Out-of-hospital cardiac arrest: determinant factors for immediate survival after cardiopulmonary resuscitation

Clinical outcomes from out-of-hospital cardiac arrest in low-resource settings - A scoping review

AIM OF THE SCOPING REVIEW

Scientific recommendations on resuscitation are typically formulated from the perspective of an ideal resource environment, with little consideration of applicability in lower-income countries. We aimed to determine clinical outcomes from out-of-hospital cardiac arrest (OHCA) in low-resource countries, to identify shortcomings related to resuscitation in these areas and possible solutions, and to suggest future research priorities.

DATA SOURCES

This scoping review was part of the continuous evidence evaluation process of the International Liaison Committee on Resuscitation (ILCOR), and was performed following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. We identified low-resource countries as countries with a low- or middle gross national income per capita (World Bank data). We performed a literature search on outcomes after OHCA in these countries, and we extracted data on the outcome. We applied descriptive statistics and conducted a post-hoc correlation analysis of cohort size and ROSC rates.

RESULTS

We defined 24 eligible studies originating from middle-income countries, but none from low-income regions, suggesting a reporting bias. The number of reported patients in these studies ranged from 54 to 3214. Utstein-style reporting was rarely used. Return of spontaneous circulation varied from 0% to 62%. Fifteen studies reported on survival to hospital discharge (between 1.0 and 16.7%) or favourable neurological outcome (between 1.0 and 9.3%). An inverse correlation was found for study cohort size and the rate of return of spontaneous circulation (ρ = -0.48, p = 0.034).

CONCLUSION

Studies of OHCA outcomes in low-resource countries are heterogeneous and may be compromised by reporting bias. Minimum cardiopulmonary resuscitation standards for low-resource settings should be developed collaboratively involving local experts, respecting culture and context while balancing competing health priorities.

Education, Implementation, and Teams: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations

For this 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations, the Education, Implementation, and Teams Task Force applied the population, intervention, comparator, outcome, study design, time frame format and performed 15 systematic reviews, applying the Grading of Recommendations, Assessment, Development, and Evaluation guidance. Furthermore, 4 scoping reviews and 7 evidence updates assessed any new evidence to determine if a change in any existing treatment recommendation was required. The topics covered included training for the treatment of opioid overdose; basic life support, including automated external defibrillator training; measuring implementation and performance in communities, and cardiac arrest centers; advanced life support training, including team and leadership training and rapid response teams; measuring cardiopulmonary resuscitation performance, feedback devices, and debriefing; and the use of social media to improve cardiopulmonary resuscitation application.

Education, Implementation, and Teams: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations

For this 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations, the Education, Implementation, and Teams Task Force applied the population, intervention, comparator, outcome, study design, time frame format and performed 15 systematic reviews, applying the Grading of Recommendations, Assessment, Development, and Evaluation guidance. Furthermore, 4 scoping reviews and 7 evidence updates assessed any new evidence to determine if a change in any existing treatment recommendation was required. The topics covered included training for the treatment of opioid overdose; basic life support, including automated external defibrillator training; measuring implementation and performance in communities, and cardiac arrest centers; advanced life support training, including team and leadership training and rapid response teams; measuring cardiopulmonary resuscitation performance, feedback devices, and debriefing; and the use of social media to improve cardiopulmonary resuscitation application.

Incremento del conocimiento en soporte vital básico facilitado por un recurso educativo digital

Introducción: La enfermedad cardiovascular es responsable de 17.3 millones de muertes por año en el mundo y conlleva a complicaciones como el paro cardiorrespiratorio, el cual se puede presentar tanto en el escenario intra como extrahospitalario. Tener una comunidad capacitada posibilita la sobrevida y/o mitigación de secuelas. Con el propósito de aumentar la población capacitada en soporte vital básico, favorecer el aprendizaje y dedicar más tiempo al desarrollo de habilidades prácticas, se construyó un recurso educativo digital. Objetivo: Determinar el efecto de un recurso educativo digital en el proceso de aprendizaje de soporte vital básico en integrantes de la comunidad de una institución de educación superior. Métodos: Estudio cuantitativo, pre-experimental tipo pre-prueba/pos-prueba en un solo grupo. Resultados: El recurso educativo digital para el aprendizaje de soporte vital básico en 110 estudiantes incrementó el conocimiento, mostró una diferencia estadísticamente significativa en los resultados del post-test en comparación con el pre-test: p<0.01 para grupos ajustados al modelo gaussiano y p<0.05 para el grupo no ajustado. Discusión: Los resultados de implementar un recurso educativo digital para la enseñanza de soporte vital básico es consecuente con los beneficios hallados en otros estudios similares. Los Objetos Virtuales de Aprendizaje favorecen en los estudiantes la motivación, el aprendizaje autorregulado y la apropiación de conocimientos, por lo que los proponen como estrategia de aprendizaje. Conclusión: El recurso educativo digital favoreció el aprendizaje e incrementó el conocimiento, requisito necesario en la formación como primer respondiente en los tres grupos de estudiantes de pregrado que participaron en el presente estudio.

An audit of in-hospital cardiopulmonary resuscitation in a teaching hospital in Saudi Arabia: A retrospective study

OBJECTIVES

Data reflecting cardiopulmonary resuscitation (CPR) efforts in Saudi Arabia are limited. In this study, we analyzed the characteristics, and estimated the outcome, of in-hospital CPR in a teaching hospital in Saudi Arabia over 4 years.

METHODS

A retrospective, observational study was conducted between January 2009 and December 2012 and included 4361 patients with sudden cardiopulmonary arrest. Resuscitation forms were reviewed. Demographic data, resuscitation characteristics, and survival outcomes were recorded.

RESULTS

The mean ± standard deviation age of arrested patient was 40 ± 31 years. The immediate survival rate was 64%, 43% at 24 h, and 30% at discharge. The death rate was 70%. Respiratory type of arrest, time and place of arrest, short duration of arrest, witnessed arrest, the use of epinephrine and atropine boluses, and shockable arrhythmias were associated with higher 24-h survival rates. A low survival rate was found among patients with cardiac types of arrest, and those with a longer duration of arrest, pulseless electrical activity, and asystole. Comorbidities were present in 3786 patients with cardiac arrest and contributed to a poor survival rate (P < 0.001).

CONCLUSIONS

The study confirms the findings of previously published studies in highly developed countries and provides some reflection on the practice of resuscitation in Saudi Arabia.

Avaliação de treinamento em suporte básico de vida para médicos e enfermeiros da atenção primária

Objetivo: Foram avaliados conhecimentos e habilidades sobre reanimação cardiopulmonar antes e após a capacitação em Suporte Básico de Vida (SBV) para médicos e enfermeiros que atuam na atenção primária. Métodos: Estudo quasi-experimental, com amostra aleatória de profissionais. Inicialmente, avaliou-se o desempenho cognitivo em um teste de múltipla escolha sobre o atendimento a uma parada cardiorrespiratória (PCR) e, em seguida, conduziu-se um atendimento simulado de PCR, para a avaliação de habilidades, usando um checklist baseado nas recomendações da American Heart Association (AHA). Após avaliação inicial, todos os profissionais participaram de curso teórico-prático em SBV, durante três encontros. Após o curso, todos se submeteram a nova avaliação. Resultados: Participaram do estudo 32 profissionais. O nível de conhecimentos e habilidades foi insatisfatório antes do curso. Após a capacitação, a média de acertos na avaliação teórico-prática apresentou aumento significativo (p<0,001). Conclusão: Registrou-se impacto positivo da capacitação em SBV para os profissionais da atenção primária.