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1.
In. Soeiro, Alexandre de Matos; Leal, Tatiana de Carvalho Andreucci Torres; Accorsi, Tarso Augusto Duenhas; Gualandro, Danielle Menosi; Oliveira Junior, Múcio Tavares de; Caramelli, Bruno; Kalil Filho, Roberto. Manual da residência em cardiologia / Manual residence in cardiology. Santana de Parnaíba, Manole, 2 ed; 2022. p.545-547, tab.
Monography in Portuguese | LILACS | ID: biblio-1352997
2.
Rev. colomb. cardiol ; 28(3): 297-298, mayo-jun. 2021.
Article in English | LILACS, COLNAL | ID: biblio-1341299

ABSTRACT

To the editor, Sinus arrest and cardiac arrest are two different terms which are often confused by many. This confusion often leads to inappropriate cardiopulmonary resuscitation (CPR) when patient is connected to defibrillator. Sinus arrest is defined as transient pause in Sino-atrial firing for more than 3 s1. When sinus arrest occurs, other latent pacemakers (atrial myocardium, cells nearby atrioventricular node, and His purkinje system) usually starts firing until Sino-atrial node recover. Sinus arrest can be prolonged till other pacemakers starts firing2. Cardiac arrest occurs when these latent pacemakers does not take up the job of alternate firing. Prolonged sinus arrest in a defibrillator may look like a cardiac arrest which might lead to unnecessary CPR. Here, we would like the put forward a new term “mechano - defibrillator dissociation” which occurs because of prolonged sinus arrest. We should be aware this, so that inappropriate CPR could be avoided. We, emergency physician also faced similar situation while resuscitating a patient because of mechano - defibrillator dissociation caused by prolonged sinus arrest/pseudo cardiac arrest. A 52-year-old male diabetic, hypertensive, and chronic alcoholic came to our emergency department (ED) with history of giddiness, syncope, and palpitation. On arrival to ED, patient was drowsy, diaphoretic, and hypotensive. Patient was connected to defibrillator which showed a heart rate of 35/min and saturation was 90% in room air. ECG showed complete heat block (CHB) and point of care echocardiography showed reduced ejection fraction.


Subject(s)
Humans , Male , Middle Aged , Sinus Arrest, Cardiac , Letter , Cardiopulmonary Resuscitation , Defibrillators
3.
Rev Rene (Online) ; 22: e61117, 2021. tab
Article in Portuguese | LILACS, BDENF | ID: biblio-1155273

ABSTRACT

RESUMO Objetivo investigar a relação entre gênero e idade com sintomas de ansiedade, depressão e ansiedade cardíaca em pacientes com cardiodesfibrilador implantável. Métodos estudo transversal, com 76 pacientes com dispositivo atendidos em um hospital universitário. Para a coleta de dados, utilizaram-se formulário sociodemográfico/clínico e duas escalas validadas no Brasil. Na análise, adotaram-se os testes qui-quadrado, exato de Fischer e Mann-Whitney, com nível de significância de 5%. Resultados observou-se que os grupos foram homogêneos entre si quanto ao gênero e à idade. As mulheres apresentaram medianas maiores, tanto nos sintomas de ansiedade quanto nos de depressão, com significância estatística. Apresentaram medianas maiores também nos sintomas de ansiedade cardíaca, porém sem significância estatística. Com relação à idade, não foram encontradas diferenças significativas para os sintomas investigados. Conclusão as mulheres apresentaram mais sintomas de ansiedade e depressão, todavia não houve relação entre a idade dos pacientes com os respectivos sintomas.


ABSTRACT Objective to investigate the relationship between gender and age with symptoms of anxiety, depression and cardiac anxiety in patients with implantable cardioverter-defibrillator. Methods cross-sectional study, with 76 patients with device attended in a university hospital. For data collection, a sociodemographic/clinical form and two validated scales were used in Brazil. In the analysis, the chi-square tests, exact Fischer and Mann-Whitney, with a significance level of 5% were adopted. Results it was observed that the groups were homogeneous in terms of gender and age. Women presented higher medians in both anxiety and depression symptoms, with statistical significance. They also presented higher medians in symptoms of cardiac anxiety, but without statistical significance. Regarding age, no significant differences were found for the symptoms investigated. Conclusion women presented more symptoms of anxiety and depression; however there was no relationship between the age of the patients and their symptoms.


Subject(s)
Anxiety , Arrhythmias, Cardiac , Perioperative Nursing , Defibrillators, Implantable , Defibrillators , Depression
4.
Rev. colomb. cardiol ; 27(5): 420-427, sep.-oct. 2020. tab
Article in English | LILACS, COLNAL | ID: biblio-1289252

ABSTRACT

Abstract Introduction: complications due to cardiac implantable electronic devices have been sparsely studied despite the increased number and complexity of these procedures in a population with multiple comorbidities. Objective: to determine the complication rate and associated risk factors at a reference center in Colombia. Methods: retrospective cohort study, which included patients who had a cardiac electronic device implanted between 2012 and 2015. Clinical records were reviewed to determine if patients developed complications during the year after the procedure, and, if so, which type and which clinical variables could be related to. Results: a total of 897 patients were included, 620 with pacemaker implants and 277 with other devices. The average age was 71.4 years, 63.9% were men, almost all the patients had a chronic disease, and 70% were de novo implants. The global complication rate was 10.9%; Lead displacement (3.6%) and pocket hematoma (3.3%) were the most frequent complications; 7.5% were major complications, and 73.5% occurred in the first month after procedure. The hospitalization rate associated with complications was 9.5%, and the median hospital stay was seven days, with 66.3% of these patients requiring new interventions. The mortality rate was 0.2% Conclusions: complications associated with cardiac implantable electronic devices occur red mainly in the first trimester after the initial intervention, were more frequent in patients under 80 years old, increased according to device complexity, and were not related to with the studied comorbidities.


Resumen Introducción: las complicaciones secundarias al implante de dispositivos cardiacos electrónicos han sido poco estudiadas a pesar del aumento en número y complejidad de estos procedimientos en población con múltiples comorbilidades. Objetivo: determinar la tasa de complicaciones del implante de dispositivos y los factores de riesgo asociados, en un centro de referencia en Colombia. Métodos: estudio de cohorte retrospectiva, que incluyó pacientes a quienes se les implantó dispositivo electrónico cardiaco entre 2012 y 2015. Se revisó la historia clínica para determinar si durante un año posterior al procedimiento, presentaron complicaciones, de qué tipo y con qué variables clínicas podría asociarse. Resultados: se incluyeron 897 pacientes, 620 con implante de marcapaso y 277 otros dispositivos. La edad promedio fue 71.4 años, 63.9% hombres, con múltiples enfermedades crónicas, 70% fueron implantes de novo. Se observó una tasa de complicaciones del 10.9%, la cual varía de acuerdo con el tipo de dispositivo. El desalojo del electrodo (3.6%) y el hematoma del bolsillo (3.3%) fueron las complicaciones más frecuentes, 7.5% fueron complicaciones mayores y 73.5% se presentaron en el primer mes postoperatorio. La tasa de hospitalización asociada a complicación fue 9.5%, mediana de estancia de 7 días, con un 66.3% de los pacientes en requerimiento de reintervención. La tasa de mortalidad fue del 0.2%. Conclusiones: las complicaciones asociadas al implante de dispositivos eléctricos cardiacos se presentaron principalmente en el primer trimestre, fueron más frecuentes en menores de 80 años, aumentaron con la complejidad del dispositivo y no se relacionaron con las comorbilidades estudiadas.


Subject(s)
Humans , Male , Aged , Defibrillators , Cardiac Resynchronization Therapy , Pacemaker, Artificial , Heart Disease Risk Factors
5.
Rev. Méd. Clín. Condes ; 31(1): 21-27, ene.-feb. 2020.
Article in Spanish | LILACS | ID: biblio-1223317

ABSTRACT

Las enfermedades cardiovasculares son muy frecuentes en la población anciana (pacientes mayores de 75 años). El enfrentamiento y manejo de ellas es distinto al indicado en pacientes jóvenes. Son escasos los estudios que incluyen población mayor de 75 años, con evidencia acerca de las diferencias que existen en la respuesta terapéutica en comparación al paciente joven. El anciano tiene mayor fragilidad y múltiples comorbilidades, con reserva cardiaca disminuida, lo que obliga a un manejo integral y acucioso. Los cambios propios de la edad repercuten tanto en riñón, cerebro, hígado, musculatura y corazón, lo que los hace pacientes más proclives a presentar complicaciones de la terapia farmacológica o intervencional. El objetivo de este artículo es resumir las recomendaciones sobre el manejo de las cardiopatías más frecuentes en el anciano, incluyendo insuficiencia cardiaca crónica, cardiopatía coronaria, hipertensión arterial, estenosis aórtica valvular y fibrilación auricular no valvular.


Cardiovascular diseases are very common in the elderly population, and their management is different. There are few studies that include population older than 75 years, with little evidence about the differences in the therapeutic response compared to the young patient. The elderly have greater fragility and multiple comorbidities, with diminished cardiac reserve, which requires a comprehensive and careful management. Changes due to advanced age, in kidney, brain, liver and musculature (among others), make them more vulnerable to complications of the pharmacological or interventional treatment. The objective of this article is to summarize the recommendations on the management of the most frequent heart diseases in the elderly, including chronic heart failure, coronary heart disease, arterial hypertension, valvular aortic stenosis, and non-valvular atrial fibrillation.


Subject(s)
Humans , Aged , Cardiovascular Diseases/diagnosis , Cardiovascular Diseases/therapy , Aortic Valve Stenosis , Pacemaker, Artificial , Arrhythmias, Cardiac , Atrial Fibrillation , Death, Sudden, Cardiac , Coronary Disease/diagnosis , Coronary Disease/therapy , Defibrillators , Heart Failure/diagnosis , Heart Failure/therapy , Hypertension/diagnosis , Hypertension/therapy
6.
Journal of Biomedical Engineering ; (6): 1095-1100, 2020.
Article in Chinese | WPRIM | ID: wpr-879241

ABSTRACT

As an important medical electronic equipment for the cardioversion of malignant arrhythmia such as ventricular fibrillation and ventricular tachycardia, cardiac external defibrillators have been widely used in the clinics. However, the resuscitation success rate for these patients is still unsatisfied. In this paper, the recent advances of cardiac external defibrillation technologies is reviewed. The potential mechanism of defibrillation, the development of novel defibrillation waveform, the factors that may affect defibrillation outcome, the interaction between defibrillation waveform and ventricular fibrillation waveform, and the individualized patient-specific external defibrillation protocol are analyzed and summarized. We hope that this review can provide helpful reference for the optimization of external defibrillator design and the individualization of clinical application.


Subject(s)
Arrhythmias, Cardiac , Defibrillators , Heart , Heart Arrest , Humans , Ventricular Fibrillation/therapy
9.
Med. infant ; 26(2): 142-146, Junio 2019.
Article in Spanish | LILACS | ID: biblio-1016341

ABSTRACT

El tratamiento de los trastornos del ritmo cardíaco ha sufrido recientemente una verdadera revolución. El empleo de avanzadas terapéuticas por catéter para tratar una gran variedad de arritmias, utilizando diferentes fuentes de energía, han permitido evolucionar de un tratamiento antiguamente basado casi con exclusividad en el empleo de fármacos antiarrítmicos, como terapia aguda y/o preventiva, a uno actualmente curativo, con el consiguiente avance que estos últimos métodos conllevan para la calidad de vida de nuestros pacientes y sus familias. La tendencia ha continuado con el empleo de navegadores 3 D que ya no requieren el empleo de radiación ionizante para efectuar estos procedimientos y permiten una mayor exactitud para mejorar los excelentes resultados alcanzados. El desarrollo de dispositivos eléctricos como los marcapasos, sumado a la aparición de otros más avanzados como defibriladores y resincronizadores cardíacos también ha contribuido a mejorar la expectativa de vida de muchos niños con cardiopatías diversas. La mejora evidenciada con el empleo de registradores de eventos implantables y el seguimiento mediante monitoreo a distancia de los diferentes dispositivos eléctricos han demostrado mejorar los resultados obtenidos con dichos métodos a largo plazo. Sin duda con la ayuda de la genética en un futuro cercano será posible hacer tratamientos cada vez más específicos para ayudar en casos de arritmias graves hereditarias o causadas por mutaciones en los canales iónicos de las células cardíacas. Si bien existen aún controversias respecto de algunos ítems muy puntuales los mismos se irán aclarando con las experiencias colaborativas en marcha en diferentes centros médicos especializados (AU)


Recently, treatment of heart rhythm disorders has revolutionized. The use of advanced catheter-based therapies to treat a wide spectrum of arrhythmias, using different energy sources, has led the treatment to evolve from an almost exclusively antiarrhythmic drug-based treatment, such as acute and/or preventive therapy, to a currently curative one, with the consequent advance that these latter methods add to the quality of life of our patients and their families. The trend has continued with the use of 3D navigators that no longer require the use of ionizing radiation to perform these procedures and allow greater accuracy to improve the excellent results achieved. The development of electrical devices, such as pacemakers, coupled with the emergence of more advanced devices, such as defibrillators and cardiac resynchronizers, has also been useful to improve the life expectancy of many children with different types of heart disease. The advances evidenced by the use of implantable event loggers and remote monitoring of different electrical devices have shown to improve the long-term results obtained with such methods. Undoubtedly, with the help of genetics in the near future it will be possible to develop increasingly specific therapies to treat patients with severe hereditary arrhythmias or those caused by mutations in the ion channels of the heart cells. Although controversy still exists regarding some very specific issues, these will be clarified with the collaborative experience underway at different specialized medical centers


Subject(s)
Humans , Pacemaker, Artificial , Arrhythmias, Cardiac/surgery , Arrhythmias, Cardiac/therapy , Defibrillators , Cardiac Electrophysiology/trends , Cardiac Resynchronization Therapy , Cryosurgery/methods , /methods
10.
Rev. colomb. cardiol ; 26(1): 17-23, ene.-feb. 2019. tab, graf
Article in Spanish | LILACS, COLNAL | ID: biblio-1058375

ABSTRACT

Resumen Objetivo: Estimar la razón de costo-efectividad de la reanimación cardiopulmonar con el uso del desfibrilador externo automático (DEA), comparado con la reanimación cardiopulmonar básica, para la reanimación de personas con pérdida de conciencia en espacios de afluencia masiva de público en Colombia. Métodos: Para estimar los costos y desenlaces de las dos alternativas de comparación, se diseñó un árbol de decisiones en el cual se reflejan los principales desenlaces posterior a la pérdida de conciencia y la reanimación con cualquiera de las dos alternativas. Se asumió la perspectiva del sistema de salud colombiano en un horizonte temporal comprendido entre el momento de la pérdida de conciencia de la persona hasta el ingreso al hospital. Las probabilidades de los eventos se obtuvieron de un meta-análisis de ensayos clínicos y la información de costos de fuentes oficiales y consulta directa a proveedores de DEA en Colombia. Los costos fueron expresados en pesos colombianos de 2016 y la efectividad en muertes evitadas. Se realizaron análisis de sensibilidad determinísticos y probabilísticos para estimar el impacto de la incertidumbre sobre las conclusiones. Resultados: La razón de costo-efectividad de la reanimación cardiopulmonar con DEA fue de $3.267.777 por muerte evitada. La probabilidad de que esta intervención sea costo-efectiva es superior al 90% para un umbral de costo-efectividad superior a 10 millones de pesos. Conclusión: Un programa de reanimación cardiopulmonar con desfibrilación temprana mediante el uso de DEA, en espacios de afluencia masiva de público, es una alternativa costo-efectiva para el sistema de salud colombiano.


Abstract Objective: To estimate the cost-effectiveness of cardiopulmonary resuscitation using an automated external defibrillator (AED) compared with basic cardiopulmonary resuscitation, for the resuscitation of unconscious patients in crowded public spaces in Colombia. Methods: A decision tree was designed in order to estimate the costs and outcomes of the two alternatives. This included the main outcomes after the loss of consciousness and resuscitation by any of the two alternatives. The perspective of the Colombian Health System was adopted in a time scale consisting of the time of loss of consciousness until hospital admission. The probabilities of the events were obtained from a meta-analysis of clinical trials, and the information on costs from official sources and direct consultations with AED providers in Colombia. The costs were expressed in Colombian pesos of 2016, and the effectiveness in deaths prevented. Deterministic and probabilistic sensitivity analyses were performed to estimate the impact of uncertainty on the conclusions. Results: The cost-effectiveness of cardiopulmonary resuscitation with AED was COP $3,267,777 per death avoided. The probability that this intervention would be cost-effective is greater than 90% for cost-effectiveness threshold greater than 10 million Colombian pesos. Conclusion: A cardiopulmonary resuscitation program with early defibrillation using an AED in crowded public spaces is a cost-effective alternative for the Colombian Health System.


Subject(s)
Humans , Costs and Cost Analysis , Defibrillators , Cost-Effectiveness Evaluation , Unconsciousness , Cardiopulmonary Resuscitation , Community Participation
11.
REME rev. min. enferm ; 23: e-1257, jan.2019.
Article in Portuguese | LILACS, BDENF | ID: biblio-1048393

ABSTRACT

OBJETIVO: desenvolver e validar um instrumento de exame clínico objetivo estruturado para o cenário de simulação sobre ressuscitação cardiopulmonar no adulto em suporte básico de vida com o uso do desfibrilador externo automático no ambiente hospitalar. MÉTODO: pesquisa aplicada, de produção tecnológica, desenvolvida na Escola de Enfermagem de Ribeirão Preto da Universidade de São Paulo, no período de janeiro de 2017 a março de 2018 com 16 profissionais experts da área de urgência e emergência para validação do exame clínico objetivo estruturado. O instrumento abordou 40 itens de intervenção relacionados ao elo da cadeia da sobrevivência da American Heart Association (2015) para realizar a avaliação clínica no cenário de simulação em ressuscitação cardiopulmonar. RESULTADOS: dos experts, 62,5% obtiveram pontuação superior ou igual a 10 nos critérios de Fehring e destaca-se que 93,75% possuem prática clínica em urgência e emergência no adulto. O exame clínico objetivo estruturado alcançou concordância de 97,34% em organização; 96,09% em objetividade; 93,75% em clareza, e na categorização da concordância interavaliador proposta por Landis e Kock evidenciou "concordância quase perfeita", com p<0,0001. CONCLUSÃO: no processo de validação pelos experts foram identificadas e acatadas as oportunidades de melhorias e o exame clínico objetivo estruturado apresentado demonstrou-se um objeto contemporâneo e adequado para aplicação no processo de ensino-aprendizagem sobre ressuscitação cardiopulmonar no adulto em suporte básico de vida com o uso do desfibrilador externo automático no ambiente hospitalar.(AU)


Objective: to develop and validate an objective structured clinical examination instrument for a simulation scenario on cardiopulmonary resuscitation in adults in basic life support, using automatic external defibrillator in the hospital environment. Method: applied research of technological production, developed at the Escola de Enfermagem in Ribeirão Preto of Universidade de São Paulo, from January 2017 to March 2018 with 16 expert professionals in the area of urgency and emergency for validation the structured objective clinical examination. The instrument addressed 40 intervention items related to the link in the chain of survival of American Heart Association (2015) to perform clinical evaluation in the cardiopulmonary resuscitation simulation scenario. Results: of the experts, 62.5% obtained a score higher than or equal to 10 in Fehring criteria and it is noteworthy that 93.75% have clinical practice in adults' urgency and emergence. The objective structured clinical examination reached agreement of 97.34% in organization; 96.09% in objectivity; 93.75% in clarity, and in the categorization of the inter-evaluator agreement proposed by Landis and Kock showed "almost perfect agreement", with p<0.0001. Conclusion: in the validation process by the experts, opportunities for improvement were identified and accepted and the objective structured clinical examination is a contemporary object and adequate for application in the teachinglearning process on cardiopulmonary resuscitation in adults on basic life support with...(AU)


Objetivo: desarrollar y validar un instrumento de examen clínico objetivo estructurado para el escenario simulado de reanimación cardiopulmonar en adultos con soporte vital básico mediante desfibrilador externo automático en el entorno hospitalario. Método: investigación aplicada de producción tecnológica, desarrollada en la Facultad de Enfermería de Ribeirão Preto de la Universidad de São Paulo, entre enero de 2017 y marzo de 2018 con 16 expertos de urgencias y emergencias para validar el examen clínico objetivo estructurado. El instrumento enfocó 40 aspectos de intervención relacionados con el eslabón de la cadena de supervivencia del American Heart Association (2015) para realizar una evaluación clínica en el escenario de reanimación cardiopulmonar simulada. Resultados: el 62.5% de los expertos obtuvo puntuación mayor o igual a 10 en los criterios de Fehring; se realza que el 93,75% tiene práctica clínica en urgencias y emergencias de adultos. El examen clínico objetivo estructurado alcanzó acuerdo de 97,34% en organización; 96,09% en objetividad; 93.75% en claridad, y la categorización acuerdo entre evaluadores propuesta por Landis y Kock mostró un "acuerdo casi perfecto", con p <0.0001. Conclusión: en el proceso de validación por parte de los expertos, se identificaron y aceptaron las oportunidades de mejora. El examen clínico objetivo estructurado resultó ser un objeto contemporáneo y apropiado para su aplicación en el proceso de enseñanza-aprendizaje de la reanimación cardiopulmonar adulta en soporte vital básico con el uso de desfibrilador externo automático en el entorno hospitalario.(AU)


Subject(s)
Humans , Adult , Clinical Competence , Cardiopulmonary Resuscitation , Educational Measurement , Simulation Exercise , Defibrillators , Emergencies
12.
Article in Korean | WPRIM | ID: wpr-758478

ABSTRACT

OBJECTIVE: Public concerns and awareness of automated external defibrillators (AEDs) are essential for improving the survival outcomes of out-of-hospital cardiac arrest (OHCA) in the community. On the other hand, the proportion of OHCA, in which AED is used in a prehospital setting, is very low in Korea. The aim of this study was to identify the barriers and training issues of AEDs. METHODS: A nationwide population-based survey was conducted to analyze the current public trends in AED awareness, training, and intention to use in 2017 (n=506). The barriers and training issues of AEDs were then documented. For trend analysis, previous tri-temporal surveys were obtained in 2007, 2011, and 2015. RESULTS: Public awareness of AEDs has increased: from 5.8% in 2007, to 30.6% in 2011, 82.6% in 2015, and 79.4% in 2017 (P<0.001). The training experience of AEDs has increased over time: from 0.5% in 2007 to 8.2% in 2011 and 33.2% in 2017. Thirty-two percent of respondents knew how and where to find the AEDs, but only 12.5% were able to certainly locate their public-access AED near their residency or work places. The reasons for being unwilling to use the AED included not knowing how to use (65.0%), fear of causing harm to the victim (21.3%), and legal liability (11.7%). CONCLUSION: Not knowing the location of AED and how to use it, and being unaware of the Good Samaritan Law were the major barriers to public access defibrillation. Further research is urgently needed if AEDs are to be increased and more lives saved.


Subject(s)
Cardiopulmonary Resuscitation , Defibrillators , Hand , Intention , Internship and Residency , Jurisprudence , Korea , Liability, Legal , Out-of-Hospital Cardiac Arrest , Public Health , Surveys and Questionnaires , Workplace
13.
Article in Korean | WPRIM | ID: wpr-758444

ABSTRACT

OBJECTIVE: This study was conducted to compare the outcome of cardiopulmonary resuscitation (CPR) with AutoPulse and LUCAS in out-of-hospital cardiac arrest patients. METHODS: Between July 2017 and March 2018, a total of 152 out-of-hospital cardiac arrest patients were included for analysis. Included patients were divided into an AutoPulse group and LUCAS group. Patient's age, sex, bystander CPR, witness arrest, initial shockable rhythm, time from arrest to CPR, pre-hospital CPR duration, in-hospital CPR duration, automatic external defibrillator operation by paramedic, intubation by paramedic, intravenous line access by paramedic and target temperature management were reviewed retrospectively. In addition, blood pH, lactate level, white blood cell (WBC) count, and delta neutrophil index (DNI) were analyzed. Additionally, return of spontaneous circulation (ROSC), hospital and intensive care unit (ICU) length of stay, complications from chest compressions, and cerebral performance category (CPC) scale at discharge were analyzed. RESULTS: No differences in initial shockable rhythm, patient characteristics, management for patients and CPR duration were observed between the two groups. ROSC were significantly higher in the LUCAS group than the AutoPulse group (17.9 vs. 34.7%, P=0.025). However, hospital and ICU length of stay, CPC scale at discharge as clinical outcome and pH, lactate level, WBC count, and DNI as laboratory outcomes were not significantly different between the AutoPulse group and LUCAS group. Although the case numbers were scarce, complications from chest compressions were not significantly different between the two groups. CONCLUSION: CPR using LUCAS showed better ROSC than CPR using AutoPulse. However, hospital and ICU length of stay and CPC scale at discharge did not differ between the two groups.


Subject(s)
Allied Health Personnel , Cardiopulmonary Resuscitation , Defibrillators , Emergency Service, Hospital , Humans , Hydrogen-Ion Concentration , Intensive Care Units , Intubation , Lactic Acid , Length of Stay , Leukocytes , Neutrophils , Out-of-Hospital Cardiac Arrest , Retrospective Studies , Thorax
14.
Korean Circulation Journal ; : 742-752, 2019.
Article in English | WPRIM | ID: wpr-759458

ABSTRACT

BACKGROUND AND OBJECTIVES: There are limited published data on the incidence and cost associated with cardiac implantable electrical device (CIED) infection for Asian patients. We analyzed the infection burden associated with the implantation of CIEDs in Korea. METHODS: In the Health Insurance Review & Assessment Service (HIRA) database during the period from January 1, 2014 to December 31, 2016, we identified 16,908 patients with CIED implantation. CIED infection was defined as either: 1) Infection-related diagnosis code by the Korean Standard Classification of Diseases after any CIED procedure; or 2) CIED removal along with systemic infection. RESULTS: The proportions of first implantation and replacement were 77.6% and 22.4%, respectively. During the follow-up period of 17.1±10.6 months, a total of 462 patients had CIED infection with incidence of 1.95 per 100 person-years with higher infection rate in replacement than first implantation (3.97 vs. 1.4 per 100 person-years, p<0.001). The average cost per person was US$ 16,584 (pacemaker, $13,736; implantable cardioverter defibrillator, $28,402; cardiac resynchronization therapy, $29,674). The risk factors of CIED infection were generator replacement (adjusted hazard ratio [aHR], 3.14; 95% confidence interval [CI], 2.60–3.78), diabetes mellitus (aHR, 1.94; 95% CI, 1.58–2.38), and congestive heart failure (aHR, 1.86; 95% CI, 1.51–2.28). CONCLUSIONS: The rate of CIED infection in Korea was 1.95 per 100 person-years with average cost of US$ 16,584. The most important risk factor was generator replacement. This result suggests that generator replacement should be performed cautiously to avoid CIED infection.


Subject(s)
Asian Continental Ancestry Group , Cardiac Resynchronization Therapy , Classification , Cohort Studies , Defibrillators , Defibrillators, Implantable , Diabetes Mellitus , Diagnosis , Follow-Up Studies , Heart Failure , Humans , Incidence , Insurance, Health , Korea , Risk Factors
15.
Rev. gaúch. enferm ; 40: e20190012, 2019. tab
Article in Portuguese | LILACS, BDENF | ID: biblio-1014142

ABSTRACT

Resumo OBJETIVO Construir e validar um objeto contemporâneo virtual de ensino, videoaula, sobre ressuscitação cardiopulmonar no adulto em suporte básico de vida com o uso do desfibrilador externo automático no ambiente hospitalar. MÉTODOS Trata-se de uma pesquisa aplicada, de produção tecnológica, com produção de vídeoaula de acordo com a trajetória metodológica proposta por Fleming, Reynolds e Wallace. Desenvolvido na Universidade do Estado de Minas Gerais e na Escola de Enfermagem de Ribeirão Preto no período de janeiro de 2017 a março de 2018. Participaram 16 enfermeiros expertises na área de urgência e emergência. Para concordância inter-avaliadores foi utilizado a estatística AC1 de Gwet. RESULTADOS A validação do roteiro/script e storyboard foi alcançada a concordância inter-avaliadores, de acordo com Landis e Kock, classificada em "concordância moderada", com AC1=0,59 e p<0,0001. CONCLUSÕES A videoaula construída e validada neste estudo, representa importante estratégia contemporânea adequada para aplicação no processo de ensino-aprendizagem.


Resumen OBJETIVO Construir y validar un objeto contemporáneo virtual de enseñanza, vídeo-lección, acerca de la reanimación cardiopulmonar con adultos en cuidados para prolongar la vida, utilizando el desfibrilador externo automático en ambiente hospitalario. MÉTODO Se trata de una investigación aplicada, de producción tecnológica en que la elaboración del vídeo-lección se llevó a cabo según la trayectoria metodológica propuesta por Fleming, Reynolds y Wallace. El estudio se desarrolló en la Universidad del Estado de Minas Gerais y en la Escuela de Enfermería de Ribeirão Preto (Brasil). Participaron de esta investigación 16 enfermeros especialistas en el área de urgencia y emergencia. Para la concordancia 'interevaluadores' se usó la estadística AC1 de Gwet. RESULTADOS Se alcanzó la concordancia 'interevaluadores' para el desarrollo del vídeo-lección a través de la validación del script y storyboard que, según Landis y Kock, es clasificada como "concordancia moderada" con AC1=0,59 y p<0,0001. CONCLUSIONES El vídeo-lección, elaborado y validado en este estudio, representa una importante estrategia contemporánea apropiada para la aplicación en el proceso de enseñanza-aprendizaje.


Abstract OBJECTIVE To elaborate and validate a teaching virtual contemporary object, video-lesson, about resuscitation cardiopulmonary with adult in life support care using automatic external defibrillator in the hospital environment. METHOD This is an applied research of techonlogical productions in witch the video-lesson elaboration was according to the methodological trajectory proposed by Fleming, Reynolds and Wallace. The research was accomplished in the Minas Gerais University State and in the Ribeirão Preto Nursing School (Brazil). Sixteen expertises nurses in the area of urgency and emergency participated of this research. The AC1 Gwet's statistic was used to the interobsevers agreement. RESULTS The validation of script and storyboard to the video-lesson development was reached the interobsevers agreement, classified as "moderate agreenment" according to Landis and Kock, with AC1=0.59 and p<0.0001. CONCLUSIONS The video-lesson elaborated and validated in this research represent an adequate contemporary important strategy to aplication in the teaching-learning process.


Subject(s)
Humans , Male , Female , Adult , Video Recording/methods , Cardiopulmonary Resuscitation/education , Defibrillators , Education, Nursing, Continuing/methods , Professional Practice/statistics & numerical data , Educational Technology , Middle Aged
16.
Singapore medical journal ; : 124-129, 2019.
Article in English | WPRIM | ID: wpr-776944

ABSTRACT

We described two patients who were successfully resuscitated from out-of-hospital cardiac arrest. Their ECGs showed ST elevations in V1 and aVR, as well as diffuse ST depression. Their ST elevation in V1 was noted to be greater than in aVR. While one patient was found to have an occlusion of the right ventricular (RV) branch of the right coronary artery, the other was found to have an occlusion of a proximal non-dominant right coronary artery supplying the RV branch. Successful primary percutaneous coronary intervention was performed for each patient with angioplasty and implantation of a drug-eluting stent. Both patients made good physical and neurological recovery.


Subject(s)
Adult , Angioplasty , Angioplasty, Balloon, Coronary , Cardiopulmonary Resuscitation , Coronary Vessels , Defibrillators , Drug-Eluting Stents , Electrocardiography , Heart Ventricles , Hepatitis B , Humans , Male , Myocardial Infarction , Diagnosis , Out-of-Hospital Cardiac Arrest , Therapeutics , Percutaneous Coronary Intervention , Resuscitation , Singapore
17.
Korean Circulation Journal ; : 119-133, 2019.
Article in English | WPRIM | ID: wpr-738772

ABSTRACT

Sarcoidosis is a multisystem granulomatous disorder of unknown etiology. The annual incidence of systemic sarcoidosis is estimated at 10–20 per 100,000 individuals. Owing to the recent advances in imaging modalities, cardiac sarcoidosis (CS) is diagnosed more frequently. The triad of CS includes conduction abnormality, ventricular tachycardia, and heart failure. Atrial and ventricular arrhythmias are caused by either inflammation or scar formation. Inflammation should be treated with immunosuppression and antiarrhythmic agents and scar formation should be treated with antiarrhythmics and/or ablation, in addition to implantable cardioverter defibrillator (ICD) implantation, if necessary. Ablation can provide a good outcome, but it might require bipolar ablation if the critical portion is located mid-myocardium. Late recurrence might be caused by reactivation of sarcoidosis, which would need to be evaluated by positron emission tomography-computed tomography imaging. Risk of sudden cardiac death (SCD) in patients with advanced atrioventricular block is not low, and ICD implantation could be considered instead of a pacemaker. For risk stratification for SCD, late gadolinium enhancement by cardiac magnetic resonance imaging or program stimulation is often used.


Subject(s)
Arrhythmias, Cardiac , Atrioventricular Block , Catheter Ablation , Cicatrix , Death, Sudden, Cardiac , Defibrillators , Defibrillators, Implantable , Electrons , Gadolinium , Heart Failure , Humans , Immunosuppression , Incidence , Inflammation , Magnetic Resonance Imaging , Recurrence , Sarcoidosis , Tachycardia, Ventricular
19.
Rev. Soc. Cardiol. Estado de Säo Paulo ; 28(3): 291-295, jul.-ago. 2018. graf
Article in English, Portuguese | LILACS | ID: biblio-916538

ABSTRACT

Um dos grandes desafios no atendimento dos pacientes nas unidades de emergência é o tratamento das arritmias ventriculares, principalmente, quando sustentadas e recorrentes, pois são de difícil tratamento e estão associadas à alta mortalidade. O principal mecanismo envolvido na sustentação das taquicardias ventriculares é o mecanismo de reentrada, devido às cicatrizes miocárdicas secundárias a diversas cardiopatias estruturais. A tempestade elétrica pode ser séria quando ocorre em portadores de desfibriladores automáticos, provocando múltiplos choques correspondentes fora do ambiente hospitalar. Nesses casos é necessária a internação hospitalar, onde medidas específicas e escalonadas de tratamento são realizadas, indo desde o manejo clínico até intervenções específicas, como programação de dispositivos eletrônicos, intervenções eletrofisiológicas ou cirúrgicas


One of the biggest challenges in the care of patients in emergency units is the treatment of ventricular arrhythmias, particularly when sustained and relapsing, as they are difficult to treat and are associated with high mortality. The main mechanism involved in the maintenance of ventricular tachycardias is the mechanism of reentry, due to myocardial scars secondary to various structural heart diseases. The electrical storm may be serious when it occurs in patients with automatic defibrillators, causing multiple corresponding shocks outside the hospital setting. In these cases, admission to hospital is necessary, where specific and stepwise treatment measures are performed, ranging from clinical management to specific interventions, such as programming of electronic devices, and electrophysiological or surgical interventions


Subject(s)
Humans , Male , Female , Pacemaker, Artificial , Arrhythmias, Cardiac/diagnosis , Arrhythmias, Cardiac/therapy , Tachycardia, Ventricular/diagnosis , Tachycardia, Ventricular/therapy , Propranolol/therapeutic use , Quinidine/therapeutic use , Verapamil/therapeutic use , Electric Stimulation Therapy/methods , Defibrillators , Diagnosis, Differential , Electrocardiography/methods , Brugada Syndrome/diagnosis , Brugada Syndrome/therapy , Heart , Heart Diseases/diagnosis , Amiodarone/therapeutic use
20.
Rev. Soc. Cardiol. Estado de Säo Paulo ; 28(3): 302-311, jul.-ago. 2018. tab, ilus, graf
Article in English, Portuguese | LILACS | ID: biblio-916547

ABSTRACT

A incidência exata de parada cardiorrespiratória (PCR) mesmo em países com registros clínicos bem estruturados ainda é desconhecida, mas as estimativas variam de 180.000 a mais de 450.000 mortes anuais. A etiologia mais comum da PCR é a doença cardiovascular isquêmica que ocasiona no desenvolvimento de arritmias letais. A sobrevivência decorrente da PCR apresenta desfechos divergentes. No cenário extra-hospitalar, os estudos relataram taxas de sobrevida de 1% a 6%. Três revisões sistemáticas de alta hospitalar sobre a PCR extra-hospitalar mostraram 5% a 10% de sobrevida entre aqueles tratados através de serviços médicos de emergência e 15% quando o distúrbio do ritmo era a fibrilação ventricular (FV). O suporte básico de vida consiste em ressuscitação cardiopulmonar (RCP) e, quando disponível, desfibrilação com desfibrilador externo automático (DEA). As chaves para a sobrevivência após a PCR são reconhecimento e tratamento precoces, especificamente, início imediato de excelente RCP e desfibrilação precoce. O presente artigo discutirá os princípios do suporte básico de vida em adultos do pré-hospitalar à sala de emergência, conforme descritos nas Diretrizes de Ressuscitação Cardiopulmonar e Atendimento Cardiovascular de Emergência do ILCOR e AHA, atualizadas em novembro de 2017


The exact incidence of cardiorespiratory arrest (CRA) even in countries with well-structured clinical records is still unknown, but estimates range from 180,000 to over 450,000 annual deaths. The most common etiology of CRA is ischemic cardiovascular disease, resulting in the development of lethal arrhythmias. Survival of CRA shows divergent outcomes. In the out-of-hospital setting, studies have reported survival rates of 1% to 6%. Three systematic reviews of hospital discharge on extra-hospital CRA showed 5% to 10% survival between those treated by emergency medical services and 15% when the rhythm disorder was ventricular fibrillation (VF). Basic life support consists of cardiopulmonary resuscitation (CPR) and, when available, defibrillation with an automatic external defibrillator (AED). The keys to survival of CRA are early recognition and treatment, specifically, immediate onset of excellent CPR and early defibrillation. This article will discuss the basics of adult life support from prehospital to emergency room, as outlined in the ILCOR and AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care, updated in November 2017


Subject(s)
Humans , Male , Female , Cardiopulmonary Resuscitation/methods , Guidelines as Topic/standards , Emergency Treatment/methods , Prehospital Care/methods , Arrhythmias, Cardiac , Ventricular Fibrillation/therapy , Coronary Artery Disease/complications , Coronary Artery Disease/etiology , Electric Countershock/methods , Cardiovascular Diseases/etiology , Epinephrine/therapeutic use , Defibrillators, Implantable , Defibrillators , Electrodes , Heart Arrest/etiology , Amiodarone/therapeutic use
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