Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 27.993
Filtrar
1.
Pediatr Pulmonol ; 56(1): 271-273, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33095516

RESUMO

Thromboembolic phenomena, particularly pulmonary emboli, have been described in adult patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, but have been less evident in children. We describe a case of a teenager with bilateral pulmonary emboli leading to cardiovascular collapse in the setting of a positive SARS-CoV-2 IgM antibody.


Assuntos
/complicações , Embolia Pulmonar/etiologia , Terapia Trombolítica , Adolescente , Angiografia por Tomografia Computadorizada , Feminino , Parada Cardíaca/etiologia , Humanos , Obesidade Pediátrica/complicações , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/tratamento farmacológico , /imunologia
2.
Curr Opin Anaesthesiol ; 34(1): 40-47, 2021 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-33369933

RESUMO

PURPOSE OF REVIEW: To describe the epidemiology, prognostication, and treatment of out- and in-hospital cardiac arrest (OHCA and IHCA) in elderly patients. RECENT FINDINGS: Elderly patients undergoing cardiac arrest (CA) challenge the appropriateness of attempting cardiopulmonary resuscitation (CPR). Current literature suggests that factors traditionally associated with survival to hospital discharge and neurologically intact survival after CA cardiac arrest in general (e.g. presenting ryhthm, bystander CPR, targeted temperature management) may not be similarly favorable in elderly patients. Alternative factors meaningful for outcome in this special population include prearrest functional status, comorbidity load, the specific age subset within the elderly population, and CA location (i.e., nursing versus private home). Age should therefore not be a standalone criterion for withholding CPR. Attempts to perform CPR in an elderly patient should instead stem from a shared decision-making process. SUMMARY: An appropriate CPR attempt is an attempt resulting in neurologically intact survival. Appropriate CPR in elderly patients requires better risk classification. Future research should therefore focus on the associations of specific within-elderly age subgroups, comorbidities, and functional status with neurologically intact survival. Reporting must be standardized to enable such evaluation.


Assuntos
Reanimação Cardiopulmonar , Hipotermia Induzida , Parada Cardíaca Extra-Hospitalar , Idoso , Idoso de 80 Anos ou mais , Parada Cardíaca , Humanos , Parada Cardíaca Extra-Hospitalar/terapia , Ordens quanto à Conduta (Ética Médica)
3.
Rev. enferm. UERJ ; 28: e50721, jan.-dez. 2020.
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-1103402

RESUMO

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


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


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


Assuntos
Humanos , Masculino , Feminino , Reanimação Cardiopulmonar/normas , Infecções por Coronavirus/complicações , Betacoronavirus , Parada Cardíaca/etiologia , Respiração Artificial/métodos , Protocolos Clínicos/normas , Reanimação Cardiopulmonar/métodos , Contenção de Riscos Biológicos/normas , Parada Cardíaca/reabilitação , Massagem Cardíaca/métodos , Equipe de Enfermagem/normas
6.
Biomed Eng Online ; 19(1): 91, 2020 Dec 03.
Artigo em Inglês | MEDLINE | ID: mdl-33272285

RESUMO

Most critically ill Covid-19 patients succumb to multiple organ failure and/or sudden cardiac arrest (SCA) as a result of comorbid endothelial dysfunction disorders which had probably aggravated by conventional mechanical assist devices. Even worse, mechanical ventilators prevent the respiratory pump from performing its crucial function as a potential generator of endothelial shear stress (ESS) which controls microcirculation and hemodynamics since birth. The purpose of this work is to bring our experience with ESS enhancement and pulmonary vascular resistance (PVR) management as a potential therapeutic solution in acute respiratory distress syndrome (ARDS). We propose a non-invasive device composed of thoracic and infradiaphragmatic compartments that will be pulsated in an alternating frequency (20/40 bpm) with low-pressure pneumatic generator (0.1-0.5 bar). Oxygen supply, nasogastric with, or without endotracheal tubes are considered.


Assuntos
/fisiopatologia , Endotélio Vascular/patologia , Respiração Artificial/instrumentação , Resistência ao Cisalhamento , Animais , Estado Terminal , Cães , Desenho de Equipamento , Feminino , Parada Cardíaca , Hemodinâmica , Masculino , Oxigênio/uso terapêutico , /terapia , Estresse Mecânico , Suínos
7.
PLoS One ; 15(12): e0237292, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33275630

RESUMO

AIM: Mouse models of sudden cardiac arrest are limited by challenges with surgical technique and obtaining reliable venous access. To overcome this limitation, we sought to develop a simplified method in the mouse that uses ultrasound-guided injection of potassium chloride directly into the heart. METHODS: Potassium chloride was delivered directly into the left ventricular cavity under ultrasound guidance in intubated mice, resulting in immediate asystole. Mice were resuscitated with injection of epinephrine and manual chest compressions and evaluated for survival, body temperature, cardiac function, kidney damage, and diffuse tissue injury. RESULTS: The direct injection sudden cardiac arrest model causes rapid asystole with high surgical survival rates and short surgical duration. Sudden cardiac arrest mice with 8-min of asystole have significant cardiac dysfunction at 24 hours and high lethality within the first seven days, where after cardiac function begins to improve. Sudden cardiac arrest mice have secondary organ damage, including significant kidney injury but no significant change to neurologic function. CONCLUSIONS: Ultrasound-guided direct injection of potassium chloride allows for rapid and reliable cardiac arrest in the mouse that mirrors human pathology without the need for intravenous access. This technique will improve investigators' ability to study the mechanisms underlying post-arrest changes in a mouse model.


Assuntos
Morte Súbita Cardíaca/patologia , Parada Cardíaca/tratamento farmacológico , Ventrículos do Coração/efeitos dos fármacos , Animais , Modelos Animais de Doenças , Feminino , Rim/efeitos dos fármacos , Nefropatias/induzido quimicamente , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Cloreto de Potássio/farmacologia , Taxa de Sobrevida , Ultrassonografia/métodos
9.
Medicine (Baltimore) ; 99(52): e23917, 2020 Dec 24.
Artigo em Inglês | MEDLINE | ID: mdl-33350794

RESUMO

INTRODUCTION: Cardiac arrest refers to the sudden termination of cardiac ejection function due to various causes. Adrenaline is an important component of resuscitation among individuals experiencing cardiac arrest. The adrenaline delivery method chiefly involved intraosseous infusion and intravenous access. However, the impact of different adrenaline delivery methods on cardiac arrest has been unclear in previous research. Thus, the present study aimed to synthesize the available evidence regarding intravenous vs intraosseous adrenaline administration in cardiac arrest. METHODS AND ANALYSIS: We will search PubMed, EMBASE, Cochrane Library, Wanfang, and China National Knowledge Infrastructure. As per the inclusion criteria, randomized controlled trials (RCTs) on adrenaline administration in cardiac arrest were selected. The primary outcome was prehospital restoration of spontaneous circulation (ROSC); the secondary endpoints were survival, favorable neurological outcome at discharge, and poor neurological outcome at ≥3 mon.We plan to use the Cochrane Collaboration's tool for assessing the bias risk for RCTs. The Grading of Recommendations Assessment, Development and Evaluation approach will grade the certainty of the evidence for all the outcome measures across studies. RevMan 5.3.5 will be used for meta-analysis. If the heterogeneity tests show slight or no statistical heterogeneity, the fixed effects model will be used, in other cases, the random effect model will be used for data synthesis. RESULTS AND CONCLUSION: This protocol will determine which epinephrine delivery method is the optimal in the management of cardiac arrest. Our findings will help clinicians and health professionals in making accurate clinical decisions about adrenaline administrations in cardiac arrest. ETHICS AND DISSEMINATION: Ethical approval was not required because this study was planned as a secondary analysis. The results will be disseminated in peer-reviewed publications, journals, and academic. INPLASY REGISTRATION NUMBER: INPLASY202090100 (DOI:10.37766/inplasy2020.9.0100).


Assuntos
Epinefrina/administração & dosagem , Parada Cardíaca/tratamento farmacológico , Infusões Intraósseas/métodos , Humanos , Metanálise como Assunto , Projetos de Pesquisa , Revisões Sistemáticas como Assunto , Vasoconstritores/administração & dosagem
10.
PLoS One ; 15(12): e0241816, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33259488

RESUMO

PURPOSE: This study aimed to determine if sequential deployment of a nurse-led Rapid Response Team (RRT) and an intensivist-led Medical Emergency Team (MET) for critically ill patients in the Emergency Department (ED) and acute care wards improved hospital-wide cardiac arrest rates. METHODS: In this single-center, retrospective observational cohort study, we compared the cardiac arrest rates per 1000 patient-days during two time periods. Our hospital instituted a nurse-led RRT in 2012 and added an intensivist-led MET in 2014. We compared the cardiac arrest rates during the nurse-led RRT period and the combined RRT-MET period. With the sequential approach, nurse-led RRT evaluated and managed rapid response calls in acute care wards and if required escalated care and co-managed with an intensivist-led MET. We specifically compared the rates of pulseless electrical activity (PEA) in the two periods. We also looked at the cardiac arrest rates in the ED as RRT-MET co-managed patients with the ED team. RESULTS: Hospital-wide cardiac arrests decreased from 2.2 events per 1000 patient-days in the nurse-led RRT period to 0.8 events per 1000 patient-days in the combined RRT and MET period (p-value = 0.001). Hospital-wide PEA arrests and shockable rhythms both decreased significantly. PEA rhythms significantly decreased in acute care wards and the ED. CONCLUSION: Implementing an intensivist-led MET-RRT significantly decreased the overall cardiac arrest rate relative to the rate under a nurse-led RRT model. Additional MET capabilities and early initiation of advanced, time-sensitive therapies likely had the most impact.


Assuntos
Morte Súbita Cardíaca/prevenção & controle , Parada Cardíaca/terapia , Equipe de Respostas Rápidas de Hospitais , Estudos de Coortes , Cuidados Críticos/métodos , Morte Súbita Cardíaca/epidemiologia , Serviço Hospitalar de Emergência , Feminino , Parada Cardíaca/epidemiologia , Parada Cardíaca/patologia , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade
11.
Mayo Clin Proc ; 95(12): 2704-2708, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33276842

RESUMO

Infection by severe acute respiratory syndrome coronavirus 2 has led to cardiac complications including an increasing incidence of cardiac arrest. The resuscitation of these patients requires a conscious effort to minimize the spread of the virus. We present a best-practice model based in four guiding principles: (1) reduce the risk of exposure to the entire health care team; (2) decrease the number of aerosol generating procedures; (3) use a small resuscitation team to limit potential exposure; and (4) consider early termination of resuscitative efforts.


Assuntos
/transmissão , Reanimação Cardiopulmonar/métodos , Serviço Hospitalar de Emergência/organização & administração , Parada Cardíaca/terapia , /complicações , Parada Cardíaca/etiologia , Humanos , Controle de Infecções/métodos , Pandemias , Equipe de Assistência ao Paciente/organização & administração , Equipamento de Proteção Individual/normas
12.
Rev Neurol ; 71(12): 431-437, 2020 12 16.
Artigo em Espanhol | MEDLINE | ID: mdl-33319345

RESUMO

INTRODUCTION: The coronavirus disease 2019 (COVID-19) caused a collapse situation in many hospitals around the world. The aim of this study is to analyse the utility of the electroencephalogram (EEG) in the management of the neurological patient during the COVID-19 pandemic. PATIENTS AND METHODS: The Clinical Neurophysiology Department of the Hospital Central de la Defensa Gomez Ulla was dissolved due to the hospital collapse situation. Therefore, the EEG was performed exceptionally in those cases with the greatest probability of providing a benefit in its management. We describe seven patients (four in ICU and three hospitalized) diagnosed with COVID-19, who underwent through an EEG. RESULTS: The EEG showed abnormalities in all cases, including one case of brain death. The EEG resulted in a change in clinical management in four of the patients (57%) and helped the clinician provide information to the family. In the other three cases, a toxic-metabolic origin was suspected before the EEG was performed, so it did not imply a change in the clinical management already proposed, although it facilitated a prognostic orientation. Slow polymorphic waves were evident in five cases. Five patients were unresponsive. Currently, one patient remain hospitalized and four have died. CONCLUSIONS: The EEG was useful and facilitated decision making in COVID-19 patients in whom it was requested. It guided the diagnosis in cases where CT was non-contributory and led to a change in therapeutic management in most patients. The most frequent findings were signs of encephalopathy and epileptiform discharges.


Assuntos
/fisiopatologia , Eletroencefalografia , Encefalite Viral/diagnóstico , /isolamento & purificação , Idoso , /diagnóstico , Comorbidade , Transtornos da Consciência/etiologia , Transtornos da Consciência/fisiopatologia , Encefalite Viral/etiologia , Feminino , Parada Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos dos Movimentos/etiologia , Transtornos dos Movimentos/fisiopatologia , Nasofaringe/virologia , Pandemias , Prognóstico , Estudos Retrospectivos
13.
J Extra Corpor Technol ; 52(4): 314-318, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33343034

RESUMO

Poor postoperative sleep quality is a common problem in patients undergoing coronary artery bypass graft surgery (CABG). The purpose of this study was to compare the effect of pulsatile and nonpulsatile pump flow on sleep quality of these patients. In this clinical trial, 52 patients undergoing on pump CABG surgery with the roller pump were randomly divided into two equal groups of 26 patients: group 1 using pulsatile pump flow and group 2 nonpulsatile pump flow while the heart was arrested. Sleep score of both groups was evaluated by Pittsburgh Sleep Quality Index questionnaire 2 days before operation and 1 month after operation, and they were compared with each other. Analysis was performed with SPSS software version 22 (SPSS for Windows Inc., Chicago, IL) using the independent t-test, chi-square test, and Fisher exact test. Both groups were the same in demographic characteristics and risk factors such as age, gender, diabetes mellitus, hypertension, hyperlipidemia, smoking, body mass index, and preoperative ejection fraction. Operation data showed no difference between two groups considering cardiopulmonary bypass time and cardiac arrest time. Preoperative sleep quality score of both groups had no significant difference (p = .84). One month postoperative sleep quality score of the pulsatile group was significantly better than that of the nonpulsatile group (p = .04). Using pulsatile flow cardiopulmonary bypass can effectively decrease postoperative sleep disorders in comparison to nonpulsatile flow.


Assuntos
Ponte de Artéria Coronária , Parada Cardíaca , Sono/fisiologia , Ponte Cardiopulmonar , Coração Auxiliar , Hemodinâmica/fisiologia , Humanos , Fluxo Pulsátil
14.
Schweiz Arch Tierheilkd ; 162(12): 735-753, 2020 12.
Artigo em Alemão | MEDLINE | ID: mdl-33263542

RESUMO

INTRODUCTION: Cardiopulmonary arrest (CPA) is the acute cessation of systemic perfusion and ventilation. It leads to a lack of tissue oxygen delivery and, if not addressed quickly, will inevitably cause death. Cardiopulmonary resuscitation (CPR) is the only available treatment for CPA and several opportunities exist to improve the veterinary team's resuscitation approach and optimize small animal CPR patient outcomes. In 2012, the Reassessment Campaign on Veterinary Resuscitation (RECOVER) initiative generated evidence-based clinical guidelines to form the basis for training and practice of CPR in dogs and cats. When employing an evidence-based, standardized approach to small animal CPR, return of spontaneous circulation can be achieved in up to 58% of patients and up to 7% of dogs and 19% of cats can be discharged from the veterinary hospital alive. Survival for dogs and cats that suffer CPA is best in patients that suffer a peri-anesthetic arrest, so high quality CPR in the anesthesia patient population is of utmost importance and expected to be the most rewarding. To ensure the best possible outcomes for any patient suffering from CPA and undergoing CPR, a comprehensive resuscitation strategy is necessary, that includes preventive and preparedness measures, basic life support (chest compressions and ventilation), advanced life support (optimization of the patient status by targeted drug therapy, cardiac rhythm monitoring, and defibrillation), and post-cardiac arrest critical care. This article summarizes the most important RECOVER CPR guidelines for the small animal practitioner.


Assuntos
Reanimação Cardiopulmonar/veterinária , Parada Cardíaca/veterinária , Hospitais Veterinários , Animais , Reanimação Cardiopulmonar/educação , Reanimação Cardiopulmonar/normas , Gatos , Cães , Parada Cardíaca/terapia , Hospitais Veterinários/normas
16.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 32(10): 1265-1268, 2020 Oct.
Artigo em Chinês | MEDLINE | ID: mdl-33198878

RESUMO

OBJECTIVE: To explore the application value of primary trauma treatment (PTC) teaching mode in special professional cardiopulmonary resuscitation (CPR) guide training. METHODS: Cluster sampling method was adopted, and the residents' committee selected special occupation population from every town/sub-district office in the southern mountainous area of Ningxia Hui Autonomous Region for CPR training. A monthly session was held from January to December 2019, with personnel trained by traditional operation teaching and individual practice method from January to June 2019 as the control group and personnel trained by PTC teaching mode from July to December 2019 as the observation group. The two groups of trainers, training objectives and assessment standards were consistent. Questionnaire survey was conducted at the beginning and end of each training period, including the degree of mastery of first-aid knowledge and skills and the level of self-efficacy, etc., to evaluate the training effect. RESULTS: There were 503 trainees in each group, and there was no significant difference in gender, age, education and occupation distribution between the two groups. There was no significant difference in the first aid principles, CPR skill level and self-efficacy between the two groups before the training. The first aid principle, CPR skills level and self-efficacy of the two groups after training were all improved, and the principle of first aid and CPR skills level in the observation group was obviously higher than that in the control group (first aid related concepts: 4.39±0.76 vs. 3.87±0.89, gold life-saving time: 5.71±0.49 vs. 4.53±0.62, the meaning of the first witnesses: 5.33±0.82 vs. 4.18±0.78, cardiac, respiratory cardiac arrest in the judgment: 5.12±0.73 vs. 4.07±0.73, CPR skills: 5.29±0.64 vs. 4.15±0.71, all P < 0.05). The self-efficacy score of the observation group was significantly higher than that of the control group (emergency attitude: 18.17±1.24 vs. 17.35±1.25, self-efficacy: 13.56±1.54 vs. 11.35±1.26, behavioral intention: 9.56±0.84 vs. 8.92±0.95, all P < 0.05). CONCLUSIONS: The application of PTC teaching mode in the training of CPR guidelines for special professions has significant effects, which can effectively help special professions to master CPR knowledge and skills, and has promotion value.


Assuntos
Reanimação Cardiopulmonar , Parada Cardíaca , Cidades , Primeiros Socorros , Humanos , Ocupações
17.
Am J Emerg Med ; 38(10): 2007-2010, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33142165

RESUMO

BACKGROUND: Socioeconomic disparities are engrained in the US healthcare system and may extend to the prehospital cardiac arrest setting where mortality is high. METHODS: Using the National Emergency Medical Services Information System (NEMSIS) database, 150,003 cases were analyzed comparing socioeconomic status and cardiac arrest outcomes. Cardiac arrest outcomes were measured by the percent of cases that achieved return of spontaneous circulation (ROSC) and the percent of cases in which ROSC occurred in the Emergency Department (ED) as opposed to a prehospital setting which was a proxy for the length of time spent in cardiac arrest. Chi-square tests checked for statistical significance and effect size was measured using Pearson's r values and linear regression coefficients. RESULTS: Comparing neighborhood poverty level and the percent of cardiac arrest cases that achieved ROSC resulted in a Pearson's r value of 0.9424 (R2 = 0.8881, p < 0.005) and a linear regression coefficient of 2.088 (p < 0.05, R2 = 0.8881, 95% CI [1.059, 3.117]) meaning for every interval increase in poverty, the chance of an individual in cardiac arrest achieving ROSC decreases 2.09%. Comparing neighborhood poverty level and the percent of ROSC cases that occurred in the ED yielded a Pearson's r value of 0.9005 (R2 = 0.8109, p < 0.05) and a linear regression coefficient of 0.7701 (p < 0.05, R2 = 0.8109, 95% CI [0.254, 1.286]) meaning for every interval increase in poverty, the chance that ROSC is delayed increases 0.77%. CONCLUSIONS: Low income individuals in cardiac arrest have a statistically significant lower probability of achieving ROSC and a higher chance of delayed ROSC.


Assuntos
Serviços Médicos de Emergência/métodos , Parada Cardíaca/mortalidade , Avaliação de Resultados em Cuidados de Saúde/tendências , Pobreza/estatística & dados numéricos , Classe Social , Adulto , Idoso , Distribuição de Qui-Quadrado , Estudos Transversais , Feminino , Parada Cardíaca/epidemiologia , Humanos , Renda/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Pobreza/tendências , Sistema de Registros/estatística & dados numéricos , Estudos Retrospectivos , Estados Unidos/epidemiologia
18.
Medicine (Baltimore) ; 99(48): e23374, 2020 Nov 25.
Artigo em Inglês | MEDLINE | ID: mdl-33235109

RESUMO

Potential attributes of virtual reality (VR) can be a breakthrough in the improvement of sudden cardiac arrest (SCA) training. However, interference with the virtual world is associated with the need of placing additional equipment on the trainee's body. The primary aim of the study was to evaluate if it does not affect the quality of chest compressions (CCs).91 voluntarily included in the study medical students participated twice in the scenario of SCA - Traditional Scenario (TS) and Virtual Reality Scenario (VRS). In both cases two minutes of resuscitation was performed.If VRS was the first scenario there were significant differences in CCs depth (VRS - Me = 47 mm [IQR 43 - 52] vs TS - Me = 48 mm [IQR 43 - 55]; P = .02) and chest relaxation (VRS - Me = 37% [IQR 5 - 91] vs TS - Me = 97% [IQR 87 - 100]; P < .001). 97.8% of respondents believe that training with the use of VR is more effective than a traditional method (P < .01). Most of the study group (91%, P < .01) denied any negative symptoms during the VR scenario.Virtual reality can be a safe and highly valued by medical students, method of hands-on CPR training. However additional VR equipment placed on the trainee's body may cause chest compressions harder to provide. If it is not preceded by traditional training, the use of VR may have an adverse impact on depth and full chest relaxation during the training. To make the best use of all the potential that virtual reality offers, future studies should focus on finding the most effective way to combine VR with traditional skill training in CPR courses curriculum.


Assuntos
Reanimação Cardiopulmonar/educação , Reanimação Cardiopulmonar/normas , Competência Clínica/normas , Parada Cardíaca/terapia , Realidade Virtual , Adolescente , Reanimação Cardiopulmonar/métodos , Estudos Transversais , Feminino , Humanos , Masculino , Manequins , Estudantes de Medicina , Adulto Jovem
19.
PLoS One ; 15(11): e0241751, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33137159

RESUMO

INTRODUCTION: Studies have shown that both perioperative and anesthesia-related cardiac arrest (CA) and mortality rates are much higher in developing countries than in developed countries. This review aimed to compare the rates of perioperative and anesthesia-related CA and mortality during 2 time periods in Brazil. METHODS: A systematic review with meta-analysis of full-text Brazilian observational studies was conducted by searching the Medline, EMBASE, LILACS and SciELO databases up to January 29, 2020. The primary outcomes were perioperative CA and mortality rates and the secondary outcomes included anesthesia-related CA and mortality events rates up to 48 postoperative hours. RESULTS: Eleven studies including 719,273 anesthetic procedures, 962 perioperative CAs, 134 anesthesia-related CAs, 1,239 perioperative deaths and 29 anesthesia-related deaths were included. The event rates were evaluated in 2 time periods: pre-1990 and 1990-2020. Perioperative CA rates (per 10,000 anesthetics) decreased from 39.87 (95% confidence interval [CI]: 34.60-45.50) before 1990 to 17.61 (95% CI: 9.21-28.68) in 1990-2020 (P < 0.0001), while the perioperative mortality rate did not alter (from 19.25 [95% CI: 15.64-23.24] pre-1990 to 25.40 [95% CI: 13.01-41.86] in 1990-2020; P = 0.1984). Simultaneously, the anesthesia-related CA rate decreased from 14.39 (95% CI: 11.29-17.86) to 3.90 (95% CI: 2.93-5.01; P < 0.0001), while there was no significant difference in the anesthesia-related mortality rate (from 1.75 [95% CI: 0.76-3.11] to 0.67 [95% CI: 0.09-1.66; P = 0.5404). CONCLUSIONS: This review demonstrates an important reduction in the perioperative CA rate over time in Brazil, with a large and consistent decrease in the anesthesia-related CA rate; however, there were no significant differences in perioperative and anesthesia-related mortality rates between the assessed time periods.


Assuntos
Anestesia/efeitos adversos , Parada Cardíaca/mortalidade , Brasil , Parada Cardíaca/etiologia , Humanos , Período Perioperatório , Taxa de Sobrevida
20.
Medicine (Baltimore) ; 99(45): e22513, 2020 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-33157915

RESUMO

RATIONALE: Therapeutic hypothermia is an effective medical treatment for neurological recovery after cardiac arrest. Here, we describe a case of successful mild therapeutic hypothermia after cardiac arrest during living-donor liver transplantation. PATIENT CONCERNS: A 54-year-old woman with alcoholic liver cirrhosis was admitted for living-donor liver transplantation. Cardiac arrest occurred during the anhepatic phase. After cardiopulmonary resuscitation, spontaneous circulation returned, but the bispectral index level remained below 10 until the end of surgery. DIAGNOSES: Neurological injury caused by global cerebral hypoperfusion was suspected. INTERVENTIONS: The patient was treated with mild therapeutic hypothermia for 24hours after resuscitation targeting a core body temperature of 34°C with surface cooling using ice bags. OUTCOMES: The patient recovered consciousness about 22 hours after the event. However, she showed symptoms of delirium even when discharged. At the 3-month follow-up exam, she showed no specific neurological complications. The transplanted liver showed no problems with regeneration. LESSONS: Mild therapeutic hypothermia may be safely adopted in cases of cardiac arrest in liver transplant patients and is beneficial for neurological recovery.


Assuntos
Parada Cardíaca/terapia , Hipotermia Induzida , Transplante de Fígado , Feminino , Humanos , Doadores Vivos , Pessoa de Meia-Idade
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA