Manejo de la vía aérea ante un caso de paro respiratorio en un escenario clínico simulado. Experiencia en una residencia de pediatría / Airway management during a respiratory arrest in a clinical simulation scenario. Experience at a pediatric residency program

Introducción. La insuficiencia respiratoria es la causa más común de paro cardíaco en pediatría; su reconocimiento y el manejo adecuado son cruciales. La simulación se utiliza para mejorar las habilidades médicas. El objetivo del trabajo fue determinar la proporción de residentes de pediatría que reconocieron un paro respiratorio (PR) pediátrico en un centro de simulación. Métodos. Se realizó un estudio observacional con 77 médicos residentes. Se utilizó un caso simulado de un paciente con dificultad respiratoria que progresa a PR. Resultados. De los 77 participantes, 48 reconocieron el paro respiratorio (62,3 %). El tiempo medio para reconocer el PR fue de 34,43 segundos. Conclusión. El 62,3 % de los participantes logró reconocer el paro respiratorio. Entre aquellos que lo identificaron, el tiempo promedio fue de 34,43 segundos. Se observaron graves deficiencias en algunas de las intervenciones esperadas.

Introduction. Respiratory failure is the most common cause of cardiac arrest in pediatrics. Recognizing and managing it adequately is critical. Simulation is used to improve medical skills. The objective of this study was to establish the proportion of pediatric residents who recognized a respiratory arrest in a child at a simulation center. Methods. This was an observational study in 77 residents. A simulation of a patient with respiratory distress that progressed to respiratory arrest was used. Results. Among the 77 participants, 48 recognized respiratory arrest (62.3%). The mean time to recognize respiratory arrest was 34.43 seconds. Conclusion. Respiratory arrest was recognized by 62.3% of participants. Among those who did so, the average time was 34.43 seconds. Severe failures were noted in some of the expected interventions.

Conhecimento dos profissionais intra-hospitalares acerca do suporte básico de vida em uma parada cardiorrespiratória / In-hospital professionals' knowledge about basic life support in cardiac arrest / Conocimiento de los profesionales intrahospitalarios sobre el soporte vital básico en la parada cardíaca

Objetivo: avaliar o efeito da intervenção educativa no conhecimento da equipe de enfermagem sobre o suporte básico de vida para o atendimento à parada cardiorrespiratória de adultos no ambiente intra-hospitalar. Método: estudo transversal com abordagem quantitativa, realizado com 25 profissionais de enfermagem em dois hospitais de região oeste de Santa Catarina - Brasil. Avaliou-se por meio da aplicação de um pré-teste, intervenção educativa e pós-teste. Resultados: houve aumento significativo no conhecimento dos profissionais. O hospital A obteve a média de acertos de 7,23 no pré-teste, elevando para 11,33 no pós-teste, com valor de p ≤ 0,0001. Já o hospital B pontuou 6,07 no pré-teste, progredindo para 11,15 no pós-teste, valor de p ≤ 0,0006. Conclusão: a intervenção realizada demonstrou ser uma estratégia eficaz, visto que os resultados pré-teste demostravam déficit significativo de conhecimento, e após a intervenção educativa, mostraram melhoria na maioria dos itens avaliados em relação ao atendimento específico.

Objective: to evaluate the effect of an educational intervention on the nursing team's knowledge about basic life support for adult cardiac arrest care in the in-hospital environment. Method: cross-sectional study with a quantitative approach, carried out with 25 nursing professionals in two hospitals in the western region of Santa Catarina - Brazil. A pre-test, educational intervention and post-test were applied. Results: there was a significant increase in the professionals' knowledge. Hospital A had a mean score of 7.23 in the pre-test, increasing to 11.33 in the post-test, with p-value ≤ 0.0001. Hospital B scored 6.07 in the pre-test, increasing to 11.15 in the post-test, p-value ≤ 0.0006. Conclusion: the intervention proved to be an effective strategy, since the pre-test results showed significant knowledge deficit, and after the educational intervention, showed improvement in most of the items evaluated in relation to specific care.

Objetivos:evaluar el efecto de una intervención educativa en el conocimiento del equipo de enfermería sobre el soporte vital básico para la atención del paro cardíaco del adulto en el ambiente intrahospitalario. Método: estudio transversal con abordaje cuantitativo, realizado con 25 profesionales de enfermería en dos hospitales de la región oeste de Santa Catarina - Brasil. Se aplicó un pre-test, una intervención educativa y un post-test. Resultados: hubo un aumento significativo de los conocimientos de los profesionales. El Hospital A obtuvo una puntuación media de 7,23 en el pre-test, aumentando a 11,33 en el post-test, con valor p ≤ 0,0001. El Hospital B obtuvo una puntuación de 6,07 en el pre-test, aumentando a 11,15 en el post-test, con valor p ≤ 0,0006. Conclusión: una intervención realizada demostró ser una estrategia eficaz, visto que os resultados previos demostraron un déficit significativo de conhecimento, y después de una intervención educativa, mostraron una mejoría na maioria dos itens avaliados em relação ao atendimento específico.

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

Lesión cerebral post paro cardiaco: aspectos médicos, éticos y legales / Brain injury after cardiac arrest: Medical, ethical and legal issues disorder

RESUMEN Los sobrevivientes de la reanimación cardiopulmonar posterior a un paro cardiaco pueden tener un amplio rango de desenlaces y van desde recuperación neurológica completa, estado de vigilia sin respuesta, compromiso cognoscitivo diverso o la muerte. La lesión del tejido cerebral se presenta inmediatamente después del paro cardíaco, durante la reanimación y al retornar la circulación espontánea. La severidad y duración de la noxa isquémica determinarán el devenir neurológico. El examen clínico es el punto de partida en el abordaje multimodal del neuropronóstico. Se debe complementar con electroencefalograma, potenciales evocados somatosensoriales, neuroimágenes y biomar-cadores séricos. Entre un 10 a 15% de los pacientes con lesión cerebral posterior al paro cardiaco evolucionan hacia muerte por criterios neurológicos y son potenciales candidatos a la donación de órganos. Un retiro temprano de las terapias de sostenimiento de vida puede malograr la posibilidad de un potencial donante de órganos. Se puede estimar de manera temprana qué pacientes tienen mayor riesgo de evolucionar a muerte por criterios neurológicos. El neurólogo tiene un papel protagónico en el manejo de pacientes con lesión cerebral post paro cardiaco y sus decisiones tienen implicaciones éticas y legales.

ABSTRACT People who survive cardiopulmonary resuscitation (CPR) after cardiac arrest, have a wide range of outcomes including complete neurological recovery, coma, compromised cognitive function and death. Injury of the brain parenchyma starts immediately after a cardiac arrest, during CPR and return of spontaneous circulation. The severity of the ischemic injury will define the neurological outcome. The first step needed to determine a neurological prognosis is the clinical exam, with the help of electroencephalography, somatosensory evoked potentials, neuroimaging, and serum biomarkers. Between 10 and 15% of patients with brain injury after a cardiac arrest, develop brain death and become potential candidates for organ donation. A premature withdrawal of vital support can hamper the possibility of organ donation. The patients with higher risk of developing brain death can be identified early based on neurological criteria. The neurologist has a major role in the approach of patients with brain injury after cardiac arrest and the decision making with legal and ethical consequences.

One case of myocardial damage caused by carbamate pesticide poisoning / 中华劳动卫生职业病杂志

The data of a patient with carbamate pesticide poisoning were analyzed. Cardiac arrest, oliguria, acute renal injury and pulmonary infection occurred during treatment. After cardiopulmonary resuscitation, tracheal intubation, CRRT, anti-infection and other symptomatic support treatment, the patient recovered and discharged. The myocardial damage caused by carbamate pesticide poisoning is easy to be ignored, and it often causes cardiac manifestations such as arrhythmia and cardiac insufficiency, and the related markers of cardiac injury, electrocardiogram and echocardiogram are also changed. Therefore, the awareness of cardiac damage caused by carbamate pesticide poisoning should be improved.

Research progress of target temperature management on protective mechanism of cardiac function after cardiac arrest / 中华危重病急救医学

Targeted temperature management (TTM) has been partially applied in patients with restoration of spontaneous circulation (ROSC) after cardiac arrest (CA). In the 2020 American Heart Association (AHA) cardiopulmonary resuscitation (CPR) guidelines, TTM is used as advanced life support after ROSC for the treatment of patients with CPR. TTM has a protective effect on cardiac function after CA, but the specific mechanism of its protective effect on cardiac function remains unclear. In this paper, the basic experimental progress, clinical trial progress and development prospect of TTM on the protective mechanism of cardiac function after CA are reviewed.

Clinical characteristics of in-hospital cardiac arrest in emergency patients in Kashgar area and analysis of influencing factors on success rate of cardiopulmonary resuscitation / 中华危重病急救医学

OBJECTIVE@#To analyze the clinical characteristics of patients with emergency in-hospital cardiac arrest (IHCA) in Kashgar, Xinjiang Uygur Autonomous Region and the factors affecting the success rate of cardiopulmonary resuscitation.@*METHODS@#Retrospectively selected patients who had cardiac arrest and cardiopulmonary resuscitation in the emergency department of the People's Hospital of 6 counties and cities in Kashgar area from January 2019 to January 2022. The clinical data of all patients were collected, including gender, age, major underlying diseases, the beginning and duration of resuscitation, the number of electric defibrillation acute physiology and chronic health evaluation II (APACHE II). According to whether the resuscitation was successful, all patients were divided into successful resuscitation group and failed resuscitation group. The clinical characteristics of the two groups were compared. Then, the influencing factors of the success rate of cardiopulmonary resuscitation in IHCA patients were analyzed by binary Logistic regression.@*RESULTS@#A total of 1 376 patients were enrolled, including 1 117 cases of failed resuscitation and 259 cases of successful resuscitation. The success rate of resuscitation was 18.82%. Compared with the resuscitation failure group, the patients in the successful resuscitation group were younger (age: 49.10±20.99 vs. 58.44±18.32), the resuscitation start time was earlier [resuscitation start time ≤ 5 minutes: 76.45% (198/259) vs. 66.61% (744/1 117)], the proportion of cardiovascular and cerebrovascular diseases was lower [cardiovascular disease: 49.42% (128/259) vs. 58.19% (650/1 117), cerebrovascular disease: 17.37% (45/259) vs. 21.58% (241/1 117)], the number of electric defibrillation was lower [times: 0 (0, 2) vs. 1 (0, 1)], the proportion of endotracheal intubation was more [80.31% (208/259) vs. 55.60% (621/1 117)], APACHE II score was lower (13.75±8.03 vs. 17.90±4.63), and the difference was statistically significant (all P < 0.01). Binary Logistic regression analysis showed that age, start time of resuscitation, ventilation mode and APACHE II score were protective factors affecting the success rate of cardiopulmonary resuscitation in patients with emergency IHCA [age: odds ratio (OR) = 0.982, 95% confidence interval (95%CI) was 0.973-0.991, P < 0.001; resuscitation start time ≤ 5 minutes: OR = 0.629, 95%CI was 0.409-0.966, P = 0.034; tracheal intubation assisted ventilation: OR = 0.243, 95%CI was 0.149-0.397, P < 0.001; low APACHE II score: OR = 0.871, 95%CI was 0.836-0.907, P < 0.001], while underlying diseases (cardiovascular diseases) are a risk factor affecting the success rate of cardiopulmonary resuscitation (OR = 1.190, 95%CI was 1.015-1.395, P = 0.036).@*CONCLUSIONS@#Age, resuscitation start time, ventilation mode, APACHE II score and major underlying diseases (cardiovascular diseases) have a greater impact on the success rate of resuscitation in IHCA patients. The above factors are conducive to improving or formulating more effective rescue strategies for IHCA patients, so as to achieve the purpose of improving the success rate of clinical treatment.

Research progress of extracorporeal cardiopulmonary resuscitation combined with therapeutic hypothermia on brain protection / 中华危重病急救医学

Compared with conventional cardiopulmonary resuscitation (CCPR), extracorporeal cardiopulmonary resuscitation (ECPR) can improve the survival rate of patients with cardiac arrest, and reduce the risk of reperfusion injury. However, it is still difficult to avoid the risk of secondary brain damage. Low temperature management has good neuroprotective potential for ECPR patients, which minimizes brain damage. However, unlike CCPR, ECPR has no clear prognostic indicator. The relationship between ECPR combined with hypothermia management-related treatment measure and neurological prognosis is not clear. This article reviews the effect of ECPR combined with different therapeutic hypothermia on brain protection and provides a reference for the prevention and treatment of neurological injury in patients with ECPR.

Analysis of relevant factors influencing the 30-day survival rate of patients with cardiac arrest and cardiopulmonary resuscitation: research based on 8-year data of a class III hospital / 中华危重病急救医学

OBJECTIVE@#To investigate the survival of patients with cardiac arrest and cardiopulmonary resuscitation (CA-CPR), and to analyze the factors influencing survival at 30 days after restoration of spontaneous circulation (ROSC).@*METHODS@#A retrospective cohort study was conducted. Clinical data of 538 patients with CA-CPR admitted to the People's Hospital of Ningxia Hui Autonomous Region from January 2013 to September 2020 were enrolled. The gender, age, underlying disease, cause of CA, type of CA, initial rhythm, presence or absence of endotracheal intubation, defibrillation, use of epinephrine, and 30-day survival rate of patients were collected. The etiology of CA and 30-day survival rate among patients with different ages were compared, as well as the clinical data between patients who survived and died at 30 days after ROSC were also compared. Multivariate Logistic regression was used to analyze the relevant factors affecting the 30-day survival rate of patients.@*RESULTS@#Among 538 patients with CA-CPR, 67 patients with incomplete information were excluded, and 471 patients were enrolled. Among 471 patients, 299 were males and 172 were females. Aged from 0 to 96 years old, 23 patients (4.9%) were < 18 years old, 205 patients (43.5%) were 18 to 64 years old, and 243 patients (51.6%) were ≥ 65 years old. 302 cases (64.1%) achieved ROSC, and 46 patients (9.8%) survived for more than 30 days. The 30-day survival rate of patients aged < 18 years old, 18-64 years old and ≥ 65 years old was 8.7% (2/23), 12.7% (26/205) and 7.4% (18/243), respectively. The main causes of CA in patients younger than 18 years were severe pneumonia (13.1%, 3/23), respiratory failure (13.1%, 3/23), and trauma (13.1%, 3/23). The main causes were acute myocardial infarction (AMI; 24.9%, 51/205), respiratory failure (9.8%, 20/205), and hypoxic brain injury (9.8%, 20/205) in patients aged 18-64 years old, and AMI (24.3%, 59/243) and respiratory failure (13.6%, 33/243) in patients aged ≥ 65 years old. Univariate analysis results revealed that the 30-day survival rate of patients with CA-CPR may be related to the the cause of CA was AMI, initial rhythm was ventricular tachycardia/ventricular fibrillation, endotracheal intubation and epinephrine. Multivariate Logistic regression analysis results showed that CA was caused by AMI [odds ratio (OR) = 0.395, 95% confidence interval (95%CI) was 0.194-0.808, P = 0.011] and endotracheal intubation (OR = 0.423, 95%CI was 0.204-0.877, P = 0.021) was a protective factor for 30 days of survival after ROSC in patients with CA-CPR.@*CONCLUSIONS@#The 30-day survival rate of CA-CPR patients was 9.8%. The 30-day survival rate of CA-CPR patients with AMI after ROSC is higher than that of patients with other CA causes, and early endotracheal intubation can improve the prognosis of patients.

Cardiac arrest patients admitted to intensive care unit after cardiopulmonary resuscitation: a retrospective cohort study to find predictors for mortality

Abstract Background In-hospital cardiac arrest is a common situation in hospital settings. Therefore, healthcare providers should understand the reasons that could affect the results of cardiopulmonary resuscitation. We aimed to determine the independent predictors for poor outcomes after the return of spontaneous circulation in in-hospital cardiac arrest patients, and also look for a relationship between patient's background parameters and the status at intensive care unit. Methods We did a retrospective cohort study using cardiac arrest patients admitted to the intensive care unit after successful cardiopulmonary resuscitation between 2011-2015. Patients' data were gathered from hospital database. Estimated probabilities of survival were computed using the Kaplan-Meier method. Cox proportional hazard models were used to determine associated risk factors for mortality. Results In total, 197 cardiac arrest patients were admitted to anesthesia intensive care unit after successful cardiopulmonary resuscitation in a 4-years period. Of 197 patients, 170 (86.3%) died in intensive care unit. Median of survival days was 4 days. Comorbidity (p= 0.01), higher duration of cardiopulmonary resuscitation (p= 0.02), lower Glasgow Coma Score (p= 0.00), abnormal lactate level (p= 0.00), and abnormal mean blood pressure (p= 0.01) were the main predictors for increased mortality in cardiac arrest patients after intensive care unit admission. Conclusion The consequent clinical status of the patients is affected by the physiological state after return of spontaneous circulation. Comorbidity, higher duration of cardiopulmonary resuscitation, lower arrival Glasgow Coma Score, abnormal lactate level, and abnormal mean blood pressure were the main predictors for increased mortality in patients admitted to the intensive care unit after successful cardiopulmonary resuscitation.

Gastric rupture during fiberoptic bronchoscopy, a rare complication of oxygen administration by nasopharyngeal cannula: a case report

Abstract Concomitant use of a nasopharyngeal catheter is frequently used for oxygen supply during fiberoptic bronchoscopy (FOB). This is a procedure that presents possible complications that are not negligible. We demonstrate the case of a 61-year-old woman who underwent FOB due to a history of hemoptoic sputum. During the procedure, gastric rupture occurred with a large pneumoperitoneum and bilateral pneumothorax requiring immediate drainage of the air and an emergent laparotomy. This was probably a complication of the nasopharyngeal catheter. The knowledge of these complications is essential for their correct identification and treatment.

Thrombus intraventriculaire gauche chez un jeune patient atteint de COVID-19 / Left intraventricular thrombus in a young patient with COVID-19

La COVID-19 est associée à un état d'hypercoagulabilité. L'incidence du thrombus intraventriculaire gauche est relativement faible en absence d'une cardiopathie hypokinétique sévère avec altération de la fraction d'éjection. Nous rapportant le cas d'un homme de 37 ans infecté par le SARS-CoV-2 présentant un thrombus intraventriculaire gauche en absence de cardiopathie connue. Le décès était survenu suiteà un arrêt cardiaque.

Parada cardiorrespiratória e cerebral: construção e validação de cenário simulado para enfermagem / Paro cardiorspiratorio y cerebral: construccíon y validación de escenario simulado para enfermería / Cardiorespiratory and cerebral arrest: construction and validation of simulated scenario for nursing

Objetivo:construir, validar e testar um cenário de simulação clínica para o manejo da parada cardiorrespiratória e cerebral para o ensino de enfermagem.Método:foi realizado design de estudo metodológico de desenvolvimento educacional realizado em três fases: elaboração de cenário simulado sobre parada cardiorrespiratória cerebral, validação do conteúdo e teste do cenário simulado com estudantes de graduação em enfermagem. A análise dos dados se deu pelo Índice de Validade de Conteúdo, considerando-se adequado um valor > 0,90 entre os juízes experts em enfermagem, e o Alfa de Cronbach para determinar a concordância da satisfação e autoconfiança na aprendizagem dos estudantes. Resultados:o cenário de simulação mostrou-se adequado para utilização no processo de ensino e aprendizagem e melhoria das competências cognitivas, comportamentais e psicomotoras, e obteve excelente índice de validação de conteúdo e na testagemdo cenário foi considerado satisfatório. Conclusão:considerou-se validado e apto para o uso nas práticas simuladas

Objective:to build, validate, and test a clinical simulation scenario for the management of cardiorespiratory and cerebral arrest for nursing education. Method:amethodological study design of educational development was carried out in three phases: development of a simulated scenario on cerebral cardiac arrest, content validation and testing of the simulated scenario with undergraduate nursing students. Data were analyzed using the Content Validity Index, with a value > 0.90 considered adequate among expert nursing judges, and Cronbach's alpha to determine the agreement of satisfaction and self-confidence in student learning. Results:the simulation scenario proved adequate for use in the teaching and learning process and to improve cognitive, behavioral and psychomotor skills, and obtained an excellent content validation index. Conclusion:it was considered validated and suitable for use in simulated practice.

Objetivo:construir, validar y probar un centro de simulación clínica para el manejo de la parada cardiorrespiratoria y cerebral para la enseñanza de la enfermería. Método:se realizó un diseño de estudio metodológico de desarrollo educativo llevado a cabo en tres fases: elaboración de un escenario simulado sobre parada cardiorrespiratoria cerebral, valoración del contenido y prueba del escenariosimulado con estudiantes de grado en enfermería. Los datos se analizaron mediante el índice de validez del contenido (un valor > 0,90 se consideró adecuado entre los jueces expertos en enfermería) y el alfa de Cronbach para determinar la concordancia de la satisfacción y la autoconfianza en el aprendizaje de los estudiantes. Resultados:el escenariode simulación se mostró adecuado para su uso en el proceso de enseñanza y aprendizaje y la mejora de las competencias cognitivas, conductuales y psicomotoras, y obtuvo un excelente índice de valoración del contenido y en la prueba del escenariose consideró satisfactorio. Conclusión:se considera validado y apto para el uso en prácticas simuladas

Estimulación cardíaca temporal de larga duración con cable activo y marcapaso permanente externo / Long-term temporary cardiac pacing with active lead and external permanent pacemaker

INTRODUCCIÓN. La estimulación cardíaca temporal de larga duración con cable activo y marcapaso permanente externo es una técnica recientemente incluida en las guías de manejo de bradicardias sintomáticas. CASOS CLÍNICOS. Se describen 4 casos de pacientes sometidos a estimulación cardíaca temporal de larga duración con cable activo y marcapaso permanente externo de la unidad de Hemodinámica del Hospital de Especialidades Carlos Andrade Marín, con indicaciones diversas. DISCUSIÓN. El tiempo medio de permanencia con el cable activo y el marcapaso externalizado fue 23 días. No hubo complicaciones del procedimiento. Un paciente falleció por causas no relacionadas con la estimulación y 2 se recuperaron en sus domicilios. CONCLUSIÓN. La técnica de estimulación temporal utilizando marcapasos permanentes recuperados se muestra extremadamente útil para mantener un marcapaso cardíaco seguro, incluso ambulatorio y por largo tiempo, hasta el implante de dispositivos definitivos. Su limitación es la factibilidad de hacerlo solo en centros de tercer nivel.

INTRODUCTION. Long-duration temporary cardiac pacing with active lead and permanent external pacemaker is a technique recently included in the guidelines for the management of symptomatic bradycardias. CLINICAL CASES. We describe 4 cases of patients who underwent long-duration temporary cardiac pacing with active lead and external permanent pacemaker at the Hemodynamics Unit of the Hospital de Especialidades Carlos Andrade Marín, with different indications. DISCUSSION. The mean length of stay with the active lead and externalized pacemaker was 23 days. There were no procedural complications. One patient died of causes unrelated to pacing and 2 recovered at home. CONCLUSIONS. The technique of temporary pacing using retrieved permanent pacemakers is extremely useful for maintaining safe cardiac pacing, even on an outpatient basis and for a long period of time, until implantation of definitive devices. Its limitation is the feasibility of doing it only in third level centers.

The simulation of cardiopulmonary resuscitation and the knowledge of rescuers: a quasi-experimental study / La simulación de la reanimación cardiopulmonar y el conocimiento de los socorristas: estudio cuasi-experimental / A simulação da reanimação cardiopulmonar e o conhecimento de socorristas: estudo quase-experimental

ABSTRACT Objective: to compare the knowledge of rescuers before and after training in cardiopulmonary resuscitation with the realistic simulation method. Method: this is a quasi-experimental study carried out with 41 Basic Life Support rescuers covering 8 bases of the 18th Regional Health of Paraná. The rescuers responded to the Instrument for Assessment of Training in Cardiopulmonary Resuscitation applied before and after the realistic simulation. Results: there was a statistically significant difference (p < 0.02) in 6 of the 10 questions, which addressed: the sequence of cardiopulmonary resuscitation maneuvers; the electrical charge of the automatic external defibrillator; the position, depth, and speed of chest compressions; the compression/ventilation ratio; and the handling of the automatic external defibrillator. In the other two questions — recognition of cardiorespiratory arrest and positive pressure ventilation device — there was no change in the answer alternative. There were 60% of correct answers for the questions when assessing prior knowledge and 90% of correct answers after the phases of the realistic simulation. Conclusion: rescuers did not fully complete the pre-test questionnaire; however, after the realistic simulation strategy, there was a significant increase in this knowledge. These results showed an improvement in the cognitive knowledge of rescuers after the simulation, which was confirmed by the increase in knowledge expressed in the post-test. This methodology can also be successfully applied to this professional category.

RESUMEN Objetivo: comparar el conocimiento de los socorristas antes y después de la capacitación de la reanimación cardiopulmonar con el método de la simulación real. Método: estudio cuasi-experimental, realizado con 41 socorristas del Soporte Vital Básico cubriendo 8 bases de la 18 Regional de Salud de Paraná. Los socorristas respondieron al Instrumento para la Evaluación de la Formación en Reanimación Cardiopulmonar, aplicado antes y después de la simulación real. Resultados: se encontraron diferencias estadísticamente significativas (p < 0,02) en 6 de las 10 preguntas, que abordaban: la secuencia de maniobras de reanimación cardiopulmonar; la carga eléctrica del desfibrilador externo automático; la posición, profundidad y velocidad de las compresiones torácicas; la relación compresión/ventilación; y el manejo del desfibrilador externo automático. En dos preguntas -reconocimiento de la parada cardíaca y dispositivo de ventilación con presión positiva- no hubo cambios en la respuesta alternativa. Hubo un 60% de respuestas correctas para las preguntas al evaluar los conocimientos previos y un 90% de respuestas correctas después de las fases de la simulación real. Conclusión: los socorristas no responden totalmente a la cuestión de la prueba previa, mientras que, tras la estrategia de simulación realista, se produjo un aumento significativo de este conocimiento. Estos resultados demostraron una mejora en el conocimiento cognitivo de los socorristas después de la simulación, comprobada por el aumento del conocimiento expreso en el post-test, que esta metodología también puede ser aplicada con éxito a esta categoría profesional.

RESUMO Objetivo: comparar o conhecimento de socorristas antes e depois da capacitação de reanimação cardiopulmonar com o método da simulação realística. Método: estudo quase-experimental realizado com 41 socorristas do Suporte Básico de Vida que contemplam 8 bases da 18° Regional de Saúde do Paraná. Os socorristas responderam ao Instrumento para Avaliação da capacitação em Ressuscitação Cardiopulmonar aplicado antes e depois da simulação realística. Resultados: obteve-se diferença estatisticamente significativa (p < 0,02) em 6 das 10 questões, as quais abordaram: a sequência das manobras de reanimação cardiopulmonar; a carga elétrica do desfibrilador externo automático; a posição, a profundidade e a velocidade das compressões torácicas; a relação compressão/ventilação; e o manuseio do desfibrilador externo automático. Já em outras duas questões — reconhecimento da parada cardiorrespiratória e dispositivo de ventilação com pressão positiva — não houve mudança quanto à alternativa de resposta. Encontraram-se 60% de acertos das questões quando avaliado o conhecimento prévio e 90% de acertos após as fases da simulação realística. Conclusão: os socorristas não atingiram com totalidade o questionário de pré-teste; entretanto, após a estratégia da simulação realística, houve um aumento significativo desse conhecimento. Esses resultados demonstraram melhoria no conhecimento cognitivo dos socorristas após simulação, o que foi comprovado pelo aumento de conhecimento expresso no pós-teste. Essa metodologia também pode ser aplicada com sucesso a essa categoria profissional.

Fatores relacionados a traumas e complicações torácicas após massagem cardíaca / Factores relacionados con traumatismos y complicaciones torácicas tras el masaje cardíaco / Factors related to trauma and chest complications after cardiac massage

Objetivo: identificar quais os principais fatores relacionados às complicações torácicas após massagem cardíaca. Método: Consiste em uma revisão integrativa da literatura. Utilizou-se a estratégia de População, Interesse e Contexto (PICo) para a construção da pergunta norteadora. As buscas foram realizadas entre os meses de julho a setembro de 2021 na Biblioteca Virtual de Saúde (BVS), e bases de dados: Medical Literature Analysis and Retrieval System Online (MEDLINE), Literatura LatinoAmericana e do Caribe em Ciências da Saúde (LILACS) e no serviço da U. S. National Library of Medicine (NLM) PubMed. Após filtragem, foram obtidos 250 artigos que com a leitura criteriosa dos títulos, resumos e aplicação dos critérios de inclusão e exclusão, 10 estudos foram selecionados. Resultados: existem fatores que interferem na eficácia da compressão e podem comprometer a saúde do indivíduo. Conclusão: apesar da massagem cardíaca possuir riscos, é imprescindível a sua realização no atendimento pré-hospitalar da PCR(AU)

Objective: to identify the main factors related to thoracic complications after cardiac massage. Method: It consists of an integrative literature review. The Population, Interest and Context (PICo) strategy was used to construct the guiding question. Searches were carried out between the months of July to September 2021 in the Virtual Health Library (VHL), and databases: Medical Literature Analysis and Retrieval System Online (MEDLINE), Latin American and Caribbean Literature on Health Sciences (LILACS) and in the US National Library of Medicine (NLM) PubMed service. After filtering, 250 articles were obtained which, after carefully reading the titles, abstracts and application of the inclusion and exclusion criteria, 10 studies were selected. Results: there are factors that interfere with the effectiveness of compression, which can compromise the individual's health. Conclusion: although cardiac massage has risks, it is essential to perform it in pre-hospital CPA care.(AU)

Objetivo: identificar los principales factores relacionados con las complicaciones torácicas posteriores al masaje cardíaco. Método: consiste en una revisión integradora de la literatura. Se utilizó la estrategia Población, Interés y Contexto (PICo) para construir la pregunta guía. Las búsquedas se realizaron entre los meses de julio a septiembre de 2021 en la Virtual Health Library (BVS) y en las bases de datos: Online Medical Literature Analysis and Retrieval System (MEDLINE), Latin American and Caribbean Literature in Health Sciences (LILACS) y en la Biblioteca Nacional de Medicina de los Estados Unidos. (NLM) Servicio PubMed. Luego del filtrado, se obtuvieron 250 artículos, con lectura atenta de los títulos, resúmenes y aplicación de los criterios de inclusión y exclusión, se seleccionaron 10 estudios. Resultados: existen factores que interfieren con la efectividad de la compresión, comprometiendo la salud del individuo. Conclusión: aunque el masaje cardíaco tiene riesgos, es fundamental realizarlo en la atención prehospitalaria de la CPA(AU)

Embolia de líquido amniótico asociada a paro cardiorrespiratorio recuperado y síndrome de Sheehan / Amniotic fluid embolism associated with recovered cardiac arrest and postpartum Sheehan's syndrome

Resumen La embolia de líquido amniótico es una condición catastrófica propia del embarazo que ocurre típicamente durante el parto o justo posterior a este, cuyo sustrato fisiopatológico no ha sido aclarado por completo. Se ha estimado, según cifras de los Estados Unidos, que su incidencia rondaría 1 por cada 12.953 partos, y en el Reino Unido 1 por cada 50.000 partos; sin embargo, estas cifras pueden ser imprecisas debido a que no existen una referencia ni un consenso respecto a los criterios diagnósticos, además de que el cuadro clínico se puede confundir con otras emergencias obstétricas. Se presenta el caso de una paciente sin antecedentes mórbidos que presenta un cuadro de embolia de líquido amniótico no fatal, caracterizado por un estado fetal no tranquilizador durante la inducción del trabajo de parto, seguido de un paro cardiorrespiratorio durante la cesárea de urgencia y la rápida y catastrófica aparición de signos clínicos de una coagulopatía de consumo grave. Se describen además las complicaciones posoperatorias y su manejo, entre ellas un síndrome de Sheehan y la aparición de convulsiones tónico-clónicas generalizadas con alteración de neuroimágenes.

Abstract Amniotic fluid embolism is a catastrophic pregnancy condition that typically occurs during or inmediately after delivery, and whose pathophysiological background has not been fully clarified. According to US records the incidence of amniotic fluid embolism could been around 1 for every 12,953 births and in the United Kingdom 1 for every 50,000 births, however these numbers may be imprecise because there is no gold standard as well as no consensus regarding the diagnostic criteria, in addition that the clinical presentation can be misdiagnosis with other obstetric emergencies. We present the clinical case of a patient without a morbid history who presents with a non-fatal amniotic fluid embolism, characterized by an non-reassuring fetal status during labor induction, followed by cardiorespiratory arrest during emergency cesarean section and the rapid and catastrophic appearance of clinical signs of a severe consumptive coagulopathy. Postoperative complications and their management are also described, including Sheehans syndrome and the appearance of generalized tonic-clonic seizures with impaired neuroimaging.

Desenvolvimento e validação de tecnologia para ensino de suporte básico de vida na parada cardiorrespiratória / Development and validation of technology for teaching basic life support in cardio-respiratory arrest / Desarrollo y validación de tecnología para la enseñanza del soporte vital básico en la parada cardíaca

RESUMO Objetivo desenvolver e validar um aplicativo multimídia em plataforma móvel para o ensino de suporte básico na parada cardiorrespiratória para estudantes de graduação da área de saúde. Método estudo metodológico conduzido em duas etapas: desenvolvimento do aplicativo e validação de conteúdo por especialistas. O aplicativo foi desenvolvido a partir do Design Instrucional Contextualizado, seguindo as etapas de análise, desenho (design), desenvolvimento e implementação. Para a validação de conteúdo, 11 especialistas avaliaram o aplicativo quanto à relevância, à clareza, à coerência, às informações, à apresentação, à navegabilidade, à acessibilidade e ao design. Resultados o aplicativo SBVida foi desenvolvido para dispositivos móveis em plataforma Android. Foi alcançado Índice de Validade de Conteúdo geral de 0,87. Conclusão o aplicativo SBVida foi desenvolvido e validado e pode contribuir para a preparação e a capacitação complementar a estudantes e profissionais de Enfermagem e de demais áreas da saúde.

ABSTRACT Objective: to develop and validate a multimedia application on a mobile platform for teaching basic support in cardiac arrest to undergraduate health care students. Method methodological study conducted in two stages: development of the application and content validation by experts. The application was developed based on Contextualized Instructional Design, following the stages of analysis, design, development, and implementation. For the content validation, 11 experts evaluated the application regarding relevance, clarity, coherence, information, presentation, navigability, accessibility, and design. Results The SBVida application was developed for mobile devices on the Android platform. An overall Content Validity Index of 0.87 was achieved. Conclusion The SBVida application was developed and validated and can contribute to the preparation and further training of students and professionals from Nursing and other health fields.

RESUMEN Objetivo desarrollar y validar una aplicación multimedia en una plataforma móvil para la enseñanza del soporte básico en la parada cardíaca a estudiantes de pregrado de salud. Método estudio metodológico realizado en dos etapas: desarrollo de la aplicación y validación del contenido por expertos. La aplicación se ha desarrollado basándose en el Design Instruccional Contextualizado, siguiendo las etapas de análisis, diseño, desarrollo e implementación. Para la validación del contenido, 11 expertos evaluaron la aplicación en cuanto a relevancia, claridad, coherencia, información, presentación, navegabilidad, accesibilidad y diseño. Resultados La aplicación SBVida fue desarrollada para dispositivos móviles en la plataforma Android. Se obtuvo un Índice de Validez de Contenido global de 0,87. Conclusión la aplicación SBVida fue desarrollada y validada y puede contribuir a la preparación y perfeccionamiento de estudiantes y profesionales de Enfermería y otras áreas de la salud.