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1.
Lancet ; 394(10216): 2255-2262, 2020 12 21.
Artigo em Inglês | MEDLINE | ID: mdl-31862250

RESUMO

BACKGROUND: More than 80% of public-access defibrillation attempts do not result in sustained return of spontaneous circulation in patients who have had an out-of-hospital cardiac arrest (OHCA) and a shockable heart rhythm before arrival of emergency medical service (EMS) personnel. Neurological and survival outcomes in such patients have not been evaluated. We aimed to assess the neurological status and survival outcomes in such patients. METHODS: This is a retropective analysis of a cohort study from a prospective, nationwide, population-based registry of 1 299 784 patients who had an OHCA event between Jan 1, 2005, and Dec 31, 2015 in Japan. The primary outcome was favourable neurological outcome (Cerebral Performance Category of 1 or 2) at 30 days after the OHCA and the secondary outcome was survival at 30 days following the OHCA. This study is registered with the University Hospital Medical Information Network Clinical Trials Registry, UMIN000009918. FINDINGS: We identified 28 019 patients with bystander-witnessed OHCA and shockable heart rhythm who had received CPR from a bystander. Of these, 2242 (8·0%) patients did not achieve return of spontaneous circulation with CPR plus public-access defibrillation, and 25 087 (89·5%) patients did not achieve return of spontaneous circulation with CPR alone before EMS arrival. The proportion of patients with a favourable neurological outcome was significantly higher in those who received public-access defibrillation than those who did not (845 [37·7%] vs 5676 [22·6%]; adjusted odds ratio [OR] after propensity score-matching, 1·45 [95% CI 1·24-1·69], p<0·0001). The proportion of patients who survived at 30 days after the OHCA was also significantly higher in those who received public-access defibrillation than those who did not (987 [44·0%] vs 7976 [31·8%]; adjusted OR after propensity score-matching, 1·31 [95% CI 1·13-1·52], p<0·0001). INTERPRETATION: Our findings support the benefits of public-access defibrillation and greater accessibility and availability of automated external defibrillators in the community. FUNDING: None.


Assuntos
Reanimação Cardiopulmonar/instrumentação , Cardioversão Elétrica/instrumentação , Doenças do Sistema Nervoso/etiologia , Parada Cardíaca Extra-Hospitalar/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Reanimação Cardiopulmonar/métodos , Desfibriladores , Cardioversão Elétrica/métodos , Serviços Médicos de Emergência , Feminino , Humanos , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/epidemiologia , Razão de Chances , Parada Cardíaca Extra-Hospitalar/complicações , Parada Cardíaca Extra-Hospitalar/mortalidade , Pontuação de Propensão , Estudos Prospectivos , Logradouros Públicos , Recuperação de Função Fisiológica , Sistema de Registros , Estudos Retrospectivos
2.
Emergencias (Sant Vicenç dels Horts) ; 31(6): 429-434, dic. 2019. tab, mapas
Artigo em Espanhol | IBECS | ID: ibc-185142

RESUMO

El objetivo de este trabajo es comparar las legislaciones autonómicas españolas en materia de formación, utilización y obligatoriedad de la instalación de desfibriladores externos automatizados (DEA) fuera del ámbito sanitario y analizar la variabilidad territorial con que se han desarrollado las regulaciones. Llevamos a cabo una revisión de las normativas publicadas en los boletines oficiales de las 17 comunidades autónomas y las 2 ciudades autónomas de España hasta mayo de 2019, extrayendo datos referidos a la regulación de la formación, el uso y la instalación de los DEA fuera del ámbito sanitario. Observamos que médicos y enfermeros están autorizados a utilizar los DEA, salvo en Murcia, donde únicamente tienen autorizado su uso los médicos. En 14 comunidades autónomas también se consideran habilitados los técnicos en emergencias sanitarias. Excepto en el País Vasco, donde cualquier ciudadano puede utilizar un DEA previa alerta a los servicios de emergencia, es necesario realizar un curso inicial acreditado para estar habilitado en el uso de estos dispositivos (cuya duración varía, según la comunidad, entre 4 y 9 horas) y debe ser renovado con una periodicidad que oscila entre uno y 3 años. Sin embargo, 11 comunidades permiten que, en caso de emergencia y en ausencia de personal habilitado, cualquier ciudadano pueda utilizar un DEA, previa alerta a los servicios de emergencia. Once autonomías regulan la obligación de instalar DEA fuera del ámbito sanitario. Se concluye que si bien todas las comunidades autónomas de España disponen de una normativa reguladora del uso y la acreditación de DEA, el mapa legislativo es muy diverso, por lo que sería deseable una política armonizadora para unificar criterios e incentivar el uso de estos dispositivos en caso de necesidad


We compared Spanish autonomous communities' regulations affecting the use of semiautomatic external defibrillators (semi-AEDs), including requirements for training and providing devices outside health care settings. We analyzed differences in the development of regulations across the different geographic areas. Regulations published in the official bulletins of Spain’s 17 autonomous communities and 2 autonomous cities in effect in May 2019 were reviewed to extract directives affecting training, authorized use, and the provision of semi-AEDs outside health care centers. We found that both doctors and nurses are authorized to use the devices in most communities, with the exception of Murcia, where only doctors may use them. Fourteen communities also authorize emergency responders to operate semi-AEDs. Other individuals must call for emergency help before using one, and specific rules vary by community. In the Basque Country anyone may use them, but in other communities, only individuals who have taken a training course on how to use a semi-AED may. The duration of training programs varies from 4 to 9 hours in different parts of Spain, and retraining is required at intervals that vary from 1 to 3 years. However, in 11 communities any citizen may use a semi-AED in an emergency in which authorized persons are not present (after first calling for emergency responders). Eleven autonomous communities regulate the required provision of semi-AEDs outside health care centers. We conclude that although Spain’s autonomous communities have regulations in place for the use of these devices, the regulatory map is highly diverse. Therefore, we think that harmonization is desirable in the interest of unifying criteria and encouraging the use of semi-AEDs when they are needed


Assuntos
Humanos , Desfibriladores/normas , Parada Cardíaca Extra-Hospitalar/terapia , Reanimação Cardiopulmonar/instrumentação , Serviços Médicos de Emergência/legislação & jurisprudência , Serviços Médicos de Emergência/normas
3.
Medicine (Baltimore) ; 98(45): e17881, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31702660

RESUMO

This study aimed to investigate the prognostic difference between AUTOPULSE and LUCAS for out-of-hospital cardiac arrest (OHCA) adult patients.A retrospective observational study was performed nationwide. Adult OHCA patients after receiving in-hospital mechanical chest compression from 2012 to 2016 were included. The primary outcomes were sustained return of spontaneous circulation (ROSC) of more than 20 minutes and survival to discharge.Among 142,906 OHCA patients, 820 patients were finally included. In multivariate analysis, female (OR, 0.57; 95% CI, 0.33-0.99), witnessed arrest (OR, 2.10; 95% CI, 1.20-3.69), and arrest cause of non-cardiac origin (OR, 0.25; 95% CI, 0.10-0.62) were significantly associated with the increase in ROSC. LUCAS showed a lower survival than AUTOPULSE (OR, 0.23; 95% CI, 0.06-0.84), although it showed no significant association with ROSC. Percutaneous coronary intervention (OR, 6.30; 95% CI, 1.53-25.95) and target temperature management (TTM; OR, 7.30; 95% CI, 2.27-23.49) were the independent factors for survival. We categorized mechanical CPR recipients by witness to compare prognostic effectiveness of AUTOPULSE and LUCAS. In the witnessed subgroup, female (OR, 0.46; 95% CI, 0.24-0.89) was a prognostic factor for ROSC and shockable rhythm (OR, 5.04; 95% CI, 1.00-25.30), percutaneous coronary intervention (OR, 12.42; 95% CI, 2.04-75.53), and TTM (OR, 9.03; 95% CI, 1.86-43.78) for survival. In the unwitnessed subgroup, no prognostic factors were found for ROSC, and TTM (OR, 99.00; 95% CI, 8.9-1100.62) was found to be an independent factor for survival. LUCAS showed no significant increase in ROSC or survival in comparison with AUTOPULSE in both subgroups.The in-hospital use of LUCAS may have a deleterious effect for survival compared with AUTOPULSE.


Assuntos
Reanimação Cardiopulmonar/instrumentação , Massagem Cardíaca/instrumentação , Parada Cardíaca Extra-Hospitalar/terapia , Idoso , Idoso de 80 Anos ou mais , Reanimação Cardiopulmonar/mortalidade , Serviços Médicos de Emergência/estatística & dados numéricos , Feminino , Massagem Cardíaca/mortalidade , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Parada Cardíaca Extra-Hospitalar/mortalidade , República da Coreia/epidemiologia , Estudos Retrospectivos , Resultado do Tratamento
4.
Medicine (Baltimore) ; 98(44): e17550, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31689757

RESUMO

BACKGROUND: Cardiac arrest (CA) is a serious threat to human health. Cardiopulmonary resuscitation (CPR) is an effective treatment for CA. Early and high-quality CPR is closely related to the survival rate of patients with CA. But manual chest compression has a lot of defects. To solve the defects and improve the quality of CPR, mechanical CPR device was invented. However, it has still controversy whether manual chest compression or mechanical chest compression is better. This systematic review was aimed to investigate the difference in clinical outcomes between manual chest compression and Lund University Cardiac Assist System (LUCAS) assisted CPR in patients with out-hospital CA. METHODS: Original research studies, conducted on adult out-of-hospital CA, were included. PubMed/Medline, EMBASE, Scopus, Cochrane Library, CNKI, and Wanfang database were searched from the setting to February 21, 2019. Odds ratio (OR) with 95% confidence interval (CI) was selected as effect scale index for evaluation of the difference in return of spontaneous circulation (ROSC), survival to hospital admission, survival to hospital discharge, and survival to 30 days. Random effects model was used in this study to estimate overall mean effects. RESULTS: A total of 6 articles, including 4 randomized controlled trials and 2 nonrandomized controlled trials, were selected. And 8501 subjects were involved to analyze the clinical outcomes of LUCAS and manual chest compression for patients with out-hospital CA. Comparisons of ROSC (33.3% vs 33.0%, P = .98; OR = 1; 95% CI: [0.89,1.13]), survival to hospital admission (22.7% vs 24.3%, P = .32; OR = 0.86; 95% CI: [0.65,1.15]), survival to hospital discharge (8.6% vs 10.7%, P = .50; OR = 0.92; 95% CI: [0.73,1.17]), and survival to 30 days (7.5% vs 8.5%, P = .50; OR = 0.92; 95% CI: [0.73,1.17]) were made. No significant difference was found. CONCLUSION: The synthesis of available evidence does not support that mechanical chest compression with LUCAS device improves clinical outcome in out-of-hospital CA patients compared with manual chest compression. Large scale studies with improved designs are still needed in the future.


Assuntos
Reanimação Cardiopulmonar/instrumentação , Reanimação Cardiopulmonar/métodos , Parada Cardíaca Extra-Hospitalar/mortalidade , Parada Cardíaca Extra-Hospitalar/terapia , Ensaios Clínicos como Assunto , Hospitalização/estatística & dados numéricos , Humanos , Análise de Sobrevida
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.
J Athl Train ; 54(10): 1074-1082, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31633408

RESUMO

CONTEXT: Recent studies suggested that a large population of high school-aged athletes participate on club sport teams. Despite attempts to document emergency preparedness in high school athletics, the adherence to emergency and medical coverage standards among club sport teams is unknown. OBJECTIVE: To determine if differences in emergency preparedness and training existed between coaches of high school teams and coaches of high school-aged club teams. DESIGN: Cross-sectional survey. SETTING: Online questionnaire. PATIENTS OR OTHER PARTICIPANTS: A total of 769 coaches (females = 266, 34.6%) completed an anonymous online questionnaire regarding their emergency preparedness and training. MAIN OUTCOME MEASURE(S): The questionnaire consisted of (1) demographics and team information, (2) emergency preparedness factors (automated external defibrillator [AED] availability, emergency action plan [EAP] awareness, medical coverage), and (3) emergency training requirements (cardiopulmonary resuscitation/AED, first aid). RESULTS: High school coaches were more likely than club sport coaches to be aware of the EAP for their practice venue (83.9% versus 54.4%, P < .001), but most coaches in both categories had not practiced their EAP in the past 12 months (70.0% versus 68.9%, P = .54). High school coaches were more likely to be made aware of the EAP during competitions (47.5% versus 37.1%, P = .02), but the majority of coaches in both categories indicated that they were never made aware of EAPs. High school coaches were more likely than club coaches to (1) have an AED available at practice (87.9% versus 58.8%, P < .001), (2) report that athletic trainers were responsible for medical care at practices (31.2% versus 8.8%, P < .001) and competitions (57.9% versus 31.2%, P < .001), and (3) be required to have cardiopulmonary resuscitation, AED, or first-aid training (P < .001). CONCLUSIONS: High school coaches displayed much greater levels of emergency preparedness and training than coaches of high school-aged club teams. Significant attention and effort may be needed to address the lack of emergency preparedness and training observed in club coaches.


Assuntos
Traumatismos em Atletas/terapia , Reanimação Cardiopulmonar , Desfibriladores/provisão & distribução , Tratamento de Emergência , Tutoria , Esportes Juvenis/lesões , Adulto , Reanimação Cardiopulmonar/instrumentação , Reanimação Cardiopulmonar/métodos , Estudos Transversais , Tratamento de Emergência/métodos , Tratamento de Emergência/normas , Feminino , Humanos , Masculino , Tutoria/métodos , Tutoria/organização & administração , Tutoria/normas , Competência Profissional , Inquéritos e Questionários , Estados Unidos , Universidades
8.
Med. intensiva (Madr., Ed. impr.) ; 43(6): 346-351, ago.-sept. 2019. ilus, graf, tab
Artigo em Espanhol | IBECS | ID: ibc-183253

RESUMO

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


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


Assuntos
Humanos , Masculino , Feminino , Adulto , Reanimação Cardiopulmonar/educação , Reanimação Cardiopulmonar/métodos , Simulação de Paciente , Manequins , Massagem Cardíaca/métodos , Reanimação Cardiopulmonar/instrumentação , Pessoal de Saúde/educação , Educação em Enfermagem/métodos , Internato e Residência , Análise Quantitativa , Massagem Cardíaca/instrumentação , Massagem Cardíaca/enfermagem , Unidades de Terapia Intensiva Pediátrica/estatística & dados numéricos
10.
J Nepal Health Res Counc ; 17(2): 222-227, 2019 Aug 04.
Artigo em Inglês | MEDLINE | ID: mdl-31455938

RESUMO

BACKGROUND: Improving the performance of health workers on neonatal resuscitation will be critical to ensure that the babies are effectively ventilated. We conducted a study to evaluate whether a bag-and-mask ventilation with monitor is effective in improving neonatal resuscitation practice in a simulated setting. METHODS: This is a cross-over design conducted in 6 public hospitals with 82 health workers of Nepal nested over a large scale stepped wedged quality improvement project. A one-day training on neonatal resuscitation was conducted. At the end of the training, participants were evaluated on the bag-and-mask ventilation performance in a manikinbased on the tidal volume, positive end expiratory pressure and air leakage from the maskin two sessions (monitor displayed versus hidden). The comparison of the neonatal resuscitation performance with and without monitor displayed is calculated. We also conducted assessment of confidence with or without monitor of the health workers. RESULTS: Adequacy of ventilation using bag-and-mask was better when the health workers were displayed monitor (90%) vs without monitor (76%) (p<0.01). The air leakage from the mask reduced when the monitor was displayed (12%) vs without (30%). The PEEP improved when the health workers used monitor as guide to conduct neonatal resuscitation in the manikin then without monitor displayed. The participants felt more confident performing ventilations during the visible sessions. CONCLUSIONS: The ventilation function monitor helped participants to improve their ventilation skills through realtime feedback of important ventilation parameters. Clinical evaluation of needs to be done to assess the effectiveness of the device.


Assuntos
Asfixia Neonatal/terapia , Reanimação Cardiopulmonar/educação , Reanimação Cardiopulmonar/instrumentação , Assistência Perinatal/normas , Competência Clínica , Estudos Cross-Over , Desenho de Equipamento , Hospitais Públicos , Humanos , Recém-Nascido , Capacitação em Serviço , Manequins , Nepal , Melhoria de Qualidade
11.
Expert Rev Med Devices ; 16(9): 771-776, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31353970

RESUMO

Introduction: Cardiac arrest remains a worldwide health problem with very poor outcome. In the absence of bystander resuscitation, survival rates decrease by 10% per minute of arrest and global ischemia. Even the best manual chest compressions, however, can only produce a fraction of normal cardiac output and blood flow to vital organs. Physiological principles and current evidence for the use of mechanical devices to increase survival and quality of life after cardiac arrest are highlighted in this review article. Areas covered: Mechanical adjuncts such as the Active Compression Decompression device, automated chest compressors and the use of a negative pressure valve (Impedance Threshold Device) can synergistically aid in improving quality of CPR and increasing cardiac output and vital organ perfusion. Expert opinion: The current conclusions that the use of mechanical adjunct devices in a preclinical setting is not recommended or neutral at best, need to be reevaluated, especially with regard to new advanced and promising treatments that require prolonged high-quality CPR during the transport to a hospital to improve the outcome of patients.


Assuntos
Encéfalo/patologia , Reanimação Cardiopulmonar/instrumentação , Equipamentos e Provisões , Impedância Elétrica , Parada Cardíaca/terapia , Humanos , Próteses e Implantes
12.
Afr Health Sci ; 19(1): 1563-1565, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31148984

RESUMO

Background: Neonatal resuscitation is a method of preventing morbidities & mortality from asphyxia. Up to 85% of facilities in sub-Saharan Africa lack supplies or skilled personnel for neonatal resuscitation. Relative to the place of birth and the skill of the birth attendant, a variety of resuscitative practice are employed to make babies cry instead of helping the baby breathe. Many painful procedures are applied when the baby is unable to cry after birth in the absence of a health care worker trained in bag-mask ventilation. Objectives: To ascertain the resuscitation practices in communities lacking bag-mask-valve devices. Methods: Surveys on the resuscitation practices during NISONM annual community outreach and mENCC trainings for four consecutive years in different geopolitical zones of the country. Results: Spanking of the baby usually in the upside down position (>90%), body massage with hot compress or salicylate containing balms, herbal concoctions, injection hydrocortisone or crystalline penicillin were used. Conclusion: There is an urgent need to address the issue of training on bag-mask ventilation and provision for frontline healthcare workers in Nigeria as a neonatal mortality reduction strategy.


Assuntos
Asfixia Neonatal/terapia , Reanimação Cardiopulmonar/instrumentação , Equipamentos e Provisões/provisão & distribução , Instalações de Saúde/estatística & dados numéricos , Respiração Artificial/instrumentação , Ressuscitação , Competência Clínica , Feminino , Humanos , Recém-Nascido , Nigéria , Gravidez
13.
Arch Dis Child ; 104(8): 793-801, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31164375

RESUMO

BACKGROUND: Performing high-quality chest compressions during cardiopulmonary resuscitation (CPR) requires achieving of a target depth, release force, rate and duty cycle. OBJECTIVE: This study evaluates whether 'real time' feedback could improve infant CPR performance in basic life support-trained (BLS) and lay rescuers. It also investigates whether delivering rescue breaths hinders performing high-quality chest compressions. Also, this study reports raw data from the two methods used to calculate duty cycle performance. METHODOLOGY: BLS (n=28) and lay (n=38) rescuers were randomly allocated to respective 'feedback' or 'no-feedback' groups, to perform two-thumb chest compressions on an instrumented infant manikin. Chest compression performance was then investigated across three compression algorithms (compression only; five rescue breaths then compression only; five rescue breaths then 15:2 compressions). Two different routes to calculate duty cycle were also investigated, due to conflicting instruction in the literature. RESULTS: No-feedback BLS and lay groups demonstrated <3% compliance against each performance target. The feedback rescuers produced 20-fold and 10-fold increases in BLS and lay cohorts, respectively, achieving all targets concurrently in >60% and >25% of all chest compressions, across all three algorithms. Performing rescue breaths did not impede chest compression quality. CONCLUSIONS: A feedback system has great potential to improve infant CPR performance, especially in cohorts that have an underlying understanding of the technique. The addition of rescue breaths-a potential distraction-did not negatively influence chest compression quality. Duty cycle performance depended on the calculation method, meaning there is an urgent requirement to agree a single measure.


Assuntos
Reanimação Cardiopulmonar/instrumentação , Retroalimentação , Parada Cardíaca/terapia , Manequins , Efeito Espectador , Serviços de Saúde da Criança , Simulação por Computador , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Resultado do Tratamento
14.
R I Med J (2013) ; 102(4): 20-22, 2019 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-31042339

RESUMO

Few events in pre-hospital medicine inspire as much attention and resources as out-of-hospital cardiac arrest (OHCA), yet the survival rate for such events has remained stagnant and unacceptably low. The first links in the chain of survival are early recognition and early CPR; yet EMS services do not arrive to the scene of a medical call for on average 7 minutes. Emergency dispatchers are generally the first trained individuals involved in medical emergencies; they can provide pre-arrival instructions, specifically telecommunicator CPR (T-CPR), and represent the potential to double the bystander CPR rate and increase return of spontaneous circulation. Yet, according to survey data, fewer than half of all public safety answering points (PSAPs) provide any T-CPR and even fewer provide hands-only CPR instruction.1 This article will provide a brief overview, history and introduction to the evidence supporting the use of T-CPR to improve outcomes in OHCA.


Assuntos
Reanimação Cardiopulmonar/história , Operador de Emergência Médica , Linhas Diretas , Parada Cardíaca Extra-Hospitalar/mortalidade , Parada Cardíaca Extra-Hospitalar/terapia , Reanimação Cardiopulmonar/instrumentação , Serviços Médicos de Emergência/métodos , História do Século XX , História do Século XXI , Humanos , Taxa de Sobrevida/tendências , Estados Unidos
15.
R I Med J (2013) ; 102(4): 23-29, 2019 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-31042340

RESUMO

OBJECTIVE: To assess the effect of a device-assisted out- of-hospital cardiac arrest (OHCA) resuscitation approach on provider performance during simulated transport. METHODS: BLS and ALS providers were randomized into control and experimental teams. Subjects were fitted with wireless heart rate (HR) monitors. Control teams simulated with standard protocols and equipment; experimental teams with resuscitation-automating devices and goal-directed protocols. Chest compression quality, pulmonary ventilation, defibrillation, and medication administration tasks were monitored; subjects' HR's were continuously recorded. RESULTS: Ten control and ten experimental teams completed the study (20 EMT-B's; 1 EMT-I, 8 EMT-C's, 11 EMT-P's) with similar resting HR's and age-predicted maximal HR's (mHR). All exhibited suboptimal in-transit resuscitation quality during initial simulations; HR did not differ significantly between the groups. Experimental teams exhibited improved chest compression and ventilation quality during transport along with lower subject HR. CONCLUSION: OHCA resuscitation automation improved the in-simulation quality of critical in-transit tasks and reduced provider exertion.


Assuntos
Reanimação Cardiopulmonar/instrumentação , Frequência Cardíaca , Parada Cardíaca Extra-Hospitalar/terapia , Esforço Físico , Treinamento por Simulação , Adulto , Reanimação Cardiopulmonar/educação , Reanimação Cardiopulmonar/métodos , Auxiliares de Emergência , Feminino , Humanos , Masculino , Adulto Jovem
16.
Prehosp Disaster Med ; 34(2): 182-187, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30981288

RESUMO

INTRODUCTION: High-quality chest compressions (CCs) are associated with high survival rates and good neurological outcomes in cardiac arrest patients. The 2015 American Heart Association (AHA; Dallas, Texas USA) Guidelines for Resuscitation defined and recommended high-quality CCs during cardiopulmonary resuscitation (CPR). However, CPR providers struggle to achieve high-quality CCs. There is a debate about the use of backboards during CPR in literature. Some studies suggest backboards improve CC quality, whereas others suggest that backboards can cause delays. This is the first study to evaluate all three components of high-quality CCs: compression depth, recoil depth, and rate, at the same time with a high number of subjects. This study evaluated the impact of backboards on CC quality during CPR. The primary outcome was the difference in successful CC rates between two groups. METHODS: This was a randomized, controlled, single-blinded study using a high-fidelity mannequin. The successful CC rates, means CC depths, recoil depths, and rates achieved by 6th-grade undergraduate medical students during two minutes of CPR were compared between two randomized groups: an experimental group (backboard present) and a control group (no backboard). RESULTS: Fifty-one of all 101 subjects (50.5%) were female, and the mean age was 23.9 (SD = 1.01) years. The number and the proportion of successful CCs were significantly higher in the experimental group (34; 66.7%) when compared to the control group (19; 38.0%; P = .0041). The difference in mean values of CC depth, recoil depth, and CC rate was significantly higher in the experiment group. CONCLUSION: The results suggest that using a backboard during CPR improves the quality of CCs in accordance with the 2015 AHA Guidelines.Sanri E, Karacabey S. The impact of backboard placement on chest compression quality: a mannequin study. Prehosp Disaster Med. 2019;34(2):182-187.


Assuntos
Reanimação Cardiopulmonar/instrumentação , Pressão , Reanimação Cardiopulmonar/métodos , Desenho de Equipamento , Equipamentos e Provisões Hospitalares/normas , Feminino , Humanos , Masculino , Manequins , Método Simples-Cego , Adulto Jovem
17.
Rev. pesqui. cuid. fundam. (Online) ; 11(3): 634-640, abr.-maio 2019. tab
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-994678

RESUMO

Objective: The study's purpose has been to describe the knowledge and performance of an urgency nursing team of the University Hospital from the Universidade Federal do Vale do São Francisco in Petrolina city, Pernambuco State, with regards to the cardio respiratory arrest event. Methods: It is a descriptive and cross-sectional study with a quantitative approach, which was carried out through a non-probabilistic sample of 101 nursing professionals who answered a questionnaire. Data were analyzed by observing the frequencies of each isolated response and the crossing of variables. Results: Twenty-three nurses and 78 nurse technicians were interviewed. Regarding the detection of a cardio respiratory arrest, immediate conduct, and the actions of both the basic life support and advanced life support, most professionals answered in a partially correct way. Conclusion: The low percentage of totally correct answers evidences the need to update the entire nursing team, maintaining the uniformity of the professional performance, thus improving the care provided to the patient showing serious health condition


Objetivo: Descrever o conhecimento e atuação da equipe de enfermagem da urgência do Hospital Universitário da Universidade Federal do Vale do São Francisco de Petrolina/PE, perante o evento PCR. Métodos: Estudo quantitativo, descritivo e transversal por uma amostragem não probabilística de 101 profissionais de enfermagem que responderam a um questionário. Os dados foram analisados por meio da observação das frequências de cada resposta isolada e do cruzamento de variáveis. Resultados: Foram entrevistados 23 enfermeiros e 78 técnicos de enfermagem. Com relação à detecção de PCR, conduta imediata, ações de SBV e SAV, a maioria dos profissionais respondeu de maneira parcialmente correta. Conclusão: O baixo percentual de respostas totalmente corretas, evidencia a necessidade de atualização de toda a equipe de enfermagem, mantendo a uniformidade das condutas, melhorando assim o atendimento prestado ao paciente grave


Objetivo: Describir el conocimiento y actuación del equipo de enfermería de la urgencia del Hospital Universitario de la Universidad Federal del Valle del São Francisco de Petrolina / PE, ante el evento PCR. Métodos: Estudio cuantitativo, descriptivo y transversal por un muestreo no probabilístico de 101 profesionales de enfermería que respondieron a un cuestionario. Los datos fueron analizados por medio de la observación de las frecuencias de cada respuesta aislada y del cruce de variables. Resultados: Fueron entrevistados 23 enfermeros y 78 técnicos de enfermería. Con respecto a la detección de PCR, conducta inmediata, acciones de SBV y SAV, la mayoría de los profesionales respondió de manera parcialmente correcta. Conclusión: El bajo porcentaje de respuestas totalmente correctas, evidencia la necesidad de actualización de todo el equipo de enfermería, manteniendo la uniformidad de las conductas, mejorando así la atención prestada al paciente grave


Assuntos
Humanos , Masculino , Feminino , Adulto , Reanimação Cardiopulmonar/enfermagem , Parada Cardíaca/terapia , Reanimação Cardiopulmonar/instrumentação , Equipe de Respostas Rápidas de Hospitais , Parada Cardíaca/enfermagem , Equipe de Enfermagem/estatística & dados numéricos
18.
Rev Lat Am Enfermagem ; 27: e3130, 2019 Mar 10.
Artigo em Inglês, Português, Espanhol | MEDLINE | ID: mdl-30916231

RESUMO

OBJECTIVE: to create and validate an educational video for teaching deaf students about cardiopulmonary resuscitation. METHOD: methodological study consisting in the creation of an educational video, validation of its content by 22 nurses with expertise in cardiorespiratory arrest, and evaluation by 16 deaf students. For data collection, the following validated instruments were used: the Instrument for Validation of Educational Content used for the validation by nurses and the Assistive Technology Assessment Questionnaire for the evaluation by deaf students. The criterion for validation was concordance higher than 80%, analyzed through the content validation index and binomial test. RESULTS: the final version of the video lasted seven minutes and thirty seconds, covered the steps that should be performed by a lay person to help a victim of cardiorespiratory arrest, presented animations and the narration in the Brazilian sign language. All the items obtained agreement among nurses and of among deaf students equal or superior to 80%. CONCLUSION: the video was considered to present valid content by the judges and comprehensible content by deaf students. Thus the video represents an inclusive technology for health education of deaf people about cardiopulmonary resuscitation.


Assuntos
Reanimação Cardiopulmonar/educação , Educação de Pessoas com Deficiência Auditiva/métodos , Educação em Enfermagem/métodos , Gravação em Vídeo/normas , Reanimação Cardiopulmonar/instrumentação , Humanos , Línguas de Sinais
19.
PLoS One ; 14(3): e0214576, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30925171

RESUMO

In this study, we construct a paddle positioning system for defibrillation training simulators. The system consists of a chest manikin fabricated based on the standard somatotype of Koreans and simulator paddles similar to those of commercial defibrillators. Multiple coils are arranged orthogonally in both the chest manikin and paddles; their positioning is based on electromagnetic induction, such that the positions of the paddles can be successfully detected across the chest. The calculated and actual positions are compared using the measured signals. We find a mean error of 0.0891 mm for all positions, with a standard deviation of 0.6611 mm. In addition, we connect our paddle positioning system to a graphical user interface that enables visualization of the paddles' current locations.


Assuntos
Desfibriladores , Manequins , Reanimação Cardiopulmonar/instrumentação , Desenho de Equipamento , Humanos , Tórax
20.
Trials ; 20(1): 108, 2019 Feb 08.
Artigo em Inglês | MEDLINE | ID: mdl-30736841

RESUMO

BACKGROUND: The research study titled "Cluster randomised trial of the clinical and cost effectiveness of the i-gel supraglottic airway device versus tracheal intubation in the initial airway management of out-of-hospital cardiac arrest (AIRWAYS-2)" is a large-scale study being run in the English emergency medical (ambulance) services (EMS). It compares two airway management strategies (tracheal intubation and the i-gel) in out-of-hospital cardiac arrest. We describe the methods used to minimise bias and the challenges associated with the set-up, enrolment, and follow-up that were addressed. METHODS: AIRWAYS-2 enrols adults without capacity when there is no opportunity to seek prior consent and when the intervention must be delivered immediately. We therefore adopted a cluster randomised design where the unit of randomisation is the individual EMS provider (paramedic). However, because paramedics could not be blinded to the intervention, it was necessary to automatically enrol all eligible patients in the study to avoid bias. Effective implementation required engagement with four large EMS and 95 receiving hospitals. Very high levels of data capture were required to ensure study integrity, and this necessitated collaborative working across multiple organisations. We sought to manage these processes by using a large and comprehensive electronic study database, implementing efficient trial procedures and comprehensive training. RESULTS: Successful implementation of the study design was facilitated by the approaches used. The necessary regulatory and ethical approvals to conduct the study were secured, and benefited from strong patient and public involvement. Early and continued consultation with decision makers within the four participating EMS resulted in a coordinated approach to study set-up. All receiving hospitals gave approval and agreed to collect data. A comprehensive database and programme of training and support were implemented. More than 1500 paramedics have been recruited to the study, and patient enrolment and follow-up has proceeded as planned. CONCLUSION: Care provided by EMS needs to be based on evidence. Although participants may be experiencing life-threatening emergencies, high-quality pre-hospital research is possible in well-designed and well-managed studies. The approaches described here can be used to support successful research that will lead to improved treatment and outcomes in similar patient groups. TRIAL REGISTRATION: ISRCTN08256118 . Registered on 22 July 2014.


Assuntos
Reanimação Cardiopulmonar/instrumentação , Serviços Médicos de Emergência , Auxiliares de Emergência , Intubação Intratraqueal/instrumentação , Parada Cardíaca Extra-Hospitalar/terapia , Ambulâncias , Reanimação Cardiopulmonar/efeitos adversos , Reanimação Cardiopulmonar/métodos , Comportamento Cooperativo , Inglaterra , Medicina de Emergência Baseada em Evidências , Humanos , Comunicação Interdisciplinar , Intubação Intratraqueal/efeitos adversos , Estudos Multicêntricos como Assunto , Parada Cardíaca Extra-Hospitalar/diagnóstico , Parada Cardíaca Extra-Hospitalar/fisiopatologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Participação dos Interessados , Resultado do Tratamento
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