Umbral crítico de administración en pacientes con trauma severo y reanimación endovascular: ¿Un concepto útil? / Critical Administration Threshold in severe trauma patients and endovascular resuscitation: A useful concept?

Introducción. Se describe la utilidad del umbral crítico de administración (CAT por su denominación en inglés) como herramienta para la reanimación hemostática en pacientes con trauma severo y oclusión endovascular aórtica. Métodos. Revisión retrospectiva de pacientes adultos con hemorragia por trauma, con o sin oclusión endovascular aórtica (REBOA), atendidos entre enero de 2015 y junio de 2020, en un centro de trauma nivel I en Cali, Colombia. Se registraron variables demográficas, severidad del trauma, estado clínico, requerimiento transfusional, tiempo hasta CAT+ y CAT alcanzado (1, 2 ó 3). Resultados. Se incluyeron 93 pacientes, se utilizó REBOA en 36 y manejo tradicional en 57. El grupo REBOA presentó mayor volumen de sangrado (mediana de 3000 ml, RIC: 1950-3625 ml) frente al grupo control (mediana de1500 ml, RIC: 700-2975ml) (p<0,001) y mayor cantidad de glóbulos rojos transfundidos en las primeras 6 horas (mediana de 5, RIC:4-9); p=0,015 y en las primeras 24 horas (mediana de 6, RIC: 4-11); p=0,005. No hubo diferencias estadísticamente significativas en número de pacientes CAT+ entre grupos o tiempo hasta alcanzarlo. Sin embargo, el estado CAT+ durante los primeros 30 minutos de la cirugía fue mayor en grupo REBOA (24/36, 66,7 %) frente al grupo control (17/57, 29,8 %; p=0,001), teniendo este mayor tasa de mortalidad intrahospitalaria frente a los pacientes CAT-. Conclusión. El umbral crítico de administración es una herramienta útil en la reanimación hemostática de pacientes con trauma y REBOA, que podría predecir mortalidad precoz.

Introduction. The objective is to describe the utility of the Critical Administration Threshold (CAT) as a tool in hemostatic resuscitation in patients with severe trauma and REBOA. Methods. Retrospective review between January 2015 and June 2020 of adult patients with hemorrhage secondary to trauma with or without REBOA in a level I trauma center in Cali, Colombia. Demographic variables, trauma severity, clinical status, transfusion needs, time to CAT+ and number of CAT achieved (1, 2 or 3) were recorded. Results. Ninety-three patients were included, in which REBOA was used in 36 and traditional management in 57. The REBOA group had a higher bleeding volume (3000 ml), IQR: 1950-3625 ml vs the control group (1500 ml, IQR: 700-2975 ml) (p<0.001) and a higher rate of PRBC units transfused in the first 6 hours (median 5, IQR: 4-9); p=0.015 and in the first 24 hours (median 6, IQR: 4-11); p=0.005. There were no statistically significant differences in the number of CAT+ patients between groups or time to CAT+. However, CAT+ status during the first 30 minutes of surgery was higher in the REBOA Group (24/36, 66.7%) vs. the control group (17/57, 29.8%; p=0.001), having this group a higher in-hospital mortality rate vs. CAT- patients. Conclusion. CAT is a useful tool in the hemostatic resuscitation of patients with trauma and REBOA that could predict early mortality.

Desenvolvimento de um design de telessimulação para o suporte básico de vida / Elaboración de un diseño de telesimulación para el soporte vital básico / Development of a telesimulation design for basic life support

Resumo Objetivo Construir e validar um design de telessimulação síncrona e observacional em enfermagem para o atendimento segundo o protocolo de suporte básico de vida intra-hospitalar no adulto. Métodos Estudo metodológico baseado nas fases do procedimento teórico realizado por meio de uma scoping review; fase empírica desenvolvida através da validação de conteúdo do design telessimulado e fase analítica em que adotou-se o índice de validade de conteúdo. Resultados Construiu-se um design para o atendimento segundo o protocolo de suporte básico de vida percorrendo seis etapas: o planejamento, preparação, participação, teledebriefing, avaliação e feedback e a aprendizagem adicional, com Índice de Validade de Conteúdo de 0,96. Conclusão O design desenvolvido foi considerado válido em conteúdo para planejar e executar a telessimulação pela enfermagem e ainda ser adaptado a outros contextos educacionais.

Resumen Objetivo Elaborar y validar un diseño de telesimulación sincrónica y observacional de enfermería para la atención de acuerdo con el protocolo de soporte vital básico intrahospitalario en adultos. Métodos Estudio metodológico basado en las fases del procedimiento teórico realizado por medio de una scoping review, fase empírica llevada cabo a través de la validación de contenido del diseño telesimulado y fase analítica en la que se adoptó el índice de validez de contenido. Resultados Se elaboró un diseño para la atención de acuerdo con el protocolo de soporte vital básico que atravesó seis etapas: planificación, preparación, participación, teledebriefing, evaluación y feedback y aprendizaje adicional, con un Índice de Validez de Contenido de 0,96. Conclusión El diseño elaborado fue considerado válido en contenido para planificar y ejecutar la telesimulación por parte de enfermeros y además puede adaptarse a otros contextos educativos.

Abstract Objective To construct and validate a synchronous and observational telesimulation design in nursing for care according to in-hospital basic life support protocol for adults. Methods A methodological study based on the phases of the theoretical procedure carried out through a scoping review; empirical phase developed through the telesimulated design content validity and analytical phase in which the content validity index was adopted. Results A care design was constructed according to the basic life support protocol, going through six steps: planning, preparation, participation, teledebriefing, assessment and feedback and additional learning, with a Content Validity Index of 0.96. Conclusion The developed design was considered valid in content to plan and execute telesimulation by nursing and still be adapted to other educational contexts.

Facteurs associés à la mortalité des urgences chirurgicales néonatales à Douala / Determinants of mortality of neonatal surgical emergencies in Douala

Introduction. Les urgences chirurgicales néonatales (UCN) se manifestent de la naissance au 28e jour de vieet nécéssitent un traitement chirurgical dans un délai court. L'objectif de ce travail est d'identifier les facteurs associés à la mortalité des UCN dans quatre hôpitaux de la ville de Douala.Méthodologie. Nous avons mené une étude transversale analytique avec collecte de données rétrospective sur une période de 10 ans, allant du 1er Janvier 2013 au 31 Décembre 2022 dans 4 hôpitaux de la ville de Douala à savoir: l'Hôpital Général, l'Hôpital Laquintinie, l'Hôpital Gynéco-obstétrique et pédiatrique de Yassa, et l'Hôpital Protestant de Ndogbati. Résultats.Laprévalence hospitalièredes urgences chirurgicales néonatalesétait de6,1%. La tranche d'âge la plus représentée était celle de 2 à 7 jours avec un sex-ratio de 1,7. La mortalité était de 48%avec une majorité de décès en post-opératoire (64,4%).Les déterminants de mortalité sur le plan sociodémographique étaient : l'âge à l'admission inférieur à 8 jours (OR= 1,95 ; P<0,001), le sexe masculin (OR=1,51 ; P=0,002); la moyenne prématurité (OR=0,91 ; P<0,001), le poids de naissance < 2500g (OR= 5,15 ; P=0,009), et le délai d'admission > 2 jours (OR=0,73 ; P<0,001). Sur le plan évolutif, les facteurs de mauvais pronostic étaient : les malformations anorectales (OR=2,23; P< 0,001), l'atrésie de l'œsophage (OR=3,63 ; P=0,001), la présence de complications post opératoires (OR= 3,45 ; P<0,001) et le sepsis (OR= 7,87; P=0,037).ConclusionLa mortalité post opératoire est très élevée. Les facteurs associés sont le long délai diagnostic, la prématurité, les pathologies malformatives digestives et le seps

Introduction.Neonatal surgical emergencies (NSE) occur from birth to the 28th day of life and require surgical treatment within a short timeframe. The objective of this study is to identify factors associated with mortality in NSE in four hospitals in the city of Douala. Methodology.We conducted a cross-sectional analytical study with retrospective data collection over a period of 10 years, from January 1st, 2013 to December 31st, 2022, in 4 hospitals in the city of Douala, namely: General Hospital, Laquintinie Hospital, Gynecological-Obstetric and Pediatric Hospital of Yassa, and Protestant Hospital of Ndogbati. Results.The hospital prevalence of neonatal surgical emergencies was 6.1%. The most represented age group was 2 to 7 days with a sex ratio of 1.7. The mortality rate was 48%, with a majority of deaths occurring in the post-operative period (64.4%). Sociodemographic determinants of mortality were: age at admission less than 8 days (OR=1.95; P<0.001), male sex (OR=1.51; P=0.002); moderate prematurity (OR=0.91; P<0.001), birth weight < 2500g (OR=5.15; P=0.009), and admission delay > 2 days (OR=0.73; P<0.001). In terms of progression, factors associated with poor prognosis were: anorectal malformations (OR=2.23; P<0.001), esophageal atresia (OR=3.63; P=0.001), presence of post-operative complications (OR=3.45; P<0.001), and sepsis (OR=7.87; P=0.037). Conclusion Post-operative mortality is very high. Associated factors include delayed diagnosis, prematurity, digestive malformative pathologies, and sepsis.

Construção e validação de cartilha educativa sobre suporte básico de vida para estudantes do ensino médio / Construction and validation of an educational booklet on basic life support for high school students / Construcción y validación de carpeta educativa sobre soporte vital básico para estudiantes de secundaria

O objetivo deste estudo é construir e validar uma cartilha educativa para estudantes do ensino médio sobre Suporte Básico de Vida nas escolas. Trata-se de uma pesquisa metodológica, realizada em três etapas. Na primeira etapa foi realizada revisão bibliográfica, na segunda etapa procedeu-se a elaboração da cartilha educativa e por fim, a validação do material por especialistas. Entre os resultados destaca-se que a cartilha aborda as principais recomendações acerca da segurança do socorrista e suporte básico de vida no adulto e possui 14 páginas. Conclui-se que todos os itens da cartilha educativa obtiveram índice de validade de conteúdo maior que 0,82 conseguindo a validação.

The objective of this study is to build and validate an educational booklet for high school students about Basic Life Support in schools. This is a methodological research, carried out in three stages. In the first stage, a bibliographic review was carried out, in the second stage, the educational booklet was elaborated and, finally, the material was validated by specialists in the subject. Among the results, it is highlighted that the booklet addresses the main recommendations regarding rescuer safety and basic adult life support and has 14 pages. It was concluded that all items in the educational booklet had a content validity index greater than 0.82, achieving validation.

El objetivo de este estudio es construir y validar una cartilla educativa para estudiantes de secundaria sobre Soporte Vital Básico en las escuelas. Se trata de una investigación metodológica, realizada en tres etapas. En la primera etapa se realizó una revisión bibliográfica, en la segunda etapa se elaboró la cartilla educativa y, finalmente, el material fue validado por especialistas en el tema. Entre los resultados, se destaca que la cartilla aborda las principales recomendaciones sobre seguridad del reanimador y soporte vital básico del adulto y tiene 14 páginas. Se concluyó que todos los ítems de la cartilla educativa tuvieron un índice de validez de contenido superior a 0,82, lográndose la validación.

Development validation and evaluation of the knowledge test on cardiopulmonary resuscitation and correct use of the automated external defibrillator in Asunción 2023

Introduction: in out-of-hospital cardiac arrest, early and efficient intervention through cardiopulmonary resuscitation (CPR) maneuvers and the use of the automated external defibrillator (AED) are the cornerstone for survival. Instruments that improve education would increase the responsiveness of lay personnel. Objectives: to develop, validate and evaluate a knowledge test on cardiopulmonary resuscitation and correct use of the automated external defibrillator in Asunción during 2023. Methodology: observational cross-sectional study, non-probabilistic sample for convenience of lay personnel users of mass attendance centers in Asunción. An exclusive questionnaire was developed on knowledge in cardiopulmonary resuscitation and the use of the automated external defibrillator (KOR-AED) based on the chain of survival in out-of-hospital cardiac arrest. Content, construct, and internal consistency were validated using expert opinion, factor analysis and Cronbach's alpha. Results: a total of 200 lay people participated, mostly shopping mall customers, with a predominance of men (63.5 %) (127), between 25-29 years old 28.5% (57). 61.5 % (123) had a university education, 75.5 % (151) had not related to health, 52 % (104) had prior knowledge of CPR, but 81.5 % (163) did not. The test showed reliability and suitability for factor analysis (Cronbach's alpha 0.75, Kaiser-Meyers-Olkin; 0.78, Bartlett p<0.05). The questions covered the first three links in the chain of survival, with items of medium to high difficulty. Women performed significantly better (p=0.04). Conclusion: the KOR-AED test is a valid and reliable instrument to improve the education of the layperson in CPR and use of the AED based on the chain of survival.

Introducción: en la parada cardíaca extrahospitalaria la actuación precoz y eficiente mediante maniobras de reanimación cardiopulmonar (RCP) y uso del desfibrilador externo automático (DEA) constituyen la piedra angular para la supervivencia. Instrumentos que mejoren la educación aumentarían la respuesta del personal lego. Objetivos: desarrollar, validar y evaluar una prueba de conocimientos sobre reanimación cardiopulmonar y uso correcto del desfibrilador externo automático en Asunción durante el 2023. Metodología: estudio observacional corte transversal, muestro no probabilístico por conveniencia de personal lego usuarios de centros de concurrencia masiva de Asunción. Se desarrolló un cuestionario exclusivo sobre conocimientos en reanimación cardiopulmonar y uso del desfibrilador externo automático (COR-DEA) basado en la cadena de supervivencia en parada cardíaca extrahospitalaria. Se validó el contenido, el constructo y la consistencia interna mediante la opinión de experto, análisis de factores y el alfa de Cronbach. Resultados: participaron 200 legos mayormente clientes de shoppings, predominando hombres 63,5 % (127) entre 25-29 años 28,5 % (57). Con educación universitaria 61,5 % (123), no relacionados con la salud 75,5 % (151), con conocimientos previos en RCP 52 % (104), pero no en DEA 81,5 % (163). El test mostró fiabilidad y adecuación para análisis factorial (Alfa de Cronbach 0.75, Kaiser-Meyers-Olkin; 0.78, Bartlett p<0.05). Las preguntas abarcarón los tres primeros eslabones de la cadena de supervivencia, con ítems de dificultad media a alta. Las mujeres tuvieron significativamente mejor desempeñó (p=0.04). Conclusión: la prueba COR-DEA es un instrumento válido y fiable para mejorar la educación del lego en RCP y uso del DEA basado en la cadena de supervivencia.

Development validation and evaluation of the knowledge test on cardiopulmonary resuscitation and correct use of the automated external defibrillator in Asunción 2023 / Desarrollo validación y evaluación de la prueba de conocimientos sobre reanimación cardiopulmonar y uso correcto del desfibrilador externo automático en Asunción 2023

Introduction: in out-of-hospital cardiac arrest, early and efficient intervention through cardiopulmonary resuscitation (CPR) maneuvers and the use of the automated external defibrillator (AED) are the cornerstone for survival. Instruments that improve education would increase the responsiveness of lay personnel. Objectives: to develop, validate and evaluate a knowledge test on cardiopulmonary resuscitation and correct use of the automated external defibrillator in Asunción during 2023. Methodology: observational cross-sectional study, non-probabilistic sample for convenience of lay personnel users of mass attendance centers in Asunción. An exclusive questionnaire was developed on knowledge in cardiopulmonary resuscitation and the use of the automated external defibrillator (KOR-AED) based on the chain of survival in out-of-hospital cardiac arrest. Content, construct, and internal consistency were validated using expert opinion, factor analysis and Cronbach's alpha. Results: a total of 200 lay people participated, mostly shopping mall customers, with a predominance of men (63.5 %) (127), between 25-29 years old 28.5% (57). 61.5 % (123) had a university education, 75.5 % (151) had not related to health, 52 % (104) had prior knowledge of CPR, but 81.5 % (163) did not. The test showed reliability and suitability for factor analysis (Cronbach's alpha 0.75, Kaiser-Meyers-Olkin; 0.78, Bartlett p<0.05). The questions covered the first three links in the chain of survival, with items of medium to high difficulty. Women performed significantly better (p=0.04). Conclusion: the KOR-AED test is a valid and reliable instrument to improve the education of the layperson in CPR and use of the AED based on the chain of survival.

Introducción: en la parada cardíaca extrahospitalaria la actuación precoz y eficiente mediante maniobras de reanimación cardiopulmonar (RCP) y uso del desfibrilador externo automático (DEA) constituyen la piedra angular para la supervivencia. Instrumentos que mejoren la educación aumentarían la respuesta del personal lego. Objetivos: desarrollar, validar y evaluar una prueba de conocimientos sobre reanimación cardiopulmonar y uso correcto del desfibrilador externo automático en Asunción durante el 2023. Metodología: estudio observacional corte transversal, muestro no probabilístico por conveniencia de personal lego usuarios de centros de concurrencia masiva de Asunción. Se desarrolló un cuestionario exclusivo sobre conocimientos en reanimación cardiopulmonar y uso del desfibrilador externo automático (COR-DEA) basado en la cadena de supervivencia en parada cardíaca extrahospitalaria. Se validó el contenido, el constructo y la consistencia interna mediante la opinión de experto, análisis de factores y el alfa de Cronbach. Resultados: participaron 200 legos mayormente clientes de shoppings, predominando hombres 63,5 % (127) entre 25-29 años 28,5 % (57). Con educación universitaria 61,5 % (123), no relacionados con la salud 75,5 % (151), con conocimientos previos en RCP 52 % (104), pero no en DEA 81,5 % (163). El test mostró fiabilidad y adecuación para análisis factorial (Alfa de Cronbach 0.75, Kaiser-Meyers-Olkin; 0.78, Bartlett p<0.05). Las preguntas abarcarón los tres primeros eslabones de la cadena de supervivencia, con ítems de dificultad media a alta. Las mujeres tuvieron significativamente mejor desempeñó (p=0.04). Conclusión: la prueba COR-DEA es un instrumento válido y fiable para mejorar la educación del lego en RCP y uso del DEA basado en la cadena de supervivencia.

EFFECTIVENESS OF SIMULATION BASED TEACHING PROGRAM ON KNOWLEDGE AND SKILL REGARDING BASIC NEONATAL RESUSCITATION PROCEDURES AMONG FEMALE HEALTH WORKERS OF SELECTED AREAS: A STUDY PROTOCOL

Background Of The Study: Worldwide, 136 million babies are born annually. 10 million require some stimulation at birth to breathe, while 6 million require basic resuscitation with a bag and mask. Evidence shows that 1 million neonatal deaths occur yearly on the day of birth. Near about 2 million babies die in the rst week of life and 4 million die in the neonatal period, which accounts for 46% of under-ve mortality. This mortality is estimated to increase to 52% in 2030 unless strategic interventions are implemented. To assess the effect of a simulation-based teaching Objective: program on knowledge and skill regarding basic neonatal resuscitation procedures among female health workers of selected areas. Pre-experimental one group pre-test post-test research design will be used. The duration of the study will Methodology: be one month. 60 female health workers from selected primary health centres and sub-health centres of Nagpur district will be selected as a sample through the simple random sampling technique. The structured questionnaire and standardized observational checklist will be used to assess the knowledge and skill respectively. Validity and reliability of the tool will be determined with appropriate standardized methods. Enhance knowledge and skill after simulation-based Expected Result: teaching program. Female health workers working in primary health centres and sub-health centres of Nagpur Limitation: district will be included in this study. The study ndings will reect the need for simulation based education to Conclusion: enhance the knowledge and skill of female health workers to identify birth asphyxia and its potential complications leading to neonatal mortality during the rst few hours after birth.

Avaliação da eficiência dos diferentes métodos de ensino de ressuscitação cardiopulmonar para crianças e adolescentes: revisão integrativa / Evaluation of the efficiency of the different methods of teaching cardiopulmonary resuscitation to children and adolescents: integrative review

Objetivo: Avaliar a eficiência dos diferentes métodos de ensino de Suporte Básico de Vida (SBV) para estudantes leigos a partir dos 12 anos de idade. Métodos: Realizou-se busca por artigos nas plataformas MEDLINE/PubMed e Lilacs/BVS, entre dezembro de 2021 e janeiro de 2022, para responder à questão norteadora "Qual a efetividade dos diferentes métodos de ensino de ressuscitação cardiopulmonar para crianças e adolescentes?". Incluíram-se artigos publicados nos últimos cinco anos, nos idiomas inglês e português. Resultados: Sete artigos abordaram os métodos de ensino: aprendizagem autorregulada, treinamento dos professores seguido dos estudantes, educação em pares; ensino online associado ao autotreinamento prático, ensino à distância, treinamento digital somado à prática, e uso de aplicativo por meio de um tabletcom posterior avaliação. Em todos os estudos houve comparação da intervenção com o treinamento convencional. De forma geral, todos os métodos de ensino contribuíram para desenvolver a habilidade de agir em situações de trauma, mas as estratégias que envolviam a presença de instrutores nos treinamentos mostraram melhores resultados, a curto e longo prazo. Conclusão: O presente estudo verificou os achados na literatura a respeito da eficácia de diferentes métodos de ensino de SBV para crianças e adolescentes. Dentre todas as abordagens observou-se melhor desempenho nos métodos que contaram com a presença de instrutores, os quais ofertaram feedback aos alunos e diminuíram as distrações. Porém, o ensino digital, o autorregulado e o aos pares também se mostraram viáveis. Logo, a escolha do método deve se pautar na realidade do público-alvo

Objective: To evaluate the efficiency of different teaching methods of Basic Life Support for lay students from 12 years of age.Methods: A search was carried out for articles on the MEDLINE/PubMed and Lilacs/BVS platforms between December 2021 and January 2022 to answer the guiding question, "How effective are the different teaching methods of cardiopulmonary resuscitation for children and adolescents?".Articles published in English and Portuguese in the last five years were included.Results: Seven articles addressed teaching methods: self-regulated learning, training of teachers followed by students, peer education, online teaching associated with practical self-training, distance learning, digital training added to practice, and application use through a tablet with subsequent evaluation.In all studies, there was a comparison between intervention and conventional training.Generally, all teaching methods contributed to developing the ability to act in trauma situations, but strategies that involved the presence of instructors in training showed better short- and long-term results.Conclusion: this study verified the findings in the literature regarding the effectiveness of different BLS teaching methods for children and adolescents.Among all approaches, better performance was observed in methods that had the presence of instructors, who offered feedback to students and reduced distractions. However, digital, self-r egulated, and peer teaching also proved viable.Therefore, the choice of method should be based on the target audience's reality

Validação de ferramentas pedagógicas: subsídio para o ensino híbrido da ressuscitação cardiopulmonar neonatal / Validación de herramientas pedagógicas: subsidio para la enseñanza híbrida de reanimación cardiopulmonar neonatal / Validation of pedagogical tools: subsidy for hybrid teaching of neonatal cardiopulmonary resuscitation

Objetivo: desenvolver e validar instrumentos de aprendizagem e avaliação voltados para o ensino híbrido da ressuscitação cardiopulmonar neonatal. Métodos: pesquisa aplicada, de produção tecnológica e validação de ferramentas pedagógicas com 13 experts por meio de First-order Agreement Coefficient. Resultados: desenvolveu-se o script e storyboard de uma videoaula com cinco módulos e um vídeo de simulação sobre um cenário clínico de atendimento da ressuscitação cardiopulmonar neonatal, além de um questionário de vinte perguntas para avaliação do conhecimento cognitivo e um Exame Clínico Objetivo Estruturado com cinco estações para análise das habilidades psicomotoras. Todos os constructos obtiveram índice de concordância interavaliadores quase perfeita. Conclusão: esta pesquisa disponibilizou ferramentas pedagógicas validadas e fundamentadas em evidências científicas sobre a ressuscitação cardiopulmonar neonatal que sustentam o ensino híbrido e adoção da simulação clínica baseada em vídeo

Objective: To develop and validate learning and assessment tools for hybrid teaching of neonatal cardiopulmonary resuscitation. Method: An applied research for technological production and validation of pedagogical tools was conducted with 13 experts using First-order Agreement Coefficient. Results: A script and storyboard for a five-module video class and a simulation video on a clinical scenario of neonatal cardiopulmonary resuscitation care were developed, as well as a twenty-question questionnaire to assess cognitive knowledge and a five-station Clinical Examination Objective Structured to analyze psychomotor skills. All constructs had an almost perfect inter-rater agreement index. Conclusion: This study provides evidence-based validated pedagogical tools for neonatal cardiopulmonary resuscitation, which support hybrid teaching and the adoption of video-based clinical simulation.

Objetivo: desarrollar y validar herramientas de aprendizaje y evaluación dirigidas a la enseñanza híbrida de la reanimación cardiopulmonar neonatal. Métodos: investigación aplicada, de producción tecnológica y validación de herramientas pedagógicas con 13 expertos mediante el First-order Agreement Coefficient. Resultados: se desarrolló un guion y storyboard para una clase de video con cinco módulos y un video de simulación sobre un escenario de reanimación cardiopulmonar neonatal, un cuestionario de veinte preguntas para el conocimiento cognitivo y un Examen Clínico Estructurado con cinco estaciones para el análisis de las habilidades psicomotoras. Los constructos tenían un índice de acuerdo entre evaluadores casi perfecto. Conclusión: esta investigación permite disponer de herramientas pedagógicas validadas y basadas en evidencia científica sobre la reanimación cardiopulmonar neonatal, que apoyan enseñanza híbrida y adopción de simulación clínica basada en video.

Advances in Shock Management and Fluid Resuscitation in Children

Shock in children is associated with signifcant mortality and morbidity, particularly in resource-limited settings. The principles of management include early recognition, fuid resuscitation, appropriate inotropes, antibiotic therapy in sepsis, supportive therapy for organ dysfunction, and regular hemodynamic monitoring. During the past decade, each step has undergone several changes and evolved as evidence that has been translated into recommendations and practice. There is a paradigm shift from protocolized-based care to personalized management, from liberal strategies to restrictive strategies in terms of fuids, blood transfusion, ventilation, and antibiotics, and from clinical monitoring to multimodal monitoring using bedside technologies. However, uncertainties are still prevailing in terms of the volume of fuids, use of steroids, and use of extracorporeal and newer therapies while managing shock. These changes have been summarized along with evidence in this article with the aim of adopting an evidence-based approach while managing children with shock.

Construção e validação de cenário clínico e checklist para avaliação de competências na reanimação cardiopulmonar / Construction and validation of a clinical scenario and checklist for assessing cardiopulmonary resuscitation skills / Construcción y validación de un escenario clínico y lista de control para evaluar las competencias en reanimación cardiopulmonar

RESUMO Objetivos: construir e validar cenário simulado e checklist para avaliação de habilidades no atendimento do paciente hemodinamicamente instável com evolução à Parada Cardiorrespiratória; e testar aplicabilidade à população-alvo, avaliando habilidades e satisfação/autoconfiança com a aprendizagem. Método: estudo metodológico realizado em três etapas (desenvolvimento do cenário e checklist, validação por juízes e teste-piloto) no período entre abril de 2020 e setembro de 2021, no estado de Minas Gerais, Brasil. Participaram 14 juízes e 24 estudantes de enfermagem. Resultados: o cenário e checklist alcançaram Coeficiente de Validade de Conteúdo superior a 90. As habilidades foram desenvolvidas adequadamente, com média 4,71 ± 0,24 na escala de satisfação-autoconfiança, e 4,83 ± 0,25 para design da simulação. Conclusão: o cenário poderá contribuir para: aperfeiçoar as atividades educativas na graduação e educação em saúde; e subsidiar estudos futuros, a fim de ampliar a qualidade do atendimento e da assistência ao paciente hemodinamicamente instável com evolução à parada cardiorrespiratória.

ABSTRACT Objectives: to build and validate a simulated scenario and checklist to assess skills in the care of hemodynamically unstable patients with evolution to Cardiorespiratory Arrest, and to test applicability to the target population, assessing skills and satisfaction/self-confidence with learning. Method: methodological study carried out in three stages (development of the scenario and checklist, validation by judges and pilot test) between April 2020 and September 2021, in the state of Minas Gerais, Brazil. Fourteen judges and 24 nursing students participated. Results: the scenario and checklist achieved a Content Validity Coefficient greater than 90. The skills were adequately developed, with a mean of 4.71 ± 0.24 on the satisfaction-self-confidence scale, and 4.83 ± 0.25 for simulation design. Conclusion: The scenario may contribute to improving educational activities in undergraduate and health education and subsidize future studies to increase the quality of care and assistance to hemodynamically unstable patients with evolution to cardiac arrest.

RESUMEN Objetivos: construir y validar un escenario simulado y una lista de verificación para evaluar las habilidades en la atención de pacientes hemodinámicamente inestables con evolución a Parada Cardiorrespiratoria; y probar la aplicabilidad a la población objetivo, evaluando las habilidades y la satisfacción/autoconfianza con el aprendizaje. Método: estudio metodológico realizado en tres etapas (desarrollo del escenario y lista de verificación, validación por jueces y prueba piloto) entre abril de 2020 y septiembre de 2021, en el estado de Minas Gerais, Brasil. Participaron 14 jueces y 24 estudiantes de enfermería. Resultados: el escenario y la lista de verificación alcanzaron un Coeficiente de Validez de Contenido superior a 90. Las habilidades se desarrollaron adecuadamente, con una media de 4,71 ± 0,24 en la escala de satisfacción-autoconfianza, y de 4,83 ± 0,25 para el diseño de la simulación. Conclusión: el escenario puede contribuir a: mejorar las actividades educativas de pregrado y formación sanitaria; y subvencionar futuros estudios para aumentar la calidad de la atención y asistencia a pacientes hemodinámicamente inestables con evolución a parada cardiaca.

Características de la atención médica durante la reanimación cardio-pulmo-cerebral intrahospitalaria

Fundamento: la reanimación cardiopulmocerebral es el conjunto de maniobras para asegurar la oxigenación de los órganos cuando la circulación de la sangre se detiene. La reanimación cardiopulmocerebral intrahospitalaria es una intervención que salva vidas. Objetivo: caracterizar la atención médica durante la reanimación cardiopulmocerebral en pacientes que presentan parada cardiaca dentro del Hospital General Universitario Dr. Gustavo Aldereguía Lima de Cienfuegos. Método se realizó un estudio descriptivo, transversal en las cinco unidades de cuidados intensivos de la Vicedirección de Urgencias, entre enero hasta junio del 2020. Se estudiaron 152 pacientes que realizaron un paro cardiorespiratorio. Se estudiaron las variables relacionadas con el paciente, los síntomas y signos previos al PCR presentados por los pacientes así como signos vitales. Resultados la media de edad fue de 62,66 años, en el 54,6 % predominó el sexo masculino. La hipertensión arterial fue la comorbilidad más frecuente con un 60,5 %. El 32,9 % tuvo un tiempo de estadía previo al evento de más de 72 horas. En orden de frecuencia los signos o síntomas previos al evento de PCR con más presencia fueron: bradicardia (32,2 %); pulsos débiles (15,1 %); inconciencia (12,5 %) y cianosis con 10,5 %. El servicio de mayor de ocurrencia fue la Unidad de Cuidados Intensivos Clínica. La asistolia constituyó el ritmo eléctrico inicial más común (57,9 %). En el 100 % de los casos se realizó manejo avanzado de la vía aérea con tubo endotraqueal. La desfibrilación estuvo indicada en 42 pacientes donde el 15,1 % de estos recibió la primera desfibrilación en menos de 5 minutos. La causa de la suspensión de la reanimación en 95 de los pacientes estudiados fue el fallecimiento. Conclusiones: la atención médica ante el paro cardiorrespiratorio debe seguir perfeccionándose, a través de la superación del personal sanitario y el desarrollo de acciones organizativas hacia el proceso de reanimación cardiopulmocerebral intrahospitalaria.

Background: cardiopulmonary-cerebral resuscitation is the set of maneuvers to ensure oxygenation of organs when blood circulation stops. In-hospital cardiopulmonary-cerebral resuscitation is a life-saving intervention. Objective: to characterize medical care during cardiopulmonary-cerebral resuscitation in patients with cardiac arrest at the Dr. Gustavo Aldereguía Lima University General Hospital in Cienfuegos. Method: a descriptive, cross-sectional study was carried out in the five intensive care units of the Emergency Department, from January to June 2020. 152 patients who suffered cardiorespiratory arrest were studied. The variables related to the patient, the symptoms and signs presented by the patients prior to the PCR, as well as vital signs, were studied. Results: the average age was 62.66 years, in 54.6% the male sex predominated. Arterial hypertension was the most frequent comorbidity with 60.5%. 32.9% had a length of stay prior to the event of more than 72 hours. In order of frequency, the most prevalent signs or symptoms prior to the PCR event were: bradycardia (32.2%); weak pulses (15.1%); unconsciousness (12.5%) and cyanosis with 10.5%. The service with the highest occurrence was the Clinical Intensive Care Unit. Asystole was the most common initial electrical rhythm (57.9%). In 100% of the cases, advanced airway management was performed with an endotracheal tube. Defibrillation was indicated in 42 patients where 15.1% of these received the first defibrillation in less than 5 minutes. The cause of suspension of resuscitation in 95 of the patients studied was death. Conclusions: medical care in the face of cardiorespiratory arrest must continue to be improved, through the improvement of health personnel and the development of organizational actions towards the process of intrahospital cardiopulmonary-cerebral resuscitation.

Tecnologias educacionais sobre suporte básico de vida para adolescentes: protocolo de scoping review / Educational technologies on basic life support for adolescents: scoping review protocol

OBJETIVO: mapear as produções sobre tecnologias educacionais construídas para ensinar suporte básico de vida para adolescentes. MÉTODO: Protocolo de revisão de escopo conduzido a partir da metodologia do Joanna Briggs Institute. Os achados serão reportados utilizando a extensão do checklist Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. O protocolo está na Open Science Framework. A questão norteadora foi elaborada com base no mnemônico PCC: População (adolescentes), Conceito (tecnologias educacionais) e Contexto (suporte básico de vida). Serão utilizadas três bases via Biblioteca Virtual em Saúde e quatro bases via Portal de Periódicos da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior. Dois revisores independentes selecionarão os artigos usando os programas EndNote® e Rayyan®, obedecendo critérios de elegibilidade. O Google Scholar e as referências dos estudos primários serão consultados como estratégias adicionais. Os resultados serão apresentados em quadros, fluxograma e discussão narrativa.

OBJECTIVE: to map the productions about educational technologies built to teach basic life support for adolescents. METHOD: Scope review protocol conducted based on the Joanna Briggs Institute methodology. Findings will be reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist extension. The protocol is in the Open Science Framework. The guiding question was elaborated based on the PCC acronym: Population (adolescents), Concept (educational technologies) and Context (basic life support). Three databases will be used via Virtual Health Library and four databases via the Journal Portal of the Coordination for the Improvement of Higher Education Personnel. Two independent reviewers will select the articles using the EndNote® and Rayyan® programs, obeying eligibility criteria. Google Scholar and references from primary studies will be consulted as additional strategies. The results will be presented in tables, flowchart and narrative discussion.

Research progress in complications and their prevention and treatment strategies during extracorporeal membrane oxygenation support for severe trauma / 中华创伤杂志

Extracorporeal membrane oxygenation (ECMO) is a technique in which breathing and circulation are supported extracorporeally. Severe trauma may induce cardiopulmonary failure, for which ECMO can play an adjunctive role in the salvage treatment of circulatory and respiratory failure when conventional treatments are ineffective. Bypass with ECMO can rapidly improve the state such as circulatory failure and hypoxemia in critically ill patients in short term and can partially or fully replace their cardiopulmonary function in long term, winning valuable time for normal recovery of cardiopulmonary function. Because of the physical state of severe trauma patients and the ECMO equipment, there are still various complications clinically. Trauma patients show high risk of bleeding, vulnerability to wound infection and probability of combined organ injury and dysfunction, so more comprehensive measures for the prevention and treatment of complications during the use of ECMO therapy are required. The authors review the research progress in complications and corresponding prevention and treatment strategies during ECMO support for severe trauma, aiming to provide a reference to prevent and treat these complications.

Characteristics and resuscitation effects of out-of-hospital sudden death: a study based on Internet data / 中华危重病急救医学

Objective:To collect the Internet news about "sudden death", analyze its characteristics and resuscitation effects, so as to provide reference for formulating intervention strategies.Methods:The Internet was used to search for "sudden death" and "cardiac arrest" on "Baidu" and "360" websites. Reports of sudden death events were collected from January 2013 to December 2022. The age, gender, characteristics of sudden death, implementation characteristics of cardiopulmonary resuscitation (CPR), and pre-hospital and final clinical outcomes of sudden death patients were recorded and analyzed. Subgroup analyses were performed for pre-hospital and final clinical outcomes. Unconditional multivariate Logistic regression analysis was used to screen the related factors affecting the pre-hospital and final clinical outcomes in patients with sudden death.Results:177 news reports were finally confirmed, involving 177 sudden death patients, including 152 males (85.9%) and 25 females (14.1%), aged (37.27±16.82) years old, and 53.1% in the 16-45 years old group. Triggering factors included strenuous exercise (29.9%), heart disease history (7.9%), overwork (6.2%), staying up late and insomnia (4.0%), activation of emotion (2.8%), and no obvious inducement (48.0%). After on-site first aid, 104 cases (58.8%) achieved restoration of spontaneous circulation (ROSC) before hospital admission, and 18 cases (10.2%) recovered consciousness. After clinical treatment, 109 cases (61.6%) achieved ROSC, 86 cases (48.6%) recovered consciousness, and 22 cases (12.4%) did not report the final outcome. Subgroup analysis showed that compared with patients who achieved pre-hospital ROSC ( n = 104), sudden death in non-ROSC patients ( n = 73) mainly occurred during sleep, in residence and without immediate CPR, full CPR, or automated external defibrillator (AED); and patients who ultimately did not recover consciousness clinically ( n = 91) showed similar characteristics compared with patients who recovered consciousness ( n = 86). Multifactorial Logistic regression analysis showed that immediate CPR [pre-hospital ROSC: odds ratio ( OR) = 8.06, 95% confidence interval (95% CI) was 2.36-27.46; final recovery of consciousness: OR = 9.10, 95% CI was 2.46-33.68] and AED defibrillation (pre-hospital ROSC: OR = 36.31, 95% CI was 4.53-291.19; final recovery of consciousness: OR = 3.53, 95% CI was 1.45-8.61) facilitated pre-hospital achievement of sudden death patients ROSC and final recovery of consciousness. Conclusions:Out-of-hospital sudden death mainly occurs in young people, and vigorous exercise is one of the potential factors for out-of-hospital sudden death, with nearly half having no obvious cause. Immediate and rapid CPR and defibrillation are the simplest and most effective on-site first aid methods. Strengthening public CPR and defibrillation education and training, and advocating healthy lifestyle are effective ways to improve the survival rate of sudden death and reduce the occurrence of sudden death. Based on practical clinical rescue experience, the implementation of bystander CPR by medical personnel is also a factor that cannot be ignored in affecting the clinical outcomes of sudden death patients.

Development and application of an smart emergency respirator with open airway / 中华危重病急救医学

To solve the problems of insufficient airway opening, insufficient or excessive ventilation, ventilation interruption, and the rescuer's physical strength during the process of cardiopulmonary resuscitation (CPR) outside the hospital and in the hospital, and to ensure the accuracy of ventilation frequency rate and tidal volume. Zhongnan Hospital and School of Nursing, Wuhan University, jointly designed and developed a smart emergency respirator with open airway function, that has been granted National Utility Model Patent of China (ZL 2021 2 1557989.8). The device is structured of pillow, pneumatic booster pump and mask. It can be used simply by plugging the pillow under the patient's head and shoulder, turning on the power supply and wearing the mask. The smart emergency respirator can quickly and effectively open the patient's airway and give accurate ventilation with adjustable ventilation parameters. The default settings are 10 times/min in respiratory rate and 500 mL in tidal volume. The whole operation does not require the operator have professional operation ability, which can be independently applied used in any cases without oxygen source or power supply, therefore, the application scenario has no limit. The device has the advantages of small size, simple operation and low production cost, which can reduce human source, save physical strength and significantly improve the quality of CPR. The device is suitable for respiratory support in multiple scenes outside and inside the hospital, and can significantly improve the success rate of treatment.

Chinese consensus of cardiopulmonary resuscitation guides prevention, treatment and rescue of cardiac arrest in pregnancy / 中华危重病急救医学

Pregnant women are a group of people in a special period, once sudden cardiac arrest (CA) occurs, it will threaten the life of both mother and child. It has become a great challenge for hospital, doctors and nurses to minimize maternal mortality during pregnancy. All the efforts should ensure the safety of both mother and child throughout the perinatal period. Because difference of the cardiopulmonary resuscitation strategies for common CA patients of the same age, the resuscitation strategies for CA patients during pregnancy need consider the patient's gestational age and fetal condition. Different resuscitation techniques, such as manual left uterine displacement (MLUD), will involve perimortem cesarean delivery (PMCD). At the same time, drugs should be reasonably used for different causes of CA during pregnancy, such as hypoxemia, hypovolemia, hyperkalemia or hypokalemia and other electrolyte disorders and hypothermia in 4Hs, as well as thrombosis, pericardial tamponade, tension pneumothorax and toxicosis in 4Ts. In view of the fact that many causes of CA in pregnancy are preventable, it is more necessary to introduce guidelines for CA in pregnancy in line with our national conditions for clinical guidance. This paper systematically reviewed the pathophysiological characteristics of CA during pregnancy, the high-risk factors of CA during pregnancy, and identified the correct resuscitation methods and prevention and treatment strategies of CA during pregnancy.

Relationship between arterial blood partial pressure of carbon dioxide and prognosis of neurological function after cardiopulmonary resuscitation / 中国基层医药

Objective:To investigate the relationship between arterial blood partial pressure of carbon dioxide and neurological outcome after cardiopulmonary resuscitation.Methods:The clinical data of 116 patients who underwent cardiopulmonary resuscitation admitted to the Intensive Care Unit and Emergency Department of the Second People's Hospital of Hefei from January 2018 to January 2020 were retrospectively analyzed. According to the average arterial blood partial pressure of carbon dioxide within 24 hours after admission, patients were divided into normal (35 mmHg ≤ PaCO 2 ≤ 55 mmHg, 1 mmHg = 0.133 kPa, n = 44), hypercapnia (PaCO 2 > 55 mmHg, n = 51), and hypocapnia (PaCO 2 < 35 mmHg, n = 21) groups. ICU stay, in-hospital mortality, and neurological outcome at discharge were compared among groups. A logistic regression analysis model was established. The relationship between PaCO 2 and neurological outcome was determined. Results:There were no significant differences in age, sex, cardiac arrest time, acute physiological and chronic health evaluation II score at admission, 1-hour mean arterial pressure, location of cardiac arrest, and initial heart rhythm among the three groups (all P > 0.05). ICU stay in the normal group [(7.23 ± 2.55) days] was significantly higher than that in the hypercapnia [(12.21 ± 4.12) days] and hypocapnia [(11.78 ± 4.72) days] groups ( t = 6.48, 4.59, both P < 0.01). In-hospital mortality in the normal group was 38.6% (17/44), which was significantly lower than 60.8% (31/51) in the hypercapnia group and 66.7% (14/21) in the hypocapnia group ( χ2 = 4.63, 4.47, both P < 0.05). The good neurological outcome rate in the normal group was 55.6% (15/44), which was significantly higher than 25.0% (5/51) in the hypercapnia group and 28.6% (2/21) in the hypocapnia group ( χ2 = 8.38, 5.14, both P < 0.05). Multivariate logistic regression analysis showed that cardiac arrest time, 1-hour mean arterial pressure, acute physiological and chronic health evaluation II score, and PaCO 2 are important factors for neurological outcomes of resuscitated patients at discharge (all P < 0.01). Conclusion:Within 24 hours after cardiopulmonary resuscitation, maintaining a normal PaCO 2 level can help improve the neurological outcome of patients at discharge.

The application of MOOC combined with peer mutual assistance in cardiopulmonary resuscitation teaching / 中华医学教育探索杂志

Objective:To explore the application effect of massive open online course (MOOC) combined with peer mutual assistance in cardiopulmonary resuscitation teaching.Methods:A total of 140 students in the same class of Batch 2015 were divided into the experimental group and the control group. In the teaching of cardiopulmonary resuscitation, the experimental group was based on the MOOC teaching platform, watched videos and topic tests before class, and used the peer mutual assistance in class. While the control group adopted traditional classroom teaching mode. The teaching effect of the two groups were evaluated by comparing the operation assessment scores and questionnaire survey of students' satisfaction with teaching. SPSS 22.0 was used for t-test and Chi-square test. Results:The operating assessment score of the experimental group was (82.20±2.31), and the operating assessment score of the control group was (75.80±1.72). The difference was statistically significant ( t=3.27, P<0.05). The questionnaire survey showed that the course satisfaction and learning motivation of the experimental group were better than those of the control group. In learning burden, the two groups had similar results ( P=0.739). Conclusion:MOOC combined with peer mutual assistance in cardiopulmonary resuscitation teaching can help students better master skills, improve students' course satisfaction and learning motivation, without increasing their learning burden.