Nuevas áreas de vida ­ Revisión muerte súbita 2018 / New areas of life ­ Sudden death review 2018

Una de cada cinco muertes en adultos en países desarrollados se debe a causas cardiovasculares; la mitad de esas muertes se produce de forma súbita y un gran porcentaje en el ámbito extrahospitalario. Las medidas de prevención se dividen en: aquellas destinadas a prevenir en primer lugar que el evento de muerte súbita cardíaca suceda, y aquellas cuyo objetivo es actuar en el momento en que el evento de muerte súbita está sucediendo. Las primeras tienen como objetivo disminuir las principales causas de muerte súbita en países desarrollados: las cardiopatías estructurales (cuya principal causa es la enfermedad coronaria). En este sentido, con el fin de intentar paliar el desarrollo de una cardiopatía que predisponga a la aparición de arritmias fatales y la MSC, se implementan medidas de prevención primarias higiénico-dietéticas y farmacológicas (con el objetivo de disminuir y el controlar los factores de riesgo) y, en aquellos con enfermedad cardiovascular ya establecida, se implementan las estrategias secundarias farmacológicas y/o quirúrgicas (revascularización, reemplazo valvular, etc.). El segundo abordaje surge del hecho de que, a pesar de todas estas medidas, un gran número de pacientes presentará eventos arrítmicos en el ámbito extrahospitalario (MSCEH), ya sea porque aunque recibieron el tratamiento óptimo presentan aún un elevado riesgo de MSC, porque no fueron diagnosticados a tiempo o porque a pesar de haber hecho estudios complementarios el diagnóstico es muy dificultoso. Existen dos estrategias: la primera son los dispositivos de cardiodesfibrilación implantables (o, más recientes, los chalecos vestibles). Estos aparatos están indicados para una población seleccionada, sea por haber presentado ya un episodio de muerte súbita abortado, o por presentar una cardiopatía (estructural o genética) que predisponga a una mayor probabilidad de sufrir un evento. La segunda estrategia es la educación y el desarrollo de programas de salud pública que permitan capacitar a la población general en la realización de RCP y el uso de desfibriladores automáticos externos (DEAs), los cuales deberían estar disponibles en cualquier lugar público. Múltiples estudios demostraron que el acceso de la población general al aprendizaje de maniobras de RCP sencillas y pragmáticas y la presencia de DEAs se traduce en un gran aumento de sobrevida sin secuelas en víctimas de MSCEH. (AU)

One of every five deaths in adults is due to cardiovascular causes, in developed countries, and half of these deaths will occur suddenly. A large percentage occur in the out of hospital setting, so measures to prevent it are divided into: those designed to prevent, in the first place, the sudden cardiac death event from happening and those whose purpose is to act when the sudden death event that has already occurred and it´s ongoing. The first aims to reduce the main causes of sudden death in developed countries: structural heart disease (with coronary heart disease as its main cause). In this regard, with the purpose to mitigate the development of a heart disease that predisposes the occurrence of fatal arrhythmias and SCD, we have primary prevention measures, like healthy life style conduct with or without pharmacological treatment, (whose objective is the reduction and control of cardiovascular risk factors) and, in those with cardiovascular disease already established, there is an implementation of pharmacological and / or surgical strategies (Revascularization, valve replacement, etc.). The second objective arises from the fact that, despite all these preventive and therapeutic measures, a large number of patients will present out-of-hospital cardiac arrest (OHCA) either because although they received optimal treatment they still remain in high risk of SCD, even because they were not diagnosed on time, or because despite having complementary studies made the diagnosis is very difficult. There are two well strategies: the first are implantable cardio-defibrillation devices (or, more recently, wearable vests). These are indicated for a selected population, either because they have already presented an episode of sudden aborted death, or because they have heart disease (structural or genetic), which predisposes to a greater probability of suffering an event. The second strategy is the education and development of public health programs that enable the general population to be trained in CPR and the use of external automatic defibrillators. (AEDs) should be available in any public place. Multiple studies showed that access to the general population for learning simple and pragmatic CPR maneuvers and the presence of AEDs is making an impact on a significant increase in survival without consequences in OHCA victims. (AU)

Diagnosis and actual management of fatal arrhythmias in children / 中国小儿急救医学

Fatal arrhythmias are much less common in children than adults and the symptoms presented may be nonspecific.The critical rescue measures for these patients are to identify and appropriately manage the arrhythmias,since when left untreated,arrhythmias may lead to cardiopulmonary compromise and arrest.Most children with a fatal arrhythmia present to a emergency physician before being referred to a pediatric cardiologist for assessment and management.Thus,the emergency pediatricians have to be able to recognize the fatal arrhythmia and to provide the acute treatment.This article was intended to provide diagnostic and acute management measures of the common types of fatal arrhythmias seen in children.