[Epidemiological characteristics of out-of-hospital cardiorespiratory arrest recorded by the 061 emergencies system (SAMU) in the Balearic Islands (Spain), 2009-2012]. / Características epidemiológicas de las paradas cardiorrespiratorias extrahospitalarias registradas por el sistema de emergencias 061 (SAMU) de la Comunidad Autónoma de las Islas Baleares (2009-2012).

OBJECTIVE: To describe the epidemiology of out-of-hospital cardiorespiratory arrest (OHCA) and identify factors associated with recovery of spontaneous circulation (ROSC). DESIGN: Observational study of OHCA registered on a continuous basis in the Emergency Medical Services (EMS) database during 2009-2012. SETTING: The islands of Mallorca, Ibiza, Menorca and Formentera (Balearic Islands, Spain). PATIENTS: OHCA in patients ≥ 18 years of age. The main variables were: Patient sex, age, probable cause, place of arrest, bystander, witnessed, basic life support (BLS), shockable rhythm, intervention time, semi-automatic defibrillator (AED), duration of cardiopulmonary arrest (CA), and ROSC. Independent variables were defined according to the Utstein protocol, and the dependent variable was defined as ROSC. RESULTS: The EMS treated 1170 OHCAs (28/100,000 persons-year). We included 1130 CA. The mean age was 61.4 years (73.4% males). Most CA (72.3%) were of cardiac etiology, and 84.7% were witnessed. A total of 840 (74.3%) received BLS and 400 (47.6%) did so before arrival of the EMS (45 by bystander relatives). AED was available in 330 cases CA (29.2%) (96 with shockable rhythm). The interval between emergency call and BLS and between emergency call and advanced life support was 8.4 and 15.8min, respectively. Shockable rhythm was monitored in 257 CAs (22.7%). ROSC occurred in 261 (23.1%). Factors associated with ROSC were age, shockable rhythm, BLS before EMS arrival, and CA duration less than 30min. CONCLUSION: The incidence rate of the OHCA is low. The proportion of patients receiving BLS from relatives was low. Age, shockable rhythm and BSL before EMS arrival were associated with ROSC.

Long-term survival after out-of-hospital cardiac arrest in children: outcomes in Andalusia in 2008-2019. / Supervivencia a largo plazo de la parada cardiaca extrahospitalaria en edad pediátrica: resultados en Andalucía durante el periodo 2008-2019.

OBJECTIVE: To determine survival to discharge and neurological outcomes on long-term follow-up of pediatric patients attended for out of-hospital cardiac arrest (OHCA). METHODS: Retrospective study based on an ongoing OHCA registry. Patients aged 16 years or younger were included. Futile resuscitation attempts were excluded. Neurological outcome on hospital discharge and on follow-up was based on variables in the Pediatric Cerebral Performance Category (PCPC) scale. Cases from January 1, 2008, through December 31, 2019, were extracted, and 2 surveys were carried out in May 2021 and January 2023. Patient follow-up time ranged from 1 to 13 years. RESULTS: Of the 13 778 patients in the registry, we found 277 (2.0%) who were aged 16 years or younger. One hundred thirty-seven patients (49.5%) were transported to a hospital, and spontaneous circulation was restored in 99 (35.7%). Thirty-six patients (13%) were discharged. The median (interquartile range) follow-up time was 2172 (978-3035) days. Thirty-one of these patients (86.1%) were alive at follow-up, 3 had died, and 2 were lost to follow-up. Neurological outcomes had worsened in 2 and improved in 6 patients. The neurological outcome of 27 of the 31 patients with complete follow-up data (87.1%) was good (PCPC scores of 1 or 2). CONCLUSIONS: In spite of the low incidence of shockable rhythm in pediatric OHCA, survival with a good neurological outcome is comparable to survival in adults. Children who are discharged after OHCA maintained or improved their neurological function over the long term.

OBJETIVO: Conocer la supervivencia al alta y la evolución neurológica tras seguimiento a largo plazo de pacientes pediátricos atendidos por parada cardíaca extrahospitalaria. METODO: Estudio retrospectivo basado en un registro continuo de parada cardiaca extrahospitalaria. Se incluyeron los pacientes pediátricos (edad menor o igual a 16 años). Se excluyeron reanimaciones consideradas fútiles. Se tomaron como variables resultado el estado neurológico al alta hospitalaria y al seguimiento de los pacientes, siguiendo el modelo de la Pediatric Cerebral Performance Category. El periodo fue del 1 de enero de 2008 al 31 de diciembre de 2019. Se realizaron dos encuestas, en mayo del 2021 y enero del 2023 con un periodo de seguimiento entre 1 y 13 años. RESULTADOS: De los 13.778 pacientes, 277 (2,0%) eran menores de 16 años; 137 (49,5%) trasladados al hospital, 99 de ellos (35,7%) con recuperación de circulación espontánea. Recibieron el alta hospitalaria 36 pacientes (13%). En el seguimiento, mediana (RIC) de 2.172 [978-3.035] días, 31 pacientes (86,1%) seguían con vida, 3 pacientes fallecieron y en dos casos no obtuvimos información. Dos pacientes sufrieron un empeoramiento del estado neurológico y 6 mejoraron. Finalmente, 27 de los 31 pacientes (87,1%) que completaron el seguimiento tenían una buena situación neurológica (PCPC1-2). CONCLUSIONES: A pesar de presentar una incidencia baja, la supervivencia con buen estado neurológico al alta hospitalaria de la parada cardiorrespiratoria extrahospitalaria pediátrica es comparable a la del adulto. Los pacientes pediátricos que recibieron el alta hospitalaria tras una parada cardiorrespiratoria extrahospitalaria mantuvieron o mejoraron su estado neurológico en el seguimiento a largo plazo.

Incidence, treatment, and factors associated with survival of out-of-hospital cardiac arrest attended by Spanish emergency services: report from the Out-of-Hospital Spanish Cardiac Arrest Registry for 2022. / Incidencia, tratamiento y factores asociados con la supervivencia de la parada cardiaca extrahospitalaria atendida por los servicios de emergencias en España: informe 2022 del registro OHSCAR.

SUMMARY: Out-of-hospital cardiac arrest is a serious public health problem worldwide. The annual incidence is estimated at around 400 000 cases in Europe and the United States, and survival rates scarcely reach 10%. However, there is considerable variation between countries and even between regions that share a similar health care system within a single country. Information recorded by the Out-of-Hospital Spanish Cardiac Arrest Registry (OHSCAR) provides information on care provided by emergency ambulance services, final health outcomes after cardiac arrest cases (including variations), the possibility of organ donation, and the impact of the COVID-19 pandemic. This paper presents the OHSCAR report for Spanish emergency services for the year 2022.

RESUMEN: La parada cardiorrespiratoria extrahospitalaria (PCREH) es un grave problema de salud pública mundial, con una incidencia anual estimada entorno a entorno a los 350.000 y 400.000 casos de PCERH en Europa y Estados Unidos, respectivamente. La supervivencia final se sitúa en porcentajes que apenas alcanzan el 10%, aunque existe una importante variabilidad entre países e incluso entre regiones del mismo país con modelos de atención similares. En España, el Registro Español de Parada Cardiaca Extrahospitalaria (acrónimo OHSCAR) ha ofrecido información sobre la asistencia a la PCRE prestada por los servicios de emergencias (SEM) y sus resultados finales en salud, así como sobre variabilidad, posibilidades de programas de donación o impacto de la pandemia COVID-19. A continuación se presenta el informe OHSCAR correspondiente a la asistencia a la PCRE por los SEM españoles durante el año 2022.

Outcomes of an extracorporeal cardiopulmonary resuscitation (ECPR) program for in- and out-of-hospital cardiac arrest in a tertiary hospital in Spain.

OBJECTIVE: To analyze if the implementation of a multidisciplinary extracorporeal cardiopulmonary resuscitation (ECPR) program in a tertiary hospital in Spain is feasible and could yield survival outcomes similar to international published experiences. DESIGN: Retrospective observational cohort study. SETTING: One tertiary referral university hospital in Spain. PATIENTS: All adult patients receiving ECPR between January 2019 and April 2023. INTERVENTIONS: Prospective collection of variables and follow-up for up to 180 days. MAIN VARIABLES OF INTEREST: To assess outcomes, survival with good neurological outcome defined as a Cerebral Performance Categories scale 1-2 at 180 days was used. Secondary variables were collected including demographics and comorbidities, cardiac arrest and cannulation characteristics, ROSC, ECMO-related complications, survival to ECMO decannulation, survival at Intensive Care Unit (ICU) discharge, survival at 180 days, neurological outcome, cause of death and eligibility for organ donation. RESULTS: Fifty-four patients received ECPR, 29 for OHCA and 25 for IHCA. Initial shockable rhythm was identified in 27 (50%) patients. The most common cause for cardiac arrest was acute coronary syndrome [29 (53.7%)] followed by pulmonary embolism [7 (13%)] and accidental hypothermia [5 (9.3%)]. Sixteen (29.6%) patients were alive at 180 days, 15 with good neurological outcome. Ten deceased patients (30.3%) became organ donors after neuroprognostication. CONCLUSIONS: The implementation of a multidisciplinary ECPR program in an experienced Extracorporeal Membrane Oxygenation center in Spain is feasible and can lead to good survival outcomes and valid organ donors.

[Survival of out-hospital cardiac arrests attended by a mobile intensive care unit in Asturias (Spain) in 2010]. / Supervivencia de las paradas cardiacas extrahospitalarias atendidas por una unidad de vigilancia intensiva móvil de Asturias en 2010.

OBJECTIVE: To evaluate attendance timings, out- and in-hospital characteristics, and survival of cardiac arrests attended by an advanced life support unit in Asturias (Spain) in 2010. Factors related to survival upon admission and at discharge were also analyzed. DESIGN: A retrospective, observational trial was carried out involving a cohort of out-hospital cardiac arrests (OHCA) occurring between 1 January 2010 and 31 December 2010, with one year of follow-up from OHCA. SETTING: Health Care Area IV of the Principality of Asturias, with a population of 342,020 in 2010. PATIENTS: All patients with OHCA and attended by an advanced life support unit were considered. MAIN VARIABLES: Demographic data, the etiology of cardiac arrest, bystander cardiopulmonary resuscitation (CPR), attendance timings and survival upon admission, at discharge and after one year. RESULTS: A total of 177 OHCA were included. Of these, 120 underwent CPR by the advanced life support team. Sixty-six of these cases (55%) were caused by presumed heart disease. A total of 63 patients (52.5%) recovered spontaneous circulation, and 51 (42.5%) maintained circulation upon admission to hospital. Thirteen patients (10.8%) were discharged alive. After one year, 11 patients were still alive (9.2%) - 9 of them (7.5%) with a Cerebral Performance Category (CPC) score of 1. Ventricular fibrillation and short attendance timings were related to increased survival. CONCLUSIONS: The survival rate upon admission was better than in other series and similar at discharge. Initial rhythm and attendance timings were related. Public automated external defibrillators (AED) were not used, and bystander CPR was infrequent.

Coronary angiography in patients without ST-segment elevation following out-of-hospital cardiac arrest. COUPE clinical trial.

INTRODUCTION AND OBJECTIVES: The role of emergency coronary angiography (CAG) and percutaneous coronary intervention (PCI) following out-of-hospital cardiac arrest (OHCA) in patients without ST-segment elevation myocardial infarction (STEMI) remains unclear. We aimed to assess whether emergency CAG and PCI would improve survival with good neurological outcome in this population. METHODS: In this multicenter, randomized, open-label, investigator-initiated clinical trial, we randomly assigned 69 survivors of OHCA without STEMI to undergo immediate CAG or deferred CAG. The primary efficacy endpoint was a composite of in-hospital survival free of severe dependence. The safety endpoint was a composite of major adverse cardiac events including death, reinfarction, bleeding, and ventricular arrhythmias. RESULTS: A total of 66 patients were included in the primary analysis (95.7%). In-hospital survival was 62.5% in the immediate CAG group and 58.8% in the delayed CAG group (HR, 0.96; 95%CI, 0.45-2.09; P=.93). In-hospital survival free of severe dependence was 59.4% in the immediate CAG group and 52.9% in the delayed CAG group (HR, 1.29; 95%CI, 0.60-2.73; P=.4986). No differences were found in the secondary endpoints except for the incidence of acute kidney failure, which was more frequent in the immediate CAG group (15.6% vs 0%, P=.002) and infections, which were higher in the delayed CAG group (46.9% vs 73.5%, P=.003). CONCLUSIONS: In this underpowered randomized trial involving patients resuscitated after OHCA without STEMI, immediate CAG provided no benefit in terms of survival without neurological impairment compared with delayed CAG. CLINICALTRIALS: gov Identifier: NCT02641626.

Persistent gender gaps in out-of-hospital cardiac arrest in Spain from 2013 through 2018. / Brecha de género persistente en la parada cardiaca extrahospitalaria en España durante el periodo 2013-2018.

OBJECTIVES: To examine gender-related differences in the management and survival of out-of-hospital cardiac arrest (OHCA) in Spain during 2 time series. MATERIAL AND METHODS: Analysis of data recorded in the prospective Spanish OHCA registry (OHSCAR in its Spanish acronym) for 2 time series (2013-2014 and 2017-2018). We included all 11 036 consecutive cases in which an emergency team intervened. The dependent variables were arrival at the hospital after return of spontaneous circulation, overall survival to discharge, and overall survival with good neurological outcomes. Sex was the independent variable. We report descriptive statistics, patient group comparisons, and changes over time. RESULTS: Women were significantly older and less likely to experience an OHCA in a public place, receive automatic external defibrillation, have a shockable heart rhythm, and be attended by an ambulance team within 15 minutes. In addition, fewer women underwent percutaneous coronary interventions or received treatment for hypothermia on admission to the hospital. In 2013-2014 and 2017-2018, respectively, the likelihood of survival was lower for women than men on admission (odds ratio [OR], 0.52 vs OR, 0.61; P .001 and P = .009 in the 2 time series) and at discharge (OR, 0.69 vs 0.72 for men; P = .001 in both time series). Survival with good neurological outcomes was also less likely in women (OR, 0.50 vs 0.63; P .001 in both series). CONCLUSION: The odds for survival and survival with good neurological outcomes were lower for women in nearly all patient groups in both time series. These findings suggest the need to adopt new approaches to address gender differences in OHCA.

OBJETIVO: Examinar las diferencias de género en las características de la parada cardiaca extrahospitalaria (PCRE), los tratamientos, la supervivencia, y los cambios evolutivos en España. METODO: Datos de dos series temporales (2013/2014 y 2017/2018) del registro prospectivo de PCRE (OHSCAR). Se incluyeron todos los casos consecutivos en los que intervino un equipo de emergencias. Las variables dependientes fueron las variables de atención de la PCRE, la llegada al hospital con pulso espontáneo, la supervivencia global al alta, y con buenos resultados neurológicos. El sexo fue la variable independiente. RESULTADOS: Las mujeres fueron significativamente mayores, menos propensas a presentar una PCRE en lugar público, recibir desfibrilación externa automática, tener un ritmo inicial desfibrilable y ser atendidas por una ambulancia en menos de 15 minutos. Además, menos mujeres recibieron intervención coronaria percutánea o hipotermia al ingreso hospitalario. Tanto en 2013/2014 como en 2017/2018 las mujeres tuvieron menos probabilidades de supervivencia al ingreso hospitalario (OR = 0,52; p 0,001; OR = 0,61; p = 0,009 respectivamente), y al alta hospitalaria (OR = 0,69; p = 0,001; OR = 0,72; p = 0,001, respectivamente) y con buenos resultados neurológicos (OR = 0,50; p 0,001; OR = 0,63; p 0,001, respectivamente). CONCLUSIONES: En ambos periodos las mujeres tuvieron menos probabilidades de sobrevivir y de hacerlo en buenas condiciones neurológicas. Estos resultados indican la necesidad de adoptar nuevos enfoques para abordar las diferencias de género en la PCRE.

Outcomes of a multidisciplinary mechanical circulatory support network in cardiogenic shock in a centre without heart transplant program: A successful interprofessional coordination model.

BACKGROUND AND OBJECTIVE: Cardiogenic shock (CS) mortality remains very high and mechanical circulatory support (MCS) may provide an effective alternative of treatment in selected patients. The aim of this study is to analyse the results of a multidisciplinary team care program (including anaesthesiologists, cardiologists, cardiothoracic surgeons, and intensivists) in CS patients who required MCS, in a tertiary centre without a heart transplant (HT) program. METHODS: Prospective observational study that sought to analyse the characteristics and survival to discharge predictors in a consecutive CS patients cohort treated with MCS. RESULTS: A total of 48 patients were included. Mean age was 61 ± 14 years. Before MCS, 45.8% of the patients presented with cardiac arrest. A 54.2% 30-day survival and 45.8% overall survival to discharge, was found. Age and vasoactive-inotropic score were independent predictors of mortality. CONCLUSIONS: A multidisciplinary team-care based MCS program in CS patients is feasible and may achieve favourable results in a centre without HT program.

[Novelties in the paediatric cardiopulmonary resuscitation recommendations and lines of development in Spain]. / Novedades en las recomendaciones de reanimación cardiopulmonar pediátrica y líneas de desarrollo en España.

OBJECTIVES: To analyse the 2020 international and European recommendations for paediatric cardiopulmonary resuscitation (CPR), highlight the most important changes and propose lines of development in Spain. METHODS: Critical analysis of the paediatric cardiopulmonary resuscitation recommendations of the European Resuscitation Council. RESULTS: The most relevant changes in the CPR recommendations for 2020 are in basic CPR the possibility of activating the emergency system after performing the five rescue ventilations with the mobile phone on loudspeaker, and in advanced CPR, bag ventilation between two rescuers if possible, the administration of epinephrine as soon as a vascular access is obtained, the increase in the respiratory rate in intubated children between 10 and 25bpm according to their age and the importance of controlling the quality and coordination of CPR. In CPR training, the importance of training non-technical skills such as teamwork, leadership and communication and frequent training to reinforce and maintain competencies is highlighted. CONCLUSIONS: It is essential that training in paediatric CPR in Spain follows the same recommendations and is carried out with a common methodology, adapted to the characteristics of health care and the needs of the students. The Spanish Paediatric and Neonatal Cardiopulmonary Resuscitation Group should coordinate this process, but the active participation of all paediatricians and health professionals who care for children is also essential.

Novelties in the pediatric cardiopulmonary resuscitation recommendations and lines of development in Spain.

OBJECTIVES: To analyse the 2020 international and European recommendations for Paediatric cardiopulmonary resuscitation (CPR), highlighting the most important changes and propose lines of development in Spain. METHODS: Critical analysis of the paediatric cardiopulmonary resuscitation recommendations of the European Resuscitation Council. RESULTS: The most relevant changes in the CPR recommendations for 2020 are in basic CPR the possibility of activating the emergency system after performing the five rescue ventilations with the mobile phone on loudspeaker, and in advanced CPR, bag ventilation between two rescuers if possible, the administration of epinephrine as soon as a vascular access is obtained, the increase in the respiratory rate in intubated children between 10 and 25 bpm according to their age and the importance of controlling the quality and coordination of CPR. In CPR training, the importance of training non-technical skills such as teamwork, leadership and communication and frequent training to reinforce and maintain competencies is highlighted. CONCLUSIONS: It is essential that training in Paediatric CPR in Spain follows the same recommendations and is carried out with a common methodology, adapted to the characteristics of health care and the needs of the students. The Spanish Paediatric and Neonatal Cardiopulmonary Resuscitation Group should coordinate this process, but the active participation of all paediatricians and health professionals who care for children is also essential.

Management of temperature control in post-cardiac arrest care: an expert report. / Manejo con control de temperatura en los cuidados posparada cardiaca: documento de expertos.

Targeted temperature management (TTM) through induced hypothermia (between 32-36 oC) is currently regarded as a first-line treatment during the management of post-cardiac arrest patients admitted to the Intensive Care Unit (ICU). The aim of TTM is to afford neuroprotection and reduce secondary neurological damage caused by anoxia. Despite the large body of evidence on its benefits, the TTM is still little used in Spain. There are controversial issues referred to its implementation, such as the optimal target body temperature, timing, duration and the rewarming process. The present study reviews the best available scientific evidence and the current recommendations contained in the international guidelines. In addition, the study focuses on the practical implementation of TTM in post-cardiac arrest patients in general and cardiological ICUs, with a discussion of the implementation strategies, protocols, management of complications and assessment of the neurological prognosis.

Analysis of bupivacaine and ropivacaine-related cardiac arrests in regional anesthesia: A systematic review of case reports.

Regional anesthesia as a component of multimodal analgesia protocols has become more and more a part of modern perioperative pain management. The widespread adoption of ultrasound guidance in regional anesthesia has surely played an important role in that growth and it has significantly improved patient safety, decreased the incidence of block failure, cardiac arrest, and reduced complication rates. The objective of this systematic review is to extract, analyze, and synthesize clinical information about bupivacaine and ropivacaine related cardiac arrest that we might have a clearer picture of the clinical presentation. The literature search identified 268 potentially relevant publications and 22 relevant case reports were included in the review. Patients' demographics, types of regional anesthesia, hypotension, heart rhythm disorders, seizures, cardiac arrest, fatal outcome, recommendations and limitations on prevention and treatment of bupivacaine and ropivacaine related cardiac arrest are analyzed and discussed in the systematic review. Both bupivacaine and ropivacaine-induced local anesthetic toxicity can result in cardiac arrest. Lipid emulsion, telemetry, local anesthetic toxicity resuscitation training appears to be promising in improvement of survival but more research is needed. Improvement and encouragement of reporting the local anesthetic toxicity are warranted to improve the quality of information that can be analyzed in order to make more precise conclusion.

Regional variation in the incidence, general characteristics, and outcomes of prehospital cardiac arrest in Spain: the Out-of-Hospital Spanish Cardiac Arrest Registry. / Variabilidad regional en incidencia, características generales y resultados finales de la parada cardiaca extrahospitalaria en España: Registro OHSCAR.

OBJECTIVES: The incidence and outcomes of care for out-of-hospital cardiac arrest (OHCA) vary greatly from country to country. We aimed to study variation in the incidence, characteristics, and outcomes of care for OHCAs given by Spanish prehospital emergency services. MATERIAL AND METHODS: Descriptive retrospective analysis of data from the Out-of-Hospital Spanish Cardiac Arrest Registry (OHSCAR) from October 2013 to October 2014. Attempts by 19 Spanish emergency services to resuscitate patients were studied. All OHCA cases were reviewed to obtain the following data: incidence, patient and event characteristics, prior emergencies, resuscitation attempts, and the main treatments provided in the hospital. If a patient was admitted, we compared the neurologic status on hospital discharge. RESULTS: Statistically significant differences were detected between emergency services (P .0001) in the incidence of attempted resuscitation and all general characteristics except sex. Hospital treatments and outcomes also differed significantly: pulse had been restored on arrival of 30.5% of patients (range 21.3% to 56.1%, P .001), and 31.8% of admitted patients were discharged in cerebral performance categories 1 or 2 (range 17.2% to 58.3%, P .001). CONCLUSION: Differences in the incidence of resuscitation attempts, key variables, and survival at discharge from the hospital are present in OHCA cases attended by prehospital emergency services in different regions of Spain.

OBJETIVO: Existe gran variabilidad internacional en la incidencia y los resultados en la atención a la parada cardiaca extrahospitalaria (PCRE). El objetivo es conocer si existe variabilidad en la incidencia, características y resultados en supervivencia en la atención a la PCRE por los servicios extrahospitalarios de emergencias (SEM) de España. METODO: Análisis descriptivo, retrospectivo de los datos del registro OHSCAR correspondientes al periodo octubre 2013-octubre 2014, que incluye pacientes atendidos por 19 SEM de España con intento de reanimación. Se recogieron los casos atendidos y variables clave sobre la asistencia a una PCRE: incidencia, características del paciente, del evento, de la actuación previa a los equipos de emergencias (EE), de la reanimación realizada, y de los principales tratamientos hospitalarios. Se comparó la situación neurológica al alta hospitalaria de los casos con ingreso hospitalario. RESULTADOS: La incidencia de casos con intento de reanimación y todas las características generales, salvo la distribución por sexo, presentaron diferencias estadísticamente significativas entre los SEM participantes (p 0,001). Hubo diferencias significativas en los tratamientos hospitalarios recibidos y en los resultados finales, tanto en la proporción de pacientes que llegaron con pulso espontáneo al hospital, 30,5%, rango entre 21,3% y 56,1% (p 0,001), como en el porcentaje de altas hospitalaria con categoría 1 o 2 de la clasificación Cerebral Perfomance Categories (CPC), sobre el total de ingresados, 31,8%, rango entre 17,2% y 58,3% (p 0,001). CONCLUSIONES: Existe una importante variabilidad entre los SEM españoles en la incidencia de casos con intento de reanimación, en todas las variables clave y en la supervivencia al alta hospitalaria de la atención a la PCRE.

Standard basic life support training of the European Resuscitation Council versus blended training: a randomized trial of a new teaching method. / Estudio experimental aleatorizado de innovación docente que compara metodología mixta frente a presencial para la formación en soporte vital básico estándar del European Resuscitation Council.

OBJECTIVES: 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). MATERIAL AND 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. CONCLUSION: The blended training method led to better results on some skill items.

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. METODO: 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.

[Modification of immediate survival after in-hospital cardiac arrest during evenings and weekends]. / Modificación de la supervivencia inmediata tras parada cardiorrespiratoria intrahospitalaria en horario de tarde-noche y fin de semana.

OBJECTIVE: To determine whether cardiac arrests occurring at night or during the weekend, carry lower immediate survival. METHOD: An analysis of logistic regression was performed, adjusted for age, sex, time to care of the cardiac arrest and first monitored rhythm, to determine whether there are differences in immediate survival. RESULTS: The immediate survival of the cohort studied (n=121) was 32 patients (26%). A difference of 13% in immediate survival between both periods studied was found. The logistic regression analysis taking immediate survival as an effect, showed that suffering an in-hospital cardiac arrest during evenings or weekends was a variable that is not associated with a successful outcome. The OR: .48 (95% CI: .20-1.12; P=.08). CONCLUSIONS: Patients who suffer a cardiac arrest in our centre during evenings or weekends are more vulnerable.

Neurological outcome and modifiable events after out-of-hospital cardiac arrest in patients managed in a tertiary cardiac centre: A ten years register.

OBJECTIVE: A study was made of the events occurring in the early post-resuscitation phase that may help to improve the outcomes at hospital discharge. DESIGN: A retrospective cohort study (2007-2017) of a prospective Utstein type registry database was carried using multivariate logistic regression analysis. Pre- and post-hospital admission events were investigated. SETTING: A tertiary cardiac centre. PARTICIPANTS: Unconscious victims of out-of-hospital cardiac arrest (OHCA) with documented ventricular tachycardia or fibrillation. MAIN VARIABLES OF INTEREST: Events occurring before and within 72h after intensive care unit (ICU) admission were recorded. The variables were analyzed to determine their impact on hospital survival and poor neurological outcome. One-year follow-up survival was also considered. Results are presented as odds ratio (OR) and 95% confidence interval (95%CI). RESULTS: Of 245 patients admitted to our ICU after OHCA, 152 (62%) were alive and 131 (86.2%) presented good neurological outcomes (cerebral performance categories≤2) at hospital discharge. The one-year follow-up survival rate was 95.9%. Age >70 years (OR 2.0; 95%CI 1.1-4.1), previous myocardial infarction (OR 2.7; 95%CI 1.2-6.1), shock upon hospital admission (OR 2.9; 95%CI 1.3-6.2), time from call to return of spontaneous circulation (ROSC) >25min (OR 3.1; 95%CI 1.6-6.0) and anticonvulsant therapy (OR 18.2; 95%CI 5.5-60) were independent predictors of poor neurological outcome. Immediate admission to the cardiac centre (OR 0.5; 95%CI 0.3-0.9) and lactate clearance reaching plasma levels <2.5mmol/l at 12h (OR 0.4; 95%CI 0.2-0.8) were associated with better outcomes. CONCLUSIONS: Unconscious OHCA patients with documented ventricular tachycardia or fibrillation may benefit from direct admission to a reference cardiac centre. Initial haemodynamic support, urgent coronary angiography and targeted management in the cardiac ICU seem to increase the likelihood of good neurological outcomes.

Training adult laypeople in basic life support. A systematic review.

INTRODUCTION AND OBJECTIVES: Bystander assistance is decisive to enhance the outcomes of out-of-hospital cardiac arrest. Despite an increasing number of basic life support (BLS) training methods, the most effective formula remains undefined. To identify a gold standard, we performed a systematic review describing reported BLS training methods for laypeople and analyzed their effectiveness. METHODS: We reviewed the MEDLINE database from January 2006 to July 2018 using predefined inclusion and exclusion criteria, considering all studies training adult laypeople in BLS and performing practical skill assessment. Two reviewers independently extracted data and evaluated the quality of the studies using the MERSQI (Medical Education Research Study Quality Instrument) scale. RESULTS: Of the 1263 studies identified, 27 were included. Most of them were nonrandomized controlled trials and the mean quality score was 13 out of 18, with substantial agreement between reviewers. The wide heterogeneity of contents, methods and assessment tools precluded pooling of data. Nevertheless, there was an apparent advantage of instructor-led methods, with feedback-supported hands-on practice, and retraining seemed to enhance retention. Training also improved attitudinal aspects. CONCLUSIONS: While there were insufficiently consistent data to establish a gold standard, instructor-led formulas, hands-on training with feedback devices and frequent retraining seemed to yield better results. Further research on adult BLS training may need to seek standardized quality criteria and validated evaluation instruments to ensure consistency.

Neuron-specific enolase kinetics: an additional tool for neurological prognostication after cardiac arrest.

INTRODUCTION AND OBJECTIVES: To analyze neuron-specific enolase (NSE) kinetics as a prognostic biomarker of neurological outcome in cardiac arrest survivors treated with targeted temperature management. METHODS: We performed a retrospective analysis of patients resuscitated from in- or out-of-hospital cardiac arrest admitted from September 2006 to May 2018 in a single tertiary care center and cooled to 32°C to 34°C for 24 hours. Blood samples for measurement of NSE values were drawn at hospital admission and at 24, 48, and 72hours after return of spontaneous circulation (ROSC). Neurological outcome was evaluated by means of the Cerebral Performance Category (CPC) score at 3 months and was characterized as good (CPC 1-2) or poor (CPC 3-5). RESULTS: Of 451 patients, 320 fulfilled the inclusion criteria and were analyzed (80.3% male, mean age 61±14.1 years). Among these, 174 patients (54.4%) survived with good neurological status. Poor outcome patients had higher median NSE values at hospital admission and at 24, 48 and 72 hours after ROSC. At 48 and 72 hours after ROSC, NSE predicted poor neurological outcome with areas under the receiver-operating characteristic curves of 0.85 (95%CI, 0.81-0.90) and 0.88 (95%CI, 0.83-0.93), respectively. In addition, delta NSE values between 72hours after ROSC and hospital admission predicted poor neurological outcome with an area under the receiver-operating characteristic curve of 0.90 (95%CI, 0.85-0.95) and was an independent predictor of unfavorable outcome on multivariate analysis (P <.001). CONCLUSIONS: In cardiac arrest survivors treated with targeted temperature management, delta NSE values between 72 hours after ROSC and hospital admission strongly predicted poor neurological outcome.

[Epidemiology of perioperative cardiac arrest and mortality in Brazil: a systematic review]. / Epidemiologia de parada cardíaca e de mortalidade perioperatória no Brasil: revisão sistemática.

BACKGROUND AND OBJECTIVES: The perioperative cardiac arrest (CA) and mortality rates in Brazil, a developing country, are higher than in developed countries. The hypothesis of this review was that knowledge of the epidemiology of perioperative CA and mortality in Brazil enables the comparison with developed countries. The systematic review aimed to verify, in studies conducted in Brazil, the epidemiology of perioperative CA and mortality. METHOD AND RESULTS: A search strategy was carried out on different databases (PubMed, EMBASE, SciELO and LILACS) to identify observational studies that reported perioperative CA and/or mortality up to 48 hours postoperatively in Brazil. The primary outcomes were data on epidemiology of perioperative CA and mortality. In 8 Brazilian studies, there was a higher occurrence of perioperative CA and mortality in males; in extremes of age; in patients in worse physical status according to the American Society of Anesthesiologists (ASA); in emergency surgeries; in general anesthesia; and in cardiac, thoracic, vascular, abdominal and neurological surgeries. The patient's disease/condition was the main triggering factor, with sepsis and trauma as the main causes. CONCLUSIONS: The epidemiology of both perioperative CA and mortality events reported in Brazilian studies does not show important differences and, in general, is similar to studies in developed countries. However, sepsis represents one of the major causes of perioperative CA and mortality in Brazilian studies, contrasting with studies in developed countries in which sepsis is a secondary cause.

Choice of access site and type of anticoagulant in acute coronary syndromes with advanced Killip class or out-of-hospital cardiac arrest.

INTRODUCTION AND OBJECTIVES: Patients who are vulnerable to hemodynamic or electrical disorders (VP) are often excluded from clinical trials and data on the optimal access-site or antithrombotic treatment are limited. We assessed outcomes of transradial vs transfemoral access and bivalirudin vs unfractionated heparin (UFH) in VP with acute coronary syndrome undergoing invasive management. METHODS: The MATRIX trial randomized 8404 patients to radial or femoral access and 7213 patients to bivalirudin or UFH. Among them, 934 (11.1%) were deemed VP due to advanced Killip class (n = 808), cardiac arrest (n = 168), or both (n = 42). The 30-day coprimary outcomes were major adverse cardiovascular and cerebrovascular events (MACE: death, myocardial infarction, or stroke) and net adverse clinical events (NACE: MACE or major bleeding). RESULTS: MACE and NACE were similarly reduced with radial vs femoral access in VP and non-VP. Transradial access was also associated with consistent relative benefits in all-cause and cardiovascular mortality or Bleeding Academic Research Consortium (BARC) 3 or 5 bleeding with greater absolute benefits in VP. The effects of bivalirudin vs UFH on MACE and NACE were consistent in VP and non-VP. Bivalirudin was associated with lower all-cause and cardiovascular mortality in VP but not in non-VP, with borderline interaction testing. Bivalirudin reduced bleeding in both VP and non-VP with a larger absolute benefit in VP. CONCLUSIONS: In acute coronary syndrome patients undergoing invasive management, the effects of randomized treatments were consistent in VP and non-VP, but absolute risk reduction with radial access and bivalirudin were greater in VP, with a 5- to 10-fold lower number needed to treat for benefits. Trial registry number: NCT01433627.