Outcomes after Clinical and Traumatic Out-of-Hospital Cardiac Arrest

BACKGROUND

Data on out-of-hospital cardiac arrest are still scarce, very varied, and indicate a poor prognosis for traumatic events.

OBJECTIVES

To describe the out-of-hospital/in-hospital survival, survival time, and neurological conditions of those treated by advanced life support units and submitted to cardiopulmonary resuscitation and compare the results of clinical and traumatic cardiac arrests.

METHODS

This is a cohort study carried out in three stages; in the first two, data were collected from the Mobile Emergency Care Service forms and medical records; then, the Brain Performance Category Scale was applied in the third stage. The sample consisted of resuscitated victims aged ≥18 years. Fisher's and log-rank tests were used to compare the causes, considering a significance level of 5%.

RESULTS

852 patients were analyzed; 20.66% were hospitalized, 4.23% survived until transfer or discharge, and 58.33% had a favorable outcome one year after arrest. There was an association between pre/in-hospital survival and the nature of the occurrence (p=0.026), but there was no difference between the survival curves (p=0.6).

CONCLUSIONS

Survival of hospitalization after out-of-hospital cardiac arrest was low; however, most who survived to be discharged achieved a favorable outcome after one year. The survival time of those hospitalized after clinical and traumatic events were similar, but pre-hospital survival was higher among trauma patients.

Model to estimate the nursing workload required by trauma victims on intensive care unit discharge

AIM

To validate a model to estimate the nursing workload required by trauma victims on intensive care unit (ICU) discharge.

BACKGROUND

Identifying a reliable model of nursing workload measurement that can assist professionals.

METHODS

A prospective cohort study conducted in 2010 (first phase) and 2015 (second phase) with 342 trauma victims admitted into the ICU of four hospitals located in São Paulo, Brazil. The original model was created during the first phase and included the Simplified Acute Physiology Score and New Injury Severity Score variables. Coefficients of determination (R² ) were calculated to identify the reliability.

RESULTS

The original model presented high reliability (R²  = 44%) in the hospital of origin, and unsatisfactory performance (R²  < 4%) in the other institutions. An improvement in R² was observed after adjusting the coefficients for each hospital.

CONCLUSION

For the Nursing Activities Score prediction of survivors for ICU discharge, trauma centres must validate the original model with coefficient adjustments for their population, or preferably derive their own models.

IMPLICATIONS FOR NURSING MANAGEMENT

Although models are useful in predicting discharge of these ICU patients, for treatment continuity after critical care and for organising services, the study showed that they should be evaluated prior to use for nursing management.

Results after implementation of a protocol on the incidence of urinary tract infection in an intensive care unit

Objective:

to compare the results of urinary tract infection incidence, by means of the rate of indwelling urethral catheter use, and to identify microorganisms in urine cultures and surveillance cultures before and after the implementation of a clinical protocol for intensive care unit patients .

Method:

urinary tract infection is defined as a positive urine culture > 105 CFU/mL, notified by the hospital infection control service, six months before and after the implementation of the protocol. The sample consisted of 47 patients, 28 reported before and 19 after implementation. The protocol established in the institution is based on the Ministry of Health manual to prevent healthcare-related infections; the goal is patient safety and improving the quality of health services.

Results:

a negative linear correlation was observed between the later months of implementation and the reduction of reported cases of urinary tract infection, using the Spearman rank order coefficient (p = 0.045), and a reduction in the number of urine culture microorganisms (p = 0.026) using the Fisher exact test.

Conclusion:

educational interventions with implementation protocols in health institutions favor the standardization of maintenance of the invasive devices, which may reduce colonization and subsequent infections.

Sobrevivência a parada cardiorrespiratória intra-hospitalar: revisão integrativa da literatura

Muitas são as vidas perdidas por Parada Cardiorrespiratória (PCR) em ambiente intra-hospitalar, porém existem poucos estudos a respeito. O objetivo deste estudo foi identificar as evidências disponíveis na literatura sobre a sobrevivência a PCR intra-hospitalar. Revisão integrativa da literatura realizada a partir da questão norteadora: quais são as evidências científicas disponíveis na literatura relacionadas à sobrevivência a PCR intra-hospitalar? A partir dos descritores “Parada Cardíaca”, “Ressuscitação cardiopulmonar” e “Sobrevivência”. Os estudos selecionados foram sistematizados nas categorias: análise das taxas de sobrevivência; fatores relacionados com a sobrevivência e taxas de sobrevivência. Diante dos resultados observou-se poucas publicações sobre o tema, taxas variáveis de sobrevivência, estudos com delineamentos divergentes e ausência de estudos nacionais, destacando-se o uso de registros Utstein Style nas pesquisas. Pode-se concluir que a divulgação de diretrizes tem contribuído com melhoria da sobrevivência mundialmente, no cenário brasileiro ainda é preciso ampliar os registros sobre sua prática e resultados.