return of spontaneous circulation (ROSC) at admission, witnessed arrest and former smoking were associated with improved 30-days-survival [(OR, 0.46; 95% CI, 0.26-0.84), (OR, 0.21; 95% CI, 0.10-0.45), (OR, 0.50; 95% CI, 0.26-0.97), (OR, 0.43; 95% CI, 0.23-0.81)], and 1-year-survival [(OR, 0.39; 95% CI, 0.19-0.82), (OR, 0.29; 95% CI, 0.12-0.7), (OR, 0.43; 95% CI, 0.2-1.00), (OR, 0.3; 95% CI, 0.14-0.63)]. CONCLUSIONS: In our study, immediate CAG, ROSC at admission, witnessed arrest and former smoking were independent predictors of survival in cardiac arrest survivors. Improvement in prehospital management including bystander CPR and best practice post-resuscitation care with optimized triage of patients to an early invasive strategy may help ameliorate overall outcome of this critically-ill patient population.


Assuntos
Reanimação Cardiopulmonar/métodos , Doença das Coronárias/epidemiologia , Parada Cardíaca Extra-Hospitalar/epidemiologia , Infarto do Miocárdio com Supradesnível do Segmento ST/epidemiologia , Idoso , Angiografia Coronária , Doença das Coronárias/diagnóstico por imagem , Doença das Coronárias/fisiopatologia , Eletrocardiografia , Feminino , Alemanha/epidemiologia , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Parada Cardíaca Extra-Hospitalar/fisiopatologia , Intervenção Coronária Percutânea , Pontuação de Propensão , Sistema de Registros , Fatores de Risco , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico por imagem , Infarto do Miocárdio com Supradesnível do Segmento ST/fisiopatologia , Sobreviventes , Triagem
3.
Scand J Trauma Resusc Emerg Med ; 27(1): 106, 2019 Nov 27.
Artigo em Inglês | MEDLINE | ID: mdl-31771619

RESUMO

BACKGROUND: Considering the significant morbidity and mortality of out-of-hospital cardiac arrest, only little data on survival or quality of life after successful resuscitation is available in Europe. Additionally, economic aspects of such events are poorly studied. The purpose of this study is to provide data for survival, quality of life and costs directly related to the cardiac arrest for a region of Switzerland served by one emergency medical service (EMS). METHODS: Eighty eight patients older than 18 years of age that were resuscitated by the EMS Winterthur in the year 2013 were included and retrospective analysis of EMS-protocols was performed. For patients alive at follow-up, 2 years after the event, a structured interview with quality of life questionnaires was conducted. This study was accepted by the local Ethics Committee. RESULTS: Thirty five percent (n = 31) of resuscitated patients were admitted alive to the hospital following out-of-hospital cardiac arrest. This incidence was as high as 60%, if the patients had a shockable rhythm as first rhythm. Survival to follow-up was 16% (n = 14). These patients had an excellent quality of life overall, with little to no limitations in daily life. There was no significant difference in survival for patients in outlying regions with comparatively longer timespans until arrival of EMS. Median EMS-costs for deceased patients were CHF 1731 (inter-quartile range 346), for survivors CHF 2'169 (inter-quartile range CHF 444) and median hospital-costs were CHF 27'707 (inter-quartile range CHF 62'783). CONCLUSION: Quality of care for patients with out-of-hospital cardiac arrest in the region of Winterthur is high, including patients in outlying regions. The associated costs are similar to other European countries. TRIAL REGISTRATION: This trial was registered with www.clinicaltrials.gov under NCT02625883.


Assuntos
Serviços Médicos de Emergência/economia , Custos Hospitalares/estatística & dados numéricos , Parada Cardíaca Extra-Hospitalar/economia , Idoso , Reanimação Cardiopulmonar , Feminino , Humanos , Masculino , Parada Cardíaca Extra-Hospitalar/epidemiologia , Qualidade de Vida , Estudos Retrospectivos , Suíça/epidemiologia , População Urbana
4.
Scand J Trauma Resusc Emerg Med ; 27(1): 102, 2019 Nov 07.
Artigo em Inglês | MEDLINE | ID: mdl-31699120

RESUMO

BACKGROUND: A national Helicopter Emergency Medical Service (HEMS) was introduced in Denmark in 2014 to ensure the availability of physician-led critical care for all patients regardless of location. Appropriate dispatch of HEMS is known to be complex, and resource utilisation is a highly relevant topic. Population-based studies on patient characteristics are fundamental when evaluating and optimising a system. The aim of this study was to describe the patient population treated by the Danish HEMS in terms of demographics, pre-hospital diagnostics, severity of illness or injury, and the critical care interventions performed. METHOD: The study is a retrospective nationwide population-based study based on data gathered from the Danish HEMS database. We included primary missions resulting in a patient encounter registered between October 1st 2014 and April 30th 2018. RESULTS: Of 13.391 dispatches registered in the study period we included 7133 (53%) primary missions with patient encounter: 4639 patients were air lifted to hospital, 174 patients were escorted to hospital by the HEMS physician in an ambulance, and in 2320 cases HEMS assisted the ground crew on scene but did not escort the patient to hospital. Patient age ranged from 0-99 years and 64% of the population were men. The median age was 60 years. The main diagnostic groups were cardio-vascular emergencies (41%), trauma (23%) and neurological emergencies (16%). In 61% of the cases, the patient was critically ill/injured corresponding to a NACA (National Advisory Committee for Aeronautics) score between 4 and 7 (both included). In more than one third of the missions a critical care intervention was performed. Ultrasound examination and endo-tracheal intubation were the critical care interventions most frequently performed (21% and 20%, respectively). CONCLUSION: The national Danish HEMS primarily attends severely ill or injured patients and often perform critical care interventions. In addition, the Danish HEMS provides rapid transport to highly specialised treatment for patients in the more rural parts of the country. Patients with cardio-vascular emergencies, trauma and neurological emergencies are among those patient groups most commonly seen. We conclude that the overall dispatch profile appears appropriate but emphasise that continuous development and refinement is essential.


Assuntos
Resgate Aéreo/estatística & dados numéricos , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Cuidados Críticos , Dinamarca/epidemiologia , Serviços Médicos de Emergência , Feminino , Humanos , Lactente , Recém-Nascido , Intubação Intratraqueal/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/epidemiologia , Doenças do Sistema Nervoso/epidemiologia , Parada Cardíaca Extra-Hospitalar/epidemiologia , Estudos Retrospectivos , Distribuição por Sexo , Índices de Gravidade do Trauma , Ultrassonografia/estatística & dados numéricos , Ferimentos e Lesões/epidemiologia , Adulto Jovem
5.
N Z Med J ; 132(1503): 75-82, 2019 10 04.
Artigo em Inglês | MEDLINE | ID: mdl-31581184

RESUMO

BACKGROUND: Last year, there were 2,000 out-of-hospital cardiac arrests (OHCA) in New Zealand, 74% received CPR but only 5.1% accessed an automated external defibrillator (AED). The average survival rate of OHCA is 13%. The aim of this study was to visit all 50 AED locations shown on www.hamiltoncentral.co.nz to assess their true availability and visibility to the public in the event of an OHCA. METHOD: All premises were visited and the first staff member encountered was asked if they were aware an AED was onsite, its location, hours of availability, if restricted access applied and whether it had been used. RESULTS: Of the 50 locations, three sites no longer exist and two AEDs were listed twice. Therefore, only 45 AEDs exist. Two sites had grossly inaccurate locations. Three AEDs (7%) were continuously available. Nine AEDs were accessible after 6pm at least one day of the week. Thirteen AEDs were available on weekends; however, five required swipe card access. None of the AEDs were located outdoors. CONCLUSION: Far fewer than 50 listed AEDs are freely available to the public, especially after 6pm and on weekends. Lack of signposting and restrictions to access would lead to delayed defibrillation. This important health issue needs addressing.


Assuntos
Desfibriladores/provisão & distribução , Cardioversão Elétrica , Serviços Médicos de Emergência , Acesso aos Serviços de Saúde/estatística & dados numéricos , Parada Cardíaca Extra-Hospitalar , Reanimação Cardiopulmonar/instrumentação , Reanimação Cardiopulmonar/métodos , Reanimação Cardiopulmonar/estatística & dados numéricos , Intervenção Médica Precoce/organização & administração , Intervenção Médica Precoce/normas , Cardioversão Elétrica/instrumentação , Cardioversão Elétrica/métodos , Cardioversão Elétrica/estatística & dados numéricos , Serviços Médicos de Emergência/métodos , Serviços Médicos de Emergência/organização & administração , Humanos , Nova Zelândia/epidemiologia , Parada Cardíaca Extra-Hospitalar/epidemiologia , Parada Cardíaca Extra-Hospitalar/terapia , Melhoria de Qualidade
6.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 31(7): 878-883, 2019 Jul.
Artigo em Chinês | MEDLINE | ID: mdl-31441414

RESUMO

OBJECTIVE: To compare the influences of extracorporeal cardiopulmonary resuscitation (ECPR) and conventional or mechanical cardiopulmonary resuscitation (CCPR/MCPR) on survival rate and neurological outcome for adult patients with out-of-hospital cardiac arrest (OHCA), and to assess the effect of ECPR. METHODS: Databases such as Medline, Embase, ScienceDirect, HighWire, Cochrane Library, Wanfang Database and China National Knowledge Infrastructure (CNKI) were searched from January 2000 to October 2018 to retrieve clinical trials on comparison of the effect of ECPR and CCPR/MCPR on survival rate and neurological outcome of adult patients with OHCA. Thereafter, the studies retrieved were based on predefined inclusion and exclusion criteria. Data were extracted and the quality of the included studies was evaluated by two researchers. A meta-analysis was performed by using RevMan 5.3 software. Sensitivity analysis was used to evaluate the stability of the results, and funnel plot was used to evaluate publication bias. RESULTS: A total of 12 studies and 2 519 patients were enrolled, including 615 patients receiving ECPR and 1 904 patients receiving CCPR/MCPR. Meta-analysis showed that compared with CCPR/MCPR, ECPR could not improve the short-term (at hospital discharge or within 1 month) survival rate in patients with OHCA [odds ratio (OR) = 2.26, 95% confidence interval (95%CI) = 0.95-5.41, P = 0.07], but could increase long-term (at more than 3 months) survival rate (OR = 3.56, 95%CI = 1.65-7.71, P = 0.001), rate of good neurological outcome at hospital discharge [Glasgow-Pittsburgh cerebral performance categories (CPC) 1-2 was defined as good neurological function; OR = 3.39, 95%CI = 1.73-6.62, P = 0.000 4], and rate of good long-term neurological outcome (OR = 3.45, 95%CI = 2.24-5.32, P < 0.000 01). Sensitivity analysis showed that the overall results did not change significantly, whether using fixed-effect model and random-effect model to analyze the differences of each effect index, or excluding one study with fewer than 50 subjects for data analysis, indicating that the results were more stable. The funnel plot suggested that there was no publication bias in the studies. But due to the small number of studies, the publication bias could not be excluded. CONCLUSIONS: ECPR could not improve the short-term survival rate at hospital discharge or within 1 month in patients with OHCA, but could increase long-term survival rate at more than 3 months, good neurological outcome at hospital discharge and long-term neurological outcome.


Assuntos
Reanimação Cardiopulmonar , Parada Cardíaca Extra-Hospitalar/epidemiologia , Adulto , China/epidemiologia , Humanos , Taxa de Sobrevida , Resultado do Tratamento
7.
Crit Care ; 23(1): 263, 2019 Jul 25.
Artigo em Inglês | MEDLINE | ID: mdl-31345244

RESUMO

BACKGROUND: It remains unclear whether men have more favorable survival outcomes after out-of-hospital cardiac arrest (OHCA) than women. METHODS: We reviewed a total of 386,535 patients aged ≥ 18 years with OHCA who were included in the Japanese registry from 2013 to 2016. The study endpoints were the rates of 1-month survival and neurologically intact survival (Cerebral Performance Category Scale score = 1 or 2). Based on age, the reviewed patients were categorized into the following eight groups: < 30, 30-39, 40-49, 50-59, 60-69, 70-79, 80-89, and ≥ 90 years. The survival outcomes in men and women were compared using hierarchical propensity score matching. RESULTS: The crude survival rate was significantly higher in men than in women in five groups: 30-39, 40-49, 50-59, 60-69, and 70-79 years (all P < 0.001). Similarly, the crude neurologically intact survival rate was significantly higher in men than in women in seven groups: < 30, 30-39, 40-49, 50-59, 60-69, 70-79, and 80-89 years (all P < 0.005). However, multivariate logistic regression analysis of each group revealed no significant sex-specific differences in 1-month survival outcomes (all P > 0.02). Moreover, after hierarchical propensity score matching, the survival outcomes did not significantly differ between both sexes (all P > 0.05). CONCLUSIONS: No significant sex-specific differences were found in the rates of 1-month survival and neurologically intact survival after OHCA.


Assuntos
Parada Cardíaca Extra-Hospitalar/mortalidade , Fatores Sexuais , Adulto , Idoso , Idoso de 80 Anos ou mais , Distribuição de Qui-Quadrado , Feminino , Humanos , Japão/epidemiologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Parada Cardíaca Extra-Hospitalar/epidemiologia , Vigilância da População/métodos , Sistema de Registros/estatística & dados numéricos , Análise de Sobrevida
8.
Emerg Med J ; 36(7): 410-415, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31171627

RESUMO

OBJECTIVES: Many registry studies on patients with out-of-hospital cardiac arrest (OHCA) have reported that conventional bag-valve-mask (BVM) ventilation is independently associated with favourable outcomes. This study aimed to compare the data of patients with OCHA with confirmed cardiac output on emergency medical services (EMS) arrival and consider the confounding factors in prehospital airway management studies. METHODS: This was a cohort study using the registry data for survivors after out-of hospital cardiac arrest in the Kanto region at 2012 in Japan (SOS-KANTO 2012). Survivors who received advanced airway management (AAM) group and a BVM group were compared for confirmed cardiac output on EMS arrival and neurolgical outcome at 1 month. Favourable neurological outcome was defined as a score of one or two on the Cerebral Performance Categories Scale. Multivariable logistic regression was used to adjust the neurological outcome by age, gender, cardiac aetiology, witnessed arrest, shockable rhythm, cardiopulmonary resuscitation performed by a bystander, BVM at prehospital ventilation and presence of confirmed cardiac output on EMS arrival. RESULTS: A total of 16 452 patients were enrolled in the SOS-KANTO 2012 study, and of those data 12 867 were analysed; 5893 patients comprised the AAM group and 6974 comprised the BVM group. Of the study participants, 386 (2.9%) had confirmed cardiac output on EMS arrival; 340 (2.6%) of the entire study group had a favourable neurological outcome. The proportion of patients with confirmed cardiac output on EMS arrival was significantly higher in the BVM group (272: 3.9%) than in the AAM group (114: 1.9%) (95% CI: 1.65 to 2.25). The proportion of patients with favourable neurological outcomes was 30% (117/386) in those with cardiac output on EMS arrival compared with 1.8% (223/12481) in those without. The OR for a good neurological outcome with BVM decreased from 3.24 (2.49 to 4.20) to 2.60 (1.97 to 3.44) when confirmed cardiac output on EMS arrival was added to the multivariable model analysis. CONCLUSION: Confirmed cardiac output on EMS arrival should be considered as confounding by indication in observational studies of prehospital airway management.


Assuntos
Manuseio das Vias Aéreas/estatística & dados numéricos , Débito Cardíaco , Parada Cardíaca Extra-Hospitalar/fisiopatologia , Idoso , Manuseio das Vias Aéreas/métodos , Manuseio das Vias Aéreas/normas , Estudos de Coortes , Serviços Médicos de Emergência/organização & administração , Serviços Médicos de Emergência/estatística & dados numéricos , Feminino , Humanos , Japão/epidemiologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Parada Cardíaca Extra-Hospitalar/epidemiologia , Vigilância da População/métodos , Sistema de Registros/estatística & dados numéricos , Sobreviventes/estatística & dados numéricos
9.
JAMA Netw Open ; 2(5): e195111, 2019 05 03.
Artigo em Inglês | MEDLINE | ID: mdl-31150086

RESUMO

Importance: Bystander interventions are a factor for improving survival of out-of-hospital cardiac arrest (OHCA), but it is hypothesized that girls and women experiencing OHCA may be less likely to receive bystander interventions than boys and men. Objective: To investigate sex disparities in receiving public-access automated external defibrillator (AED) pad application and bystander-initiated cardiopulmonary resuscitation (CPR) among students who experienced OHCA in school settings. Design, Setting, and Participants: This nationwide cohort study used the Stop and Prevent Cardiac Arrest, Injury, and Trauma in Schools (SPIRITS) database to link databases from 2 nationally representative registries-the Injury and Accident Mutual Aid Benefit System of the Japan Sport Council and the All-Japan Utstein Registry of the Fire and Disaster Management Agency. Students from elementary schools (ages 6-12 years), junior high schools (ages 12-15 years), high schools (ages 15-21 years), and technical colleges (ages 15-21 years) who experienced nontraumatic OHCA involving attempted resuscitation by emergency medical service personnel or bystanders in school settings from April 1, 2008, to December 31, 2015, were included. Data analysis was performed from January 5, 2019, to April 11, 2019. Exposures: Sex and school level. Main Outcomes and Measures: Application of public-access AED pads or initiation of CPR by a bystander. Results: A total of 232 students who experienced OHCA with nontraumatic causes in school settings (mean [SD] age, 14.5 [2.9] years; 175 [75.4%] male) were included. In multivariable analysis of the full cohort of students who experienced OHCA, female sex was associated with significantly lower odds of receiving public-access AED pad application compared with male sex (36 of 57 female students [63.2%] received AED pad application vs 141 of 175 male students [80.6%]; adjusted odds ratio [OR], 0.44; 95% CI, 0.20-0.97; P = .04). In the subgroup analysis of students who experienced OHCA in high schools or technical schools, female sex was associated with significantly lower odds of receiving public-access AED pad application compared with male sex (10 of 18 female students [55.6%] vs 84 of 101 male students [83.2%]; adjusted OR, 0.26; 95% CI, 0.08-0.87; P = .03). Among the full cohort, 48 of 57 female students (84.2%) and 151 of 175 male students (86.3%) received CPR from bystanders (adjusted OR, 0.81; 95% CI, 0.30-2.22), and there were no significant differences in receiving bystander-initiated CPR between sexes, irrespective of school level. Conclusions and Relevance: Among students who experienced OHCA in schools in Japan, female sex was associated with lower odds of receiving public-access AED pad application compared with male sex.


Assuntos
Reanimação Cardiopulmonar/estatística & dados numéricos , Desfibriladores/estatística & dados numéricos , Disparidades nos Níveis de Saúde , Parada Cardíaca Extra-Hospitalar/terapia , Adolescente , Feminino , Humanos , Japão/epidemiologia , Masculino , Parada Cardíaca Extra-Hospitalar/epidemiologia , Estudos Prospectivos , Instituições Acadêmicas , Distribuição por Sexo , Estudantes/estatística & dados numéricos
10.
Sci Total Environ ; 682: 333-339, 2019 Sep 10.
Artigo em Inglês | MEDLINE | ID: mdl-31125746

RESUMO

BACKGROUND: Recent studies have reported associations between global climate change and mortality. However, future projections of temperature-related out-of-hospital cardiac arrest (OHCA) have not been thoroughly evaluated. Thus, we aimed to project temperature-related morbidity for OHCA concomitant with climate change. METHODS: We collected national registry data on all OHCA cases reported in 2005-2015 from all 47 Japanese prefectures. We used a two-stage time series analysis to estimate temperature-OHCA relationships. Time series of current and future daily mean temperature variations were constructed according to four climate change scenarios of representative concentration pathways (RCPs) using five general circulation models. We projected excess morbidity for heat and cold and the net change in 1990-2099 for each climate change scenario using the assumption of no adaptation or population changes. RESULTS: During the study period, 739,717 OHCAs of presumed cardiac origin were reported. Net decreases in temperature-related excess morbidity were observed under higher emission scenarios. The net change in 2090-2099 compared with 2010-2019 was -0.8% (95% empirical confidence interval [eCI]: -1.9, 0.1) for a mild emission scenario (RCP2.6), -2.6% (95% eCI: -4.4, -0.8) for a stabilization scenario (RCP4.5), -3.4% (95% eCI: -5.7, -1.0) for a stabilization scenario (RCP6.0), and - 4.2% (95% eCI: -8.3, -0.1) for an extreme emission scenario (RCP8.5). CONCLUSIONS: Our study indicates that Japan is projected to experience a substantial net reduction in OHCAs in higher-emission scenarios. The decrease in risk is limited to a specific morbidity cause, and a broader assessment within climate change scenarios should consider other direct and indirect impacts.


Assuntos
Mudança Climática , Temperatura Baixa/efeitos adversos , Previsões , Temperatura Alta/efeitos adversos , Parada Cardíaca Extra-Hospitalar/epidemiologia , Humanos , Japão , Parada Cardíaca Extra-Hospitalar/etiologia
11.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 31(4): 439-443, 2019 Apr.
Artigo em Chinês | MEDLINE | ID: mdl-31109417

RESUMO

OBJECTIVE: To analyze the first aid situation of patients with out-of-hospital cardiac arrest (OHCA) in Zhengzhou City, and to explore the related factors affecting the prognosis of cardiopulmonary resuscitation (CPR) in patients with OHCA. METHODS: Retrospective analysis of patients with OHCA admitted to Zhengzhou Emergency Medical Rescue Center from June 2016 to June 2018 was performed. General information of patients, such as gender, age, bystander, the quality of bystander CPR (medical personnel, non-medical personnel), 120 reception time (day/night), location (family, public place, hotel, other), emergency medical service (EMS) response time, duration of CPR, first detected heart rhythm, defibrillation, mode of ventilation (balloon mask, laryngeal mask, endotracheal intubation), epinephrine dose, cause of cardiac arrest, outcome of resuscitation [restoration of spontaneous circulation (ROSC) or death] were collected. The risk factors of CPR prognosis were analyzed with univariate and multivariate Logistic regression analysis. RESULTS: (1) The result of general investigation: 7 728 cases with OHCA in the past two years, among whom 3 891 were clinically dead upon arrival, 1 413 were not rescued, 2 424 were actively rescued, and only 51 got ROSC. There were 73.71% (5 696/7 728) patients calling "120" during 07:01-23:00 and 26.29% (2 032/7 728) patients during 23:01-07:00. The response time of EMS was (9.36±6.75) minutes. Cardiac arrest mostly occurred at home, which accounting for 61.61% (4 761/7 728), followed by public places, which accounting for 16.19% (1 251/7 728). The incidence of cardiac arrest was higher in males than in females [63.11% (4 877/7 728) vs. 36.89% (2 851/7 728)]. 54.94% (4 246/7 728) of patients were over 60 years old. Cardiogenic factors were the most important etiology, which accounting 38.63% (2 985/7 728), followed by trauma, which accounting 19.16% (1 481/7 728). (2) The risk factors of prognosis of CPR: univariate Logistic regression analysis showed that age, bystander CPR, 120 reception time, duration of CPR, first detected heart rhythm, epinephrine dose and the cause of cardiac arrest were related to the ROSC in OHCA patients [age: odds ratio (OR) = 0.450, 95% confidence interval (95%CI) = 0.257-0.787; bystander CPR: OR = 6.446, 95%CI = 4.695-8.851; 120 reception time: OR = 1.941, 95%CI = 1.114-3.382; duration of CPR: OR = 0.163, 95%CI = 0.074-0.360; first detected heart rhythm: OR = 0.080, 95%CI = 0.042-0.155; epinephrine dose: OR = 0.423, 95%CI = 0.241-0.740; cause of cardiac arrest: OR = 1.901, 95%CI = 1.091-3.314; all P < 0.05]. Multivariate Logistic regression analysis showed that non-medical personnel, medical personnel, shockable rhythm, duration of CPR < 10 minutes and epinephrine dose < 5 mg were favorable factors for ROSC in OHCA patients (non-medical personnel: OR = 24.552, 95%CI = 10.192-59.144; medical personnel: OR = 36.960, 95%CI = 17.572-77.740; shockable rhythm: OR = 0.036, 95%CI = 0.015-0.087; duration of CPR < 10 minutes: OR = 0.191, 95%CI = 0.069-0.526; epinephrine dose < 5 mg: OR = 0.259, 95%CI = 0.125-0.537; all P < 0.01). CONCLUSIONS: (1) Male patients with OHCA in Zhengzhou City were more than female patients, and the age of most patients was older than 60 years old. OHCA often happened at home, followed by public places. The etiology was mainly cardiogenic, followed by trauma. EMS response time was a little long, the success rate of recovery was low, and pre-hospital emergency treatment needs to be further improved. (2) Bystander CPR, shockable rhythm, duration of CPR < 10 minutes and epinephrine dose < 5 mg were beneficial to ROSC.


Assuntos
Reanimação Cardiopulmonar , Serviços Médicos de Emergência , Parada Cardíaca Extra-Hospitalar/terapia , China/epidemiologia , Cidades , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Parada Cardíaca Extra-Hospitalar/epidemiologia , Prognóstico , Estudos Retrospectivos , Fatores de Risco
12.
Scand J Trauma Resusc Emerg Med ; 27(1): 40, 2019 Apr 08.
Artigo em Inglês | MEDLINE | ID: mdl-30961651

RESUMO

BACKGROUND: Out-of-hospital cardiac arrest (OHCA) affects some 275,000 individuals in Europe each year. Time from collapse to defibrillation is essential for survival. As emergency medical services (EMS) response times in Sweden have increased, novel methods are needed to facilitate early treatment. Unmanned aerial vehicles (i.e. drones) have potential to deliver automated external defibrillators (AED). The aim of this simulation study was to explore bystanders' experience of a simulated OHCA-situation where a drone delivers an AED and how the situation is affected by having one or two bystanders onsite. METHODS: This explorative simulation study used a mixed methodology describing bystanders' experiences of retrieving an AED delivered by a drone in simulated OHCA situations. Totally eight participants were divided in two groups of bystanders a) alone or b) in pairs and performed CPR on a manikin for 5 minutes after which an AED was delivered by a drone at 50 m from the location. Qualitative data from observations, interviews of participants and video recordings were analysed using content analysis alongside descriptive data on time delays during bystander interaction. RESULTS: Three categories of bystander experiences emerged: 1) technique and preparedness, 2) support through conversation with the dispatcher, and 3) aid and decision-making. The main finding was that retrieval of an AED as delivered by a drone was experienced as safe and feasible for bystanders. None of the participants hesitated to retrieve the AED; instead they experienced it positive, helpful and felt relief upon AED-drone arrival and were able to retrieve and attach the AED to a manikin. Interacting with the AED-drone was perceived as less difficult than performing CPR or handling their own mobile phone during T-CPR. Single bystander simulation introduced a significant hands-off interval when retrieving the AED, a period lasting 94 s (range 75 s-110 s) with one participant compared to 0 s with two participants. CONCLUSION: The study shows that it made good sense for bystanders to interact with a drone in this simulated suspected OHCA. Bystanders experienced delivery of AED as safe and feasible. This has potential implications, and further studies on bystanders' experiences in real cases of OHCA in which a drone delivers an AED are therefore necessary.


Assuntos
Reanimação Cardiopulmonar/métodos , Tomada de Decisões , Desfibriladores/provisão & distribução , Cardioversão Elétrica/instrumentação , Serviços Médicos de Emergência/métodos , Modelos Teóricos , Parada Cardíaca Extra-Hospitalar/terapia , Idoso , Idoso de 80 Anos ou mais , Coleta de Dados , Feminino , Humanos , Incidência , Masculino , Manequins , Parada Cardíaca Extra-Hospitalar/epidemiologia , Suécia/epidemiologia , Gravação em Vídeo
13.
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
15.
Nat Rev Cardiol ; 16(7): 407-416, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30858511

RESUMO

Out-of-hospital cardiac arrest (OHCA) remains a leading cause of death worldwide, with substantial geographical, ethnic and socioeconomic disparities in outcome. Successful resuscitation efforts depend on the 'chain of survival', which includes immediate recognition of cardiac arrest and activation of the emergency response system, early bystander cardiopulmonary resuscitation (CPR) with an emphasis on chest compressions, rapid defibrillation, basic and advanced emergency medical services and integrated post-cardiac arrest care. Well-orchestrated telecommunicator CPR programmes can improve rates of bystander CPR - a critical link in the chain of survival. High-performance CPR by emergency medical service providers includes minimizing interruptions in chest compressions and ensuring adequate depth of compressions. Developing local, regional and statewide systems with dedicated high-performing cardiac resuscitation centres for post-resuscitation care can substantially improve survival after OHCA. Innovative digital tools for recognizing cardiac arrest where and when it occurs, notifying potential citizen rescuers and providing automated external defibrillators at the scene hold the promise of improving survival after OHCA. Improved implementation of the chain of survival can save thousands of lives each year.


Assuntos
Reanimação Cardiopulmonar , Massagem Cardíaca , Hospitais Especializados , Parada Cardíaca Extra-Hospitalar/diagnóstico , Parada Cardíaca Extra-Hospitalar/terapia , Antiarrítmicos/uso terapêutico , Reanimação Cardiopulmonar/normas , Cardioversão Elétrica , Serviços Médicos de Emergência/normas , Epinefrina/uso terapêutico , Massagem Cardíaca/normas , Humanos , Parada Cardíaca Extra-Hospitalar/epidemiologia , Taxa de Sobrevida , Telecomunicações , Vasoconstritores/uso terapêutico
16.
Medicine (Baltimore) ; 98(10): e14611, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30855446

RESUMO

Studies are divided on the effect of day-night temporal differences on clinical outcomes in out-of-hospital cardiac arrest (OHCA). This study aimed to elucidate any differences in OHCA survival between day and night occurrence, and the factors associated with differences in survival.This was a prospective, observational study of OHCA cases across multinational Pan-Asian sites. Cases were divided according to time call received by dispatch centers into day (0700H-1900H) and night (1900H-0659H). Primary outcome was 30-day survival. Secondary outcomes were prehospital and hospital modifiable resuscitative characteristics.About 22,501 out of 55,881 cases occurred at night. Night cases were less likely to be witnessed (40.2% vs. 43.1%, P < .001), more likely to occur at home (32.5% vs. 29%, P < .001), had non-shockable initial rhythms (90.8% vs. 89.4%, P < .001), lower bystander CPR rates (36.2 vs. 37.6%, P = .001), lower bystander AED application rate (0.3% vs. 0.7%, P < .001), lower rates of prehospital defibrillation (13% vs. 14.4%, P < .001), and were less likely to receive prehospital adrenaline (9.8% vs. 11%, P < .001). 30-day survival at night was lower with an adjusted odds ratio of 0.79 (95% CI 0.73-0.86, P < .001). On multivariate logistic regression, occurrence at night was associated with decreased provision of bystander CPR, bystander AED application, and prehospital adrenaline.30-day survival was worse in OHCA occurring at night. There were circadian patterns in incidence. Bystander CPR and bystander AED application were significantly lower at night in multivariate analysis. This would at least partially explain the decreased survival at night.


Assuntos
Parada Cardíaca Extra-Hospitalar/epidemiologia , Parada Cardíaca Extra-Hospitalar/terapia , Idoso , Ásia/epidemiologia , Feminino , Humanos , Incidência , Masculino , Fotoperíodo , Estudos Prospectivos , Análise de Sobrevida , Fatores de Tempo , Resultado do Tratamento
17.
JAMA Netw Open ; 2(3): e191011, 2019 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-30924892

RESUMO

Importance: Out-of-hospital cardiac arrest (OHCA) is a major public health issue, and in recent years, the number of OHCAs among the elderly population, aged 65 years or older, has significantly increased in developed countries. Objective: To evaluate the demographic and clinical characteristics and outcomes of patients 65 years or older who experienced OHCA based on the location-public, residential, or nursing home-where it occurred in Japan. Design, Setting, and Participants: This prospective, nationwide, population-based cohort study used information collected by the All-Japan Utstein Registry to examine data from 293 615 patients 65 years or older who experienced OHCA during the period from January 2013 to December 2015 in Japan. Data analyses were conducted from June to July 2018. Main Outcomes and Measures: The primary outcome was 1-month survival with a favorable outcome that was defined as a cerebral performance category score of 1 or 2 (1, good cerebral performance; 2, moderate cerebral disability; 3, severe cerebral disability; 4, coma or vegetative state; and 5, death or brain death). Multivariable logistic regression analyses were conducted to examine favorable outcome by location. Results: A total of 233 511 patients with OHCA were included in the final analysis; 29 911 (12.8%) occurred in a public location, 157 087 (67.3%) at a residential location, and 46 513 (19.9%) at a nursing home. The median age of the patients was 83.0 years (interquartile range, 76.0-88.0 years), and the proportion of men was 53.1% (124 108 of 233 511). The proportion of favorable neurologic outcomes was 4.5% (1351 of 29 911) in public locations, 1.0% (1555 of 157 087) in residential locations, and 0.6% (301 of 46 513) in nursing homes. Patients with cardiac arrests in public locations had a significantly higher likelihood of achieving a favorable neurologic outcome than those in residential locations (adjusted odds ratio, 1.36; 95% CI, 1.25-1.48), whereas those in nursing homes were less likely to achieve a favorable neurologic outcome (adjusted odds ratio, 0.62; 95% CI, 0.54-0.72). However, this difference in outcomes among patients based on location decreased with age. Conclusions and Relevance: The outcomes of patients 65 years or older after OHCA differed by the location of the cardiac arrest. These outcomes may be improved by updating existing response measures across all locations.


Assuntos
Parada Cardíaca Extra-Hospitalar , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Japão/epidemiologia , Masculino , Casas de Saúde , Parada Cardíaca Extra-Hospitalar/epidemiologia , Parada Cardíaca Extra-Hospitalar/mortalidade , Estudos Prospectivos , Logradouros Públicos
18.
Mayo Clin Proc ; 94(4): 577-587, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30922691

RESUMO

OBJECTIVE: To assess whether sex-based disparities occur by location of arrest in out-of-hospital cardiac arrest (OHCA) victims receiving bystander cardiopulmonary resuscitation (BCPR). PATIENTS AND METHODS: This secondary analysis of the All-Japan Utstein Registry included patients 18 years and older with OHCA of medical origin in public or residential locations, witnessed by bystanders, from January 1, 2013, through December 31, 2015. We assessed the likelihood of receiving BCPR based on sex differences and by arrest location. Sex-based disparities in receiving BCPR stratified by age and location were assessed via multivariable logistic regression analyses. RESULTS: During the study period, 373,359 OHCAs were registered, and 84,734 were eligible for analysis. Overall, 54.2% of women (3123 of 5766) and 57.0% of men (8672 of 15,213) received BCPR in public locations (P<.001), and 46.5% of women (11,263 of 24,216) and 44.0% of men (17,390 of 39,539) received BCPR in residential locations (P<.001). In the multivariable logistic regression analyses, there was no significant difference between the sexes in terms of who received BCPR in public locations (adjusted odds ratio [AOR], 0.99; 95% CI, 0.92-1.06), and women had a higher likelihood of receiving BCPR in residential locations (AOR, 1.08; 95% CI, 1.04-1.13). In public locations, women aged 18 to 64 years were less likely to receive BCPR (AOR, 0.86; 95% CI, 0.74-0.99), and when witnessed by a non-family member, women were less likely to receive BCPR regardless of age group. CONCLUSION: The reasons for this sex-based disparity should be better understood to facilitate public health interventions.


Assuntos
Reanimação Cardiopulmonar/estatística & dados numéricos , Disparidades em Assistência à Saúde , Parada Cardíaca Extra-Hospitalar/terapia , Adulto , Idoso , Feminino , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Parada Cardíaca Extra-Hospitalar/epidemiologia , Fatores de Risco , População Rural/estatística & dados numéricos , Fatores Sexuais , População Urbana/estatística & dados numéricos , Adulto Jovem
19.
Am J Cardiol ; 123(8): 1255-1261, 2019 04 15.
Artigo em Inglês | MEDLINE | ID: mdl-30770091

RESUMO

Most important prognostic factors in the postcardiac arrest patients who underwent targeted temperature management (TTM) derive from the periarrest period. Whether early invasive hemodynamics predict survival or neurologic outcomes remains unknown. We retrospectively reviewed all comatose survivors of cardiac arrest who underwent TTM at the Coronary Intensive Care Unit of a Quaternary Center between January 2015 and June 2017. Patients were required to have a set of invasive hemodynamics available at initiation of TTM to be included. Those with cooling initiated before admission and temperature of <36°C before obtaining hemodynamics were excluded. Univariate logistic and multivariate regression were conducted to test whether cardiac index (Fick-cardiac index ≥2.2 vs <2.2 L/min/m2), pulmonary capillary wedge pressure (PCWP ≥18 vs <18 mm Hg), systemic vascular resistance (SVR >1200 vs 800 to 1200 vs <800 dynes⋅s/cm5) or Forrester hemodynamic profiles were predictive of survival and favorable neurologic outcomes at hospital discharge. Total of 52 consecutive arrest survivors who underwent TTM were studied demonstrating a wide variability in invasive hemodynamic parameters. There was no association between cardiac index (p = 0.45 and p = 0.10), PCWP (p = 0.90 and p = 0.60), SVR (0.95 and p = 0.17) or Forrester hemodynamic profiles (p = 0.40 and p = 0.42) and survival or favorable neurologic outcome at discharge. In conclusion, comatose arrest survivors who underwent TTM presents with a wide spectrum of invasive hemodynamics highlighting the heterogeneity of the postcardiac arrest syndrome. Early invasive hemodynamics did not predict survival or favorable neurologic outcomes at hospital discharge.


Assuntos
Reanimação Cardiopulmonar/métodos , Hemodinâmica/fisiologia , Hipotermia Induzida/métodos , Parada Cardíaca Extra-Hospitalar/terapia , Feminino , Seguimentos , Mortalidade Hospitalar/tendências , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Ohio/epidemiologia , Parada Cardíaca Extra-Hospitalar/epidemiologia , Parada Cardíaca Extra-Hospitalar/fisiopatologia , Estudos Retrospectivos , Taxa de Sobrevida/tendências , Sobreviventes , Resultado do Tratamento
20.
J Am Heart Assoc ; 8(2): e010330, 2019 01 22.
Artigo em Inglês | MEDLINE | ID: mdl-30661423

RESUMO

Background It is believed that most sudden cardiac arrests ( SCA s) in young people occur in previously healthy people with rare risk factors for sudden death. Few studies have investigated large populations with complete ascertainment. Our objective was to use multisource records to identify and classify all out-of-hospital cardiac arrests in the Greater Toronto Area (population 6.6 million) in people aged 2 to 45 years from 2009 to 2012. Methods and Results Expert reviewers employed a systematic process, with emergency medical services, in-hospital and coroner records, to adjudicate the cause of death as SCA from cardiac or noncardiac causes. We report the adjudicated etiologies, circumstances, triggers, and characteristics of the SCA cohort. Of 2937 eligible out-of-hospital cardiac arrest cases, 608 (20.7%) SCA s had an adjudicated etiology of cardiac cause (120 survivors and 488 nonsurvivors). Two thirds of these SCA patients had a history of cardiovascular disease, and over 50% had been diagnosed with ≥1 cardiovascular disease risk factor. Moreover, 20.1% of SCA s were diagnosed with psychiatric disease and 30% had central nervous system drugs prescribed. Over 30% of SCA patients had central nervous system active drugs, including drugs of abuse detected postmortem, with opioids and ethanol being detected most frequently. Potentially heritable structural cardiac diseases accounted for only 6.9% of SCA events, with acquired cardiac diseases comprising the rest. Conclusions The underlying causes of SCA , in people aged 2 to 45 years, often occur in those with previously diagnosed cardiovascular diseases, and are associated with contributory factors including prescribed medications, recreational drugs, and a concomitant psychiatric history.


Assuntos
Reanimação Cardiopulmonar/métodos , Doenças Cardiovasculares/epidemiologia , Serviços Médicos de Emergência/métodos , Transtornos Mentais/complicações , Parada Cardíaca Extra-Hospitalar/etiologia , Medição de Risco/métodos , Adolescente , Adulto , Doenças Cardiovasculares/complicações , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Incidência , Masculino , Transtornos Mentais/epidemiologia , Pessoa de Meia-Idade , Ontário/epidemiologia , Parada Cardíaca Extra-Hospitalar/epidemiologia , Parada Cardíaca Extra-Hospitalar/terapia , Prevalência , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida/tendências , Adulto Jovem
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