Cardiac arrests of hospital staff and visitors: Experience from the national registry of cardiopulmonary resuscitation

Emergency Medical Response for Non-Hospitalized Person Events in a Children's Hospital

OBJECTIVES

Hospital-based code blue (CB) teams are designed for hospitalized patients (HP) with unanticipated medical emergencies outside of an ICU. At our freestanding pediatric institution, the same team responds to CB calls involving nonhospitalized persons (NHP) throughout the hospital campus. We hypothesized there are significant differences between the characteristics of NHP and HP requiring emergency medical response, and most responses for NHP do not require advanced critical care.

METHODS

We analyzed a retrospective cohort of CB responses at our large, urban, academic children's medical center from January to December 2017. We evaluated the demographic and clinical characteristics of these HP compared with NHP events.

RESULTS

There were 168 CB activations during the study, of which 135 (80.4%) were for NHP. Ninety-one (67.4%) of the NHP responses involved adults (age >18 years) compared with 6 (18.2%) of the HP. Triggers for CB team activation for NHP were most frequently syncope (42.2%), seizure (10.3%), or fall (9.6%) compared with seizure (30.3%), hypoxia (27.3%), or anaphylaxis (12.1%) for HP. Critical interventions such as bag-mask ventilation and cardiopulmonary resuscitation were infrequently performed for either cohort.

CONCLUSIONS

CB activations in our pediatric institution more often involve NHP than HP. NHP responses are more likely to involve adults and infrequently require advanced interventions. Use of a pediatric CB team for NHP events may be an unnecessary use of pediatric critical care resources. Future studies are warranted to evaluate the most effective team composition, training, and response system for NHP in a freestanding children's hospital.

Cardiopulmonary resuscitation during the COVID-19 pandemic in Spain

OBJECTIVES

The disease COVID-19 produces serious complications that can lead to cardiorespiratory arrest. Quality cardiopulmonary resuscitation (CPR) can improve patient prognosis. The objective of this study is to evaluate the performance of the specialty of Anesthesiology in the management of CPR during the pandemic.

METHODS

A survey was carried out with Google Forms consisting of 19 questions. The access link to the questionnaire was sent by email by the Spanish Society of Anesthesia (SEDAR) to all its members.

RESULTS

225 responses were obtained. The regions with the highest participation were: Madrid, Catalonia, Valencia and Andalusia. 68.6%% of the participants work in public hospitals. 32% of the participants habitually work in intensive care units (ICU), however, 62.1% have attended critical COVID-19 in the ICU and 72.6% have anesthetized them in the operating room. 26,3% have attended some cardiac arrest, 16,8% of the participants admitted to lead the manoeuvres, 16,8% detailed that it had been another department, and 66,2% was part of the team, but did not lead the assistance. Most of the CPR was performed in supine, only 5% was done in prone position. 54.6% of participants had not taken any course of Advance Life Support (ALS) in the last 2 years. 97.7% of respondents think that Anesthesia should lead the in-hospital CPR.

CONCLUSION

The specialty of Anesthesiology has actively participated in the care of the critically ill patient and in the management of CPR during the COVID-19 pandemic. However, training and/or updating in ALS is required.

Cardiopulmonary resuscitation during the COVID-19 pandemic in Spain

Objetivos

La enfermedad por COVID-19 produce graves complicaciones que pueden derivar en parada cardiorrespiratoria (PCR). Una resucitación cardiopulmonar (RCP) de calidad puede mejorar el pronóstico de los pacientes. El objetivo de este estudio fue evaluar el desempeño de la especialidad de Anestesiología y Reanimación en el manejo de la RCP durante la pandemia en España.

Métodos

Se realizó una encuesta con Google Forms que constaba de 19 preguntas. El link de acceso al cuestionario fue enviado vía correo electrónico por la Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor (SEDAR) a todos sus miembros.

Resultados

Se obtuvieron 225 respuestas. Las provincias con mayor participación fueron: Madrid, Cataluña, Valencia y Andalucía. El 68,6%% de los participantes trabajan en la sanidad pública. Un 32% de los participantes se dedican habitualmente a los cuidados intensivos; sin embargo, el 62,1% ha atendido a enfermos de COVID-19 en cuidados críticos y un 72,6% los ha anestesiado en el quirófano. El 26,3% ha atendido alguna PCR, el 16,8% lideró las maniobras, el 16,8% presenció la PCR pero no participó en la RCP, y el 66,2% formó parte del equipo, pero no lideró la asistencia. La mayoría de las RCP se realizaron en supino, sólo el 5% fueron ejecutadas en prono. El 54,6% de los participantes no habían realizado ningún curso de soporte vital avanzado (SVA) en los últimos dos años. El 97,7% de los participantes opinan que Anestesia debe liderar la RCP intrahospitalaria.

Conclusión

La especialidad de Anestesiología y Reanimación ha participado activamente en la atención del paciente crítico y en el manejo de la RCP durante la pandemia por COVID-19. Sin embargo, resulta necesaria la formación y/o actualización en SVA.