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1.
Emergencias (Sant Vicenç dels Horts) ; 32(1): 45-48, feb. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-ET2-3436

RESUMO

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


Assuntos
Humanos , Feminino , Adulto , Reanimação Cardiopulmonar/métodos , Reanimação Cardiopulmonar/normas , Sociedades Médicas/normas , Reanimação Cardiopulmonar/educação , Parada Cardíaca , Índice de Massa Corporal
2.
Medicine (Baltimore) ; 99(1): e18452, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31895774

RESUMO

BACKGROUND: The aim of this study was to compare three intubation methods during cardiopulmonary resuscitation using an adult-manikin. METHODS: Thirty-nine paramedics were included in this study. Each participant performed endotracheal intubation during continuous chest compressions using 3 different methods: conventional Macintosh laryngoscope without additional intubation aids (MAC), conventional Macintosh laryngoscope with gum-elastic bougie (GEB), or flexible tip bougie (FTB). First attempt intubation success rate and intubation time was measured. RESULTS: Intubation success rate was 39% with the use of MAC, 92% with GEB and 95% with FTB. It was statistically lower with MAC than with GEB (P < .001) and FTB (P < .001). There was no difference between GEB and FTB in intubation success rate (P = .644). The mean(SD) intubation time was 28.43 (13.81)s with MAC, 25.69 (5.35)s with GEB and 21.41 (2.88)s with FTB. Intubation time was significantly longer with GEB than with FTB (P < .001). CONCLUSIONS: Within limitations, results of our study suggest that intubation aids facilitate tracheal intubation during continuous chest compressions. Using flexible tip bougie shortens the duration of the procedure compared to gum elastic bougie.


Assuntos
Reanimação Cardiopulmonar/métodos , Intubação Intratraqueal/instrumentação , Estudos Cross-Over , Humanos , Laringoscópios , Manequins , Estudos Prospectivos , Fatores de Tempo
3.
Medicine (Baltimore) ; 99(2): e18658, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31914051

RESUMO

RATIONALE: Despite increasing number of left ventricular assist device (LVAD) implantation, standardized cardiopulmonary resuscitation (CPR) protocol for patients with LVAD, especially in out-of-hospital settings are not well known. PATIENT CONCERNS: A 41-year-old LVAD implanted man became cardiac arrest in an out-of-hospital setting. Bystander CPR was started and the patient was brought to our hospital without noticing LVAD. Upon arrival, the medical staff noted the LVAD and that the battery of the LVAD was exhausted. DIAGNOSIS: Cardiac arrest on LVAD. INTERVENTIONS: It took 50 minutes to change the battery, then the patient has become ventricular fibrillation; hence, we introduced extracorporeal membranous oxygenation and defibrillated the patient. After the sinus rhythm was restored, the LVAD started working uneventfully. OUTCOMES: The patient became brain dead. LESSONS: There are several difficulties in treating these patients. First, hemodynamic collapse is difficult to diagnose. Second, chest compression for LVAD implanted patients remains controversial. Third, education to first responders who are not familiar with LVAD are not enough. Appropriate education for those issues is needed.


Assuntos
Reanimação Cardiopulmonar/métodos , Coração Auxiliar , Parada Cardíaca Extra-Hospitalar/terapia , Adulto , Cardioversão Elétrica , Fontes de Energia Elétrica , Oxigenação por Membrana Extracorpórea , Humanos , Masculino , Parada Cardíaca Extra-Hospitalar/complicações , Fibrilação Ventricular/etiologia , Fibrilação Ventricular/terapia
4.
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
5.
Orv Hetil ; 160(46): 1832-1839, 2019 Nov.
Artigo em Húngaro | MEDLINE | ID: mdl-31707820

RESUMO

Post-resuscitation brain injury forms the leading cause of death of patients after successful cardiopulmonary resuscitation that explains why post-resuscitation neuroprotection is the most important part of post-resuscitation therapy. The goals of the neuroprotection tools available today are preventing the evolution of primary and formation of secondary brain injury. We are going to summarize the neuroprotective possibilities that we can reach today. We will discuss the role of pharmacologic strategies including sedation, the modalities of upholding brain perfusion, the monitoring of proper hemodynamic variables and the practice of targeted temperature management. It is very important to avoid hypo- and hyperoxia, to keep normocapnia, normoglycemia and to control seizures during the management of post-cardiac arrest patients. There is still a lack of evidence to prove which pharmacologic agent may be effective in postresuscitation neuroprotection, however, there are some promising results regarding thiamine. Hemodynamic management guided by higher level hemodynamic monitoring may be beneficial in enhancing brain perfusion but more clinical studies are needed to investigate its usefulness. Targeted temperature management constitutes the main element of post-resuscitation neuroprotection, however, the details of its implementation raise several questions. Orv Hetil. 2019; 160(46): 1832-1839.


Assuntos
Lesões Encefálicas/prevenção & controle , Reanimação Cardiopulmonar/métodos , Parada Cardíaca/terapia , Hipotermia Induzida/métodos , Neuroproteção , Parada Cardíaca/complicações , Humanos , Fármacos Neuroprotetores/uso terapêutico
6.
Orv Hetil ; 160(46): 1821-1825, 2019 Nov.
Artigo em Húngaro | MEDLINE | ID: mdl-31707822

RESUMO

Cardiopulmonary resuscitation is one of the most emergent medical procedures. Maintaining our resuscitative efforts at the highest level possible is not only our professional, but also ethical duty. International scientific societies, like the European Resuscitation Council (ERC) and the American Heart Association (AHA) publish regularly their guidelines, based on robust scientific evidence, or (where it is not available) widely accepted expert panels' opinion. Current clinical experience shows that a growing proportion of cardiac arrests is non-arrhytmogenic in origin. In these cases scientific guidelines, but also bare clinical judgement suggests searching for reversible causes and correcting them parallel with standard resuscitation efforts. Without this, a good outcome is rarely achievable. Intra-arrest protocolised ultrasound exam can be a powerful tool in detecting reversible causes, and also an aid in the correction of some. By reviewing the current literature and scientific guidelines, I aim to tailor the role and usefulness of intra-arrest ultrasound exam as an integrated part of the resuscitation efforts. Orv Hetil. 2019; 160(46): 1821-1825.


Assuntos
Reanimação Cardiopulmonar/métodos , Parada Cardíaca/diagnóstico por imagem , Ultrassonografia , Humanos , Estados Unidos
7.
Rev Assoc Med Bras (1992) ; 65(10): 1300-1307, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31721963

RESUMO

OBJECTIVES: 1) To evaluate the efficiency of a new method of training laypeople on cardiopulmonary resuscitation (CPR). 2) To assess previous knowledge of the participants. METHODS: Instructors were trained according to the 2015 American Heart Association Guidelines, with emphasis on CPR. Dummies made with PET bottles were used, and a questionnaire was applied to the participants before and after training. Statistical analysis was performed in the R commander program. Participants with incomplete documents were excluded from the study. RESULTS: Out of 101 participants, 96 were included: 69 lay people, 17 health professionals, and ten health students. There was an improvement in the overall performance after training (mean pre: 62.7%, mean post: 75.8%, p <0.01), also present in the following main concepts: "mouth-to-mouth breathing is not necessary" (p <0.01), "risk of contamination" (p <0.01), "compression technique" (p <0.01). The concepts "recognition of severity" and "what is chest compression" did not improve, but had good pre-test means, 96.8% and 81.2%. There was no statistical difference in the knowledge between the groups (laypeople vs. health professionals and students, pre=0,06 e post=0,33). CONCLUSION: The tools used in training were efficient. However, further studies are necessary to assess the long-term impact of this intervention.


Assuntos
Reanimação Cardiopulmonar/educação , Reanimação Cardiopulmonar/métodos , Educação em Saúde/métodos , Adolescente , Adulto , Brasil , Escolaridade , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde/educação , Humanos , Masculino , Pessoa de Meia-Idade , Estudantes , Inquéritos e Questionários , Adulto Jovem
8.
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
9.
Medicine (Baltimore) ; 98(44): e17752, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31689831

RESUMO

Dispatcher assisted cardiopulmonary resuscitation (DACPR) by Emergency medical services has been shown to improve rates of early out of hospital cardiac arrest (OHCA) recognition and early cardiopulmonary resuscitation (CPR) for OHCA. This study measures the impact of introducing DACPR on OHCA recognition, CPR rates and on patient outcomes in a pilot region in Kuwait.EMS treated OHCA data over 10 months period (February 21-December 31, 2017) before and after the intervention was prospectively collected and analyzed.Comprehensive DACPR in the form of: a standardized dispatch protocol, 1-day training package and quality assurance and improvement measures were applied to Kuwait EMS central Dispatch unit only for pilot region. Primary outcomes: OHCA recognition rate, CPR instruction rate, and Bystander CPR rate. Secondary outcome: survival to hospital discharge.A total of 332 OHCA cases from the EMS archived data were extracted and after exclusion 176 total OHCA cases remain. After DACPR implementation OHCA recognition rate increased from 2% to 12.9% (P = .037), CPR instruction rate increased from 0% to 10.4% (P = .022); however, no significant change was noted for bystander CPR rates or prehospital return of spontaneous circulation. Also, survival to hospital discharge rate did not change significantly (0% before, and 0.8% after, P = .53)In summary, DACPR implementation had positive impacts on Kuwait EMS system operational outcomes; early OHCA recognition and CPR instruction rates in a pilot region of Kuwait. Expanding this initiative to other regions in Kuwait and coupling it with other OHCA system of care interventions are needed to improve OHCA survival rates.


Assuntos
Reanimação Cardiopulmonar/educação , Operador de Emergência Médica/educação , Serviços Médicos de Emergência/métodos , Parada Cardíaca Extra-Hospitalar/terapia , Idoso , Reanimação Cardiopulmonar/métodos , Feminino , Implementação de Plano de Saúde , Humanos , Kuweit , Masculino , Pessoa de Meia-Idade , Alta do Paciente/estatística & dados numéricos , Projetos Piloto , Avaliação de Programas e Projetos de Saúde , Estudos Prospectivos , Resultado do Tratamento
10.
Pan Afr Med J ; 33: 289, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31692808

RESUMO

Introduction: This study explores why resuscitation is withheld when mobile emergency medical team arrive at the scene of a cardiac arrest. Methods: We conducted a prospective, observational study in pre hospital emergency services. We included adults' patients, with a suspicion of non-traumatic cardiac arrest (CA) in an out of hospital environment, who received or not cardiopulmonary resuscitation (CPR) by our mobile emergency medical service teams. An analytic study was conducted in order to identify independent factors that could influence the decision to resuscitate OHCA. Results: During study, 228 patients were enrolled, the mean age was 64 +/- 14 years and 59% were men. Eighteen patients (8%) received bystander CPR by witnesses. The median time elapsed to arrive at the scene was 13 [8-25] min. The median "noflow" was 22 [10-34] min. The resuscitation decision was taken by the mobile EMS staff for 106 patients (46.5%). For other patients, the decision not to resuscitate was motivated solely by the finding of a confirmed state of death in an elderly patient (p = 0.045). The predictive decision factor for resuscitation was the no flow time less than 18.5 min, Odds Ratio adjusted with 95% confidence interval to: 1.38 (1.24 - 3.55) (p <0.001). Overall out of hospital survival rate was 17% of resuscitated patients. Conclusion: The decision to resuscitate a cardiac arrest outside of the hospital depends more on the "no flow" time than on the presumed etiologies.


Assuntos
Reanimação Cardiopulmonar/métodos , Tomada de Decisões , Serviços Médicos de Emergência/estatística & dados numéricos , Parada Cardíaca Extra-Hospitalar/terapia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Taxa de Sobrevida , Fatores de Tempo
11.
Undersea Hyperb Med ; 46(5): 633-634, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31683361

RESUMO

A 54-year-old man suffered a leg cramp while diving in the ocean at a depth of 20 meters. He began to surface, with his ascent based on a decompression table. He lost consciousness at the surface and was rescued by a nearby boat. The boat staff judged him to be in cardiac arrest, so they performed chest compressions. When the boat reached port where an ambulance was waiting, emergency medical technicians confirmed that the patient was in cardiac arrest; his initial rhythm was asystole. Treated with basic life support, the patient was then transported to a rendezvous point, where a physician-staffed helicopter waited. The patient remained in cardiac arrest, so the staff of the helicopter performed tracheal intubation with mechanical ventilation, securing a venous route, infusion of adrenaline, and mechanical chest compression. On arrival at our hospital 100 minutes after collapse, he remained in cardiac arrest. Continued advanced cardiac life support failed to obtain spontaneous circulation. Whole-body computed tomography (CT) at 120 minutes after the collapse showed multiple gas bubbles in the heart, aorta, inferior vena cava, cerebral artery, coronary artery and portal vein with lung edema. This is the first case to show gas in the bilateral coronary arteries on CT. The present case clearly demonstrates that decompression sickness can also induce acute coronary syndrome.


Assuntos
Síndrome Coronariana Aguda/diagnóstico por imagem , Vasos Coronários/diagnóstico por imagem , Doença da Descompressão/complicações , Embolia Aérea/diagnóstico por imagem , Síndrome Coronariana Aguda/etiologia , Aorta/diagnóstico por imagem , Reanimação Cardiopulmonar/métodos , Mergulho/efeitos adversos , Embolia Aérea/etiologia , Evolução Fatal , Coração/diagnóstico por imagem , Parada Cardíaca/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X/métodos
12.
Medicine (Baltimore) ; 98(45): e17853, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31702646

RESUMO

BACKGROUND: The recommended chest compression technique for a single rescuer performing infant cardiopulmonary resuscitation is the two-finger technique. For 2 rescuers, a two-thumb-encircling hands technique is recommended. Several recent studies have reported that the two-thumb-encircling hands technique is more effective for high-quality chest compression than the two-finger technique for a single rescuer performing infant cardiopulmonary resuscitation. We undertook a systematic review and meta-analysis of infant manikin studies to compare two-thumb-encircling hands technique with two-finger technique for a single rescuer. METHODS: We searched MEDLINE, EMBASE, and the Cochrane Library for eligible randomized controlled trials published prior to December 2017, including cross-over design studies. The primary outcome was the mean difference in chest compression depth (mm). The secondary outcome was the mean difference in chest compression rate (counts/min). A meta-analysis was performed using Review Manager (version 5.3. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014). RESULTS: Six studies that had reported data concerning both chest compression depth and chest compression rate were included. The two-thumb-encircling hands technique was associated with deeper chest compressions compared with two-finger technique for mean chest compression depth (mean difference, 5.50 mm; 95% confidence interval, 0.32-10.69 mm; P = .04), but no significant difference in the mean chest compression rate (mean difference, 7.89 counts/min; 95% confidence interval, to 0.99, 16.77 counts/min; P = .08) was noted. CONCLUSION: This study indicates that the two-thumb-encircling hands technique is a more appropriate technique for a single rescuer to perform high-quality chest compression in consideration of chest compression depth than the two-finger technique in infant manikin studies.


Assuntos
Reanimação Cardiopulmonar/métodos , Parada Cardíaca/terapia , Feminino , Dedos , Humanos , Lactente , Masculino , Manequins , Ensaios Clínicos Controlados Aleatórios como Assunto
13.
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
14.
Emergencias (Sant Vicenç dels Horts) ; 31(5): 327-334, oct. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-184122

RESUMO

Objetivo. Determinar la incidencia de lesiones torácicas óseas graves (LTOG) y de lesiones viscerales graves (LVG) secundarias a reanimación cardiopulmonar (RCP) y estudiar las variables asociadas a ellas. Método. Se analizaron los datos del proyecto ReCaPTa, estudio prospectivo de la muerte súbita, con varias fuentes de información. Se incluyeron los pacientes no supervivientes a un intento de RCP manual, entre abril de 2014 y mayo de 2016, en los que se aplicó un protocolo autópsico específico para el estudio de las lesiones secundarias a la RCP. Resultados. Se analizaron 109 sujetos, con una mediana de edad de 63 años y un 32,1% de mujeres. El 63,3% presentaron LTOG y el 14,7%, LVG. El grupo con LTOG fue de mayor edad (63 vs 59 años, p = 0,031) y se asoció a una mayor proporción de pacientes con un perímetro torácico > 101 cm (56,5 vs 30%, p = 0,016) y con un perímetro abdominal > 100 cm (62,3 vs 37,5%, p = 0,017). En un análisis multivariado el perímetro torácico > 101 cm fue el único factor de riesgo para LTOG (OR 2,45; IC 95% 1,03-5,84) y el sexo femenino fue el único factor de riesgo para LVG (OR 5,02; IC 95% 1,18-21,25). Conclusión. Los pacientes con un perímetro torácico mayor de 101 cm y las mujeres presentan un riesgo superior de lesiones graves debidas a la RCP


Objective. To determine the incidence of serious rib cage damage (SRD) and serious visceral damage (SVD) secondary to cardiopulmonary resuscitation (CPR) and to explore associated factors. Methods. We analyzed data from the prospective registry of cases of sudden death in Tarragona, Spain (the ReCaPTa study). Cases were collected from multiple surveillance sources. In this study we included the cases of autopsied nonsurvivors after attempted manual CPR between April 2014 and May 2016. A specific protocol to detect injuries secondary to CPR was used during the autopsies. Results. We analyzed 109 cases. The mean age at death was 63 years and 32.1% were women. SRD were found in 63.3% and SVD in 14.7%. The group with SRD were significantly older (63 vs 59 years, P=.031) and included higher percentages of persons with a chest circumference over 101 cm (56.5 vs 30%, P=.016) and a waist circumference over 100 cm (62.3 vs 37.5%, P=.017). A multivariable analysis confirmed chest circumference over 101 cm as the only risk factor for SRD (odds ratio [OR], 2.45; 95% CI, 1.03-5.84) and female sex as the only risk factor for SVD (OR, 5.02; 95% CI, 1.18-21.25). Conclusion. Women and any patient with a chest circumference greater than 101 cm are at greater risk for serious injuries related to CPR


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Reanimação Cardiopulmonar/métodos , Ferimentos e Lesões/complicações , Ferimentos e Lesões/epidemiologia , Fatores de Risco , Caixa Torácica/lesões , Fraturas das Costelas/complicações , Fraturas das Costelas/epidemiologia , Curva ROC
15.
Croat Med J ; 60(4): 325-332, 2019 Aug 31.
Artigo em Inglês | MEDLINE | ID: mdl-31483118

RESUMO

AIM: To assess the effect of the time for emergency medical services (EMS) arrival on resuscitation outcome in the transition period of the EMS system in Istra County. METHODS: This retrospective study analyzed the data from 1440 patients resuscitated between 2011 and 2017. The effect of demographic data, period of the year, time for EMS arrival, initial cardiopulmonary resuscitation (CPR) provider, initial cardiac rhythm, and airway management method on CPR outcome was assessed with multivariate logistic regression. RESULTS: Survivors were younger than non-survivors (median of 66 vs 70 years, P<0.001) and had shorter time for EMS arrival (median of 6 vs 8 min, P<0.001). The proportion of non-survivors was significantly higher when initial basic life support (BLS) was performed by bystanders without training (83.8%) or when no CPR was performed before EMS team arrival (87.3%) than when BLS was performed by medical professionals (66.8%) (P<0.001). Sex, airway management, and tourist season had no effect on CPR outcome. CONCLUSION: Since the time for arrival and level of CPR provider training showed a significant effect on CPR outcome, further organizational effort should be made to reduce the time for EMS arrival and increase the number of individuals trained in BLS.


Assuntos
Reanimação Cardiopulmonar/métodos , Reanimação Cardiopulmonar/estatística & dados numéricos , Serviços Médicos de Emergência/métodos , Serviços Médicos de Emergência/estatística & dados numéricos , Parada Cardíaca Extra-Hospitalar/mortalidade , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Manuseio das Vias Aéreas/métodos , Croácia/epidemiologia , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores Socioeconômicos , Taxa de Sobrevida , Fatores de Tempo
16.
Int Heart J ; 60(5): 1043-1049, 2019 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-31484867

RESUMO

Acute coronary syndrome (ACS) is the major cause of out-of-hospital cardiac arrest (OHCA). The relationship between the findings from the study of coronary images and return of spontaneous circulation (ROSC) interval is still unknown. Hence, we investigated this relationship in ACS patients with OHCA.A cohort of 2779 patients was admitted to our emergency center due to cardiopulmonary arrest (CPA) between April 2011 and March 2015. We included ACS patients who had CPA with ventricular fibrillation (VF) as an initial rhythm, were successfully resuscitated, underwent coronary angiography (CAG), had a culprit lesion, and were diagnosed with ACS (n = 58; age, 63.7 ± 12.0 years; 93.1% male).We divided the 58 patients into two groups, an early ROSC group (ROSC ≤ 20 minutes: E-ROSC) and a late ROSC group (ROSC > 20 minutes: L-ROSC), and then analyzed their characteristics.The finding of a collateral artery for the culprit lesion location, Rentrop II-III, and TIMI III flow on CAG on arrival presented no significant differences between the two groups (Rentrop II-III: 25.0% versus 23.5%, P = 0.90; TIMI III: 33.3% versus 35.3%, P = 0.88). The incidence of multivessel coronary artery disease (MVD) was lower in the E-ROSC group than in the L-ROSC group (16.7% versus 58.8%, P = 0.001).Collateral and TIMI flow were not associated with ease of resuscitation, but MVD may have a negative impact on resuscitation, especially in VF patients.


Assuntos
Síndrome Coronariana Aguda/terapia , Reanimação Cardiopulmonar/métodos , Doença da Artéria Coronariana/terapia , Circulação Coronária/fisiologia , Parada Cardíaca Extra-Hospitalar/terapia , Intervenção Coronária Percutânea/métodos , Síndrome Coronariana Aguda/diagnóstico por imagem , Síndrome Coronariana Aguda/mortalidade , Idoso , Reanimação Cardiopulmonar/mortalidade , Causas de Morte , Estudos de Coortes , Angiografia Coronária/métodos , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/mortalidade , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Japão , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Parada Cardíaca Extra-Hospitalar/mortalidade , Intervenção Coronária Percutânea/mortalidade , Prognóstico , Recuperação de Função Fisiológica/fisiologia , Estudos Retrospectivos , Medição de Risco , Estatísticas não Paramétricas , Análise de Sobrevida
17.
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
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