Resuscitation highlights in 2011

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.

Effectiveness of SAPS III to predict hospital mortality for post-cardiac arrest patients

PURPOSE

The mortality for patients admitted to intensive care unit (ICU) after cardiac arrest (CA) remains high despite advances in resuscitation and post-resuscitation care. The Simplified Acute Physiology Score (SAPS) III is the only score that can predict hospital mortality within an hour of admission to ICU. The objective was to evaluate the performance of SAPS III to predict mortality for post-CA patients.

METHODS

This retrospective single-center observational study included all patients admitted to ICU after CA between August 2010 and March 2013. The calibration (standardized mortality ratio [SMR]) and the discrimination of SAPS III (area under the curve [AUC] for receiver operating characteristic [ROC]) were measured. Univariate logistic regression tested the relationship between death and scores for SAPS III, SAPS II, Sequential Organ Failure Assessment (SOFA) Score and Out-of-Hospital Cardiac Arrests (OHCA) score. Independent factors associated with mortality were determined.

RESULTS

One-hundred twenty-four patients including 97 out-of-hospital CA were included. In-hospital mortality was 69%. The SAPS III was unable to predict mortality (SMRSAPS III: 1.26) and was less discriminating than other scores (AUCSAPSIII: 0.62 [0.51, 0.73] vs.

AUCSAPSII

0.75 [0.66, 0.84], AUCSOFA: 0.72 [0.63, 0.81], AUCOHCA: 0.84 [0.77, 0.91]). An early return of spontaneous circulation, early resuscitation care and initial ventricular arrhythmia were associated with a better prognosis.

CONCLUSIONS

The SAPS III did not predict mortality in patients admitted to ICU after CA. The amount of time before specialized CPR, the low-flow interval and the absence of an initial ventricular arrhythmia appeared to be independently associated with mortality and these factors should be used to predict mortality for these patients.