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Medicine (Baltimore) ; 99(5): e19070, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32000456


RATIONALE: Extracorporeal membrane oxygenation (ECMO) in multiple trauma patients with post-traumatic respiratory failure can be quite challenging because of the need for systemic anticoagulation, which may lead to excessive bleeding. In the last decade, there is a growing body of evidence that veno-venous ECMO (VV-ECMO) is lifesaving in multiple trauma patients with acute respiratory distress syndrome, thanks to technical improvements in ECMO devices. PATIENT CONCERNS: We report a case of a 17-year-old multiple trauma patient who was drunken and had confused mentality. DIAGNOSES: She was suffered from critical respiratory failure (life-threatening hypoxemia and severe hypercapnia/acidosis lasting for 70 minutes) accompanied by cardiac arrest and trauma-induced coagulopathy during general anesthesia. INTERVENTIONS: We decided to start heparin-free VV-ECMO after cardiac arrest considering risk of hemorrhage. OUTCOMES: She survived with no neurologic sequelae after immediate treatment with heparin-free VV-ECMO. LESSONS: Heparin-free VV-ECMO can be used as a resuscitative therapy in multiple trauma patients with critical respiratory failure accompanied by coagulopathy. Even in cases in which life-threatening hypoxemia and severe hypercapnia/acidosis last for >1 hours during CPR for cardiac arrest, VV-ECMO could be considered a potential lifesaving treatment.

Oxigenação por Membrana Extracorpórea/métodos , Traumatismo Múltiplo/terapia , Adolescente , Transtornos da Coagulação Sanguínea/terapia , Feminino , Parada Cardíaca/terapia , Humanos , Síndrome do Desconforto Respiratório do Adulto/terapia
Emergencias (Sant Vicenç dels Horts) ; 32(1): 45-48, feb. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-185853


Objetivo. Evaluar los resultados de la formación mixta frente a la presencial en un curso de soporte vital básico/desfibrilador externo automático (SVB/DEA), así como su retención a los 9 meses. Método. Estudio experimental aleatorizado que compara los resultados de la formación en SVB/DEA entre un grupo control (GC) que recibió formación presencial de 4 horas frente a un grupo experimental (GE) que recibió formación en metodología mixta: 2 horas virtuales y 2 horas presenciales. Resultados. Participaron 89 alumnos (45 del GC y 44 del GE). Después de la formación, el GC obtuvo mejores puntuaciones en conocimientos [8,6 (DE 0,9) frente a 8,0 (DE 1,14), p = 0,013]. El GE obtuvo mejores puntuaciones en las habilidades del tiempo en segundos de "hands off" y en el porcentaje de la rexpansión completa del tórax. Los conocimientos decaen a los 9 meses, pero sin diferencias entre los dos grupos. La retención global baja de 8,31 (DE 1,1) a 6,04 (DE 1,6) (p = 0,001), en 9 meses, pero de forma similar en ambos grupos. En las habilidades prácticas no hubo diferencias entre los dos grupos ni al finalizar el curso ni a los 9 meses. Conclusiones. Con la metodología virtual se obtienen mejores resultados en algunos parámetros de las habilidades

Objective. To evaluate the immediate and 9-month results of blended versus standard training in basic life support and the use of an automatic external defibrillator (BLS/AED). Methods. Randomized trial comparing the results of standard BLS/AED training to blended training. The control group received 4 hours of standard instruction from a trainer and the experimental blended-training group received 2 hours of virtual training and 2 hours of in-person instruction. Results. Eighty-nine students participated, 45 in the control group and 44 in the experimental group. The controls achieved better mean (SD) knowledge scores immediately after training (8.6 [0.9] vs 8.0 [1.14] in the experimental group, P=.013). The blended training group scored better on certain skill markers (hands-off time in seconds and compressions followed by complete chest recoil). Participant knowledge had decreased at 9 months without significant between-group differences. Overall, retention fell from a score of 8.31 (1.1) to 6.04 (1.6) (P=.001) in 9 months and the loss was similar in the 2 groups. No differences in practical skills between the groups were observed at the end of the course or 9 months later. Conclusions. The blended training method led to better results on some skill ítems

Humanos , Feminino , Adulto , Reanimação Cardiopulmonar/métodos , Reanimação Cardiopulmonar/normas , Sociedades Médicas/normas , Reanimação Cardiopulmonar/educação , Parada Cardíaca , Índice de Massa Corporal
Adv Exp Med Biol ; 1232: 323-329, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31893427


Recent guidelines on cardiopulmonary resuscitation (CPR) have stressed the necessity to improve the quality of CPR. Our previous studies demonstrated the usefulness of monitoring cerebral blood oxygenation (CBO) during CPR by near-infrared spectroscopy (NIRS). The present study evaluates whether the NIRO-CCR1, a new NIRS device, is as useful in the clinical setting as the NIRO-200NX. We monitored CBO in 20 patients with cardiac arrest by NIRS. On the arrival of patients at the emergency department, the attending physician immediately assessed whether the patient was eligible for this study after conventional advanced life support and, if eligible, measured CBO in the frontal lobe by NIRS. We found that in all patients, the cerebral blood flow waveform was in synchrony with the chest compressions. Moreover, the tissue oxygenation index increased following cardiopulmonary bypass (CPB) in patients undergoing CPB, including one patient in whom CBO was monitored using the NIRO-CCR1. In addition, although the NIRO-CCR1 could display the pulse rate (Tempo) in real time, Tempo was not always detected, despite detection of the cerebral blood flow waveform. This suggested that chest compressions may not have been effective, indicating that the NIRO-CCR1 also seems useful to assess the quality of CPR. This study suggests that the NIRO-CCR1 can measure CBO during CPR in patients with cardiac arrest as effectively as the NIRO-200NX; in addition, the new NIRO-CCR1 may be even more useful, especially in prehospital fields (e.g. in an ambulance), since it is easy to carry.

Reanimação Cardiopulmonar , Circulação Cerebrovascular , Parada Cardíaca , Monitorização Fisiológica , Oximetria , Espectroscopia de Luz Próxima ao Infravermelho , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica/instrumentação , Monitorização Fisiológica/normas , Oximetria/instrumentação , Oximetria/normas , Projetos Piloto , Espectroscopia de Luz Próxima ao Infravermelho/instrumentação , Espectroscopia de Luz Próxima ao Infravermelho/normas
Crit Care ; 24(1): 6, 2020 01 06.
Artigo em Inglês | MEDLINE | ID: mdl-31907075


Targeted temperature management (TTM) is a complex intervention used with the aim of minimizing post-anoxic injury and improving neurological outcome after cardiac arrest. There is large variability in the devices used to achieve cooling and in protocols (e.g., for induction, target temperature, maintenance, rewarming, sedation, management of post-TTM fever). This variability can explain the limited benefits of TTM that have sometimes been reported. We therefore propose the concept of "high-quality TTM" as a way to increase the effectiveness of TTM and standardize its use in future interventional studies.

Parada Cardíaca , Hipotermia Induzida , Temperatura Corporal , Febre , Humanos , Temperatura Ambiente
Hu Li Za Zhi ; 67(1): 4-5, 2020 Feb.
Artigo em Chinês | MEDLINE | ID: mdl-31960390


Disease progression often differs among patients. According to study findings, changes in vital signs, blood oxygen saturation, and consciousness are each related closely to acute deterioration in disease status (Sutherasan et al., 2018). The early warning system (EWS) is a predictive approach to detecting deterioration in disease condition based on the observation of slight variations in patient vital signs and clinical symptoms (Smith et al., 2014). Most patients experience changes in specific physiological variables before experiencing a cardiac arrest. The implementation of a comprehensive EWS facilitates the early identification and prevention of serious adverse events such as unexpected cardiac arrest and death, and may help reduce the risk of other unexpected events as well (Gerry et al., 2017). For medical team members, the use of EWS not only permits the detection of changes in patient condition at an early stage but also allows healthcare workers to respond more proactively and effectively. Moreover, EWS has been shown to improve communication, increase cooperation, and strengthen personal responsibility among healthcare workers (Burns et al., 2018). In summary, implementing EWS allows the prompt initiation of appropriate patient treatment and helps improve patient-care outcomes. While recognizing the importance of incorporating EWS into patient care in clinical and home-based institutions as an important strategy to protecting the lives of patients, appropriate standardized warning systems must be tailored to address different disease characteristics. Changes in patient condition are traditionally addressed through nursing assessment followed by physician notification and response. However, this process may be affected by factors such as assessment accuracy, cultural differences, confidence, and past experiences that may result in decision-making errors (Wood, Chaboyer, & Carr, 2019). The integration of EWS and medical informatics technology is expected to reduce the risks of human-interpretation-related omissions and errors (Downey, Tahir, Randell, Brown, & Jayne, 2017). Although the use of medical informatics technology to enhance EWS remains in its infancy, this will certainly be one of the future trends in patient care. The articles in this issue, in addition to introducing EWS, elucidate the current application of EWS in clinical critical conditions and introduce how informatics technology is being combined in home EWS applications. These articles comprise a rich body of information on EWS that may referenced in clinical nursing care, home care, education, and research.

Deterioração Clínica , Diagnóstico Precoce , Parada Cardíaca/prevenção & controle , Humanos , Sinais Vitais
Hu Li Za Zhi ; 67(1): 6-11, 2020 Feb.
Artigo em Chinês | MEDLINE | ID: mdl-31960391


Related studies in the literature indicate that over half (50-84%) of patients exhibit physiological variations 6 hours before experiencing cardiac arrest. Early warning systems improve the ability of medical teams to detect patient deterioration and then immediately treat sudden cardiac arrest during patient hospitalization. This article aims to strengthen general understanding among clinical medical staffs of the early warning system. Understanding the reasons and motivations for establishing this system is expected to help readers better distinguish the physiological monitoring indicators of this system and its importance in terms of improving patient safety. In particular, using the system to identify patients at risk levels of medium or higher will help facilitate their timely transfer to an intensive care unit for appropriate monitoring and care. This article further explores the application of early warning systems in nursing to help nurses understand their professional roles and responsibilities as members of the rapid-response team. Finally, information in this article teaches medical staffs how to avoid unanticipated cardiac arrest events, create a comprehensive patient safety environment, and improve the quality of medical care.

Deterioração Clínica , Diagnóstico Precoce , Parada Cardíaca/prevenção & controle , Equipe de Respostas Rápidas de Hospitais/organização & administração , Humanos , Papel do Profissional de Enfermagem