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.

Conocimiento sobre reanimación cardiopulmonar del personal de enfermería / Conocimiento sobre reanimación cardiopulmonar del personal de enfermería

Introducción. La parada cardiorrespiratoria consiste en la interrupción brusca, inesperada y potencialmente reversible de la respiración y circulación espontánea. Representa el extremo más grave de situaciones de emergencia con elevadas tasas de mortalidad. Objetivo. Determinar el nivel de conocimiento acerca de reanimación cardiopulmonar (RCP) en el personal de enfermería de las especialidades troncales del Hospital Nacional de Itauguá en julio de 2023.Materiales y métodos. Estudio observacional descriptivo y analítico en el que se incluyó al personal de enfermería de las especialidades troncales del Hospital Nacional de Itauguá enjulio de 2023. Las variables estudiadas fueron sexo, edad, especialidad troncal y nivel de conocimientos en RCP. Se utilizó el cuestionario de conocimientos para enfermeros sobre reanimación cardio-pulmonar. Para la comparación de conocimientos entre las especialidades se utilizó la prueba chi cuadrado a un nivel de significancia de 0,05. Resultados. Se incluyeron 122enfermeros/as, 36de ginecología/obstetricia, 33 de medicina interna, 30 de pediatría y 23 de cirugía general. La edad media fue 37,63 ± 7,75 años, 69,7% de sexo femenino y 54,9% del departamento Central. El puntaje promedio global fue 5,55±2,72,significativamente (p = 0,001)mayor en la especialidad de cirugía general (6,61±2,39) comparado a la de pediatría (3,40±2,59). El nivel de conocimientos fue insuficiente en el 56,6%de los participantes, 83% de la especialidad de pediatría y 43,5% de cirugía general. Conclusión. El nivel de conocimiento del personal de enfermería sobre reanimación cardiopulmonar es deficiente y sobre todo en la especialidad de pediatría. Palabras clave: conocimiento; reanimación cardiopulmonar; enfermeros

Introduction. Cardiorespiratory arrest consists of the sudden, unexpected and potentially reversible interruption of breathing and spontaneous circulation. It represents the most serious extreme of emergency situations with high mortality rates. Objective. To determine the level of knowledge about cardiopulmonary resuscitation (CPR) in the nursing staff of the core specialties of the "Hospital Nacional de Itauguá" in July 2023. Materials and methods. Descriptive and analytical observational study in which the nursing staff of the core specialties of the "Hospital Nacional of Itauguá"was included in July 2023. The variables studied were sex, age, core specialty and level of knowledge in CPR. The knowledge questionnaire for nurses about cardio-pulmonary resuscitation was used. To compare knowledge between the specialties, the chi-square test was used at a significance level of 0.05. Results.122 nurses were included, 36 from gynecology/obstetrics, 33 from internal medicine, 30 from pediatrics and 23 from general surgery. The mean age was 37.63 ± 7.75 years, 69.7% female and 54.9% from the Central department. The overall average score was 5.55±2.72, significantly (p = 0.001) higher in the specialty of general surgery (6.61±2.39) compared to pediatrics (3.40±2.59). The level of knowledge was insufficient in 56.6% of the participants, 83% in the specialty of pediatrics and 43.5% in general surgery. Conclusion. The level of knowledge of nursing staff about cardiopulmonary resuscitation is poor, especially in the specialty of pediatrics. Key words: knowledge; cardiopulmonary resuscitation; nurses

A relevância em abordar suporte básico de vida para estudantes em escolas públicas e privadas / The relevance of addressing basic life support for students in public and private schools / La relevancia de abordar el soportevital básico para estudiantes en escuelas públicas y privadas

Objetivo:Investigar a relevância da abordagem de suporte básico de vida aos estudantes nas escolas públicas e privadas. Método:Trata-se de um trabalho constituído através de um estudo descritivo, exploratório, por intermédio de uma revisão sistemática, utilizandoestratégias qualitativas de pesquisa. Ao todo, nove artigos foram escolhidos, cujos critérios foram inclusão, exclusão e éticos. Posteriormente houve a leitura dos textos completos e descarte de conteúdos que fugiam da temática. Utilizou-se como base de dados a Biblioteca Virtual em Saúde e a PUBMED (Serviço da U. S. National Library of Medicine). Resultados:Verificou-se que os estudantes que tiveram contato com a temática Suporte Básico de Vida, por meio de simulações e questionários, se mostraram mais preparados para salvar vidas, prevenir acidentes e reduzir danos. Visto que, as emoções e o desenvolvimento de habilidades foram diretamente ligadas, pois, as emoções positivas contribuíram para maior adesão das informações e desenvolvimento de habilidades. Considerações Finais: Assim sendo, os estudantes entendem a relevância de abordar esse assunto e com treinamento contínuo nas escolas a longo prazo irá manter a expertise dos alunos, garantindo chances altas para salvar uma vida.

Objective:To investigate the relevance of the basic life support approach to students in public and private schools. Method:This is a work constituted through a descriptive, exploratory study, through an integrative review, using qualitative research strategies. In all, nine articles were chosen, whose criteria were inclusion, exclusion and ethical. Subsequently, the complete texts were read and contents that deviated from the theme were discarded. The Virtual Health Library and PUBMED (Service of the U.S. National Library of Medicine) were used as a database. Results:It was found that students who had contact with the theme Basic Life Support, through simulations and questionnaires, were more prepared to save lives, prevent accidents and reduce harm. Since emotions and skill development were directly linked, as positive emotions contributed to greater adherence to information and skill development. Final considerations:Therefore, students understand the relevance of addressing this subject and with continuous training in schools in the long term, students' expertise will be maintained, guaranteeing high chances of saving a life.

Objetivo:Investigar la pertinencia del abordaje de soporte vital básico para estudiantes de escuelas públicas y privadas. Método: Este es un trabajo constituido a través de un estudio descriptivo, exploratorio, a través de una revisión integradora, utilizando estrategias de investigación cualitativa. En total, se eligieron nueve artículos, cuyos criterios fueron de inclusión, exclusión y éticos. Posteriormente, se leyeron los textos completos y se descartaron los contenidos que se desviaban del tema. Se utilizó como base de datos la Virtual Health Library y PUBMED (Service of the U.S. National Library of Medicine). Resultados: Se constató que los estudiantes que tuvieron contacto con el tema Soporte Básico de Vida, a través de simulacros y cuestionarios, estaban máspreparados para salvar vidas, prevenir accidentes y reducir daños. Dado que las emociones y el desarrollo de habilidades estaban directamente relacionados, las emociones positivas contribuyeron a una mayor adherencia a la información y al desarrollo de habilidades. Consideraciones Finales: Por lo tanto, los estudiantes entienden la relevancia de abordar este tema y con la formación continua en las escuelas a largo plazo, se mantendrá la experiencia de los estudiantes, garantizando altas posibilidades de salvar una vida

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.

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.

Commotio cordis (conmoción cardíaca) en un niño. Reporte de un caso / Commotio cordis (cardiac concussion) in a child. A case report

Commotio cordis o conmoción cardíaca es un síndrome arritmogénico mecano-eléctrico raro y mortal. Es la segunda causa de muerte súbita en atletas jóvenes. Se asocia con una lesión que se produce durante la práctica deportiva, en la que un proyectil impacta a alta velocidad en el precordio y provoca una arritmia que conduce a la muerte inmediata del individuo sin una reanimación cardíaca. En las autopsias, los corazones son estructuralmente sanos. Con el conocimiento de este síndrome y las capacitaciones de reanimación cardiorrespiratoria a la comunidad, las tasas de supervivencia han mejorado. El objetivo de este trabajo es describir un paciente que llegó a nuestro hospital con conmotio cordis y su evolución, enfatizando la importancia de medidas de prevención y capacitación de la población en técnicas de reanimación cardiopulmonar y uso del desfibrilador externo automático para la supervivencia de los pacientes que sufren esta entidad.

Commotio cordis or cardiac concussion is a rare and fatal mechano-electric arrhythmogenic syndrome. It is the second most common cause of sudden cardiac death in young athletes. It is most commonly associated with a sports-related injury, wherein, there is a high-velocity impact between a projectile and the precordium, causing arrhythmia that leads to the immediate death of the individual without cardiac resuscitation. On autopsy, the heart is structurally normal. With increasing awareness of this condition and community training in cardiopulmonary resuscitation, survival rates have been improving. The objective of this study is to describe the case of a patient who arrived at our hospital with commotio cordis and his course, emphasizing the importance of prevention and training of the population in cardiopulmonary resuscitation techniques and the use of the automated external defibrillator for the survival of patients suffering from commotio cordis.

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.

Effectiveness of educational video on deaf people's knowledge and skills for cardiopulmonary resuscitation: a randomized controlled trial / Efectividad de video educativo sobre conocimiento y habilidad de personas sordas para reanimación cardiopulmonar: ensayo controlado aleatorizado / Efetividade de vídeo educativo no conhecimento e habilidade de surdos para ressuscitação cardiopulmonar: ensaio randomizado controlado

ABSTRACT Objective: To analyze the effectiveness of an educational video on deaf people's knowledge and skills about cardiopulmonary resuscitation. Method: A randomized trial, carried out at three schools with 113 deaf people (control group = 57 and intervention group = 56). After the pre-test, the control group was exposed to the lecture, while the intervention group was exposed to the video. The post-test occurred immediately after the intervention and was repeated after 15 days. A validated instrument was used, with 11 questions, presented in video/Libras (to enable understanding by deaf people) and in written/printed form (to record the answers). Results: In the analysis of knowledge, the median of correct answers in the pre-test was similar between the groups (p = 0.635), while the intervention group had a higher accuracy in the immediate post-test (p = 0.035) and after 15 days (p = 0.026). In the skill analysis, the median of correct answers in the pre-test was higher in the control group (p = 0.031). There was no difference in the immediate post-test (p = 0.770), and there was a higher accuracy in the intervention group in the post-test after 15 days (p = 0.014). Conclusion: The video proved to be effective in increasing deaf people's knowledge and skills about cardiopulmonary resuscitation. Brazilian Registry of Clinical Trials: RBR-5npmgj.

RESUMEN Objetivo: Analizar la efectividad de un video educativo sobre el conocimiento y la habilidad de las personas sordas acerca de la reanimación cardiopulmonar. Método: Ensayo aleatorizado, realizado en tres escuelas con 113 personas sordas (grupo control = 57 y grupo intervención = 56). Después de la prueba previa, el grupo de control fue expuesto a la conferencia, mientras que el grupo de intervención fue expuesto al video. La posprueba se realizó inmediatamente después de la intervención, y se repitió a los 15 días. Se utilizó un instrumento validado, con 11 preguntas presentadas en video/Libras (para que los sordos comprendan) y en forma escrita/impresa (para registrar las respuestas). Resultados: En el análisis de conocimientos, la mediana de aciertos en la preprueba fue similar entre los grupos (p = 0,635), mientras que el grupo intervención tuvo mayor acierto en la posprueba inmediato (p = 0,035) y después 15 días (p = 0,026). En el análisis de habilidades, la mediana de aciertos en la preprueba fue mayor en el grupo control (p = 0,031). No hubo diferencia en la posprueba inmediato (p = 0,770), y el grupo intervención tuvo más éxito en la posprueba a los 15 días (p = 0,014). Conclusión: El video demostró ser efectivo para aumentar el conocimiento y las habilidades de las personas sordas sobre la reanimación cardiopulmonar. Registro Brasileño de Ensayos Clínicos: RBR-5npmgj.

RESUMO Objetivo: Analisar a efetividade de vídeo educativo no conhecimento e habilidade de surdos acerca da ressuscitação cardiopulmonar. Método: Ensaio randomizado, realizado em três escolas com 113 surdos (grupo controle = 57 e grupo intervenção = 56). Após o pré-teste, o grupo controle foi exposto à aula expositiva, enquanto o grupo intervenção foi exposto ao vídeo. O pós-teste ocorreu imediatamente depois da intervenção, e foi repetido após 15 dias. Foi utilizado instrumento validado, com 11 questões apresentadas em vídeo/libras (para viabilizar compreensão dos surdos) e de forma escrita/impressa (para registro das respostas). Resultados: Na análise do conhecimento, a mediana dos acertos do pré-teste foi semelhante entre os grupos (p = 0,635), enquanto houve maior acerto do grupo intervenção no pós-teste imediato (p = 0,035) e após 15 dias (p = 0,026). Na análise da habilidade, a mediana dos acertos do pré-teste foi maior no grupo controle (p = 0,031). Não houve diferença no pós-teste imediato (p = 0,770), e houve maior acerto do grupo intervenção no pós-teste após 15 dias (p = 0,014). Conclusão: O vídeo mostrou-se efetivo no aumento do conhecimento e habilidade de surdos acerca da ressuscitação cardiopulmonar. Registro Brasileiro de Ensaios Clínicos: RBR-5npmgj.

Conhecimento da equipe de enfermagem sobre reanimação cardiopulmonar antes e após capacitação / Conocimiento del equipo de enfermería sobre reanimación cardiopulmonar antes y después de capacitación / Knowledge of the nursing team on cardiopulmonary resuscitation before and after training

Objetivo: avaliar o conhecimento dos profissionais da equipe de enfermagem no atendimento à parada cardiorrespiratória e comparar antes e após capacitação. Método: pesquisa prospectiva e comparativa, realizada em um hospital público em São Paulo, em 2021, com 68 profissionais. Foi aplicado um questionário sobre parada cardiorrespiratória antes e após capacitação, para comparação. Resultados: a maioria dos profissionais reconhece os sinais clássicos de parada cardiorrespiratória e a sequência correta de atendimento, todavia, teve dificuldade em identificar os ritmos chocáveis e as ações após a desfibrilação. A média de acertos antes e após a realização da capacitação foi de 43,65 e 66,11, respectivamente, e corrobora com a eficácia da ação educativa. Conclusão: é extremamente relevante ofertar, sistematicamente, capacitações à equipe, de modo a garantir uma assistência mais segura e eficaz.

Objetivo: evaluar el conocimiento de los profesionales del equipo de enfermería en la atención a la parada cardiorrespiratoria y comparar antes y después de capacitación. Método: investigación prospectiva y comparativa, realizada en un hospital público en São Paulo, en 2021, con 68 profesionales. Se aplicó un cuestionario sobre parada cardiorrespiratoria antes y después de capacitación, para comparación. Resultados: la mayoría de los profesionales reconocen los signos clásicos de parada cardiorrespiratoria y la secuencia correcta de atención, sin embargo, tuvo dificultad en identificar los ritmos chocables y las acciones después de la desfibrilación. El promedio de aciertos antes y después de la realización de la capacitación fue de 43,65 y 66,11, respectivamente, y corrobora con la eficacia de la acción educativa. Conclusión: es extremadamente relevante ofrecer, sistemáticamente, capacitaciones al equipo, de modo a garantizar una asistencia más segura y eficaz.

Objective: to evaluate the knowledge of nursing staff professionals in the care of cardiorespiratory arrest and to compare before and after training. Method: prospective and comparative research, conducted in a public hospital in São Paulo, in 2021, with 68 professionals. A questionnaire on cardiorespiratory arrest before and after training was applied for comparison. Results: most professionals recognize the classic signs of cardiorespiratory arrest and the correct sequence of care, however, had difficulty identifying the shockable rhythms and actions after defibrillation. The average number of correct answers before and after the training was 43.65 and 66.11, respectively, and corroborates the effectiveness of the educational action. Conclusion: it is extremely relevant to systematically offer training to the team in order to ensure safer and more effective care.

Reanimación cardiopulmocerebral en la carrera Medicina: diferencias entre los planes de estudios D y E / Cardiopulmonary-cerebral resuscitation in the Medicine career: differences between study plans D and E

Fundamento: la reanimación cardiopulmocerebral básica está presente como curso propio en los planes de estudios "D" y "E" de la carrera de Medicina; aunque en ambos la organización del proceso tiene sus particularidades. Objetivo: precisar las diferencias en cuanto a estructura, proceso docente y resultados académicos en la enseñanza de la reanimación cardiopulmocerebral básica, entre los planes de estudios "D" y "E" de la carrera de Medicina. Métodos: se realizó un estudio descriptivo, prospectivo, transversal, en la Universidad de Ciencias Médicas de Cienfuegos en los años 2017 y 2019. Se utilizaron métodos teóricos y empíricos. Para comparar resultados se utilizó el universo estudiantil en ambos años, para evaluar satisfacción y calidad una muestra aleatoria simple. Se utilizaron técnicas de estadística descriptiva. Para ambos cursos se utilizó similar escenario y claustro de profesores. Resultados: las diferencias entre ambos planes derivan de los componentes no personales del proceso docente; el plan "D" tiene 20 horas y el "E" 40, con lo cual se amplían sus contenidos. Todos los temas y objetivos del plan "D" estuvieron incluidos en el "E". Hubo similitud en las promociones general (80.4 % y 75.2 %) y de calidad (50.6 % y 53.1 %) en ambos años. El cumplimiento de las expectativas, satisfacción y calidad del proceso fue valorado de muy alto y alto (más 98 %) por los estudiantes en ambos cursos. Conclusiones: aunque existieron diferencias en el proceso enseñanza aprendizaje entre ambos planes, no hubo repercusión en la satisfacción de los estudiantes, calidad del proceso docente, ni los resultados académicos. La variante del plan "E" es más integral para la formación básica del apoyo vital.

Background: basic cardiopulmonary-cerebral resuscitation is present as its own course in the "D" and "E" study plans of the Medicine career; although in both the organization of the process has its particularities. Objective: to specify the differences in terms of structure, teaching process and academic results in the teaching of basic cardiopulmonary-cerebral resuscitation, between the "D" and "E" study plans of the Medicine career. Methods: a descriptive, prospective, cross-sectional study was carried out at Cienfuegos University of Medical Sciences from 2017 to 2019. Theoretical and empirical methods were used. To compare results, the student universe was used in both years, to evaluate satisfaction and quality a simple random sample. Descriptive statistical techniques were used. For both courses, a similar scenario and faculty were used. Results: the differences between both plans derive from the non-personal components of the teaching process; plan "D" has 20 hours and plan "E" 40, which expands its contents. All the topics and objectives of plan "D" were included in plan "E". There was similarity in the general (80.4% and 75.2%) and quality (50.6% and 53.1%) school grades in both years. The fulfillment of the expectations, satisfaction and quality of the process was valued as very high and high (more than 98%) by the students in both courses. Conclusions: although there were differences in the teaching-learning process between both plans, there was no impact on student satisfaction, quality of the teaching process, or academic results. The "E" plan variant is more comprehensive for basic life support training.

Efeito de uma capacitação em reanimação cardiopulmonar no conhecimento, satisfação e autoconfiança na aprendizagem de enfermeiros: estudo quase-experimental / Effect of cardiopulmonary resuscitation training on knowledge, satisfaction and self-confidence in learning of nurses: a quasi-experimental study / Efecto del entrenamiento en reanimación cardiopulmonar sobre el conocimiento, la satisfacción y la autoconfianza en el aprendizaje de enfermeros: un estudio cuasi experimental

Objetivo: avaliar o efeito de uma capacitação que associa abordagem teórica com simulação clínica em reanimação cardiopulmonar no conhecimento, satisfação e autoconfiança na aprendizagem de enfermeiros. Métodos: estudo quase-experimental, realizado com enfermeiros de um hospital terciário, por meio de capacitação teórica e simulação clínica de reanimação cardiopulmonar. Antes e após a capacitação foram aplicados questionários; a Escala de Satisfação do Estudante e Autoconfiança na Aprendizagem foi aplicada após a capacitação. Resultados: participaram 31 enfermeiros, 90,32% eram do sexo feminino, com média de idade de 33,93 anos (DP = 9,02). A média de acertos no questionário pré-teste foi 8,90 (DP ± 1,95) e a média de acertos pós-teste foi de 11,58 (DP ± 1,26; p < 0,001). Quanto à satisfação e autoconfiança a média geral foi 4,51 (DP ± 0,10). Conclusão: a intervenção educativa utilizada para capacitação, que associa abordagem teórica e simulação clínica em reanimação cardiopulmonar promove melhora do conhecimento dos enfermeiros em suporte básico e avançado de vida, satisfação e autoconfiança na aprendizagem.

Objective: to evaluate the effect of a training that combines a theoretical approach with clinical simulation in cardiopulmonary resuscitation on the knowledge, satisfaction and self-confidence in learning of nurses. Methods:quasi-experimental study conducted with nurses from a tertiary hospital, through theoretical training and clinical simulation of cardiopulmonary resuscitation. Questionnaires were applied before and after the training; the Scale of Student Satisfaction and Self-Confidence in Learning was applied after training. Results:thirty-one nurses participated, 90.32% were female, mean age of 33.93 years (SD = 9,02). The mean number of correct answers in the pre-test questionnaire was 8.90 (SD ± 1.95) and after the test it was 11.58 (SD ± 1.26; p < 0.001). As for satisfaction and self-confidence, the overall average was 4.51 (SD ± 0.10). Conclusion: the educational intervention used in training, which combines a theoretical approach and clinical simulation in cardiopulmonary resuscitation, improves nurses' knowledge of basic and advanced life support, satisfaction and self-confidence in learning.

Objetivo: evaluar el efecto de un entrenamiento que combina un enfoque teórico con simulación clínica en reanimación cardiopulmonar sobre el conocimiento, la satisfacción y la autoconfianza en el aprendizaje de los enfermeros. Métodos: estudio cuasi experimental realizado con enfermeros de un hospital de tercer nivel, mediante entrenamiento teórico y simulación clínica de reanimación cardiopulmonar. Se aplicaron cuestionarios antes y después de la capacitación; después del entrenamiento se aplicó la Escala de Satisfacción y Autoconfianza del Estudiante en el Aprendizaje. Resultados: participaron 31 enfermeros, 90,32% del sexo femenino, edad media de 33,93 años (DE = 9,02). La media de aciertos en el cuestionario pretest fue de 8,90 (DE ± 1,95) y después del test fue de 11,58 (DE ±1,26; p < 0,001). En cuanto a la satisfacción y autoconfianza, la media global fue de 4,51 (DE ± 0,10). Conclusión: la intervención educativa utilizada para la formación, que combina el enfoque teórico y la simulación clínica en reanimación cardiopulmonar, mejora el conocimiento de los enfermeros sobre el soporte vital básico y avanzado, la satisfacción y la autoconfianza en el aprendizaje.

Prática deliberada e prática deliberada em ciclos rápidos para suporte básico de vida: scoping review / Práctica deliberada y práctica deliberada en ciclos rápidos para soporte básico de vida: revisión de alcance / Deliberate practice and rapid cycle deliberate practice for basic life support: a scoping review

Resumo Objetivo mapear evidências sobre a prática deliberada (PD) e a prática deliberada em ciclos rápidos (PDCR) no ensino do Suporte Básico de Vida (SBV) de estudantes de ciências da saúde. Método scoping review, conforme JBI Reviewer's Manual for Scoping Reviews e PRISMA-ScR. Buscas e seleções foram realizadas nas bases de dados estabelecidas por intermédio de descritores e sinônimos, analisando a relevância dos estudos, selecionando os que responderam à pergunta de investigação, no período de abril a novembro de 2021. Em dezembro de 2022 realizou-se atualização da busca e seleção dos estudos. Resultados dos 4.155 estudos encontrados, 116 foram analisados na íntegra, com 9 incluídos neste estudo. 44,4% são americanos e 66,6% foram realizados em cursos de medicina. 11,1% apresentaram cenários simulados no contexto intra e extra-hospitalar, e 11,1%, em cenários intra-hospitalares. Conclusão e implicações para a prática a PD e a PDCR no ensino em saúde vêm sendo consolidadas nos últimos anos, evidenciando melhorias de aprendizado e retenção de conhecimento ao longo do tempo. Foi identificado que a maioria dos estudos abordam o contexto hospitalar, demonstrando a lacuna de produção de conhecimento pré-hospitalar. Ademais, a maioria dos estudos se concentrou entre Europa e América do Norte, confirmando a necessidade de realização de estudos para aplicabilidade da PD e PDCR em SBV em diferentes públicos e contextos.

Resumen Objetivo mapear evidencias sobre Práctica Deliberada (PD) y Práctica Deliberada em Ciclos Rápidos (PDCR) em la enseñanza del Soporte Básico de Vida (SBV) a estudiantes del área de la salud. Método una scoping review según JBI Reviewer's Manual for Scoping Reviews y PRISMA-ScR. Se realizaron búsquedas y selecciones en las bases de datos establecidas a través de descriptores y sinónimos, analizando la pertinencia de los estudios, seleccionando aquellos que respondían a la pregunta de investigación, de abril a noviembre de 2021. En diciembre de 2022 se realizó la actualización de la búsqueda y selección de estudios. Resultados de los 4.155 estudios encontrados, 116 fueron analizados en su totalidad, siendo 9 incluidos en este estudio. El 44,4% son estadounidenses y el 66,6% se realizaron en cursos de medicina. El 11,1% presentó escenarios simulados en el contexto intra y extrahospitalario y el 11,1% en escenarios intrahospitalarios. Conclusión e implicaciones para la práctica PD y PDCR en educación para la salud se han consolidado en los últimos años, mostrando mejoras en el aprendizaje y la retención de conocimientos a lo largo del tiempo. Se identificó que la mayoría de los estudios abordan el contexto hospitalario, demostrando la brecha de producción de conocimiento prehospitalario. Además, la mayoría de los estudios se concentraron en Europa y América del Norte, lo que confirma la necesidad de realizar estudios sobre la aplicabilidad de PD y PDCR en SBV en diferentes audiencias y contextos.

Abstract Objective to map evidence on deliberate practice (DP) and rapid cycle deliberate practice (RCDP) in teaching Basic Life Support (BLS) to health occupations students. Method a scoping review according to JBI Reviewer's Manual for Scoping Reviews and PRISMA-ScR. Searches and selections were carried out in the databases through descriptors and synonyms, and it was analyzed the relevance of the studies, selecting those that answered the research question, from April to November 2021. In December 2022, study search and selection were updated. Results of the 4,155 studies found, 116 were analyzed in full, with 9 included in this study. 44.4% are Americans and 66.6% were accomplished in medical courses. 11.1% presented simulated scenarios in the intra- and extra-hospital context, and 11.1%, in intra-hospital scenarios. Conclusion and implications for practice DP and RCDP in health education have been consolidated in recent years, showing improvements in learning and knowledge retention over time. This scope identified that most studies address the hospital context, which demonstrates the knowledge production gap in the pre-hospital area. Furthermore, most of the studies focused on Europe and North America, confirming the need to carry out studies for the applicability of DP and RCDP in BLS in different audiences and contexts.

Survey on the application of external cardiopulmonary resuscitation in Chinese children with sudden cardiac arrest / 中华儿科杂志

Objectives: To investigate the current application status and implementation difficulties of extracorporeal cardiopulmonary resuscitation (ECPR) in children with sudden cardiac arrest. Methods: This cross-sectional survey was conducted in 35 hospitals. A Children's ECPR Information Questionnaire on the implementation status of ECPR technology (abbreviated as the questionnaire) was designed, to collect the data of 385 children treated with ECPR in the 35 hospitals. The survey extracted the information about development of ECPR, the maintenance of extracorporeal membrane oxygenation (ECMO) machine, the indication of ECPR, and the difficulties of implementation in China. These ECPR patients were grouped based on their age, the hospital location and level, to compare the survival rates after weaning and discharge. The statistical analysis used Chi-square test and one-way analysis of variance for the comparison between the groups, LSD method for post hoc testing, and Bonferroni method for pairwise comparison. Results: Of the 385 ECPR cases, 224 were males and 161 females. There were 185 (48.1%) survival cases after weaning and 157 (40.8%) after discharge. There were 324 children (84.2%) receiving ECPR for cardiac disease and 27 children (7.0%) for respiratory failure. The primary cause of death in ECPR patients was circulatory failure (82 cases, 35.9%), followed by brain failure (80 cases, 35.0%). The most common place of ECPR was intensive care unit (ICU) (278 cases, 72.2%); ECPR catheters were mostly inserted through incision (327 cases, 84.9%). There were 32 hospitals (91.4%) had established ECMO emergency teams, holding 125 ECMO machines in total. ECMO machines mainly located in ICU (89 pieces, 71.2%), and the majority of hospitals (32 units, 91.4%) did not have pre-charged loops. There were no statistically significant differences in the post-withdrawal and post-discharge survival rates of ECPR patients among different age groups, regions, and hospitals (all P>0.05). The top 5 difficulties in implementing ECPR in non-ICU environments were lack of ECMO machines (16 times), difficulty in placing CPR pipes (15 times), long time intervals between CPR and ECMO transfer (13 times), lack of conventional backup ECMO loops (10 times), and inability of ECMO emergency teams to quickly arrive at the site (5 times). Conclusion: ECPR has been gradually developed in the field of pediatric critical care in China, and needs to be further standardized. ECPR in non-ICU environment remains a challenge.

Prognostic value of hemoglobin-to-red cell distribution width ratio in patients with cardiopulmonary resuscitation after out-of-hospital cardiac arrest / 中华危重病急救医学

OBJECTIVE@#To investigate the prognostic value of hemoglobin-to-red cell distribution width ratio (HRR) in patients with cardiopulmonary resuscitation (CPR) after out-of-hospital cardiac arrest (OHCA).@*METHODS@#A retrospective study was conducted. Patients aged ≥ 18 years with OHCA who were transferred to intensive care unit (ICU) after successful CPR from the emergency room of the First Affiliated Hospital of Zhengzhou University from August 2016 to February 2022 were enrolled. General clinical data, initial vital signs, acute physiology and chronic health evaluation II (APACHE II), Glasgow coma scale (GCS), first laboratory indicators after admission to ICU [including white blood cell count (WBC), red blood cell count (RBC), hemoglobin (Hb), pH value, lactic acid (Lac), 6-hour lactic acid clearance (LCR), red cell distribution width (RDW), HRR], length of ICU stay were collected. According to whether the patients died in hospital, the patients were divided into survival group and death group. Binary Logistic regression was used to analyze the independent factors influencing the prognosis of patients after CPR. Receiver operator characteristic curve (ROC curve) was drawn to analyze the predictive value of independent influencing factors for the prognosis of patients after CPR.@*RESULTS@#A total of 122 patients were enrolled after OHCA CPR, of which 88 died in hospital, the in-hospital mortality was 72.13%. There were no significant differences in age, past medical history, initial vital signs and WBC in ICU between the two groups. Compared with the death group, the survival group had higher GCS score, RBC, Hb, pH value, 6-hour LCR, HRR, lower APACHE II score, Lac, RDW level, and longer length of ICU stay. Multivariate Logistic regression analysis showed that APACHE II score, GCS score, 6-hour LCR, HRR, length of ICU stay were independent factors influencing the prognosis of patients after CPR [APACHE II score: odds ratio (OR) = 0.784, 95% confidence interval (95%CI) was 0.683-0.901, P = 0.001; GCS score: OR = 1.390, 95%CI was 1.059-1.823, P = 0.018; 6-hour LCR: OR = 1.039, 95%CI was 1.015-1.064, P = 0.001; HRR: OR = 2.047, 95%CI was 1.383-3.029, P < 0.001; length of ICU stay: OR = 1.128, 95%CI was 1.046-1.216, P = 0.002]. ROC curve analysis showed that HRR, 6-hour LCR and APACHE II score could predict the prognosis of patients after CPR. The sensitivity was 85.3% and the specificity was 54.5% when the area under the ROC curve (AUC) of HRR was 0.731, and the cut-off value was 8.555. The sensitivity was 88.2% and the specificity was 46.6%, when the AUC of 6-hour LCR was 0.701, and the cut-off value was 28.947%. The sensitivity was 73.9% and the specificity was 79.4% when the AUC of APACHE II score was 0.848, the cut-off value was 22.000. The predictive value of the combination of HRR and 6-hour LCR was higher than that of a single index. The sensitivity was 79.3% and the specificity was 76.1%, when the AUC was 0.796, the cut-off value was 0.296.@*CONCLUSIONS@#HRR, 6-hour LCR and APACHE II score have high prognostic value in patients with OHCA after CPR. HRR < 8.555, 6-hour LCR < 28.947% and APACHE II score > 22.000 indicated poor prognosis.

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.

Pulse pressure loss after extracorporeal cardiopulmonary resuscitation is an independent predictor of ECMO weaning failure / 中华危重病急救医学

OBJECTIVE@#To analyze the predictors of successful weaning off extracorporeal membrane oxygenation (ECMO) after extracorporeal cardiopulmonary resuscitation (ECPR).@*METHODS@#The clinical data of 56 patients with cardiac arrest who underwent ECPR in Hunan Provincial People's Hospital (the First Affiliated Hospital of Hunan Normal University) from July 2018 to September 2022 were retrospectively analyzed. According to whether ECMO was successfully weaning off, patients were divided into the successful weaning off group and the failed weaning off group. The basic data, duration of conventional cardiopulmonary resuscitation (CCPR, the time from cardiopulmonary resuscitation to ECMO), duration of ECMO, pulse pressure loss, complications, and the use of distal perfusion tube and intra-aortic balloon pump (IABP) were compared between the two groups. Univariate and multivariate Logistic regression analyses were performed to identify the risk factors for weaning failure of ECMO.@*RESULTS@#Twenty-three patients (41.07%) were successfully weaned from ECMO. Compared with the successful weaning off group, patients in the failed weaning off group were older (years old: 46.7±15.6 vs. 37.8±16.8, P < 0.05), higher incidence of pulse pressure loss and ECMO complications [81.8% (27/33) vs. 21.7% (5/23), 84.8% (28/33) vs. 39.1% (9/23), both P < 0.01], and longer CCPR time (minutes: 72.3±19.5 vs. 54.4±24.6, P < 0.01), shorter duration of ECMO support (hours: 87.3±81.1 vs. 147.7±50.8, P < 0.01), and worse improvement in arterial blood pH and lactic acid (Lac) levels after ECPR support [pH: 7.1±0.1 vs. 7.3±0.1, Lac (mmol/L): 12.6±2.4 vs. 8.9±2.1, both P < 0.01]. There were no significant differences in the utilization rate of distal perfusion tube and IABP between the two groups. Univariate Logistic regression analysis showed that the factors affecting the weaning off ECMO of ECPR patients were pulse pressure loss, ECMO complications, arterial blood pH and Lac after installation [pulse pressure loss: odds ratio (OR) = 3.37, 95% confidence interval (95%CI) was 1.39-8.17, P = 0.007; ECMO complications: OR = 2.88, 95%CI was 1.11-7.45, P = 0.030; pH after installation: OR = 0.01, 95%CI was 0.00-0.16, P = 0.002; Lac after installation: OR = 1.21, 95%CI was 1.06-1.37, P = 0.003]. After adjusting for the effects of age, gender, ECMO complications, arterial blood pH and Lac after installation, and CCPR time, showed that pulse pressure loss was an independent predictor of weaning failure in ECPR patients (OR = 1.27, 95%CI was 1.01-1.61, P = 0.049).@*CONCLUSIONS@#Early loss of pulse pressure after ECPR is an independent predictor of failed weaning off ECMO in ECPR patients. Strengthening hemodynamic monitoring and management after ECPR is very important for the successful weaning off ECMO in ECPR.