ABSTRACT
Objective To evaluate the effect of extracorporeal cardiopulmonary resuscitation (ECPR) and conventional cardiopulmonary resuscitation (CCPR) on survival and neurological function in adult patients with cardiac arrest.Methods The PubMed and Web of Science were searched to collect relevant literature from Jan 1980 to Nov 2015,and two reviewers strictly distinguished the studies,assessed the quality of studies and picked up the valuable data for statistical analysis by using RevMan 5.0.Results A total of 8 studies involving 27 18 patients were included in our review.Of them,462 patients were treated with ECPR and 2 256 patients were cared with CCPR.The meta analysis showed that the survival discharge rate (OR =2.92,95％ CI:2.24-3.81,P ＜ 0.01),long-term survival rate (OR =2.97,95％ CI:2.11-4.19,P＜0.01) and neurological function status (OR=3.50,95％CI:2.36-5.81,P＜ 0.01) of ECPR (n =182) were better than those of CCPR (n =182).In 4 studies,propensity score matching was used to minimize bias and heterogeneity.The meta analysis also showed that the rate of ROSC,survival discharge rate,long-term survival rate and neurological function status in ECPR were superior over CCPR.Conclusions ECPR would be the excellent measures to improve ROSC rate,survival discharge rate,long-term survival rate and neurological outcome in adult victims with cardiac arrest.
ABSTRACT
Las guías en Reanimación propuestas por la Sociedad Americana del Corazón enfatizan en la necesidad del correcto aprendizaje e implementación de las técnicas, habilidades y conocimientos en reanimación cardiocerebropulmonar básica como base fundamental y como determinante principal en las tasas de morbimortalidad de los pacientes que se presentan con paro cardiorrespiratorio. De igual manera plantea un verdadero reto para el personal lego y personal relacionado con el área de la salud que actúan como primeros respondientes en la atención de estos pacientes, y que hace necesario que se conozcan y se apliquen de manera optima los procedimientos propuestos por la Sociedad Americana del Corazón. Esto a su vez implica que este personal debe tener un adecuado entrenamiento para la adquisición de habilidades y destrezas correctas y además, que perduren en el tiempo, y es allí, donde la educación en reanimación juega un papel muy importante a través de la formación teórica y practica, mediante grupos operativos de trabajo que guíen el aprendizaje, y el uso de tecnología en simulación que permite la retroalimentación de los procedimientos aprendidos. Es indispensable entonces, el conocimiento y evaluación de las tasas de efectividad de los diferentes cursos en Reanimación diseñados, y de especial interés el ofrecido por el comité de Reanimación de la Sociedad Colombiana de Anestesiología y Reanimación en donde actualmente se lleva a cabo un estudio en investigación para determinar la efectividad en el aprendizaje e identificar las posibles debilidades que puedan mejorarse y ofrecer así educación de alta calidad .
The resuscitation guidelines proposed by the American Heart Association (AHA) emphasize the need for a proper learning and implementation of techniques, skills and knowledge regarding basic cerebral cardiopulmonary resuscitation as a fundamental basis and principal determinant of morbidity and mortality rates of patients presenting with cardio respiratory arrest. Likewise, the AHA`s guidelines state a truly challenge for the non expert (lego or non health care professional) persons and health care related workers, who are the first responders in the medical care process of these patients; this situation generates the need for the knowledge and optimal implementation of the procedures proposed by the American Heart Association. This in turn implies that these personnel must have adequate training to acquire correct skills and abilities, which endure over time, and it is there, where the education in resuscitation plays a very important role across the theoretical and practical training, working through task forces that guide the learning and the use of simulation technology that allows a feedback process of the procedures learned. It is essential then, the knowledge and assessment of the effectiveness rates in the different designed courses of Resuscitation, and the special interest offered by the committee of Resuscitation of the Colombian Society of Anesthesiology and Resuscitation where is currently carrying out a study of investigation to determine the effectiveness in learning and identifying the potential weaknesses that can be improved and so provide high quality education .