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Felipe VS, Salinas Sanz JA, Barrios Miras E, Del Río Pastoriza I, Noriega Echevarría I, Alijas Merillas MJ, Moreno Madrid F, Peláez Cantero MJ, García Iñiguez JP, Riaño Galán I. Accompaniment of minors during health care procedures. An Pediatr (Barc) 2023; 99:321-328. [PMID: 37977964 DOI: 10.1016/j.anpede.2023.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 09/08/2023] [Indexed: 11/19/2023] Open
Abstract
In clinical practice, it is not rare to encounter situations in which parents and families are asked to leave the child alone with the health care team in rooms full of devices throughout the performance of procedures, which at times may give rise not only to conflicts but, more importantly, emotional sequelae in children or adolescents. We conducted a narrative review of the literature by searching the digital library of the public health care system of Andalusia for articles concerning the experiences of health care professionals and families with the accompaniment of paediatric patients during health care procedures. We restricted the search to studies published in Spanish or English and conducted in humans. The review evinced the need to humanise care in order to improve care quality. The need to accompany minors is supported by the evidence from works that have analysed the factors involved in the persistence of these behaviours and attitudes in both professionals and parents. We consider it necessary to develop institutional policies and appoint mediators to compile the statements of different national and international societies, taking into account legal aspects but, above all, the pertinent values from a health care ethics perspective, and in pursuit of the best interests of the child.
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Affiliation(s)
- Verjano Sánchez Felipe
- Área integrada de Pediatría y Neonatología, Hospital Universitario Costa del Sol, Marbella, Spain.
| | | | | | | | - Iñigo Noriega Echevarría
- Hospital Universitario del Niño Jesús, Madrid, Spain; Universidad Internacional de La Rioja, La Rioja, Spain
| | | | | | | | | | - Isolina Riaño Galán
- Área Gestión Clínica Pediatría, Hospital Universitario Central, Asturias, Spain
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Santa Cruz Hernando AS, Nieves-Alonso JM, Mjertan A, Gutiérrez Martínez D, Planas Roca A. In-hospital cardiac arrest: Incidence, prognostic factors and results. Rev Esp Anestesiol Reanim (Engl Ed) 2023; 70:373-380. [PMID: 36940853 DOI: 10.1016/j.redare.2022.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 06/28/2022] [Indexed: 03/23/2023]
Abstract
BACKGROUND AND AIMS In-hospital cardiac arrest (CA) is a clinical entity with high morbidity and mortality that occurs in up to 2% of hospitalized patients. It is a public health problem with important economic, social, and medical repercussions, and as such its incidence needs to be reviewed and improved. The aim of this study was to determine the incidence of in-hospital CA, return of spontaneous circulation (ROSC), and survival rates at Hospital de la Princesa, and to define the clinical and demographic characteristics of patients with in-hospital CA. PATIENTS AND METHODS Retrospective observational chart review of patients presenting in-hospital CA and treated by anaesthesiologists from the hospital's rapid intervention team. Data were collected over 1 year. RESULTS Forty four patients were included in the study, of which 22 (50%) were women. Mean age was 75.7 years (±15.78 years), and incidence of in-hospital CA was 2.88 per 100,000 hospital admissions. Twenty two patients (50%) achieved ROSC and 11 patients (25%) survived until discharge home. The most prevalent comorbidity was arterial hypertension (63.64%); 66.7% of cases were not witnessed, and only 15.9% presented a shockable rhythm. CONCLUSIONS These results are similar to those reported in other larger studies. We recommend introducing immediate intervention teams and devoting time to training hospital staff in in-hospital CA.
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Affiliation(s)
- Alvar Santa Santa Cruz Hernando
- Servicio de Anestesiología y Reanimación, Médico Adjunto Servicio de Anestesiología y Reanimación del Hospital Clínico San Carlos, Hospital Universitario de La Princesa, Madrid, Spain.
| | - Jesús Manuel Nieves-Alonso
- Servicio de Anestesiología y Reanimación, Médico Adjunto Servicio de Anestesiología y Reanimación del Hospital Universitario de La Princesa, Hospital Universitario de La Princesa, Madrid, Spain
| | - Amadea Mjertan
- Servicio de Anestesiología y Reanimación, Médico Adjunto Servicio de Anestesiología y Reanimación del Hospital Universitario de La Princesa, Hospital Universitario de La Princesa, Madrid, Spain
| | - Diego Gutiérrez Martínez
- Servicio de Anestesiología y Reanimación, Médico Adjunto Servicio de Anestesiología y Reanimación del Hospital Universitario Puerta de Hierro, Hospital Universitario de La Princesa, Madrid, Spain
| | - Antonio Planas Roca
- Servicio de Anestesiología y Reanimación, Jefe de Servicio de Anestesiología y Reanimación del Hospital Universitario de La Princesa, Hospital Universitario de La Princesa, Madrid, Spain
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Pedrazas-López D, de Pablo-Márquez B, Cunillera-Puértolas O, Almeda-Ortega J. RCParvulari training: A basic life support training methodology applied to 5-year-old students: Effectiveness in a cluster-randomized clinical trail. An Pediatr (Barc) 2023; 98:99-108. [PMID: 36740509 DOI: 10.1016/j.anpede.2023.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 05/04/2022] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Basic life support training in school age is a topical issue because, with adequate training, any person can help save a life. METHODS Cluster clinical trial with data collection through an ad hoc self-administered, semi-structured questionnaire. The target population encompassed the students aged 4-6 years enrolled in 49 educational centres. The centres were randomly allocated to the intervention or control group. The intervention group was trained with the RCParvulari® methodology, consisting of theoretical and practical training on the first link of the chain of survival. The control group only received theoretical training. We evaluated participants before and immediately after the intervention and between 3 and 12 months post intervention by means of the questionnaire. We assessed the acquisition and retention over time of the knowledge and skills covered in the training compared to previous trainings in both groups. RESULTS A total of 1327 schoolchildren (79% of the target population) participated. The level of knowledge acquired immediately after training and after 3-12 months compared to baseline was significantly better (P < .001) in the intervention group than in the control group, both in early recognition and contacting of emergency services (112) and in remembering the "mouth-nose-eyes" mnemonic. CONCLUSIONS The RCParvulari® methodology significantly contributed to an improved ability to recognize a possible medical emergency, start the chain of survival by alerting an adult and call the 112 emergency number in students in the last year of preschool education.
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Affiliation(s)
- David Pedrazas-López
- Centro de Atención Primaria Sant Andreu de la Barca, Dirección de Atención Primaria Costa de Ponent, Institut Català de la Salut, Sant Andreu de la Barca, Barcelona, Spain
| | | | - Oriol Cunillera-Puértolas
- Unidad de Apoyo a la Investigación de Costa de Ponent, Fundació Institut Universitari per a la Investigació en Atenció Primària Jordi Gol (IDIAPJGol), Cornellà de Llobregat, Barcelona, Spain; Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain
| | - Jesús Almeda-Ortega
- Unidad de Apoyo a la Investigación de Costa de Ponent, Fundació Institut Universitari per a la Investigació en Atenció Primària Jordi Gol (IDIAPJGol), Cornellà de Llobregat, Barcelona, Spain; Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain
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Ortiz-Movilla R, Funes-Moñux RM, Domingo-Comeche LD, Beato-Merino M, Martínez-Bernat L, Royuela-Vicente A, Román-Riechmann E, Marín-Gabriel MÁ. Combined application of various quality assessment tools in neonatal resuscitation. An Pediatr (Barc) 2022; 97:405-14. [PMID: 36257893 DOI: 10.1016/j.anpede.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 06/27/2022] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION In neonatal resuscitation, it is important to know whether the use of a combination of quality assessment tools has an impact on the preparation of the resuscitation bed and equipment, the correct performance of the procedure and the clinical outcomes of the most vulnerable neonates. MATERIAL AND METHODS Multicentre, prospective, quasi-experimental interventional study in five level III-A neonatal units. In the pre- and post-intervention phases, both of which lasted 1 year, there were weekly random audits of the stabilization beds in the delivery room to assess their preparation. In the post-intervention phase, checklists, briefings and debriefings were used in the resuscitation of neonates delivered before 32 weeks. We compared the performance of the procedure and early post-resuscitation outcomes in the 2 periods. RESULTS Total of 852 audits were carried out in the pre-intervention period and 877 in the post-intervention period. There was a greater percentage of audits that did not identify defects in the second phase (63% vs 81%; P < .001). The first phase included 75 resuscitations and the second 48, out of which all the quality assessment tools had been used in 36 (75%). We did not find any differences in the main clinical variables during stabilization, although we observed a trend towards fewer technical problems during the procedure in the second period. CONCLUSIONS The use of random audits, checklists, briefings and debriefings in the resuscitation of newborns delivered before 32 weeks is feasible but has no impact on short-term clinical outcomes or correct performance of the procedure. Audits of neonatal resuscitation beds significantly improved their preparation.
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Ballesteros-Peña S, Vallejo-de la Hoz G, Fernández-Aedo I, Etayo-Sancho A, Berasaluze-Sanz L, Domínguez-García J. Rescuers' characteristics associated with the correct chest compression during cardiopulmonary resuscitation. Enferm Intensiva (Engl Ed) 2022; 33:126-131. [PMID: 35934626 DOI: 10.1016/j.enfie.2021.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 05/10/2021] [Indexed: 06/15/2023]
Abstract
AIM To analyse the caregivers' physical, anthropometrical and educational characteristics associated with adequate chest compression and full chest recoil during cardiopulmonary resuscitation (CPR). METHODS An observational prospective research study was conducted. Emergency and critical care health professionals and students performed two minutes of chest compressions on a dummy. Depth and residual leaning after the compressions were assessed and their association with several variables (physical, anthropometrical, and educational) was analysed using logistic regression models. RESULTS Two hundred thirty-eight volunteers participated. Previous experience of the rescuer in less than six CPRs (OR = 3.03; 95% CI 1.2-7.63) was related to a higher probability of not achieving an adequate depth of compressions. Greater height (OR: .93; 95% CI .87-.99) and grip strength (OR: .94; 95% CI .89-.99) were associated with correct performance of chest compression. We did not find any characteristic related to chest recoil. CONCLUSIONS The caregiver's previous experience with CPR was the strongest factor associated with adequate performance of chest compressions. To a lesser extent, the professional's height and upper body muscle strength also have an influence. No factors associated with the adequacy of full chest recoil were identified.
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Affiliation(s)
- S Ballesteros-Peña
- Osakidetza, Organización Sanitaria Integrada Bilbao-Basurto, Bilbao, Vizcaya, Spain.
| | - G Vallejo-de la Hoz
- Biocruces Bizkaia Health Research Institute, Barakaldo, Vizcaya, Spain; Universidad del País Vasco/Euskal Herriko Unibertsitatea (UPV/EHU), Leioa, Vizcaya, Spain; Osakidetza, Organización Sanitaria Integrada Barrualde-Galdakao, Galdakao, Vizcaya, Spain
| | - I Fernández-Aedo
- Biocruces Bizkaia Health Research Institute, Barakaldo, Vizcaya, Spain; Universidad del País Vasco/Euskal Herriko Unibertsitatea (UPV/EHU), Leioa, Vizcaya, Spain
| | - A Etayo-Sancho
- Red de Transporte Sanitario Urgente de Bizkaia, Urduliz, Vizcaya, Spain
| | - L Berasaluze-Sanz
- Biocruces Bizkaia Health Research Institute, Barakaldo, Vizcaya, Spain; Osakidetza, Organización Sanitaria Integrada Barrualde-Galdakao, Galdakao, Vizcaya, Spain
| | - J Domínguez-García
- Biocruces Bizkaia Health Research Institute, Barakaldo, Vizcaya, Spain; Osakidetza, Organización Sanitaria Integrada Ezkerraldea-Enkarterri-Cruces, Barakaldo, izcaya, Spain
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Rodríguez-Reyes H, Ortiz-Galván F, Ibarrola M, Celaya-Cota M, Dubner S, Asensio-Lafuente E, Ayala EN, Mendoza-Novoa P, Muñoz-Gutiérrez LMM, Sarquella-Brugada G, Mendoza I, Márquez MF. Treatment of adult, child and newborn cardiac arrest victims with COVID-19. Recommendations from the Interamerican Society of Cardiology / Sociedad Interamericana de Cardiología (SIAC), Mexican National Cardiologists Association / Asociación Nacional de Cardiólogos de México (ANCAM) and Mexican Society of Cardiology / Sociedad Mexicana de Cardiología (SMC). Arch Cardiol Mex 2021; 91:64-73. [PMID: 34968378 PMCID: PMC10161862 DOI: 10.24875/acm.20000243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
La pandemia de COVID-19 ha infligido grandes estragos a la población y en especial al personal de salud. Los esfuerzos de reanimación exigen modificaciones potenciales de las guías internacionales existentes de reanimación cardiopulmonar (RCP) debido al elevado índice de contagiosidad del virus SARS-CoV-2. Se considera que hasta 15% de los casos de COVID-19 tiene una enfermedad grave y 5% padece un trastorno crítico con una mortalidad promedio del 3%, la cual varía según sean el país y las características de los pacientes. La edad y las comorbilidades como la hipertensión arterial, enfermedad cardiovascular, obesidad y diabetes incrementan la mortalidad hasta 24%. También se ha informado un aumento reciente del número de casos de paro cardíaco extrahospitalario (PCEH). Aunque el paro cardíaco (PC) puede ser efecto de factores diversos en estos pacientes, en la mayoría de los casos se ha demostrado que el origen es respiratorio, con muy pocos casos de causa cardíaca. Se debe considerar la indicación de iniciar o continuar las maniobras de RCP por dos razones fundamentales: la posibilidad de sobrevida de las víctimas, que hasta la fecha se ha registrado muy baja, y el riesgo de contagiar al personal de salud, que es muy alto. The COVID-19 pandemic is having a large impact on the general population, but it has taken a specially high toll on healthcare personnel. Resuscitation efforts require potential modifications of the present Cardiopulmonary Resuscitation (CPR) international guidelines because of the transmissibility rate of the new SARS-CoV 2 virus. It has been seen that up to 15% of COVID-19 patients have a severe disease, 5% have a critical form of infection and the mean death rate is 3%, although there are significant differences according to the country that reports it and patients’ baseline conditions that include age, presence of arterial hypertension, cardiovascular disease, diabetes or obesity. In these high risk subjects, mortality might go up to 24%. There are also reports of a recent increase in out-of-hospital cardiopulmonary arrest (OHCA) victims. Cardiac arrest (CA) in these subjects might be related to many causes, but apparently, that phenomenon is related to respiratory diseases rather than cardiac issues. In this context, the decision to start or continue CPR maneuvers has to be carefully assessed, because of the low survival rate reported so far and the high contagion risk among healthcare personnel.
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Affiliation(s)
| | - Fernando Ortiz-Galván
- Centro Universitario del Sur, Universidad de Guadalajara, Ciudad Guzmán, Jalisco, México
| | - Martín Ibarrola
- Centro Cardiovascular BV. Bella Vista. Buenos Aires. Argentina
| | | | - Sergio Dubner
- Servicio de Electrofisiología y Arritmias, Sanatorio clínica y maternidad de los Arcos, Buenos Aires, Argentina
| | | | - Elaine Núñez Ayala
- Unidad de Electrofisiología, arritmias y marcapasos, Centro Cardiovascular, Cedimat. Santo Domingo. Rep. Dominicana
| | - Pablo Mendoza-Novoa
- Unidad de arritmias y estimulación cardiaca. Hospital Nacional Dos de Mayo, Lima Perú
| | | | - Georgia Sarquella-Brugada
- Unidad de Arritmias Pediátricas, Cardiopatías Familiares y muerte Súbita, Hospital Sant Joan de Déu, Barcelona, España
| | - Iván Mendoza
- Cardiología tropical, Universidad Central de Venezuela, Caracas, Venezuela
| | - Manlio F Márquez
- Investigación clínica, Instituto Nacional de Cardiología, Ignacio Chávez, ciudad de México, México
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Rojo E, Maestre JM, Piedra L, Esteban J, Sánchez B, Hoz V, Del Moral I. [Interprofessional team training with in situ simulation to improve the quality of cardiopulmonary resuscitation]. J Healthc Qual Res 2021; 37:92-99. [PMID: 34824042 DOI: 10.1016/j.jhqr.2021.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 09/19/2021] [Accepted: 10/04/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION In situ simulation facilitates training in clinical settings under similar emotional pressure that occurs in real life situations. The objective of the present study was to assess the feasibility, implementation, facilitators self-confidence and teaching challenges of a training program of cardiopulmonary resuscitation through an in situ simulation plan. METHOD A training program was designed for the facilitators. The number of professionals trained and in situ simulations performed were recorded, as well as the logistical challenges. An ad hoc survey was designed to assess facilitators self-confidence and educational challenge which were classified using the debriefing assessment for simulation in healthcare©. RESULTS During a period of 3 years, 95 trained facilitators implemented 378 in situ simulations that allowed to train 1281 nursing professionals working at inpatient units. Integration of in situ simulations with daily activities and availability of facilitators were the main logistical challenges. Stablishing and maintaining a stimulating learning environment and structuring the debriefing in an organized way were the main educational challenges. CONCLUSIONS In situ simulation helps to train the coordination of nursing teams taking care of patients in cardiorespiratory arrest and to identify the risks that may affect patient safety. Identifying the educational challenges during the implementation of in situ simulation facilitates the design of specific educational and monitoring strategies.
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Affiliation(s)
- Elena Rojo
- Hospital virtual Valdecilla, Santander, España; Hospital Universitario Valdecilla, Santander, España.
| | - Jose M Maestre
- Hospital virtual Valdecilla, Santander, España; Hospital Universitario Valdecilla, Santander, España
| | - Liébana Piedra
- Hospital virtual Valdecilla, Santander, España; Hospital Sierrallana/Tres Mares, Torrelavega, España
| | | | - Beatriz Sánchez
- Hospital virtual Valdecilla, Santander, España; Hospital de Laredo, Laredo, España
| | - Verónica Hoz
- Hospital virtual Valdecilla, Santander, España; Hospital Sierrallana/Tres Mares, Torrelavega, España
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Cereceda-Sánchez FJ, Clar-Terradas J, Moros-Albert R, Mascaró-Galmés A, Navarro-Miró M, Molina-Mula J. [I-Gel® laryngeal mask versus bag-valve-mask in instrumental cardiopulmonary resuscitation under capnographic monitoring: Cluster-randomized pilot clinical trial]. Aten Primaria 2021; 53:102062. [PMID: 34044355 PMCID: PMC8167161 DOI: 10.1016/j.aprim.2021.102062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 10/19/2020] [Accepted: 10/26/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To compare the basic airway and the advanced airway with the supraglottic device I-Gel®, by means of capnography during intermediate CPR. DESIGN Randomized experimental pilot study by groups. SETTING Out-hospital care basic life support units on the Island of Mallorca. PARTICIPANTS Adults attended after cardiorespiratory arrest of non-traumatic origin. INTERVENTIONS Advanced airway management during instrumental CPR with I-Gel® or basic CPR with bag-valve-mask, under capnographic monitoring. MAIN MEASUREMENTS Capnometric levels obtained according to the device used, number of insertions of the I-Gel®, cases without achieving correct insertion/ventilation by branches, achievement of ROSC in CPR and number of hospital live admissions. RESULTS Twenty-three cases were recruited for analysis. The insertion success rate of the I-Gel® was 92.9% at the first attempt, the mean capnometric values were 16.3mmHg in the control group and 27.4% in the intervention group. 34.8% (n=8) of the patients achieved spontaneous circulation recovery at some point and 26.1% (n=6) were admitted to hospital alive. The survival analysis, taking into account the arrival of the unit and the first minute of ventilations recorded together with the variable hospital admission, suggests a certain trend of greater survival in the intervention branch (P=.066). CONCLUSIONS The use of I-Gel® raises an improvement in the ventilation of the patients in PCR, evidenced by the mean capnometric values in the intervention group, finding no correlation with CPR outcome variables.
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Affiliation(s)
| | | | - Rut Moros-Albert
- Gerencia SAMU 061 Baleares, Palma de Mallorca, Islas Baleares, España
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Ballesteros-Peña S, Vallejo-de la Hoz G, Fernández-Aedo I, Etayo-Sancho A, Berasaluze-Sanz L, Domínguez-García J. Rescuers' characteristics associated with the correct chest compression during cardiopulmonary resuscitation. Enferm Intensiva (Engl Ed) 2021; 33:S1130-2399(21)00082-1. [PMID: 34419348 DOI: 10.1016/j.enfi.2021.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 05/05/2021] [Accepted: 05/10/2021] [Indexed: 11/26/2022]
Abstract
AIM To analyse the caregivers' physical, anthropometrical and educational characteristics associated with adequate chest compression and full chest recoil during cardiopulmonary resuscitation (CPR). METHODS An observational prospective research study was conducted. Emergency and critical care health professionals and students performed two minutes of chest compressions on a dummy. Depth and residual leaning after the compressions were assessed and their association with several variables (physical, anthropometrical, and educational) was analysed using logistic regression models. RESULTS Two hundred thirty-eight volunteers participated. Previous experience of the rescuer in less than six CPRs (OR: 3.03; CI 95%: 1.2-7.63) was related to a higher probability of not achieving an adequate depth of compressions. Greater height (OR: .93; 95% CI: .87-.99) and grip strength (OR: .94; 95% CI: .89-.99) were associated with correct performance of chest compression. We did not find any characteristic related to chest recoil. CONCLUSIONS The caregiver's previous experience with CPR was the strongest factor associated with adequate performance of chest compressions. To a lesser extent, the professional's height and upper body muscle strength also have an influence. No factors associated with the adequacy of full chest recoil were identified.
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Affiliation(s)
- S Ballesteros-Peña
- Osakidetza, Organización Sanitaria Integrada Bilbao-Basurto, Bilbao, Vizcaya, España; Biocruces Bizkaia Health Research Institute, Barakaldo, Vizcaya, España; Universidad del País Vasco/Euskal Herriko Unibertsitatea (UPV/EHU), Leioa, Vizcaya, España.
| | - G Vallejo-de la Hoz
- Biocruces Bizkaia Health Research Institute, Barakaldo, Vizcaya, España; Universidad del País Vasco/Euskal Herriko Unibertsitatea (UPV/EHU), Leioa, Vizcaya, España; Osakidetza, Organización Sanitaria Integrada Barrualde-Galdakao, Galdakao, Vizcaya, España
| | - I Fernández-Aedo
- Biocruces Bizkaia Health Research Institute, Barakaldo, Vizcaya, España; Universidad del País Vasco/Euskal Herriko Unibertsitatea (UPV/EHU), Leioa, Vizcaya, España
| | - A Etayo-Sancho
- Red de Transporte Sanitario Urgente de Bizkaia, Urduliz, Vizcaya, España
| | - L Berasaluze-Sanz
- Biocruces Bizkaia Health Research Institute, Barakaldo, Vizcaya, España; Osakidetza, Organización Sanitaria Integrada Barrualde-Galdakao, Galdakao, Vizcaya, España
| | - J Domínguez-García
- Biocruces Bizkaia Health Research Institute, Barakaldo, Vizcaya, España; Osakidetza, Organización Sanitaria Integrada Ezkerraldea-Enkarterri-Cruces, Barakaldo, Vizcaya, España
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López-Herce J, Manrique I, Calvo C, Rodríguez A, Carrillo Á, Sebastián V, Del Castillo J. [Novelties in the paediatric cardiopulmonary resuscitation recommendations and lines of development in Spain]. An Pediatr (Barc) 2021; 96:146-146. [PMID: 34148822 DOI: 10.1016/j.anpedi.2021.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 05/28/2021] [Indexed: 10/21/2022] Open
Abstract
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.
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Affiliation(s)
- Jesús López-Herce
- Servicio de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón de Madrid, Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid; Grupo Español de Reanimación Cardiopulmonar Pediátrica y Neonatal. Red de Salud Materno-Infantil (SAMID II). RETICS financiada por el PN I+D+i 2013-2016, ISCIII- Subdirección General de Evaluación y Fomento de la Investigación y el Fondo Europeo de Desarrollo Regional (FEDER) Ref: RD16/0022/0007. Grupo Español de Reanimación Cardiopulmonar Pediátrica y Neonatal.
| | - Ignacio Manrique
- Instituto Valenciano de Pediatría, Grupo Español de Reanimación Cardiopulmonar Pediátrica y Neonatal
| | - Custodio Calvo
- Grupo Español de Reanimación Cardiopulmonar Pediátrica y Neonatal
| | - Antonio Rodríguez
- Área de Pediatría, Servicio de Críticos, Intermedios y Urgencias Pediátricas, Hospital Clínico Universitario de Santiago de Compostela; Grupo de Investigación CLINURSID, Departamento de Enfermería, Universidad de Santiago de Compostela, Instituto de Investigación de Santiago (IDIS); Red de Salud Materno-Infantil (SAMID II). RETICS financiada por el PN I+D+i 2013-2016, ISCIII- Subdirección General de Evaluación y Fomento de la Investigación y el Fondo Europeo de Desarrollo Regional (FEDER) Ref: RD16/0022/0007; Grupo Español de Reanimación Cardiopulmonar Pediátrica y Neonatal
| | - Ángel Carrillo
- Grupo Español de Reanimación Cardiopulmonar Pediátrica y Neonatal
| | - Valero Sebastián
- Centro de Salud Fuente de San Luis, Valencia; Grupo Español de Reanimación Cardiopulmonar Pediátrica y Neonatal
| | - Jimena Del Castillo
- Servicio de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón de Madrid, Instituto de Investigación Sanitaria del Hospital Gregorio Marañón; Grupo Español de Reanimación Cardiopulmonar Pediátrica y Neonatal. Red de Salud Materno-Infantil (SAMID II). RETICS financiada por el PN I+D+i 2013-2016, ISCIII- Subdirección General de Evaluación y Fomento de la Investigación y el Fondo Europeo de Desarrollo Regional (FEDER) Ref: RD16/0022/0007. Grupo Español de Reanimación Cardiopulmonar Pediátrica y Neonatal
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Castillo García J, Sánchez Salado JC, Gual Santandreu M, Molina Mazón CS, Blasco Lucas A, Sbraga F, López Sánchez G. Discharge survival of patients undergoing ECMO therapy after ECPR in a third level hospital. Enferm Intensiva (Engl Ed) 2021; 32:73-78. [PMID: 34099267 DOI: 10.1016/j.enfie.2020.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 03/03/2020] [Indexed: 11/18/2022]
Abstract
GOAL The goal of this study was to assess the survival to hospital discharge in patients after the implementation of venoarterial-extracorporeal membrane oxygenation (VA-ECMO) during cardiopulmonary arrest (simultaneously or during the first six hours after the event) in a Spanish tertiary hospital. METHOD This is a descriptive and retrospective study conducted with patients subjected to VA-ECMO therapy during or after cardiopulmonary resuscitation (CPR) in the last 10 years. The variables were extracted from the electronic medical record of each patient. RESULTS 175 ECMO therapies were implemented, 84% (147) were VA-ECMO, and the indication for 17% (25) was CPR. In 40% (10), ECMO therapy was initiated simultaneously during CPR, and the rest (15) during the first six hours after the event. Survival rates reached 44%. CONCLUSIONS The use of CPR in well-selected patients can improve their survival.
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Affiliation(s)
- J Castillo García
- Enfermería, Perfusionista, Quirófano, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - J C Sánchez Salado
- Cardiología, Unidad Coronaria, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - M Gual Santandreu
- Cardiología, Unidad Coronaria, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - C S Molina Mazón
- Enfermería, Unidad Coronaria, Supervisión, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - A Blasco Lucas
- Cirugía Cardiaca, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - F Sbraga
- Cirugía Cardiaca, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - G López Sánchez
- Enfermería, Perfusionista, Quirófano, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
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Castillo García J, Sánchez Salado JC, Gual Santandreu M, Molina Mazón CS, Blasco Lucas A, Sbraga F, López Sánchez G. Discharge survival of patients undergoing ECMO therapy after ECPR in a third level hospital. Enferm Intensiva (Engl Ed) 2021; 32:73-8. [PMID: 33051151 DOI: 10.1016/j.enfi.2020.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 01/21/2020] [Accepted: 03/03/2020] [Indexed: 11/21/2022]
Abstract
GOAL The goal of this study was to assess the survival to hospital discharge in patients after the implementation of venoarterial-extracorporeal membrane oxygenation (VA-ECMO) during cardiopulmonary arrest (simultaneously or during the first six hours after the event) in a Spanish tertiary hospital. METHOD This is a descriptive and retrospective study conducted with patients subjected to VA-ECMO therapy during or after cardiopulmonary resuscitation (ECPR) in the last 10 years. The variables were extracted from the electronic medical record of each patient. RESULTS 175 ECMO therapies were implemented, 84% (147) were VA-ECMO, and the indication for 17% (25) was ECPR. In 40% (10), ECMO therapy was initiated simultaneously during CPR, and the rest (15) during the first six hours after the event. Survival rates reached 44%. CONCLUSIONS The use of CPR in well-selected patients can improve their survival.
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Otero-Agra M, Varela-Casal C, Castillo-Pereiro N, Casillas-Cabana M, San Román-Mata S, Barcala-Furelos R, Rodríguez-Núñez A. [Can we train the chain of survival while playing? Validation of the tool «Rescube»]. An Pediatr (Barc) 2021; 94:213-22. [PMID: 32919930 DOI: 10.1016/j.anpedi.2020.07.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/14/2020] [Accepted: 07/21/2020] [Indexed: 12/16/2022] Open
Abstract
PURPOSE To validate the content and adequacy of the «Rescube» training material that includes adapted information from the chain of survival. MATERIAL AND METHODS The study included three steps: (i)material development by 7 experts, following Delphi method; (ii)assessment of training material by 11 experts by means of a Likert score and calculation of content validity; and (iii)pilot study in two groups of 5 to 8years-old: Rescube group (GR; n=60) and Traditional group (GT; n=60). GR was trained with Rescube and a Teddy bear, while GT was traditionally trained with a pediatric manikin. Participants were individually assessed at baseline, and one week and one month after training. RESULTS All content validity indexes calculated are above the recommended cut-off for analysis with more than 9 experts (≥0,80). Children's learning results were positive, with percentages equal or higher than 80% in all registered variables at the first (one week) evaluation and equal or higher than 67% when evaluated one month after training. No significant differences were detected between groups. CONCLUSION The Rescube training tool based on infantile pictures is valid and useful to train young schoolchildren in the chain of survival.
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Ballesteros-Peña S, Fernández-Aedo I, de la Fuente-Sancho I. Regulations for using semiautomatic external defibrillators outside health care settings in Spain: a review and comparison of the current situation across autonomous communities. Emergencias 2020; 31:429-434. [PMID: 31777216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
We compared Spanish autonomous communities' regulations affecting the use of semiautomatic external defibrillators (semi-AEDs), including requirements for training and providing devices outside health care settings. We analyzed differences in the development of regulations across the different geographic areas. Regulations published in the official bulletins of Spain's 17 autonomous communities and 2 autonomous cities in effect in May 2019 were reviewed to extract directives affecting training, authorized use, and the provision of semi-AEDs outside health care centers. We found that both doctors and nurses are authorized to use the devices in most communities, with the exception of Murcia, where only doctors may use them. Fourteen communities also authorize emergency responders to operate semi-AEDs. Other individuals must call for emergency help before using one, and specific rules vary by community. In the Basque Country anyone may use them, but in other communities, only individuals who have taken a training course on how to use a semi-AED may. The duration of training programs varies from 4 to 9 hours in different parts of Spain, and retraining is required at intervals that vary from 1 to 3 years. However, in 11 communities any citizen may use a semi-AED in an emergency in which authorized persons are not present (after first calling for emergency responders). Eleven autonomous communities regulate the required provision of semi-AEDs outside health care centers. We conclude that although Spain's autonomous communities have regulations in place for the use of these devices, the regulatory map is highly diverse. Therefore, we think that harmonization is desirable in the interest of unifying criteria and encouraging the use of semi-AEDs when they are needed.
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Affiliation(s)
- Sendoa Ballesteros-Peña
- Organización Sanitaria Integrada de Bilbao-Basurto, Bilbao, España. Facultad de Medicina y Enfermería, Universidad del País Vasco/Euskal Herriko Unibertsitatea, Leioa, Bizkaia, España
| | - Irrintzi Fernández-Aedo
- Facultad de Medicina y Enfermería, Universidad del País Vasco/Euskal Herriko Unibertsitatea, Leioa, Bizkaia, España
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Calheiros J, Charco-Mora P. Effectiveness of different supralottic airways during resuscitation manoeuvres. A systematic review. Rev Esp Anestesiol Reanim (Engl Ed) 2020; 67:316-324. [PMID: 32143822 DOI: 10.1016/j.redar.2020.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 12/20/2019] [Accepted: 01/13/2020] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Supraglottic airways, which are easily inserted and minimize interruptions in cardiopulmonary resuscitation manoeuvres, are now widely used in pre- and in-hospital emergencies. However, most studies in these devices do not specify whether they ensure good ventilation during CPR. This systematic review aims to determine whether there is evidence that supraglotic airways enable effective ventilation during resuscitation. METHODS The MEDLINE and COCHRANE databases were searched for studies published in English up to 30 November 2018. Eligible studies were all those that objectively evaluated tidal volume during resuscitation maneuvers in patients over 18 years of age using various supraglottic airways. RESULTS A total of 3734 articles were identified, of which 252 were duplicates. Only 1 objectively evaluated ventilation during resuscitation maneuvers and presented data relevant to this review. The study included 470 patients, 51 of which underwent spirometry. Only 4.48% of patients survived to hospital discharge; however, the correlation with ventilation effectiveness was not assessed. CONCLUSION There is no scientific evidence that supraglottic airways provide effective ventilation during resuscitation maneuvers. Evaluation by spirometry, chest impedance and ultrasound may help to determine the ventilatory efficacy of supraglottic airways during CPR, and clarify whether this factor contributes to the difficulties experienced in reversing cardiorespiratory arrest.
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Affiliation(s)
- J Calheiros
- Departamento de Anestesia, Unidade Local de Saúde de Matosinhos, Hospital Pedro Hispano, Matosinhos, Portugal.
| | - P Charco-Mora
- Departamento de Anestesiología y Cuidados Intensivos, Hospital Clínico Universitario de Valencia, Valencia, España
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Abelairas-Gómez C, Tipton MJ, González-Salvado V, Bierens JJLM. Drowning: epidemiology, prevention, pathophysiology, resuscitation, and hospital treatment. Emergencias 2020; 31:270-280. [PMID: 31347808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
This narrative review discusses the evidence relevant to key aspects of drowning, which is defined by the World Health Organization as the process of respiratory difficulty caused by submersion/immersion in liquid. The length of time the victim is submerged is a key factor in survival and neurologic damage. Although respiratory distress and hypoxia are the main events, other complications affecting various systems and organs may develop. Drowning is one of the main causes of accidental death worldwide, yet deaths from drowning are underestimated and morbidity is unknown. Prevention is essential for reducing both mortality and morbidity, but if prevention fails, the speed of access to and the quality of prehospital and hospital care will determine the prognosis. It is therefore essential to understand the factors and mechanisms involved in these emergencies.
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Affiliation(s)
- Cristian Abelairas-Gómez
- Grupo de Investigación CLINURSID y Facultad de Ciencias de la Educación, Universidade de Santiago de Compostela, España. Instituto de Investigación Sanitaria (IDIS) de Santiago de Compostela, España
| | - Michael J Tipton
- Extreme Environments Laboratory, Department of Sport and Exercise Science, University of Portsmouth, Portsmouth, Reino Unido
| | - Violeta González-Salvado
- Instituto de Investigación Sanitaria (IDIS) de Santiago de Compostela, España. Servicio de Cardiología, Complejo Hospitalario Universitario de Santiago, CIBERCV, Universidade de Santiago de Compostela, Santiago de Compostela, España
| | - Joost JLM Bierens
- Research Group Emergency and Disaster Medicine, Vrije Universiteit Brussel, Bruselas, Bélgica
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Castillo García J, Cerdà Vila M, de Balanzó Fernández X, Quintana Riera S, Ferrés-Amat E, Rodríguez Higueras E. Standard basic life support training of the European Resuscitation Council versus blended training: a randomized trial of a new teaching method. Emergencias 2020; 32:45-48. [PMID: 31909912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
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.
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Affiliation(s)
- Jordi Castillo García
- Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona. Facultad de Medicina y Ciencias de la Salud, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, España. Consell Català de Resuscitació . Barcelona, España
| | | | | | | | - Elvira Ferrés-Amat
- Servicio Oral y Maxilofacial del Servició de Odontología Pediátrica. Hospital de Nens de Barcelona. Universitat Internacional de Catalunya, Barcelona, España
| | - Encarnación Rodríguez Higueras
- Consell Català de Resuscitació . Barcelona, España. Enfermería en la Facultad de Medicina y Ciencias de la Salud, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, España
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Abelairas-Gómez C, Carballo-Fazanes A, Martínez-Isasi S, López-García S, Rico-Díaz J, Rodríguez-Núñez A. [Knowledge and attitudes on first aid and basic life support of Primary and Preschool teachers and parents]. An Pediatr (Barc) 2020; 92:268-76. [PMID: 31870834 DOI: 10.1016/j.anpedi.2019.10.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 09/03/2019] [Accepted: 10/27/2019] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the knowledge of first aid (FA) of primary and pre-school teachers and the parents of children in these education stages. METHODS A questionnaire already used in previous publications was employed and consisted of 4 sections: 1) general information; 2) assessment of FA knowledge; 3) questions about FA, and 4) attitudes about FA. The questionnaire was sent by e-mail in Google Forms format to different education centres of the Autonomous Community of Galicia. The centres were asked to send them to the school staff and parents of the pupils so that they could be completed. RESULTS A total of 470 questionnaires were analysed (177 teachers; 242 parents and 51 teachers with children). More than half (268, 57%) of the participants stated to have knowledge of FA. In the case of the teachers, a relationship was found between having this information and teaching these contained in the classroom (P=.008). Only 4 participants managed to arrange the basic life support sequence, and none of them correctly answered the questions on cardiopulmonary resuscitation. More than 95% of the sample considered it necessary to include FA in the school curriculum and in the study plans of degrees destined for teacher training. CONCLUSIONS The majority of teachers and parents had training in FA, although none of them responded correctly to the questions related to basic life support. The inclusion of these contents in school curricula would be recommendable, but it requires training the teaching staff beforehand. The inclusion of these contents in university study plans should be a measure to take into account.
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Azeli Y, Barbería E, Jiménez-Herrera M, Ameijide A, Axelsson C, Bardaj A. Serious injuries secondary to cardiopulmonary resuscitation: incidence and associated factors. Emergencias 2019; 31:327-334. [PMID: 31625304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVES To determine the incidence of serious rib cage damage (SRD) and serious visceral damage (SVD) secondary to cardiopulmonary resuscitation (CPR) and to explore associated factors. MATERIAL AND METHODS We analyzed data from the prospective registry of cases of sudden death in Tarragona, Spain (the ReCaPTa study). Cases were collected from multiple surveillance sources. In this study we included the cases of autopsied nonsurvivors after attempted manual CPR between April 2014 and May 2016. A specific protocol to detect injuries secondary to CPR was used during the autopsies. RESULTS We analyzed 109 cases. The mean age at death was 63 years and 32.1% were women. SRD were found in 63.3% and SVD in 14.7%. The group with SRD were significantly older (63 vs 59 years, P=.031) and included higher percentages of persons with a chest circumference over 101 cm (56.5 vs 30%, P=.016) and a waist circumference over 100 cm (62.3 vs 37.5%, P=.017). A multivariable analysis confirmed chest circumference over 101 cm as the only risk factor for SRD (odds ratio [OR], 2.45; 95% CI, 1.03-5.84) and female sex as the only risk factor for SVD (OR, 5.02; 95% CI, 1.18-21.25). CONCLUSION Women and any patient with a chest circumference greater than 101 cm are at greater risk for serious injuries related to CPR.
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Affiliation(s)
- Youcef Azeli
- Sistema d'Emergències Mèdiques de Catalunya, L'Hospitalet de Llobregat, Barcelona, España. Servicio de Urgencias, Hospital Universitari Sant Joan de Reus, Reus, Tarragona, España. Institut d'Investigació Sanitaria Pere Virgili, Tarragona, España
| | - Eneko Barbería
- Institut de Medicina Legal y Forense de Catalunya, Tarragona, España. Universitat Rovira i Virgili, Tarragona, España
| | | | - Alberto Ameijide
- Unidad de Bioestadística, Fundació Lliga per a la Investigació i Prevenció del Càncer, Reus, Tarragona, España
| | | | - Alfredo Bardaj
- Institut d'Investigació Sanitaria Pere Virgili, Tarragona, España. Universitat Rovira i Virgili, Tarragona, España. Servicio de Cardiología, Hospital Universitari Joan XXIII, Tarragona, España
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Castro Delgado R, Nieves Ureña C, Sousa Fernández A, Roza Alonso C, Arcos González P. Bystander use of automated external defibrillators in the Spanish autonomous community of the Principality of Asturias in 2012-2014. Emergencias 2019; 30:415-418. [PMID: 30638347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
On-site bystander use of automated external defibrillators (AEDs) was analized in Asturias, Spain, between January 2012 and December 2014. Hospital management and neurologic state on discharge were also studied. Our retrospective observational population-based design had 3 phases comrpising: 1) a telephone survey of facilities with onsite public-access AEDsc, 2) analysis of relevant case records held by the Asturian emergency medical service, and 3) analysis of relevant hospital case records. Thirteen cases of AED use by bystanders were found. Eleven patients (84.5%) had initial shockable rhythms. Three patients (23%) died before reaching the hospital, 1 (7.6%) died in hospital, and 9 (69.2%) survived. All of the survivors had a shockable rhythm and all had a score of 1 on the Cerebral Performance Category scale on discharge. Eight of the 10 patients who were alive on arrival at the hospital were treated with primary angioplasty; therapeutic hypothermia was applied in 3 cases. The mean (SD) hospital stay of survivors was 9.4 (4.88) days. We conclude that bystander use of an AED notably improves survival in out-of-hospital sudden cardiac arrest, probably related to shortening the delay in starting defibrillation.
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Affiliation(s)
- Rafael Castro Delgado
- Unidad de Investigación en Emergencia y Desastre. Universidad de Oviedo, España. SAMU-Asturias, España
| | - Cristina Nieves Ureña
- Unidad de Investigación en Emergencia y Desastre. Universidad de Oviedo, España. Hospital Universitario Central de Asturias, Oviedo, España
| | - Alejandra Sousa Fernández
- Unidad de Investigación en Emergencia y Desastre. Universidad de Oviedo, España. Hospital Universitario Central de Asturias, Oviedo, España
| | - César Roza Alonso
- Unidad de Investigación en Emergencia y Desastre. Universidad de Oviedo, España. SAMU-Asturias, España
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González-Salvado V, Rodríguez-Ruiz E, Abelairas-Gómez C, Ruano-Raviña A, Peña-Gil C, González-Juanatey JR, Rodríguez-Núñez A. Training adult laypeople in basic life support. A systematic review. ACTA ACUST UNITED AC 2019; 73:53-68. [PMID: 30808611 DOI: 10.1016/j.rec.2018.11.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Accepted: 11/07/2018] [Indexed: 02/03/2023]
Abstract
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.
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Affiliation(s)
- Violeta González-Salvado
- Servicio de Cardiología, Hospital Clínico Universitario de Santiago de Compostela, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Santiago de Compostela, A Coruña, Spain; Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), A Coruña, Spain; Grupo CLINURSID, Universidade de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain.
| | - Emilio Rodríguez-Ruiz
- Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), A Coruña, Spain; Servicio de Medicina Intensiva, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - Cristian Abelairas-Gómez
- Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), A Coruña, Spain; Grupo CLINURSID, Universidade de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain; Facultad de Ciencias de la Educación, Universidade de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - Alberto Ruano-Raviña
- Departamento de Medicina Preventiva y Salud Pública, Universidad de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Spain
| | - Carlos Peña-Gil
- Servicio de Cardiología, Hospital Clínico Universitario de Santiago de Compostela, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Santiago de Compostela, A Coruña, Spain; Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), A Coruña, Spain
| | - José Ramón González-Juanatey
- Servicio de Cardiología, Hospital Clínico Universitario de Santiago de Compostela, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Santiago de Compostela, A Coruña, Spain; Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), A Coruña, Spain
| | - Antonio Rodríguez-Núñez
- Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), A Coruña, Spain; Grupo CLINURSID, Universidade de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain; Unidad de Cuidados Intensivos Pediátricos, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain; Escuela de Enfermería, Universidade de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
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Cerezo Espinosa C, Segura Melgarejo F, Melendreras Ruiz R, García-Collado ÁJ, Nieto Caballero S, Juguera Rodríguez L, Pardo Ríos S, García Torrano S, Linares Stutz E, Pardo Ríos M. Virtual reality in cardiopulmonary resuscitation training: a randomized trial. Emergencias 2019; 31:43-46. [PMID: 30656873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To assess the efficacy of virtual reality (VR) in cardiopulmonary resuscitation (CPR) training. MATERIAL AND METHODS Experimental, analytic, cross-sectional study of a CPR training method using VR. Participants were randomly assigned to train in a control group or a VR group. RESULTS The mean (SD) scores on a scale of 10 after training were 9.28 (0.91) in the VR group and 7.78 (1.63) in the control group, for a mean difference of 1.49 (95% CI, 0.96-2.02; P<.001). The VR group achieved a mean of 97.5 (9.7) compressions/min, versus 80.9 (7.7) compressions/min in the control group, for a mean difference of 16.6 compressions/min (95% CI, 15.0-18.2; P=.003). The mean compression depth in the VR group was 34.0 (6.5) mm, versus 27.9 (4.9) mm in the control group, for a mean difference of 6.7 (95% CI, 5.7-7.8; P<.001). CONCLUSION Training with VR can improve CPR theoretical knowledge and practical skills.
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Affiliation(s)
- Cristina Cerezo Espinosa
- Programa Doctorado en Ciencias de la Salud, Universidad Católica de Murcia (UCAM), España. Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España
| | | | | | | | - Sergio Nieto Caballero
- Programa Doctorado en Ciencias de la Salud, Universidad Católica de Murcia (UCAM), España. Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España. Gerencia de Urgencias y Emergencias Sanitarias 061 de la Región de Murcia, España
| | | | - Sergio Pardo Ríos
- Conserjería de Educación y Universidades de la Región de Murcia, España
| | | | | | - Manuel Pardo Ríos
- Gerencia de Urgencias y Emergencias Sanitarias 061 de la Región de Murcia, España
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23
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Avellanas Chavala ML, Ayala Gallardo M, Soteras Martínez Í, Subirats Bayego E. Management of accidental hypothermia: A narrative review. Med Intensiva 2019; 43:556-568. [PMID: 30683520 DOI: 10.1016/j.medin.2018.11.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 11/16/2018] [Accepted: 11/24/2018] [Indexed: 01/25/2023]
Abstract
A narrative review is presented on the diagnosis, treatment and management of accidental hypothermia. Although all these processes form a continuum, for descriptive purposes in this manuscript the recommendations are organized into the prehospital and in-hospital settings. At prehospital level, it is advised to: a) perform high-quality cardiopulmonary resuscitation for cardiac arrest patients, regardless of body temperature; b) establish measures to minimize further cooling; c) initiate rewarming; d) prevent rescue collapse and continued cooling (afterdrop); and (e) select the appropriate hospital based on the clinical and hemodynamic situation of the patient. Extracorporeal life support has revolutionized rewarming of the hemodynamically unstable victim or patients suffering cardiac arrest, with survival rates of up to 100%. The new evidences indicate that the management of accidental hypothermia has evolved favorably, with substantial improvement of the final outcomes.
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Affiliation(s)
- M L Avellanas Chavala
- Unidad de Medicina Intensiva, Hospital General San Jorge, Huesca, España; Unidad Funcional de Congelaciones y Patologías de Montaña, Hospital General San Jorge, Huesca, España; Máster en Medicina de Urgencia y Rescate en Montaña, Universidad de Zaragoza, Zaragoza, España.
| | | | - Í Soteras Martínez
- Servicio de Urgencias; Hospital de Cerdanya, Puigcerdà, Gerona, España; Facultad de Medicina, Universidad de Girona, Gerona, España
| | - E Subirats Bayego
- Hospital de Cerdanya, Puigcerdà, Gerona, España; Facultad de Medicina, Universidad de Girona, Gerona, España
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Navalpotro-Pascual S, Blanco-Blanco Á, Torre-Puente JC. Experience of emergency healthcare professionals in cardiopulmonary resuscitation and its relationship with self-efficacy: A qualitative approach. Enferm Clin (Engl Ed) 2019; 29:155-69. [PMID: 30529053 DOI: 10.1016/j.enfcli.2018.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 08/27/2018] [Accepted: 09/30/2018] [Indexed: 11/21/2022]
Abstract
AIM To gain a deeper knowledge of the phenomenon of cardiopulmonary resuscitation by capturing the meanings that professionals attach to the behaviour of reanimation and its relationship with Social Cognitive Theory. METHOD Qualitative research from a phenomenological approach focussing on field work with a focus group of professionals from Madrid (doctors, nurses and technicians), as well as a previous study. After the transcription of the data, it was coded, categories were formed and it was grouped into dimensions, interpreting the data according to the Social Cognitive Theory. Data was collected from other sources, experience of professionals and family members who had witnessed a cardiopulmonary resuscitation, until the saturation of the data. RESULTS The phenomena that affect the people involved in a cardiopulmonary resuscitation were explored holistically. The relevant aspects to feel able to perform cardiopulmonary resuscitation, as well as those that may hinder the behaviour were identified. Two dimensions were found, personal and situational factors, as well as several categories in each dimension related to Bandura's theory of self-efficacy. CONCLUSIONS Professionals' self-efficacy in a cardiopulmonary resuscitation does not always depend on the technical skills acquired. Personal and situational factors influence the professional being able to vary their behaviour cognitively and emotionally. This knowledge enables cardiopulmonary resuscitation competencies in a clinical situation to be improved and individualized training programmes to be designed in teaching practice.
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Tíscar-González V, Gastaldo D, Moreno-Casbas MT, Peter E, Rodriguez-Molinuevo A, Gea-Sánchez M. [Presence of relatives during cardiopulmonary resuscitation: Perspectives of health professionals, patients and family in the Basque Country]. Aten Primaria 2019; 51:269-77. [PMID: 29571750 DOI: 10.1016/j.aprim.2017.12.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 12/02/2017] [Accepted: 12/31/2017] [Indexed: 11/29/2022] Open
Abstract
Objetivo Explorar la percepción acerca de la presencia de familiares durante la reanimación cardiopulmonar (RCP) en pacientes adultos, de los propios pacientes y familiares, enfermeras y médicos. Diseño Se desarrolló un estudio cualitativo exploratorio y un análisis temático. Emplazamiento Atención Primaria, Atención Hospitalaria y Servicio de Emergencias del Servicio Vasco de Salud. Participantes La selección de los participantes se realizó a través de muestreo intencional. Se desarrollaron 4 grupos de discusión: uno de pacientes y familiares, 2 de enfermeras y uno de médicos. Método Se realizó un análisis temático. Se utilizaron técnicas de triangulación entre investigadores e investigador-informante. Se utilizó el programa informático Open Code 4.1. Resultados Se identificaron 3 categorías significativas: impacto de la actuación en la familia; peso de la responsabilidad ética y legal; poder, lugar donde sucede la parada y supuestos culturales. Conclusiones La RCP es un constructo social influido por los valores de los contextos socioculturales específicos. En este estudio, los pacientes y familiares describieron temor y resistencia a presenciar la RCP. Por su parte, los profesionales sanitarios consideran que su decisión reviste complejidad, siendo necesario valorar cada caso de forma independiente e integrando a pacientes y familiares en la toma de decisiones. Como líneas de investigación futuras sería recomendable profundizar sobre la experiencia subjetiva de familiares que hayan presenciado la RCP y el impacto de los elementos contextuales y socioculturales en sus percepciones.
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López-Herce Cid J, Rodríguez Núñez A, Carrillo Álvarez Á, Zeballos Sarrato G, Martínez Fernández-Llamazares C, Calvo Macías C. [Materials for the paediatric resuscitation trolley or backpack: Expert recommendations]. An Pediatr (Barc) 2017; 88:173.e1-173.e7. [PMID: 28688610 DOI: 10.1016/j.anpedi.2017.05.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 05/15/2017] [Accepted: 05/25/2017] [Indexed: 11/25/2022] Open
Abstract
Cardio-respiratory arrest (CPA) is infrequent in children, but it can occur in any place and at any time. This fact means that every health care facility must always have the staff and material ready to resuscitate a child. These recommendations are the consensus of experts of the Spanish Paediatric and Neonatal Resuscitation Group on the material and medication for paediatric and neonatal resuscitation and their distribution and use. CPR trolleys and backpacks must include the essential material to quickly and efficiently perform a paediatric CPR. At least one CPR trolley must be available in every Primary Care facility, Paediatric Intensive Care Unit, Emergency Department, and Pre-hospital Emergency Areas, as well as in paediatric wards, paediatric ambulatory areas, and radiology suites. This trolley must be easily accessible and exclusively include the essential items to perform a CPR and to assist children (from newborns to adolescents) who present with a life-threatening event. Such material must be familiar to all healthcare staff and also include the needed spare parts, as well as enough drug doses. It must also be re-checked periodically. The standardisation and unification of the material and medication of paediatric CPR carts, trolleys, and backpacks, as well as the training of the personnel in their use are an essential part of the paediatric CPR.
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Affiliation(s)
- Jesús López-Herce Cid
- Servicio de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón de Madrid. Instituto de investigación sanitaria del Hospital Gregorio Marañón. Facultad de Medicina. Universidad Complutense de Madrid. Grupo Español de Reanimación Cardiopulmonar Pediátrica y Neonatal. Red de Salud Maternoinfantil y del Desarrollo (RedSAMID). RETICS financiada por el PN I+D+I 2008-2011, ISCIII - Subdirección General de Evaluación y Fomento de la Investigación y el Fondo Europeo de Desarrollo Regional (FEDER), ref. RD16/0022.
| | - Antonio Rodríguez Núñez
- Área de Pediatría, Servicio de Críticos, Intermedios y Urgencias Pediátricas. Hospital Clínico Universitario de Santiago de Compostela. Departamento de Radiología, Psiquiatría, Salud Pública, Enfermería y Medicina de la Universidad de Santiago de Compostela (USC). Grupos de Investigación CLINURSID (USC) y Soporte Vital y Simulación (Instituto de Investigación de Santiago). Instituto de Investigación de Santiago (IDIS). Red de Salud Maternoinfantil (SAMID II). RETICS financiada por el PN 2018-2011, el ISCIII- Subdirección General de Evaluación y Fomento de la Investigación y el Fondo Europeo de Desarrollo Regional (FEDER) ref: RD16/0022
| | - Ángel Carrillo Álvarez
- Servicio de Cuidados Intensivos Pediátricos. Hospital General Universitario Gregorio Marañón de Madrid. Instituto de investigación sanitaria del Hospital Gregorio Marañón. Facultad de Medicina. Universidad Complutense de Madrid. Grupo Español de Reanimación Cardiopulmonar Pediátrica y Neonatal. Red de Salud Maternoinfantil y del Desarrollo (RedSAMID). RETICS financiada por el PN I+D+I 2008-2011, ISCIII - Subdirección General de Evaluación y Fomento de la Investigación y el Fondo Europeo de Desarrollo Regional (FEDER), ref. RD16/0022
| | - Gonzalo Zeballos Sarrato
- Servicio de Neonatología. Hospital General Universitario Gregorio Marañón de Madrid. Instituto de investigación sanitaria del Hospital Gregorio Marañón. Grupo Español de Reanimación Cardiopulmonar Pediátrica y Neonatal
| | - Cecilia Martínez Fernández-Llamazares
- Servicio de Farmacia. Hospital General Universitario Gregorio Marañón de Madrid. Instituto de investigación sanitaria del Hospital Gregorio Marañón. Red de Salud Maternoinfantil y del Desarrollo (RedSAMID). RETICS financiada por el PN I+D+I 2008-2011, ISCIII - Subdirección General de Evaluación y Fomento de la Investigación y el Fondo Europeo de Desarrollo Regional (FEDER), ref. RD16/0022
| | - Custodio Calvo Macías
- Emérito SAS. Asociado a UGC Críticos y Urgencias Pediátricas. Hospital Regional Universitario de Málaga. Grupo Español de Reanimación Cardiopulmonar Pediátrica y Neonatal
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López-Herce J, Rodríguez Núñez A, Maconochie I, Van de Voorde P, Biarent D, Eich C, Bingham R, Rajka T, Zideman D, Carrillo Á, de Lucas N, Calvo C, Manrique I. [Current international recommendations for pediatric cardiopulmonary resuscitation: the European guidelines]. Emergencias 2017; 29:266-281. [PMID: 28825283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This summary of the European guidelines for pediatric cardiopulmonary resuscitation (CPR) emphasizes the main changes and encourages health care professionals to keep their pediatric CPR knowledge and skills up to date. Basic and advanced pediatric CPR follow the same algorithm in the 2015 guidelines. The main changes affect the prevention of cardiac arrest and the use of fluids. Fluid expansion should not be used routinely in children with fever in the abuse of signs of shock because too high a volume can worsen prognosis. Rescue breaths should last around 1 second in basic CPR, making pediatric recommendations consistent with those for adults. Chest compressions should be at least as deep as one-third the anteroposterior diameter of the thorax. Most children in cardiac arrest lack a shockable rhythm, and in such cases a coordinated sequence of breaths, chest compressions, and administration of adrenalin is essential. An intraosseous canula may be the first choice for introducing fluids and medications, especially in young infants. In treating supraventricular tachycardia with cardioversion, an initial dose of 1 J/kg is currently recommended (vs the dose of 0.5 J/kg previously recommended). After spontaneous circulation is recovered, measures to control fever should be taken. The goal is to reach a normal temperature even before arrival to the hospital.
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Affiliation(s)
- Jesús López-Herce
- Servicio de Cuidados Intensivos Pediátricos, Hospital Gregorio Marañón de Madrid. Facultad de Medicina. Universidad Complutense, Madrid, España
| | - Antonio Rodríguez Núñez
- Servicio Urgencias Pediátricas, Hospital Clínico Universitario de Santiago de Compostela, España
| | - Ian Maconochie
- Paediatric Emergency Medicine Department, Imperial College Healthcare NHS Trust and BRC Imperial NIHR, Londres, Reino Unido
| | - Patric Van de Voorde
- Paediatric Intensive Care and Emergency Medicine Departments, University Hospital Ghent and Ghent University, Gante, Bélgica
| | - Dominique Biarent
- Paediatric Intensive Care and Emergency Medicine Departments, Université Libre de Bruxelles, Hôpital Universitaire des Enfants, Bruselas, Bélgica
| | - Christof Eich
- Department of Anaesthesia, Paediatric Intensive Care and Emergency Medicine, Auf der Bult Children's Hospital, Hanover, Alemania
| | - Robert Bingham
- Department of Paediatric Anaesthesia, Great Ormond Street Hospital for Children, Londres, Reino Unido
| | - Thomas Rajka
- Paediatric Intensive Care Department, Womens and Childrens Division, Oslo University Hospital, Oslo, Noruega
| | - David Zideman
- Anaesthesia Department, Imperial College Healthcare NHS Trust, Londres, Reino Unido
| | - Ángel Carrillo
- Servicio de Cuidados Intensivos Pediátricos, Hospital Gregorio Marañón de Madrid. Facultad de Medicina. Universidad Complutense, Madrid, España
| | | | - Custodio Calvo
- Servicio de Urgencias Pediátricas, Hospital Regional U. de Málaga, España
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Loma-Osorio P, Nuñez M, Aboal J, Bosch D, Batlle P, Ruiz de Morales E, Ramos R, Brugada J, Onaga H, Morales A, Olivet J, Brugada R. The Girona Territori Cardioprotegit Project: Performance Evaluation of Public Defibrillators. ACTA ACUST UNITED AC 2017; 71:79-85. [PMID: 28522305 DOI: 10.1016/j.rec.2017.04.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 03/02/2017] [Indexed: 11/16/2022]
Abstract
INTRODUCTION AND OBJECTIVES In recent years, public access defibrillation programs have exponentially increased the availability of automatic external defibrillators (AED) in public spaces but there are no data on their performance in our setting. We conducted a descriptive analysis of the performance of AED since the launch of a public defibrillation program in our region. METHODS A retrospective analysis was conducted of electrocardiographic tracings and the performance of AED in a public defibrillation program from June 2011 to June 2015 in the province of Girona, Spain. RESULTS There were 231 AED activations. Full information was available on 188 activations, of which 82% corresponded to mobile devices and 18% to permanent devices. Asystole was the most prevalent rhythm (42%), while ventricular fibrillation accounted for 23%. The specificity of the device in identifying a shockable rhythm was 100%, but there were 8 false negatives (sensitivity 83%). There were 47 shockable rhythms, with a spontaneous circulation recovery rate of 49% (23 cases). There were no accidents related to the use of the device. CONCLUSIONS Nearly half of the recorded rhythms were asystole. The AED analyzed showed excellent safety and specificity, with moderate sensitivity. Half the patients with a shockable rhythm were successfully treated by the AED.
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Affiliation(s)
- Pablo Loma-Osorio
- Servicio de Cardiología, Hospital Universitari Dr. Josep Trueta, Girona, Spain; Departamento de Ciencias Médicas, Facultad de Medicina, Universidad de Girona, Girona, Spain.
| | - Maria Nuñez
- Servicio de Cardiología, Hospital Universitari Dr. Josep Trueta, Girona, Spain
| | - Jaime Aboal
- Servicio de Cardiología, Hospital Universitari Dr. Josep Trueta, Girona, Spain
| | - Daniel Bosch
- Servicio de Cardiología, Hospital Universitari Dr. Josep Trueta, Girona, Spain
| | - Pau Batlle
- Departamento de Salud, Diputación de Girona (Dipsalut), Girona, Spain
| | | | - Rafael Ramos
- Departamento de Ciencias Médicas, Facultad de Medicina, Universidad de Girona, Girona, Spain; Instituto de Investigación en Atención Primaria (IDIAP Jordi Gol), Girona, Spain
| | - Josep Brugada
- Instituto del Tórax, Hospital Clínic i Provincial de Barcelona, Barcelona, Spain
| | - Hisao Onaga
- Servicio de Emergencias Médicas (SEM), Región Sanitaria de Girona, Girona, Spain
| | - Alex Morales
- Departamento de Salud, Diputación de Girona (Dipsalut), Girona, Spain
| | - Josep Olivet
- Grupo de Investigación, Salud y Atención Sanitaria, Universidad de Girona, Girona, Spain
| | - Ramon Brugada
- Servicio de Cardiología, Hospital Universitari Dr. Josep Trueta, Girona, Spain; Departamento de Ciencias Médicas, Facultad de Medicina, Universidad de Girona, Girona, Spain; Centro de Genética Cardiovascular, Instituto de investigación biomédica de Girona (IDIBGI), Girona, Spain
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González-Calvete L, Barcala-Furelos R, Moure-González JD, Abelairas-Gómez C, Rodríguez-Núñez A. Utility of a simple lighting device to improve chest compressions learning. ACTA ACUST UNITED AC 2017; 64:506-512. [PMID: 28400132 DOI: 10.1016/j.redar.2017.02.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Revised: 02/24/2017] [Accepted: 02/27/2017] [Indexed: 01/20/2023]
Abstract
INTRODUCTION The recommendations on cardiopulmonary resuscitation (CPR) emphasize the quality of the manoeuvres, especially chest compressions (CC). Audiovisual feedback devices could improve the quality of the CC during CPR. The aim of this study was to evaluate the usefulness of a simple lighting device as a visual aid during CPR on a mannequin. MATERIAL AND METHODS Twenty-two paediatricians who attended an accredited paediatric CPR course performed, in random order, 2min of CPR on a mannequin without and with the help of a simple lighting device, which flashes at a frequency of 100 cycles per minute. The following CC variables were analyzed using a validated compression quality meter (CPRmeter®): depth, decompression, rate, CPR time and percentage of compressions. RESULTS With the lighting device, participants increased average quality (60.23±54.50 vs. 79.24±9.80%; P=.005), percentage in target depth (48.86±42.67 vs. 72.95±20.25%; P=.036) and rate (35.82±37.54 vs. 67.09±31.95%; P=.024). CONCLUSIONS A simple light device that flashes at the recommended frequency improves the quality of CC performed by paediatric residents on a mannequin. The usefulness of this CPR aid system should be assessed in real patients.
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Affiliation(s)
- L González-Calvete
- Servicio de Urgencias de Pediatría, Hospital de Cabueñes, Gijón, Asturias, España.
| | - R Barcala-Furelos
- Grupo de Investigación CLINURSID, Departamento de Enfermería, Universidad de Santiago de Compostela, Santiago de Compostela, La Coruña, España; Grupo de Investigación REMOSS, Facultad de Educación Física y Ciencias del Deporte, Universidad de Vigo, Pontevedra, España
| | - J D Moure-González
- Área de Pediatría. Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, La Coruña, España
| | - C Abelairas-Gómez
- Grupo de Investigación CLINURSID, Departamento de Enfermería, Universidad de Santiago de Compostela, Santiago de Compostela, La Coruña, España; Facultad de Ciencias de la Salud, Universidad Europea del Atlántico, Santander, España
| | - A Rodríguez-Núñez
- Servicio de Críticos y Urgencias Pediátricas, Hospital Clínico Universitario de Santiago de Compostela, La Coruña, España; Instituto de Investigación de Santiago (IDIS), Santiago de Compostela, La Coruña, España; Red SAMID II, Instituto Carlos III, Madrid, España
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van Tulder R, Roth D, Laggner R, Krammel M, Schriefl C, Kienbacher C, Novosad H, Chwojka CC, Sterz F, Havel C, Schreiber W, Herkner H. [Dispatchers' impressions and actual quality of cardiopulmonary resuscitation during telephone-assisted bystander cardiopulmonary resuscitation: a pooled analysis of 94 simulated, manikin-based scenarios]. Emergencias 2017; 29:11-17. [PMID: 28825263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVES The quality of telephone-assisted cardiopulmonary resuscitation (CPR) needs improvement. This study investigates whether a dispatchers' perception is an adequate measure of the actual quality of CPR provided by laypersons. MATERIAL AND METHODS Individual participant data from 3 randomized simulation trials, with identical methodology but different interventions, were combined for this analysis. Professional dispatchers gave telephone assistance to laypersons, who each provided 10 minutes of CPR on a manikin. Dispatchers were requested to classify the quality of providers' CPR as adequate or inadequate. Based on actual readings from manikins we classified providers' performance as adequate at 5-6 cm for depth and 100-120 compressions per minute (cpm) for rate. We calculated metrics of dispatcher accuracy. RESULTS Six dispatchers rated the performance of 94 laypersons (38 women [42%]) with a mean (SD) age of 37 (14) years. In 905 analyzed minutes of telephone-assisted CPR, the mean compression depth and rate was 41 (13) mm and 98 (24) cpm, respectively. Analysis of dispatchers' diagnostic test accuracy for adequate compression depth yielded a sensitivity of 65% (95 CI 36%-95%) and specificity of 42% (95% CI, 32%-53%). Analysis of their assessment of adequate compression rate yielded a sensitivity of 75% (95% CI, 64%-86%) and specificity of 42% (95% CI, 32%-52%). Although dispatchers always underestimated the actual values of CPR parameters, the female dispatchers evaluations were less inaccurate than the evaluations of make dispatchers; the dispatchers overall (males and females together) underestimated the adequacy of female laypersons' CPR performance to a greater degree than female dispatchers did. CONCLUSION The ability of dispatchers to estimate the quality of telephone-assisted CPR is limited. Dispatchers estimates of CPR adequacy needs to be studied further in order to find ways that telephone-assisted CPR might be improved.
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Affiliation(s)
| | - Dominik Roth
- Department of Emergency Medicine, Medical University of Vienna, Austria
| | - Roberta Laggner
- Department of Emergency Medicine, Medical University of Vienna, Austria
| | - Mario Krammel
- Department of General Anaesthesiology, Intensive Care and Pain Management, Medical University of Vienna
| | | | - Calvin Kienbacher
- Department of Emergency Medicine, Medical University of Vienna, Austria
| | - Heinz Novosad
- NOTRUF NOE GmbH, Emergency Call and Coordination Centre, Lower Austria
| | | | - Fritz Sterz
- Department of Emergency Medicine, Medical University of Vienna, Austria
| | - Christof Havel
- Department of Emergency Medicine, Medical University of Vienna, Austria
| | | | - Harald Herkner
- Department of Emergency Medicine, Medical University of Vienna, Austria
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Carbayo T, de la Mata A, Sánchez M, López-Herce J, Del Castillo J, Carrillo A. [Multiple organ failure after spontaneous return of circulation in cardiac arrest in children]. An Pediatr (Barc) 2016; 87:34-41. [PMID: 27449158 DOI: 10.1016/j.anpedi.2016.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 05/26/2016] [Accepted: 06/20/2016] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To assess the frequency of the multiple organ failure and the prognostic value of multiple organ failure scores in children who have recovered from an in-hospital cardiac arrest. PATIENTS AND METHODS A single centre, observational, and retrospective study was conducted on children between 1 month and 16 years old who suffered an in-hospital cardiac arrest and achieved return of spontaneous circulation (ROSC). In the first 24-48hours and between the fifth and the seventh day after ROSC, a record was made of the scores on paediatric severity (PRISM and PIM II) and multiple organ failure scales (PELOD and P-MODS), along with the clinical and analytical data, and including monitoring and treatment, mortality and cause of death. RESULTS Of the total of 41 children studied, 70.7% male were male, and the median age was 38 months. The overall mortality during admission was 41.5%, with 14.6% dying in the first 48hours, and 7.6% in the following 3 to 5 days. In the first 48hours, clinical severity and multiple organ failure scores were higher in the patients that died than in survivors (PRISM 29 vs. 21) P=.125, PIM II (26.8% vs. 9.2%) P=.02, PELOD (21 vs. 12) P=.005, and P-MODS (9 vs. 6) P=.001. Between the fifth and seventh day, the scores on the four scales were also higher in patients who died, but only those of the PELOD (20.5 vs. 11) p=.002 and P-MODS (6.5 vs. 3) P=.003 reached statistical significance. CONCLUSIONS Mortality in children after return of spontaneous circulation after cardiac arrest is high. The multiple organ failure after return of spontaneous circulation after cardiac arrest in children is associated with increased mortality.
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Affiliation(s)
- Tania Carbayo
- Servicio de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón, Madrid, España; Instituto de Investigación Sanitaria, Hospital Gregorio Marañón, Madrid, España; Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España
| | - Alba de la Mata
- Servicio de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón, Madrid, España; Instituto de Investigación Sanitaria, Hospital Gregorio Marañón, Madrid, España; Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España
| | - Marina Sánchez
- Servicio de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón, Madrid, España; Instituto de Investigación Sanitaria, Hospital Gregorio Marañón, Madrid, España; Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España
| | - Jesús López-Herce
- Servicio de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón, Madrid, España; Instituto de Investigación Sanitaria, Hospital Gregorio Marañón, Madrid, España; Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España.
| | - Jimena Del Castillo
- Servicio de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón, Madrid, España; Instituto de Investigación Sanitaria, Hospital Gregorio Marañón, Madrid, España; Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España
| | - Angel Carrillo
- Servicio de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón, Madrid, España; Instituto de Investigación Sanitaria, Hospital Gregorio Marañón, Madrid, España; Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España
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Fontanals J, Magaldi M, Caballero Á, Fontanals M. [Prognostic factors for in-hospital cardiopulmonary arrests. A review of 760 cases]. Med Clin (Barc) 2016; 147:49-55. [PMID: 27237362 DOI: 10.1016/j.medcli.2016.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 04/04/2016] [Accepted: 04/14/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND OBJECTIVE The aim of this study is to analyse in-hospital cardiopulmonary arrests (CA) that took place in conventional wards and evaluate their prognostic factors. PATIENTS AND METHOD Retrospective review of in-hospital CA which occurred in our hospital over a 9-year period. CA that took place in intensive care areas, emergency rooms and operating theatres were excluded from the study. The following data were collected: demographic data, cause and initial rhythm of CA, internal control data, time, place, methods and results after cardiopulmonary resuscitation (CPR) (recovery of spontaneous circulation, [ROSC], and survival at discharge [SAD]) and neurologic performance at discharge. Results were analysed with SPSS(®) v. 20 predictive analytics software. RESULTS Average age was 66.9±17.5 years; 63.5% male. CA team arrived in 1.75±0.74min on average, and the average length of CPR was 25.8±16.10min. First rhythm: a) shockable rhythms=22.1%; b) asystole=66.2%, and c) pulseless electrical activity=11.7%. ROSC=51% and SAD=24.8%. Factors associated with a better prognostic (P<.05): age, reason for hospital admission, patient's previous physical condition, principal cause of CA, number of defibrillations and average length of CPR. CONCLUSIONS Despite having studied several variables as prognostic factors for CA and some of them being statistically significant, early prediction for survival for an in-hospital CA remains uncertain. Our study suggests that applying rational organisational measures, 25% of in-hospital CA could be discharged from hospital in good condition, and therefore, these organisational and educational measures should be extended to large hospitals.
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Affiliation(s)
- Jaume Fontanals
- Servicio de Anestesiología y Reanimación, Hospital Clínic de Barcelona, Barcelona, España
| | - Marta Magaldi
- Servicio de Anestesiología y Reanimación, Hospital Clínic de Barcelona, Barcelona, España.
| | - Ángel Caballero
- Servicio de Anestesiología y Reanimación, Hospital Clínic de Barcelona, Barcelona, España
| | - Montserrat Fontanals
- Servicio de Anestesiología y Reanimación, Hospital Clínic de Barcelona, Barcelona, España
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Sanz-Sanjosé E, Ariño Irujo JJ, Sánchez Martín CE, González Perrino C, López-Timoneda F. Minimum oxygen flow needed for vital support during simulated post-cardiorespiratory arrest resuscitation. Rev Esp Anestesiol Reanim 2016; 63:261-266. [PMID: 26549726 DOI: 10.1016/j.redar.2015.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Revised: 07/30/2015] [Accepted: 08/08/2015] [Indexed: 06/05/2023]
Abstract
According to the ERC and the AHA guidelines, FiO2 should be titrated to achieve an O2Sat ≥ 94%. The aim of this study was to determine the minimum oxygen flow and time needed to reach an FiO2 of 0.32 and 0.80 during post-cardiac arrest care. An experimental analysis was performed that consisted of a simulated post-cardiac arrest situation. Different resuscitators were tested and connected to an artificial lung: Mark IV, SPUR II, Revivator Res-Q, O-TWO. The oxygen flow levels tested were 2, 5, 10 and 15 lpm. Bonferroni and Mann-Whitney U tests were used. An FiO2 of 0.32 or more was obtained using any of the oxygen flow and resuscitators. Only the Mark IV achieved an FiO2 of 0.80 after a minimum of 75s ventilating with 2 or 5 lpm. Clinical and statistical differences (P<.05) were found: at 15 lpm it took 35s to reach an FiO2 of 0.80 or more for Mark IV (85.6 [0.3]) and Revivator (84.3 [1.5]) compared to 50s for SPUR II (87.1 [6.4]); at 2 lpm, all of the devices reached an FiO2 of ≥ 0.32 at 30s(Mark IV (34.8 [1.3]), Revivator (35.7 [1.5]) and SPUR II (34.4 [2.1]), except for O-TWO, which took 35s (36.3 [4.3]). Patients could be ventilated with any of the resuscitators using 2 lpm to obtain an FiO2 of 0.32, although possibly O-TWO would be the last option during the first 60s. In order to reach an FiO2 of 0.80, ventilating with 10 lpm should be sufficient, and preferably using Mark IV or Revivator Res-Q. In conclusion, on observing the results of our study, in any possible scenario, it would be advisable to use Revivator Res-Q or Mark IV rather than O-TWO or SPUR II.
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Affiliation(s)
- E Sanz-Sanjosé
- Servicio de Anestesiología y Reanimación, Hospital Clínico San Carlos, Madrid, España.
| | - J J Ariño Irujo
- Servicio de Anestesiología y Reanimación, Al Noor Hospital, Khalifa Branch, Abu Dabi, Emiratos Árabes Unidos
| | - C E Sánchez Martín
- Servicio de Anestesiología y Reanimación, Hospital Clínico San Carlos, Madrid, España
| | - C González Perrino
- Servicio de Anestesiología y Reanimación, Hospital Clínico San Carlos, Madrid, España
| | - F López-Timoneda
- Servicio de Anestesiología y Reanimación, Hospital Clínico San Carlos, Madrid, España
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Abelairas-Gómez C, Rodríguez-Núñez A, Vilas-Pintos E, Prieto Saborit JA, Barcala-Furelos R. [Effects of real-time audiovisual feedback on secondary-school students' performance of chest compressions]. Emergencias 2015; 27:189-192. [PMID: 29077313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To describe the quality of chest compressions performed by secondary-school students trained with a realtime audiovisual feedback system. MATERIAL AND METHODS The learners were 167 students aged 12 to 15 years who had no prior experience with cardiopulmonary resuscitation (CPR). They received an hour of instruction in CPR theory and practice and then took a 2-minute test, performing hands-only CPR on a child mannequin (Prestan Professional Child Manikin). Lights built into the mannequin gave learners feedback about how many compressions they had achieved and clicking sounds told them when compressions were deep enough. RESULTS All the learners were able to maintain a steady enough rhythm of compressions and reached at least 80% of the targeted compression depth. Fewer correct compressions were done in the second minute than in the first (P=.016). CONCLUSION Real-time audiovisual feedback helps schoolchildren aged 12 to 15 years to achieve quality chest compressions on a mannequin.
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García del Águila J, López-Messa J, Rosell-Ortiz F, de Elías Hernández R, Martínez del Valle M, Sánchez-Santos L, López-Herce J, Cerdà-Vila M, Roza-Alonso CL, Bernardez-Otero M. Recommendations in dispatcher-assisted bystander resuscitation from emergency call center. Med Intensiva 2015; 39:298-302. [PMID: 25895627 DOI: 10.1016/j.medin.2015.02.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Revised: 02/23/2015] [Accepted: 02/25/2015] [Indexed: 11/28/2022]
Abstract
Dispatch-assisted bystander cardiopulmonary resuscitation in out-of-hospital cardiac arrest has been shown as an effective measure to improve the survival of this process. The development of a unified protocol for all dispatch centers of the different emergency medical services can be a first step towards this goal in our environment. The process of developing a recommendations document and the realization of posters of dispatch-assisted cardiopulmonary resuscitation, agreed by different actors and promoted by the Spanish Resuscitation Council, is presented.
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Affiliation(s)
- J García del Águila
- Empresa Pública de Emergencias Sanitarias (EPES) de Andalucía, Sevilla, España
| | - J López-Messa
- Servicio de Medicina Intensiva, Complejo Asistencial Universitario de Palencia, Palencia, España.
| | - F Rosell-Ortiz
- Empresa Pública de Emergencias Sanitarias (EPES) de Andalucía, Sevilla, España
| | | | | | - L Sánchez-Santos
- Fundacion Publica Urxencias Sanitarias de Galicia-061, A Coruña, España
| | - J López-Herce
- Unidad de Cuidados Intensivos Pediátricos, Hospital Universitario Gregorio Marañón, Madrid, España
| | - M Cerdà-Vila
- Consell Català de Ressuscitació, Barcelona, España
| | - C L Roza-Alonso
- Servicio de Asistencia Médica Urgente (SAMU-Asturias), Oviedo, España
| | - M Bernardez-Otero
- Fundacion Publica Urxencias Sanitarias de Galicia-061, A Coruña, España
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van Tulder R, Roth D, Krammel M, Laggner R, Schriefl C, Kienbacher C, Lorenzo Hartmann A, Novosad H, Constantin Chwojka C, Havel C, Schreiber W, Herkner H. [Effects of a voice metronome on compression rate and depth in telephone assisted, bystander cardiopulmonary resuscitation: an investigator-blinded, 3-armed, randomized, simulation trial]. Emergencias 2015; 27:357-363. [PMID: 29094836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVES We investigated the effect on compression rate and depth of a conventional metronome and a voice metronome in simulated telephone-assisted, protocol-driven bystander Cardiopulmonary resucitation (CPR) compared to standard instruction. MATERIAL AND METHODS Thirty-six lay volunteers performed 10 minutes of compression-only CPR in a prospective, investigator-blinded, 3-arm study on a manikin. Participants were randomized either to standard instruction ("push down firmly, 5 cm"), a regular metronome pacing 110 beats per minute (bpm), or a voice metronome continuously prompting "deep-deepdeep- deeper" at 110 bpm. The primary outcome was deviation from the ideal chest compression target range (50 mm compression depth x 100 compressions per minute x 10 minutes = 50 m). Secondary outcomes were CPR quality measures (compression and leaning depth, rate, no-flow times) and participants' related physiological response (heart rate, blood pressure and nine hole peg test and borg scales score). We used a linear regression model to calculate effects. RESULTS The mean (SD) deviation from the ideal target range (50 m) was -11 (9) m in the standard group, -20 (11) m in the conventional metronome group (adjusted difference [95%, CI], 9.0 [1.2-17.5 m], P=.03), and -18 (9) m in the voice metronome group (adjusted difference, 7.2 [-0.9-15.3] m, P=.08). Secondary outcomes (CPR quality measures and physiological response of participants to CPR performance) showed no significant differences. CONCLUSION Compared to standard instruction, the conventional metronome showed a significant negative effect on the chest compression target range. The voice metronome showed a non-significant negative effect and therefore cannot be recommended for regular use in telephone-assisted CPR.
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Affiliation(s)
| | - Dominik Roth
- Department of Emergency Medicine, Medical University of Vienna, Austria
| | - Mario Krammel
- Department of General Anaesthesiology, Intensive Care and Pain Management, Viena, Austria
| | - Roberta Laggner
- Department of Emergency Medicine, Medical University of Vienna, Austria
| | | | - Calvin Kienbacher
- Department of Emergency Medicine, Medical University of Vienna, Austria
| | | | - Heinz Novosad
- NOTRUF NOE GmbH, Emergency Call and Coordination Centre, Lower Austria, Viena, Austria
| | | | - Christoph Havel
- Department of Emergency Medicine, Medical University of Vienna, Austria
| | | | - Harald Herkner
- Department of Emergency Medicine, Medical University of Vienna, Austria
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Socias Crespí L, Ceniceros Rozalén MI, Rubio Roca P, Martínez Cuellar N, García Sánchez A, Ripoll Vera T, Lesmes Serrano A. [Epidemiological characteristics of out-of-hospital cardiorespiratory arrest recorded by the 061 emergencies system (SAMU) in the Balearic Islands (Spain), 2009-2012]. Med Intensiva 2014; 39:199-206. [PMID: 25499904 DOI: 10.1016/j.medin.2014.04.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2013] [Revised: 03/31/2014] [Accepted: 04/19/2014] [Indexed: 10/24/2022]
Abstract
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.
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Affiliation(s)
- L Socias Crespí
- Servicio de Medicina Intensiva, Hospital Son Llàtzer, Palma de Mallorca, España.
| | - M I Ceniceros Rozalén
- Servicio de Emergencias del 061 Illes Balears, SAMU_061, IB_Salut, Palma de Mallorca, España
| | - P Rubio Roca
- Servicio de Emergencias del 061 Illes Balears, SAMU_061, IB_Salut, Palma de Mallorca, España
| | - N Martínez Cuellar
- Servicio de Emergencias del 061 Illes Balears, SAMU_061, IB_Salut, Palma de Mallorca, España
| | - A García Sánchez
- Servicio de Medicina Intensiva, Hospital Son Llàtzer, Palma de Mallorca, España
| | - T Ripoll Vera
- Servicio de Cardiología, Ciberobn, Grupo de investigación en cardiopatías genéticas y muerte súbita de les Illes Balears, Hospital Son Llàtzer, Palma de Mallorca, España
| | - A Lesmes Serrano
- Servicio de Medicina Intensiva Plan Nacional de RCP, SEMICYUC, Hospital Universitario Nuestra Señora de Valme, Sevilla, España
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Serrano M, Rodríguez J, Espejo A, del Olmo R, Llanos S, Del Castillo J, López-Herce J. [Relationship between previous severity of illness and outcome of in-hospital cardiac arrest]. An Pediatr (Barc) 2014; 81:9-15. [PMID: 24286880 DOI: 10.1016/j.anpedi.2013.09.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2013] [Revised: 09/09/2013] [Accepted: 09/26/2013] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES To analyze the relationship between previous severity of illness, lactic acid, creatinine and inotropic index with mortality of in-hospital cardiac arrest (CA) in children, and the value of a prognostic index designed for adults. METHODS The study included total of 44 children aged from 1 month to 18 years old who suffered a cardiac arrest while in hospital. The relationship between previous severity of illness scores (PRIMS and PELOD), lactic acid, creatinine, treatment with vasoactive drugs, inotropic index with return of spontaneous circulation and survival at hospital discharge was analyzed. RESULTS The large majority (90.3%) of patients had a return of spontaneous circulation, and 59% survived at hospital discharge. More than two-thirds (68.2%) were treated with inotropic drugs at the time of the CA. The patients who died had a higher lactic acid before the CA (3.4 mmol/L) than survivors (1.4 mmol/L), P=.04. There were no significant differences in PRIMS, PELOD, creatinine, inotropic drugs, and inotropic index before CA between patients who died and survivors. CONCLUSION A high lactic acid previous to cardiac arrest could be a prognostic factor of in-hospital cardiac arrest in children.
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Affiliation(s)
- M Serrano
- Servicio de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón, Instituto de Investigación, Hospital General Universitario Gregorio Marañón, Madrid, Red de Salud Maternoinfantil y del Desarrollo (Red SAMID), Madrid, España
| | - J Rodríguez
- Servicio de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón, Instituto de Investigación, Hospital General Universitario Gregorio Marañón, Madrid, Red de Salud Maternoinfantil y del Desarrollo (Red SAMID), Madrid, España
| | - A Espejo
- Servicio de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón, Instituto de Investigación, Hospital General Universitario Gregorio Marañón, Madrid, Red de Salud Maternoinfantil y del Desarrollo (Red SAMID), Madrid, España
| | - R del Olmo
- Servicio de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón, Instituto de Investigación, Hospital General Universitario Gregorio Marañón, Madrid, Red de Salud Maternoinfantil y del Desarrollo (Red SAMID), Madrid, España
| | - S Llanos
- Servicio de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón, Instituto de Investigación, Hospital General Universitario Gregorio Marañón, Madrid, Red de Salud Maternoinfantil y del Desarrollo (Red SAMID), Madrid, España
| | - J Del Castillo
- Servicio de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón, Instituto de Investigación, Hospital General Universitario Gregorio Marañón, Madrid, Red de Salud Maternoinfantil y del Desarrollo (Red SAMID), Madrid, España
| | - J López-Herce
- Servicio de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón, Instituto de Investigación, Hospital General Universitario Gregorio Marañón, Madrid, Red de Salud Maternoinfantil y del Desarrollo (Red SAMID), Madrid, España.
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Fraga-Sastrías JM, Aguilera-Campos A, Barinagarrementería-Aldatz F, Ortíz-Mondragón C, Asensio-Lafuente E. [Prehospital cardiac resuscitation in Queretaro, Mexico. Report of 3 cases. Importance of an integral emergency medical care system]. Arch Cardiol Mex 2014; 84:79-83. [PMID: 24831432 DOI: 10.1016/j.acmx.2013.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Revised: 07/23/2013] [Accepted: 08/20/2013] [Indexed: 11/19/2022] Open
Abstract
In Mexico, out-of-hospital cardiac arrest is a health problem that represents 33,000 to 150,000 or more deaths per year. The few existent reports show mortality as high as 100% in contrast to some international reports that show higher survival rates. In Queretaro, during the last 5 years there were no successful resuscitation cases. However, in 2012 some patients were reported to have return of spontaneous circulation. We report in this article 3 cases with return of spontaneous circulation and pulse at arrival to the hospital. Two of the patients were discharged alive, one of them with poor cerebral performance category. Community cardiopulmonary resuscitation, early defibrillation and better emergency medical system response times, are related with survival. This poorly explored health problem in Queretaro could be increased with quality and good public education, bystander assisted cardiopulmonary resuscitation, police involvement in cardiopulmonary resuscitation and defibrillation, public access defibrillation programs and measurement of indicators and feedback for better results.
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Affiliation(s)
- Juan Manuel Fraga-Sastrías
- Dirección de Enseñanza e Investigación, Hospital Tec 100, Querétaro, México; Academia Mexicana de Medicina Prehospitalaria A.C., Querétaro, México.
| | | | | | | | - Enrique Asensio-Lafuente
- Academia Mexicana de Medicina Prehospitalaria A.C., Querétaro, México; División de Medicina Interna, Hospital Tec 100, Querétaro, México
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López-Herce J, del Castillo J, Cañadas S, Rodríguez-Núñez A, Carrillo A. In-hospital pediatric cardiac arrest in Spain. ACTA ACUST UNITED AC 2013; 67:189-95. [PMID: 24774393 DOI: 10.1016/j.rec.2013.07.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2013] [Accepted: 07/17/2013] [Indexed: 11/26/2022]
Abstract
INTRODUCTION AND OBJECTIVES The objective was to analyze the characteristics and prognostic factors of in-hospital pediatric cardiac arrest in Spain. METHODS A prospective observational study was performed to examine in-hospital pediatric cardiac arrest. Two hundred children were studied, aged between 1 month and 18 years, with in-hospital cardiac arrest. Univariate and multivariate logistic regression analyses were performed to assess the influence of each factor on survival to hospital discharge. RESULTS Return of spontaneous circulation was achieved in 74% of the patients and 41% survived to hospital discharge. The survival rate was significantly higher than that reported in a previous Spanish study 10 years earlier (25.9%). In the univariate analysis, the factors related to mortality were body weight higher than 10 kg; continuous infusion of vasoactive drugs prior to cardiac arrest; sepsis and neurological disorders as causes of cardiac arrest, the need for treatment with adrenaline, bicarbonate, and volume expansion, and prolonged cardiopulmonary resuscitation. In the multivariate analysis, the factors related to mortality were hematologic/oncologic diseases, continuous infusion of vasoactive drugs prior to cardiac arrest, cardiopulmonary resuscitation for more than 20 min, and treatment with bicarbonate and volume expansion. CONCLUSIONS Survival after in-hospital cardiac arrest in children has significantly improved in recent years. The factors related to in-hospital mortality were hematologic/oncologic diseases, continuous infusion of vasoactive drugs prior to cardiac arrest, the duration of cardiopulmonary resuscitation, and treatment with bicarbonate and volume expansion.
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Affiliation(s)
- Jesús López-Herce
- Servicio de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Instituto de Investigación del Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | - Jimena del Castillo
- Servicio de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Instituto de Investigación del Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Sonia Cañadas
- Sección de Cuidados Intensivos Pediátricos, Hospital Vall d'Hebron, Barcelona, Spain
| | - Antonio Rodríguez-Núñez
- Servicio de Cuidados Intensivos Pediátricos y Urgencias, Hospital Clínico Universitario de Santiago, Santiago de Compostela, A Coruña, Spain
| | - Angel Carrillo
- Servicio de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Instituto de Investigación del Hospital General Universitario Gregorio Marañón, Madrid, Spain
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