Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 12.653
Filtrar
1.
Biomedica ; 40(Supl. 2): 180-187, 2020 10 30.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-33152202

RESUMO

The pandemic caused by COVID19 is associated with an increase in the number of cases of cardiorespiratory arrest, which has resulted in ethical concerns regarding the enforceability of cardiopulmonary resuscitation, as well as the conditions to carry it out. The risk of aerosol transmission and the clinical uncertainties about the efficacy, the potential sequelae, and the circumstances that could justify limiting this procedure during the pandemic have multiplied the ethical doubts on how to proceed in these cases. Based on ethical and legal grounds, this paper offers a practical guide on how to proceed in the clinical setting in cases of cardiopulmonary arrest during the pandemic. The criteria of justice, benefit, no harm, respect for autonomy, precaution, integrity, and transparency are asserted in an organized and practical framework for decision-making regarding cardiopulmonary resuscitation.


Assuntos
Betacoronavirus , Reanimação Cardiopulmonar/ética , Infecções por Coronavirus/complicações , Parada Cardíaca/terapia , Pandemias , Pneumonia Viral/complicações , Guias de Prática Clínica como Assunto , Diretivas Antecipadas , Aerossóis , Microbiologia do Ar , Reanimação Cardiopulmonar/métodos , Tomada de Decisão Clínica , Colômbia/epidemiologia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Parada Cardíaca/etiologia , Humanos , Controle de Infecções/métodos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Futilidade Médica , Exposição Ocupacional , Pandemias/prevenção & controle , Autonomia Pessoal , Equipamento de Proteção Individual , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Justiça Social
3.
Medicine (Baltimore) ; 99(42): e22728, 2020 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-33080730

RESUMO

BACKGROUND: Implementation of dispatcher-assisted cardiopulmonary resuscitation (DACPR) has increased the likelihood of bystander CPR upon cardiac arrest. However, the quality of CPR has been found to be very low. In this study, we aimed to compare CPR quality between the current DACPR practices and the interventional instruction of adding verbal encouragement from the dispatcher. METHODS: In this randomized controlled trial, we recruited adult (age ≥18) laypersons who were non-health care providers and had never received any previous verified CPR training. They were randomly selected to perform DACPR using metronome sounds (mDACPR) as per the standard protocol, or DACPR with metronome sounds along with human encouragement (mheDACPR). The ratio of accurate compression rate, depth, and complete release for each CPR phase was examined. RESULTS: Sixty nine records (34, mDACPR; 35, mheDACPR) were taken. The median proportion of accurate chest compression rate was initially 29.5% with mDACPR, and significantly increased to 71% after 2 minutes of CPR administration (P = .046). However, the median ratio of accurate chest compression depth was 61.5% in the first phase, and significantly decreased to 0% in the last phase (P < .001). In contrast, for the mheDACPR group, a high accurate compression rate was maintained throughout the 2 minutes of CPR administration (91%, 100%, 100%, 100%). CONCLUSION: To maintain the quality of CPR administered by bystanders, continuous feedback and repeated human encouragement should be provided during DACPR. Active dispatcher intervention reduces the time required to reach an appropriate CPR rate and allows for the maintenance of accurate compression rates.


Assuntos
Reanimação Cardiopulmonar , Comunicação , Operador de Emergência Médica , Parada Cardíaca/terapia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários
4.
Med Lav ; 111(5): 399-403, 2020 Oct 31.
Artigo em Italiano | MEDLINE | ID: mdl-33124611

RESUMO

BACKGROUND: Every year in Italy and all around the world, cardiac arrest hits almost 1 person every 1000 people; a great deal of these events is likely to strike people outside their private houses. OBJECTIVES: Analyzing a cohort of cardiac arrest events occurred in various public- and work-places across a territorial area concerning an Emergency Unit related to the national emergency number (118) and assessing the efficacy of a first-aid intervention and the usage of a defibrillator while handling an acute cardiac event. METHODS: We analyzed data of 32 sanitary interventions on cardiac arrest events occurred from January 2015 to June 2018 across USL Toscana Centro - Pistoia and Empoli's territory. RESULTS: The acute cardiac event occurred in a "strictly speaking workplace" in 28.2% of cases, and in 18.7% during work activity. An AED was present for immediate cardiac arrest treatment in 15.6% of cases with a survival rate of 100% (n=5/5) (p=0.04); in 84.4% of cases the AED was available only after the arrival of national emergency rescuers and the relative survival rate was 40.74% (n=11/27). Regarding cardiopulmonary resuscitation, the survival rate appears to be higher (55.5% Vs 42.8%) when it was started by witnesses. CONCLUSIONS: The results of this study suggest that early defibrillation provided by work-related First Aid Emergency Procedure, may be a primary aid and a desirable standard to improve both workers' and private citizens' survival rate after cardiac arrest.


Assuntos
Serviços Médicos de Emergência , Parada Cardíaca , Cardioversão Elétrica , Parada Cardíaca/epidemiologia , Parada Cardíaca/terapia , Humanos , Itália/epidemiologia , Local de Trabalho
5.
Rev Lat Am Enfermagem ; 28: e3340, 2020.
Artigo em Inglês, Português, Espanhol | MEDLINE | ID: mdl-33027401

RESUMO

OBJECTIVE: to evaluate the knowledge of basic education students before and after educational intervention on Basic Life Support in a situation of adult cardiorespiratory arrest. METHOD: quasi-experimental study conducted with 335 students from three elementary schools. Data was collected using an instrument that captured sociodemographic data and knowledge about Basic Life Support. Subsequently, they were analyzed by descriptive and analytical statistics. RESULTS: students' knowledge in the post-test (p <0.05) was significantly higher than in the pre-test. The average of the pre-test scores was 4.12 ± 1.7 and, in the post-test it was 6.53 ± 1.9 (p = 0.00). CONCLUSION: the results demonstrated effectiveness of the intervention with the expansion of knowledge about Basic Life Support in cardiorespiratory arrest. The results reinforce the importance of Nursing in health education actions in elementary schools.


Assuntos
Reanimação Cardiopulmonar , Parada Cardíaca , Adulto , Criança , Educação em Saúde , Conhecimentos, Atitudes e Prática em Saúde , Parada Cardíaca/terapia , Humanos , Estudantes
6.
J Cardiothorac Surg ; 15(1): 295, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33008478

RESUMO

BACKGROUND: Veno-arterial extracorporeal membrane oxygenation (ECMO) is increasingly being utilized in patients with massive pulmonary embolism (PE). However, the efficacy and the safety remain uncertain. This study aimed to investigate clinical courses and outcomes in ECMO-treated patients with acute PE. METHODS: Twenty-one patients with acute PE rescued by ECMO from January 2012 to December 2019 were retrospectively analysed. Clinical features, laboratory biomarkers, and imaging findings of these patients were reviewed, and the relationship with immediate outcome and clinical course was investigated. RESULTS: Sixteen patients (76.2%) experienced refractory circulatory collapse requiring cardiopulmonary resuscitation (CPR) or ECMO support within 2 h after the onset of cardiogenic shock, and none could receive definitive reperfusion therapy before ECMO initiation. Before or during ECMO support, more than 90% of patients had imaging signs of right ventricular (RV) dysfunction. In normotension patients, the computed tomography (CT) value was a valuable predictor of rapid disease progression compared with cardiac troponin I level. Ultimately, in-hospital death occurred in ten patients (47.6%) and 90% of them died of prolonged CPR-related brain death. Cardiac arrest was a significant predictor of poor prognosis (p = 0.001). CONCLUSIONS: ECMO appears to be a safe and effective circulatory support in patients with massive PE. Close monitoring in intensive care unit is recommended in patients with RV dysfunction and aggressive use of ECMO may reduce the risk of sudden cardiac arrest and improve clinical outcome.


Assuntos
Oxigenação por Membrana Extracorpórea , Embolia Pulmonar/terapia , Doença Aguda , Adulto , Idoso , Idoso de 80 Anos ou mais , Morte Encefálica , Reanimação Cardiopulmonar , Feminino , Parada Cardíaca/etiologia , Parada Cardíaca/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Embolia Pulmonar/complicações , Reperfusão , Estudos Retrospectivos , Choque Cardiogênico/terapia , Tomografia Computadorizada por Raios X , Disfunção Ventricular Direita/etiologia
7.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 32(9): 1145-1148, 2020 Sep.
Artigo em Chinês | MEDLINE | ID: mdl-33081908

RESUMO

Acute poisoning induced cardiac arrest (APCA) is an acute circulatory failure caused by severe poisoning, which is characterized by complicated mechanisms, limited treatment methods and poor prognosis. Recently, emerging evidence has demonstrated that extracorporeal membrane oxygenation (ECMO) could be a promising tool that may benefit the patients with APCA refractory to conventional resuscitation methods. However, further well-designed studies are needed to evaluate and resolve the emerged problems during the process of ECMO therapy in patients with APCA, such as population indications, optimal conditions, cost-effectiveness, etc. Therefore, this article reviews the epidemiology and mechanism of APCA, and the experimental and clinical studies of the application of ECMO in APCA, in order to explore the clinical value of ECMO in the treatment of APCA patients.


Assuntos
Oxigenação por Membrana Extracorpórea , Parada Cardíaca , Análise Custo-Benefício , Parada Cardíaca/terapia , Humanos , Ressuscitação
10.
Emerg Med Clin North Am ; 38(4): 755-769, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32981615

RESUMO

There are approximately 350,000 out-of-hospital cardiac arrests and 200,000 in-hospital cardiac arrests annually in the United States, with survival rates of approximately 5% to 10% and 24%, respectively. The critical factors that have an impact on cardiac arrest survival include prompt recognition and activation of prehospital care, early cardiopulmonary resuscitation, and rapid defibrillation. Advanced life support protocols are continually refined to optimize intracardiac arrest management and improve survival with favorable neurologic outcome. This article focuses on current treatment recommendations for adult nontraumatic cardiac arrest, with emphasis on the latest evidence and controversies regarding intracardiac arrest management.


Assuntos
Reanimação Cardiopulmonar/métodos , Parada Cardíaca/terapia , Manuseio das Vias Aéreas , Antiarrítmicos/administração & dosagem , Pressão Sanguínea , Dióxido de Carbono/análise , Diástole , Ecocardiografia , Cardioversão Elétrica , Serviço Hospitalar de Emergência , Epinefrina/administração & dosagem , Humanos , Hipotermia Induzida , Infusões Intraósseas , Infusões Intravenosas , Monitorização Fisiológica , Sistemas Automatizados de Assistência Junto ao Leito , Guias de Prática Clínica como Assunto , Vasoconstritores/administração & dosagem
11.
Emerg Med Clin North Am ; 38(4): 771-782, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32981616

RESUMO

Patients resuscitated from cardiac arrest require complex management. An organized approach to early postarrest care can improve patient outcomes. Priorities include completing a focused diagnostic work-up to identify and reverse the inciting cause of arrest, stabilizing cardiorespiratory instability to prevent rearrest, minimizing secondary brain injury, evaluating the risk and benefits of transfer to a specialty care center, and avoiding early neurologic prognostication.


Assuntos
Parada Cardíaca/terapia , Prevenção Secundária , Temperatura Corporal , Encéfalo/diagnóstico por imagem , Circulação Cerebrovascular , Eletrocardiografia , Eletroencefalografia , Serviço Hospitalar de Emergência , Oxigenação por Membrana Extracorpórea , Parada Cardíaca/etiologia , Humanos , Hipóxia-Isquemia Encefálica/prevenção & controle , Anamnese , Transferência de Pacientes , Intervenção Coronária Percutânea , Exame Físico , Prognóstico , Radiografia Torácica , Respiração Artificial , Convulsões/diagnóstico , Convulsões/etiologia , Tomografia Computadorizada por Raios X
12.
Emerg Med Clin North Am ; 38(4): 819-839, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32981620

RESUMO

Pediatric cardiac arrest is a relatively rare but devastating presentation in infants and children. In contrast to adult patients, in whom a primary cardiac dysrhythmia is the most likely cause of cardiac arrest, pediatric patients experience cardiovascular collapse most frequently after an initial respiratory arrest. Aggressive treatment in the precardiac arrest state should be initiated to prevent deterioration and should focus on support of oxygenation, ventilation, and hemodynamics, regardless of the presumed cause. Unfortunately, outcomes for pediatric cardiac arrest, whether in hospital or out of hospital, continue to be poor.


Assuntos
Parada Cardíaca/terapia , Ressuscitação/métodos , Manuseio das Vias Aéreas , Glicemia/análise , Criança , Maus-Tratos Infantis/terapia , Cardioversão Elétrica , Eletroencefalografia , Serviço Hospitalar de Emergência , Epinefrina/uso terapêutico , Oxigenação por Membrana Extracorpórea , Parada Cardíaca/etiologia , Cardiopatias Congênitas/terapia , Frequência Cardíaca , Humanos , Hipotermia/complicações , Hipotermia/terapia , Hipotermia Induzida , Pneumopatias/terapia , Pais , Exame Físico , Envenenamento/terapia , Avaliação de Processos em Cuidados de Saúde , Valores de Referência , Insuficiência Respiratória/terapia , Taxa Respiratória , Ordens quanto à Conduta (Ética Médica) , Sepse/terapia , Choque/etiologia , Choque/terapia , Vasoconstritores/uso terapêutico , Ferimentos e Lesões/terapia
13.
Emerg Med Clin North Am ; 38(4): 857-869, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32981622

RESUMO

The obesity pandemic now affects hundreds of millions of people worldwide. As obesity rates continue to increase, emergency physicians are called on with increasing frequency to resuscitate obese patients. This article discusses important anatomic, physiologic, and practical challenges imposed by obesity on resuscitative care. Impacts on hemodynamic monitoring, airway and ventilator management, and pharmacologic therapy are discussed. Finally, several important clinical scenarios (trauma, cardiac arrest, and sepsis), in which alterations to standard treatments may benefit obese patients, are highlighted.


Assuntos
Obesidade/complicações , Ressuscitação/métodos , Manuseio das Vias Aéreas/métodos , Analgésicos/administração & dosagem , Antibacterianos/administração & dosagem , Composição Corporal , Fármacos Cardiovasculares/administração & dosagem , Doenças Cardiovasculares/complicações , Relação Dose-Resposta a Droga , Serviço Hospitalar de Emergência , Parada Cardíaca/terapia , Humanos , Hipnóticos e Sedativos/administração & dosagem , Medidas de Volume Pulmonar , Consumo de Oxigênio , Farmacocinética , Respiração com Pressão Positiva , Sepse/complicações , Sepse/terapia , Ferimentos e Lesões/complicações , Ferimentos e Lesões/terapia
14.
Emerg Med Clin North Am ; 38(4): 891-901, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32981624

RESUMO

Evaluating and treating traumatic cardiac arrest remains a challenge to the emergency medicine provider. Guidelines have established criteria for patients who can benefit from treatment and resuscitation versus those who will likely not survive. Patient factors that predict survival are penetrating injury, signs of life with emergency medical services or on arrival to the Emergency Department, short length of prehospital cardiopulmonary resuscitation, cardiac motion on ultrasound, pediatric patients, and those with reversible causes including pericardial tamponade and tension pneumothorax. Newer technologies such as resuscitative endovascular balloon occlusion of the aorta, selective aortic arch perfusion, and extracorporeal membrane oxygenation may improve outcomes, but remain primarily investigational.


Assuntos
Parada Cardíaca/terapia , Ferimentos e Lesões/complicações , Abdome/diagnóstico por imagem , Aorta , Oclusão com Balão , Serviço Hospitalar de Emergência , Oxigenação por Membrana Extracorpórea , Coração/diagnóstico por imagem , Parada Cardíaca/etiologia , Humanos , Guias de Prática Clínica como Assunto , Ressuscitação , Ordens quanto à Conduta (Ética Médica) , Toracotomia , Ultrassonografia
15.
Emerg Med Clin North Am ; 38(4): 903-917, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32981625

RESUMO

Care of the critically ill pregnant patient is anxiety-provoking for those unprepared, as the emergency physician must consider not only the welfare of the immediate patient, but of the fetus as well. Familiarity with the physiologic changes of pregnancy and how they affect clinical presentation and management is key. Although some medications may be safer in pregnancy than others, stabilizing the pregnant patient is paramount. Emergency physicians should target pregnancy-specific oxygen and ventilation goals and hemodynamics and should be prepared to perform a perimortem cesarean section, should the mother lose pulses, to increase chances for maternal and fetal survival.


Assuntos
Complicações na Gravidez/terapia , Ressuscitação/métodos , Manuseio das Vias Aéreas , Gasometria , Cesárea , Contraindicações de Medicamentos , Estado Terminal , Serviço Hospitalar de Emergência , Feminino , Monitorização Fetal , Parada Cardíaca/etiologia , Parada Cardíaca/terapia , Humanos , Hipnóticos e Sedativos/administração & dosagem , Intubação Intratraqueal , Troca Materno-Fetal , Ventilação não Invasiva , Circulação Placentária , Gravidez/fisiologia , Complicações na Gravidez/diagnóstico , Insuficiência Respiratória/terapia , Choque/terapia
16.
Emerg Med Clin North Am ; 38(4): 945-959, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32981628

RESUMO

Extracorporeal membrane oxygenation (ECMO) is a mechanical way to provide oxygenation, ventilation, and perfusion to patients with severe cardiopulmonary failure. Extracorporeal cardiopulmonary resuscitation (ECPR) describes the use of ECMO during cardiac arrest. ECPR requires an organized approach to resuscitation, cannula insertion, and pump initiation. Selecting the right patients for ECPR is an important aspect of successful programs. A solid understanding of the components of the ECMO circuit is critical to troubleshooting problems. Current evidence suggests a substantial benefit of ECPR compared with traditional CPR for refractory cardiac arrest but is limited by lack of randomized trials to date.


Assuntos
Oxigenação por Membrana Extracorpórea/métodos , Débito Cardíaco , Contraindicações de Procedimentos , Serviço Hospitalar de Emergência , Parada Cardíaca/terapia , Humanos , Seleção de Pacientes , Insuficiência Respiratória/terapia , Ressuscitação/métodos , Choque Cardiogênico/terapia
17.
Medicine (Baltimore) ; 99(30): e21274, 2020 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-32791707

RESUMO

We analyzed cardiopulmonary resuscitation (CPR) rates, deaths preceded by CPR, and survival trends after in-hospital CPR, using a sample of nationwide Korean claims data for the period 2003 to 2013.The Korean National Health Insurance Service-National Sample Cohort is a stratified random sample of 1,025,340 subjects selected from among approximately 46 million Koreans. We evaluated the annual incidence of CPR per 1000 admissions in various age groups, hospital deaths preceded by CPR, and survival rate following in-hospital CPR. Analyses of the relationships between survival and patient and hospital characteristics were performed using logistic regression analysis.A total of 5918 in-hospital CPR cases from 2003 to 2013 were identified among eligible patients. The cumulative incidence of in-hospital CPR was 3.71 events per 1000 admissions (95% confidence interval 3.62-3.80). The CPR rate per 1000 admissions was highest among the oldest age group, and the rate decreased throughout the study period in all groups except the youngest age group. Hospital deaths were preceded by in-hospital CPR in 18.1% of cases, and the rate decreased in the oldest age group. The survival-to-discharge rate in all study subjects was 11.7% during study period, while the 6-month and 1-year survival rates were 8.0% and 7.2%, respectively. Survival tended to increase throughout the study period; however, this was not the case in the oldest age group. Age and malignancy were associated with lower survival rates, whereas myocardial infarction and diabetes mellitus were associated with higher survival rates.Our result shows that hospital deaths were preceded by in-hospital CPR in 18.1% of case, and the survival-to-discharge rate in all study subjects was 11.7% during the study period. Survival tended to increase throughout the study period except for the oldest age group. Our results provide reliable data that can be used to inform judicious decisions on the implementation of CPR, with the ultimate goal of optimizing survival rates and resource utilization.


Assuntos
Reanimação Cardiopulmonar/mortalidade , Parada Cardíaca/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Bases de Dados Factuais , Feminino , Parada Cardíaca/terapia , Hospitalização/estatística & dados numéricos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , República da Coreia/epidemiologia , Assistência Terminal/legislação & jurisprudência , Adulto Jovem
18.
Pediatrics ; 146(2)2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32732263

RESUMO

With increasing focus in the last decade on post-cardiac arrest care in pediatrics, return of spontaneous circulation, survival rates, and neurologic outcome have improved. As part of this postarrest care, both the American Heart Association and the American Academy of Neurology state it is reasonable to consider targeted temperature management in pediatric comatose patients, although this care is challenging and time sensitive, with many gaps in knowledge remaining. Many pediatric patients will still not survive or will suffer severe neurocognitive impairment despite the therapeutic arsenal provided. Adult guidelines suggest providing postarrest supportive care and limiting prognosis discussions with families until after 72 hours of therapy, but pediatric clinicians are advised to consider a multitude of factors given the lack of data. What, then, should clinicians do if family members of a patient who has been resuscitated request the withdrawal of all life support in the 24 hours immediately postarrest? In this Ethics Rounds, we present such a case and the responses of different clinicians and bioethicists.


Assuntos
Eutanásia Passiva/ética , Parada Cardíaca/terapia , Ressuscitação , Suspensão de Tratamento/ética , Tomada de Decisão Clínica/ética , Eletroencefalografia , Humanos , Hipotermia Induzida , Lactente , Prognóstico
19.
Transplantation ; 104(8): 1542-1552, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32732830

RESUMO

Uncontrolled donation after circulatory death (uDCD) refers to donation from persons who die following an unexpected and unsuccessfully resuscitated cardiac arrest. Despite the large potential for uDCD, programs of this kind only exist in a reduced number of countries with a limited activity. Barriers to uDCD are of a logistical and ethical-legal nature, as well as arising from the lack of confidence in the results of transplants from uDCD donors. The procedure needs to be designed to reduce and limit the impact of the prolonged warm ischemia inherent to the uDCD process, and to deal with the ethical issues that this practice poses: termination of advanced cardiopulmonary resuscitation, extension of advanced cardiopulmonary resuscitation beyond futility for organ preservation, moment to approach families to discuss donation opportunities, criteria for the determination of death, or the use of normothermic regional perfusion for the in situ preservation of organs. Although the incidence of primary nonfunction and delayed graft function is higher with organs obtained from uDCD donors, overall patient and graft survival is acceptable in kidney, liver, and lung transplantation, with a proper selection and management of both donors and recipients. Normothermic regional perfusion has shown to be critical to achieve optimal outcomes in uDCD kidney and liver transplantation. However, the role of ex situ preservation with machine perfusion is still to be elucidated. uDCD is a unique opportunity to improve patient access to transplantation therapies and to offer more patients the chance to donate organs after death, if this is consistent with their wishes and values.


Assuntos
Seleção do Doador/métodos , Rejeição de Enxerto/prevenção & controle , Parada Cardíaca/mortalidade , Preservação de Órgãos/métodos , Transplante de Órgãos/métodos , Aloenxertos/provisão & distribução , Seleção do Doador/ética , Seleção do Doador/legislação & jurisprudência , Rejeição de Enxerto/etiologia , Acesso aos Serviços de Saúde , Parada Cardíaca/terapia , Humanos , Transplante de Órgãos/efeitos adversos , Transplante de Órgãos/ética , Transplante de Órgãos/legislação & jurisprudência , Perfusão/instrumentação , Perfusão/métodos , Ressuscitação/ética , Resultado do Tratamento , Isquemia Quente/efeitos adversos
20.
Pediatrics ; 146(3)2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32788267

RESUMO

CONTEXT: The International Liaison Committee on Resuscitation Neonatal Life Support Task Force reviewed evidence for the duration of cardiopulmonary resuscitation (CPR) for newborns immediately after birth. OBJECTIVE: To summarize evidence for ongoing CPR on the outcomes of survival, neurodevelopment, and the composite of survival without moderate or severe neurodevelopmental impairment (NDI). DATA SOURCES: Medline, Embase, Evidence-Based Medicine Reviews, Cumulative Index to Nursing and Allied Health Literature, and Scientific Electronic Library Online were searched between inception and February 29, 2020. STUDY SELECTION: Two independent reviewers selected studies of newborns with at least 10 minutes of asystole, bradycardia, or pulseless electrical activity for which CPR is indicated. DATA EXTRACTION: Two independent reviewers extracted data and appraised the risk of bias. RESULTS: In 16 eligible studies, researchers reported outcomes of 579 newborns born between 1982 and 2017. Within individual studies, 2% to 100% of infants survived to last follow-up (hospital discharge through 12 years). Summarized across studies, 237 of 579 (40.9%) newborns survived to last follow-up. In 13 studies, researchers reported neurodevelopmental outcomes of 277 newborns. Of these, 30 of 277 (10.8%) survived without moderate or severe impairment, and 240 of 277 (87%) met the composite outcome of death or NDI (191 died and 49 survived with moderate or severe impairment). LIMITATIONS: There was very low certainty of evidence because of risk of bias and inconsistency. CONCLUSIONS: Infants with ongoing CPR at 10 minutes after birth are at high risk for mortality and neurodisability, but survival without moderate or severe NDI is possible. One specified duration of CPR is unlikely to uniformly predict survival or survival without neuroimpairment.


Assuntos
Bradicardia/terapia , Reanimação Cardiopulmonar/estatística & dados numéricos , Desenvolvimento Infantil , Parada Cardíaca/terapia , Transtornos do Neurodesenvolvimento/epidemiologia , Comitês Consultivos , Viés , Frequência Cardíaca , Humanos , Recém-Nascido , Transtornos do Neurodesenvolvimento/mortalidade , Sobreviventes/estatística & dados numéricos , Fatores de Tempo
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA