Effects of mechanical cardiopulmonary resuscitation during vertical spatial pre-hospital transport in patients with cardiac arrest: a historical cohort study / 中华危重病急救医学

OBJECTIVE@#To analyze the effect of mechanical cardiopulmonary resuscitation (CPR) on patients with cardiac arrest with the vertical spatial pre-hospital emergency transport.@*METHODS@#A retrospective cohort study was conducted. The clinical data of 102 patients with out-of-hospital cardiac arrest (OHCA) who were transferred to the emergency medicine department of Huzhou Central Hospital from the Huzhou Emergency Center from July 2019 to June 2021 were collected. Among them, the patients who performed artificial chest compression during the pre-hospital transfer from July 2019 to June 2020 served as the control group, and the patients who performed artificial-mechanical chest compression (implemented artificial chest compression first, and implemented mechanical chest compression immediately after the mechanical chest compression device was ready) during pre-hospital transfer from July 2020 to June 2021 served as the observation group. The clinical data of patients of the two groups were collected, including basic data (gender, age, etc.), pre-hospital emergency process evaluation indicators [chest compression fraction (CCF), total CPR pause time, pre-hospital transfer time, vertical spatial transfer time], and in-hospital advanced resuscitation effect evaluation indicators [initial end-expiratory partial pressure of carbon dioxide (PETCO2), rate of restoration of spontaneous circulation (ROSC), time of ROSC].@*RESULTS@#Finally, a total of 84 patients were enrolled, including 46 patients in the control group and 38 in the observation group. There was no significant difference in gender, age, whether to accept bystander resuscitation or not, initial cardiac rhythm, time-consuming pre-hospital emergency response, floor location at the time of onset, estimated vertical height, and whether there was any vertical transfer elevator/escalator, etc. between the two groups. In the evaluation of the pre-hospital emergency process, the CCF during the pre-hospital emergency treatment of patients in the observation group was significantly higher than that in the control group [69.05% (67.35%, 71.73%) vs. 61.88% (58.18%, 65.04%), P < 0.01], the total pause time of CPR was significantly shorter than that in the control group [s: 266 (214, 307) vs. 332 (257, 374), P < 0.05]. However, there was no significant difference in the pre-hospital transfer time and vertical spatial transfer time between the observation group and the control group [pre-hospital transfer time (minutes): 14.50 (12.00, 16.75) vs. 14.00 (11.00, 16.00), vertical spatial transfer time (s): 32.15±17.43 vs. 27.96±18.67, both P > 0.05]. It indicated that mechanical CPR could improve the CPR quality in the process of pre-hospital first aid, and did not affect the transfer of patients by pre-hospital emergency medical personnel. In the evaluation of the in-hospital advanced resuscitation effect, the initial PETCO2 of the patients in the observation group was significantly higher than that of the patients in the control group [mmHg (1 mmHg ≈ 0.133 kPa): 15.00 (13.25, 16.00) vs. 12.00 (11.00, 13.00), P < 0.01], the time of ROSC was significantly shorter than that in the control group (minutes: 11.00±3.25 vs. 16.64±2.54, P < 0.01), and the rate of ROSC was slightly higher than that in the control group (31.58% vs. 23.91%, P > 0.05). It indicated that continuous mechanical compression during pre-hospital transfer helped to ensure continuous high-quality CPR.@*CONCLUSIONS@#Mechanical chest compression can improve the quality of continuous CPR during the pre-hospital transfer of patients with OHCA, and improve the initial resuscitation outcome of patients.

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.

Registro prospectivo de pacientes que presentan paro cardiorrespiratorio extrahospitalario en Santiago, Chile / A registry of out-of-hospital cardiac arrest in Chile

BACKGROUND: The rate of survival to hospital discharge is less than 10% for out-of-hospital cardiac arrest (OHCA). AIM: To develop and implement a Chilean prospective, standardized cardiac arrest registry following the Utstein criteria. MATERIAL AND METHODS: We conducted a prospective registry for patients presenting at an urban, academic, high complexity emergency department (ED) after having an OHCA. The facility serves approximately 10% of the national population. Data were registered and analyzed following the Utstein criteria for reporting OHCA. RESULTS: For three years, 289 patients aged 59 ± 19 years (63% men) were included. Fifty seven percent of patients were taken to a health care facility for the first medical assessment by relatives or witnesses and 34% was assisted and transferred by prehospital personnel. In the subgroup of non-traumatic OHCA, 28% (n = 54) received bystander cardiopulmonary resuscitation (CPR). The registered cardiac rhythms were asystole (61%), pulseless electrical activity (PEA) (25%) and ventricular tachycardia (VT) or ventricular fibrillation (VF) (11%). The overall survival rate to discharge from the hospital was 10%, while survival with mRankin score 0-1 was 5%. The median hospitalization length of stay was 18 days among those who survived, compared with five days for the group of patients that died during the hospital stay. CONCLUSIONS: OHCA is an important cause of death in Chile. The development of a national registry that follows the International Liaison Committee on Resuscitation guidelines is the first step to assess the profile of OHCA in the region. It will provide crucial information to identify prognostic factors and variables that can help develop standards of care and set up the basis to optimize cardiac arrest management within our country and region.

Inter-hospital trends of post-resuscitation interventions and outcomes of out-of-hospital cardiac arrest in Singapore

INTRODUCTION@#Hospital-based resuscitation interventions, such as therapeutic temperature management (TTM), emergency percutaneous coronary intervention (PCI) and extracorporeal membrane oxygenation (ECMO) can improve outcomes in out-of-hospital cardiac arrest (OHCA). We investigated post-resuscitation interventions and hospital characteristics on OHCA outcomes across public hospitals in Singapore over a 9-year period.@*METHODS@#This was a prospective cohort study of all OHCA cases that presented to 6 hospitals in Singapore from 2010 to 2018. Data were extracted from the Pan-Asian Resuscitation Outcomes Study Clinical Research Network (PAROS CRN) registry. We excluded patients younger than 18 years or were dead on arrival at the emergency department. The outcomes were 30-day survival post-arrest, survival to admission, and neurological outcome.@*RESULTS@#The study analysed 17,735 cases. There was an increasing rate of provision of TTM, emergency PCI and ECMO (P<0.001) in hospitals, and a positive trend of survival outcomes (P<0.001). Relative to hospital F, hospitals B and C had lower provision rates of TTM (≤5.2%). ECMO rate was consistently <1% in all hospitals except hospital F. Hospitals A, B, C, E had <6.5% rates of provision of emergency PCI. Relative to hospital F, OHCA cases from hospitals A, B and C had lower odds of 30-day survival (adjusted odds ratio [aOR]<1; P<0.05 for hospitals A-C) and lower odds of good neurological outcomes (aOR<1; P<0.05 for hospitals A-C). OHCA cases from academic hospitals had higher odds ratio (OR) of 30-day survival (OR 1.3, 95% CI 1.1-1.5) than cases from hospitals without an academic status.@*CONCLUSION@#Post-resuscitation interventions for OHCA increased across all hospitals in Singapore from 2010 to 2018, correlating with survival rates. The academic status of hospitals was associated with improved survival.

Clinical evaluation of the use of laryngeal tube versus laryngeal mask airway for out-of-hospital cardiac arrest by paramedics in Singapore

INTRODUCTION@#It remains unclear which advanced airway device has better placement success and fewer adverse events in out-of-hospital cardiac arrests (OHCAs). This study aimed to evaluate the efficacy of the VBM laryngeal tube (LT) against the laryngeal mask airway (LMA) in OHCAs managed by emergency ambulances in Singapore.@*METHODS@#This was a real-world, prospective, cluster-randomised crossover study. All OHCA patients above 13 years of age who were suitable for resuscitation were randomised to receive either LT or LMA. The primary outcome was placement success. Per-protocol analysis was performed, and the association between outcomes and airway device group was compared using multivariate binomial logistic regression analysis.@*RESULTS@#Of 965 patients with OHCAs from March 2016 to January 2018, 905 met the inclusion criteria, of whom 502 (55.5%) were randomised to receive LT while 403 (44.5%) were randomised to receive LMA. Only 174 patients in the LT group actually received the device owing to noncompliance. Placement success rate for LT was lower than for LMA (adjusted odds ratio [OR] 0.52, 95% confidence interval [CI] 0.31-0.90). Complications were more likely when using LT (OR 2.82,0 95% CI 1.64-4.86). Adjusted OR for prehospital return of spontaneous circulation (ROSC) was similar in both groups. A modified intention-to-treat analysis showed similar outcomes to the per-protocol analysis between the groups.@*CONCLUSION@#LT was associated with poorer placement success and higher complication rates than LMA. The likelihood of prehospital ROSC was similar between the two groups. Familiarity bias and a low compliance rate to LT were the main limitations of this study.

Effectiveness of cardiopulmonary resuscitation training in the teaching of family members of cardiac patients / Efectividad del entrenamiento sobre resucitación cardiopulmonar en el aprendizaje de familiares de pacientes cardíacos / Efetividade de treinamento sobre ressuscitação cardiopulmonar na aprendizagem de familiares de pacientes cardiopatas

ABSTRACT Objective: To evaluate the effectiveness of a cardiopulmonary resuscitation training in the skill acquisition of family members of heart disease patients. Method: A quasi-experimental study, conducted in a hospital in São Paulo, Brazil. The study participants were one or more relatives of patients with heart disease that were hospitalized at the institution. In the first phase, the participant's skills and theoretical knowledge on cardiopulmonary resuscitation were evaluated before and immediately after the training. The second phase took place one month after the training, in which the same evaluations were applied. The McNemar's and Stuart-Maxwell tests were adopted (5% significance level). Results: The theoretical knowledge of family members before and after training increased and a great retention of this knowledge after 30 days of training was observed. Immediately after training, the family members showed significant improvement of skills in the 15 analyzed actions and, after one month of training, they maintained most of the acquired practices on cardiopulmonary resuscitation, except for chest compressions frequency and the time between turning on the defibrillator and delivering the shock. Conclusion: Cardiopulmonary resuscitation training was effective in the acquisition of theoretical and practical knowledge of the family members.

RESUMEN Objetivo: Evaluar la efectividad del entrenamiento sobre resucitación cardiopulmonar en el aprendizaje de familiares de pacientes cardíacos. Método: Estudio cuasiexperimental, realizado en un hospital de São Paulo, Brasil. Participaron de la investigación uno o más familiares de pacientes cardíacos, hospitalizados en la institución. La primera fase evaluó los conocimientos teóricos y habilidades de los participantes sobre resucitación cardiopulmonar antes e inmediatamente después del entrenamiento. La segunda fase se realizó un mes después del entrenamiento, con la aplicación de las mismas evaluaciones. Se adoptaron las pruebas de McNemar y Stuart-Maxwell (nivel de significación del 5%). Resultados: Los familiares incrementaron sus conocimientos teóricos antes y después del entrenamiento, los cuales persistieron después de 30 días de la capacitación. Después del entrenamiento, los familiares mejoraron significativamente las habilidades en las 15 acciones analizadas y, después de un mes de capacitación, mantuvieron la mayoría de las prácticas asimiladas sobre reanimación cardiopulmonar, excepto la frecuencia de las compresiones torácicas y el tiempo entre encender el desfibrilador y aplicar la descarga. Conclusión: El entrenamiento de resucitación cardiopulmonar fue efectivo en el aprendizaje teórico y práctico de los familiares.

RESUMO Objetivo: Avaliar a efetividade de um treinamento sobre ressuscitação cardiopulmonar na aprendizagem de familiares de pacientes cardiopatas. Método: Estudo quase experimental, realizado em hospital de São Paulo, Brasil. Participaram da pesquisa um ou mais familiares de pacientes cardiopatas internados na instituição. Na primeira fase foram avaliados o conhecimento teórico e as habilidades dos participantes sobre a ressuscitação cardiopulmonar antes e imediatamente após o treinamento. A segunda fase aconteceu um mês após o treinamento, com a aplicação das mesmas avaliações. Os testes McNemar e Stuart-Maxwell foram adotados (nível de significância de 5%). Resultados: Houve aumento do conhecimento teórico dos familiares antes e após o treinamento e elevada retenção desse conhecimento após 30 dias da capacitação. Os familiares apresentaram, após o treinamento, melhora significativa das habilidades nas 15 ações analisadas e, após um mês da capacitação, mantiveram a maioria das práticas assimiladas sobre ressuscitação cardiopulmonar, com exceção da frequência das compressões torácicas e do tempo entre ligar o desfibrilador e aplicar o choque. Conclusão: O treinamento sobre ressuscitação cardiopulmonar foi efetivo na aprendizagem teórica e prática dos familiares.

O ensino de ressuscitação cardiopulmonar para jovens: quais os benefícios e as metodologias empregadas? / Teaching cardiopulmonary resuscitation to young people: what are the benefits and methodologies used?

Doenças cardiovasculares constituem a principal causa de mortalidade no mundo, sendo que a parada cardiorrespiratória (PCR) representa cerca de 320 mil mortes por ano no Brasil. Estima-se que metade das PCRs ocorram em ambiente extra-hospitalar, sendo 80% presenciados exclusivamente por pessoas leigas. Sabe-se que o tempo entre a PCR e o início da ressuscitação cardiopulmonar (RCP) é um fator crítico, visto que a cada minuto há uma redução em até 10% das chances de sobrevivência da vítima. A partir disso, constata-se que é de suma importância a capacitação de leigos para realizarem RCP, especialmente, a população jovem, que além de estar apta a realizar as manobras, representa uma importante fonte de disseminação de informação. Alguns países já adotam como obrigatório o treinamento de RCP no currículo escolar. No Brasil, contudo, ainda não existem aulas voltadas para o desenvolvimento das habilidades do suporte básico de vida (SBV). Diante disso, faz-se necessária a análise das intervenções realizadas em outros países para entender quais estratégias de ensino vêm sendo utilizadas. Dessa forma, o objetivo do presente estudo foi realizar uma revisão bibliográfica acerca das metodologias e resultados alcançados em processos de capacitação de alunos do ensino médio sobre SBV. Para isso, realizou-se uma revisão narrativa, na base de dados PubMed, resultando ao total 10 artigos, de acordo com os critérios empregados. Tais estudos demonstram que o ensino da RCP para alunos do ensino médio parece apresentar boa resposta, especialmente quando as intervenções são de longo prazo e abordam mais de uma metodologia de ensino.

Cardiovascular diseases are the main cause of mortality in the world, and cardiorespiratory arrest (CRP) represents about 320 thousand deaths per year in Brazil. It is estimated that half of the CRP occur outside the hospital, and among these cases, 80% are seen exclusively by laypeople. It is believed that the time between CRP and the onset of cardiopulmonary resuscitation (CPR) is the most critical factor, since every minute there is a reduction of up to 10% in the victim's chances of survival. From this, it appears that the training of laypeople to perform CPR is of utmost importance, especially the young population, who are able to perform the maneuvers and are a source of information dissemination. Some countries have already adopted the mandatory insertion of CPR training in the school curriculum. In Brazil, there are still no classes aimed at developing the skills of basic life support (BLS). In view of this, it is of utmost importance to analyze the interventions carried out in other countries to understand which teaching strategies are being used. Thus, the objective of the present study was to carry out a bibliographic review about the methodologies and results achieved in processes of training high school students on BLS. For this, a bibliographic review was carried out on the PubMed platform and 10 articles were included. Studies have shown that teaching CPR to high school students is effective, especially those who address more than one teaching methodology and make long-term interventions.

Paro cardiaco extrahospitalario: conocimientos en una comunidad universitaria / Out-of-hospital cardiac arrest: knowledge in a university community

Objetivo: determinar el nivel de conocimiento de una comunidad universitaria en Bogotá, para actuar como primer respondiente ante situaciones de emergencia como el paro cardiorrespiratorio y sus principales causas. Metodología: estudio cuantitativo, descriptivo y transversal. Muestra: 1.294 integrantes de una comunidad universitaria, margen de error 3,0 %; nivel de confianza 97,0 %. Muestreo por conveniencia. La información se recolectó a través de la plataforma Google Forms®, por medio de un cuestionario de catorce preguntas, distribuidas en tres categorías: reconocimiento del evento, activación de sistema de emergencias y atención inicial. Se cumplieron los requisitos éticos para la investigación en salud en Colombia. Resultados: el 62,7 % de los participantes identificó las acciones para reconocer un paro cardiorrespiratorio y, aunque el 83,6 % ante estas situaciones llamaría a emergencias, solo el 37,0 % afirmó conocer el número telefónico. La sospecha de síndrome coronario agudo es un evento considerado por un 68,2 % como una emergencia; no sucede lo mismo con el accidente cerebrovascular, donde solo el 52,1 %, tenía esta claridad. El 81, 4 % describió acciones correctas frente a una víctima con obstrucción grave de la vía aérea por cuerpo extraño y el 50,6 % si la obstrucción es leve. Conclusión: el nivel de conocimiento de la comunidad universitaria en materia de atención del paro cardiorrespiratorio extrahospitalario es bajo predominantemente relacionado con las maniobras de reanimación cardiopulmonar y la operación del desfibrilador externo automático. Resulta necesario implementar estrategias educativas dirigidas a todas las comunidades, y esto podría ser una oportunidad de desarrollo para el profesional de enfermería en los diferentes ámbitos de acción.

Objective: To determine the level of knowledge of a university community in Bogotá to act as first responders in emergencies like cardiopulmonary arrests and their main causes. Methods: Quantitative, descriptive, and cross-sectional study. Sample: 1294 members of a university community, 3% error, 97% confidence level. Convenience sampling method was used. Data were collected through the Google Forms® platform using a 14-item questionnaire, addressing three categories: event recognition, emergency system activation, and initial assistance. The ethical requirements for health research in Colombia were met. Results: More than half of the participants (62.7%) identified the actions to recognize cardiopulmonary arrest and, although 83.6% would call the emergency services in such situations, only 37.0% said they knew the telephone number. Suspected acute coronary syndrome is considered by 68.2% as an emergency; this is not the case of strokes, which only 52.1% considered them emergencies. Correct actions were described by 81.4% of the participants for severe foreign body airway obstruction and by 50.6% for mild airway obstruction. Conclusion: The university community's knowledge level about out-of-hospital cardiopulmonary arrest assistance is low, especially regarding cardiopulmonary resuscitation and use of an automated external defibrillator. Implementing educational strategies aimed at all communities is necessary, and it could mean a development opportunity for nursing professionals in different fields of action.

Objetivo: determinar o nível de conhecimento de uma comunidade universitária de Bogotá, para atuar como o primeiro respondente em situações de emergência como parada cardiorrespiratória e suas principais causas. Metodologia: estudo quantitativo, descritivo e transversal. Amostra: 1.294 membros de uma comunidade universitária, margem de erro de 3,0%; nível de confiança de 97,0%. Amostragem por conveniência. As informações foram coletadas por meio da plataforma Google Forms®, mediante um questionário de quatorze perguntas, distribuídas em três categorias: reconhecimento do evento, acionamento do sistema de emergência e atendimento inicial. Cumpriram-se os requisitos éticos para a pesquisa em saúde na Colômbia. Resultados: 62,7% dos participantes identificaram as ações para reconhecer uma parada cardiorrespiratória e, embora 83,6% ligassem para o pronto-socorro nessas situações, apenas 37,0% afirmaram conhecer o número de telefone. A suspeita de síndrome coronariana aguda é um evento considerado por 68,2% como uma emergência; o mesmo não acontece com o acidente vascular cerebral, onde apenas 52,1% tinham essa clareza. 81,4% descreveram ações corretas diante de uma vítima com obstrução grave de via aérea por corpo estranho e 50,6% se a obstrução for leve. Conclusão: o nível de conhecimento da comunidade universitária quanto ao atendimento à parada cardíaca extra-hospitalar é baixo, predominantemente relacionado às manobras de reanimação cardiopulmonar e ao funcionamento do desfibrilador externo automático. É necessária a implementação de estratégias educacionais voltadas para todas as comunidades, e esta pode ser uma oportunidade de desenvolvimento para o profissional de enfermagem nos diferentes campos de atuação.

Parada Cardiorrespiratória Extra-Hospitalar durante a Pandemia da Doença por Coronavírus 2019 (COVID-19) no Brasil: A Mortalidade Oculta / Out-Of-Hospital Cardiac Arrest during the Coronavirus Disease 2019 (COVID-19) Pandemic in Brazil: The Hidden Mortality

Resumo O mundo mudou em apenas alguns meses após o surgimento da doença do novo coronavírus 2019 (COVID-19), causada por um betacoronavírus denominado síndrome respiratória aguda grave por coronavírus 2 (SARS-CoV-2). A COVID-19 foi declarada uma pandemia pela Organização Mundial da Saúde (OMS) em 11 de março de 2020. O Brasil apresenta atualmente o segundo maior índice de mortalidade por COVID-19 do mundo, perdendo apenas para os EUA. A pandemia da COVID-19 está se espalhando rapidamente pelo mundo, com mais de 181 países afetados. O presente editorial se refere ao artigo publicado nos Arquivos Brasileiros de Cardiologia: "Aumento de óbitos domiciliares devido a parada cardiorrespiratória em tempos de pandemia de COVID-19"1 Seus principais resultados mostram um aumento gradual na taxa de paradas cardiorrespiratórias extra-hospitalares durante a pandemia da doença por coronavírus 2019 (COVID-19) na cidade de Belo Horizonte, Minas Gerais, Brasil. Seus dados demonstram um aumento proporcional de 33% dos óbitos domiciliares em março de 2020 em relação aos períodos anteriores. O estudo é o primeiro artigo brasileiro a demonstrar a mesma tendência observada em outros países.

Abstract The world changed in just a few months after the emergence of the novel coronavirus disease 2019 (COVID-19), caused by a beta coronavirus named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). COVID-19 was declared a pandemic by the World Health Organization (WHO) on March 11, 2020. Brazil currently has the world's second-highest COVID-19 death toll, second only to the USA. The COVID-19 pandemic is spreading fast in the world with more than 181 countries affected. This editorial refers to the article published in Arquivos Brasileiros de Cardiologia: "Increase in home deaths due to cardiorespiratory arrest in times of COVID-19 pandemic."1 Their main results show a gradual increase in the rate of out-of-hospital cardiac arrest during the Coronavirus disease 2019 (COVID-19) pandemic in the city of Belo Horizonte, Minas Gerais, Brazil. Their data demonstrate a proportional increase of 33% of home deaths in March 2020 compared to previous periods. Their study is the first Brazilian paper to demonstrate the same trend observed in other countries.

Paro cardiorrespiratorio por electrocución tratado con éxito extrahospitalariamente / Cardiorespiratory Arrest Caused by Electrocution Successfully Treated in an Extra-Hospital Situation / Parada cardiorrespiratória por eletrocussão tratada com sucesso de maneira extra-hospitalar

Resumen Introducción: son pocos los datos documentados sobre los resultados de la reanimación cardiopulmonar en el paro cardiorrespiratorio extrahospitalario por causa de electrocución. El paro cardiorrespiratorio se produce cuando una descarga eléctrica interrumpe de forma abrupta la actividad eléctrica normal del corazón, lo que genera una electrocución y una alteración en los movimientos cardiacos y, por consiguiente, bombeo anormal de sangre y oxígeno a los tejidos. Ello constituye una emergencia clínica que puede ocasionar nefastas consecuencias de no tomarse medidas enérgicas e inmediatas. Presentación del caso: hombre con paro cardiorrespiratorio producido por electrocución y manejado en un ámbito extra-hospitalario, quien respondió con éxito a las maniobras aplicadas. Personal técnico y de salud iniciaron precozmente la reanimación cardiopulmonar y luego fue reforzada por personal médico, que aplicó desflbrilación en dos ocasiones con desflbrilador externo automático (DEA). Con ello se logró recuperar los signos vitales del paciente y trasladarlo a un centro asistencial para continuar su manejo intrahospitalario. Conclusión: la realización de una reanimación precoz y la desfibrilación de pacientes electrocutados, así como las medidas encaminadas a la protección del cerebro, son la norma prioritaria en la asistencia pre-hospitalaria de estos pacientes, quienes son potencialmente recuperables. Por tal razón, es importante que la comunidad, en general, esté preparada y que el personal de salud se reentrene en soporte vital básico, que incluye el manejo del DEA para dar oportunidad de sobrevivir a personas que sufran un paro cardiorrespiratorio extrahospitalario.

Abstract Introduction: There are few the documented data about the cardiopulmonary resuscitation results in the cardiorespiratory arrest extra-hospital due to the electrocution. The cardiorespiratory arrest occurs when the heart's normal electrical activity is abruptly interrupted by electric shocks generated by electrocution, causing the disturbance in the cardiac movements and, consequently, abnormal pumping of blood and oxygen to the tissues. The cardiorespiratory arrest due to electrocution is one clinic emergency that can cause disastrous consequences, if energetic measures are not taken immediately. Case presentation: A man with cardiorespiratory arrest produced by electrocution and managed in an extra-hospital area, who responded successfully to the maneuvers applied. The cardiopulmonary resus-citation maneuvers were precociously started by the health technical staff; next, reinforced by medical it, applying the defibrillation on two occasions, with external automatic defibrillator (AED), recovering the patient's vital signs and allowing his transfer to a healthcare center to continue in-hospital management. Conclusion: The performing of early resuscitation and defibrillation of electrocuted patients, as well as the measures aimed at protecting the brain, are the priority rules in the pre-hospital scene of these patients, who are potentially recoverable. For this reason, it is important that the community, in general, be ready, and the health staff gets trained in basic vital support that includes the management of AED to give the opportunity of surviving to people that suffer a cardiorespiratory arrest.

Resumo Introdução: são poucos os dados documentados sobre os resultados da reanimação cardiopulmonar na parada cardiorrespiratória extra-hospitalar por causa de eletrocussão. A parada cardiorrespiratória se produz quando a atividade elétrica normal do coração é interrompida abruptamente pela descarga elétrica que gera a eletrocussão causando alterado nos movimentos cardíacos e por conseguinte bombeamento anormal de sangue e oxigeno aos tecidos. A parada cardiorrespiratória causada por eletrocussão é uma emergência clínica que pode ocasionar nefastas consequências, de não tomar medidas enérgicas e imediatas. Apresentação do caso: homem com parada cardiorrespiratória, produzida por eletrocussão e manejado em um âmbito extra-hospitalar, quem respondeu com sucesso ás manobras aplicadas. A rearrumação cardiopulmonar foi iniciada precocemente por pessoal técnico de saúde, posteriormente reforjadas por pessoal médico, aplicando a desfibrilação em duas ocasiões, com desfibrilador automático externo (DEA), recuperando os signos vitais do paciente e permitindo seu traslado e um centro assistencial para continuar manejo intra-hospitalar. Conclusão: a realizado de uma rearrumação precoce e desfibrilação de pacientes eletrocutados, assim como as medidas encaminhadas á proteção do cérebro, são a norma prioritária na assistência pré-hospitalar destes pacientes, os quais são potencialmente recuperáveis; por esta razão é importante que a comunidade, em geral, esteja preparada e que o pessoal de saúde se retreine em suporte vital básico que inclua o manejo do DEA para dar oportunidade de sobrevida a pessoas que sofram uma parada cardiorrespiratória extra-hospitalar.

Time de resposta rápida e atendimento de paradas cardíacas extra-hospitalares / Rapid response Team and out-of-hospital cardiac arrest

Times de Resposta Rápida (TRR) são equipes multidisciplinares treinadas para atender indivíduos com intercorrências agudas e graves, incluindo parada cardiorrespiratória (PCR) súbita, nas unidades de internação. O objetivo deste trabalho é discutir as particularidades do emprego de um TRR hospitalar no atendimento de PCRs extra-hospitalares, utilizando a experiência do time do Instituto Central do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (ICHC-FMUSP) para elucidação. Metodologia: Estudo retrospectivo, descritivo, utilizando o banco de dados do TRR do ICHC-FMUSP. Foram levantados todos os casos classificados como PCR súbita atendidos em ambiente extra-hospitalar, nos anos de 2014 a 2016. Dados globais de cinco pacientes que evoluíram com alta hospitalar e nível neurológico preservado foram descritos e analisados em detalhes. Resultados: Entre 11 atendimentos, oito tiveram retorno da circulação espontânea (RCE) na cena (72,2%) e três morreram no local. Dos oito pacientes admitidos com vida no Departamento de Emergência, cinco tiveram alta hospitalar após o evento (45,5%). A média de tempo de resposta foi 3 ± 1,2 minutos e o intervalo chamada-choque foi de 7,25 ± 3,2 minutos. Os ritmos de parada foram fibrilação ventricular (80%) e atividade elétrica sem pulso (20%). Dois pacientes foram diagnosticados com doença coronariana grave e quatro receberam um cardiodesfibrilador implantável (CDI) para profilaxia secundária de morte súbita. Um paciente, entre os cinco que tiveram alta, faleceu em outro serviço. Conclusão: Apesar de pouco usual, o emprego de um TRR hospitalar no atendimento de PCRs extra-hospitalares pode ser benéfico. Os desfechos favoráveis provavelmente decorreram do treinamento da equipe e da rapidez na realização do atendimento. A investigação cardiológica dos sobreviventes identificou pacientes com doenças graves, que, portanto, mais se beneficiariam da assistência de um time especializado

Introduction: Rapid Response Teams (RRT) are multidisciplinary groups trained to treat individuals with severe and acute events, including sudden cardiac arrest (CA), in in-patient units. The aim of this report is to discuss the singularities of deploying a hospital RRT for out-of-hospital CA assistance, using the experience of the team at the Instituto Central of Hospital das Clínicas of the University of São Paulo School of Medicine (ICHC-FMUSP) as illustration. Methodology: A retrospective, descriptive analysis was conducted, using the RRT database of the ICHC-FMUSP. All cases classified as sudden CA treated outside of the hospital between 2014 and 2016 were surveyed. Global data for five patients who progressed to discharge from hospital free of neuro - logical impairment were described and analyzed in detail. Results: Of the 11 cases, 8 had return of spontaneous circulation (ROSC) at the scene (72.2%), and 3 died on site. Of the 8 patients admitted to the Emergency Department, 5 were discharged from the hospital after the event (45.5%). The average response time was 3±1.2minutes, and the call-to-shock time interval was 7.25±3.2minutes. The cardiac arrest rhythms were ventricular fibrillation (80%) and pulseless electrical activity (20%). Two patients were diagnosed with severe coronary disease and four received an implantable cardioverter-defibrillator (ICD) for secondary prophylaxis of sudden death. One patient, of the 5 discharged, died in another unit. Conclusion: Although unusual, the use of a hospital RRT for out-of-hospital CA assistance can be beneficial. The favorable outcomes likely resulted from the team's training and the speed with which the treatment was given. Cardiovascular evaluation of the survivors identified patents with severe diseases, which would, therefore, most benefit from the care of a specialized team

New Termination-of-Resuscitation Models and Prognostication in Out-of-Hospital Cardiac Arrest Using Electrocardiogram Rhythms Documented in the Field and the Emergency Department

BACKGROUND: Electrocardiogram (ECG) rhythms, particularly shockable rhythms, are crucial for planning cardiac arrest treatment. There are varying opinions regarding treatment guidelines depending on ECG rhythm types and documentation times within pre-hospital settings or after hospital arrivals. We aimed to determine survival and neurologic outcomes based on ECG rhythm types and documentation times. METHODS: This prospective observational study of 64 emergency medical centers was performed using non-traumatic out-of-hospital cardiac arrest registry data between October 2015 and June 2017. From among 4,608 adult participants, 4,219 patients with pre-hospital and hospital ECG rhythm data were enrolled. Patients were divided into 3 groups: those with initial-shockable, converted-shockable, and never-shockable rhythms. Patient characteristics and survival outcomes were compared between groups. Further, termination of resuscitation (TOR) validation was performed for 6 combinations of TOR criteria confirmed in previous studies, including 2 rules developed in the present study. RESULTS: Total survival to discharge after cardiac arrest was 11.7%, and discharge with good neurologic outcomes was 7.9%. Survival to discharge rates and favorable neurologic outcome rates for the initial-shockable group were the highest at 35.3% and 30.2%, respectively. There were no differences in survival to discharge rates and favorable neurologic outcome rates between the converted-shockable (4.2% and 2.0%, respectively) and never-shockable groups (5.7% and 1.9%, respectively). Irrespective of rhythm changes before and after hospital arrival, TOR criteria inclusive of unwitnessed events, no pre-hospital return of spontaneous circulation, and asystole in the emergency department best predicted poor neurologic outcomes (area under the receiver operating characteristic curve of 0.911) with no patients classified as Cerebral Performance Category 1 or 2 (specificity = 1.000). CONCLUSION: Survival outcomes and TOR predictions varied depending on ECG rhythm types and documentation times within pre-hospital filed or emergency department and should, in the future, be considered in treatment algorithms and prognostications of patients with out-of-hospital cardiac arrest. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03222999

The comparisons of prehospital treatments in traumatic and non-traumatic out-of-hospital cardiac arrests

OBJECTIVE: The outcome of traumatic cardiac arrests remains poor. Nevertheless, the prehospital treatments for traumatic arrests are insufficient in Korea. This study was conducted to compare the prehospital treatments in traumatic and non-traumatic out-of-hospital cardiac arrests (OHCA). METHODS: This was a retrospective, single-center study based on the prospectively collected database of an academic tertiary medical center. The study period was from 2009 to 2017. The following items were compared: age, sex, rates of bystander cardiopulmonary resuscitation (CPR), prehospital intubation, prehospital defibrillation, prehospital epinephrine administration, CPR duration, rates of return of spontaneous circulation, and the survival discharge. RESULTS: Among 786 arrest patients, there were 226 (28.7%) traumatic cardiac arrests and 560 (71.2%) non-traumatic cardiac arrests. The rate of bystander CPR was lower (3.1% vs. 17.5%, P<0.001) in traumatic OHCAs. The prehospital intubation, defibrillation, and epinephrine administration were lower in traumatic OHCAs. CONCLUSION: The prehospital treatments, including bystander CPR, prehospital intubation, and epinephrine administration, were performed less actively in traumatic OHCAs. On the other hand, these results were limited to a single hospital.

National survey of awareness and training experience of automated external defibrillator

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.

Targeted temperature management is related to improved clinical outcome of out-of-hospital cardiac arrest with non-shockable initial rhythm

OBJECTIVE: The benefits of targeted temperature management (TTM) for resuscitated out of hospital cardiac arrest (OHCA) with an initial non-shockable rhythm are still unclear. This study examined whether TTM reduces the mortality and improves the neurological outcomes of OHCA with a non-shockable initial rhythm. METHODS: This study analyzed the clinical outcome of 401 resuscitated patients with an initial non-shockable rhythm among a total of 1,616 OHCA patients who were registered in Cardiac Arrest Pursuit Trial with Unique Registration and Epidemiologic Surveillance. The impact of TTM was investigated after accounting for the patients' propensity for TTM. The primary outcome was a 30-day in-hospital course with a neurologically favorable outcome defined by a cerebral performance categories scale ≤2. RESULTS: TTM was performed in 89 patients (22%) with an initial non-shockable rhythm. Patients who has received TTM had a tendency to be younger, more likely to be female, and more likely to undergo percutaneous coronary intervention. The clinical outcome of the patients in the initial non-shockable rhythm treated by TTM was superior to those without TTM (hazard ratio [HR], 0.36; 95% confidence interval [CI], 0.27–0.46). Further analysis after propensity score matching or inverse probability of treatment weighting (IPTW) showed consistent findings (propensity score matching: HR, 0.32; 95% CI, 0.22–0.45; IPTW: HR, 0.40; 95% CI, 0.31–0.52; P<0.001, all). CONCLUSION: In this nationwide OHCA registry, TTM was related to an approximately three-fold better 30-day neurologically favorable survival of resuscitated patients with TTM treatment than patients without TTM in the initial non-shockable rhythm.

Identifying out-of-hospital cardiac arrest patients by using International Classification of Diseases codes and procedure code

OBJECTIVE: This study was conducted to evaluate the validity of the International Classification of Diseases, 10th revision (ICD-10) codes for identifying patients who suffered out-of-hospital cardiac arrest (OHCA). METHODS: Consecutive data pertaining to adult patients who suffered OHCA or received ICD-10 codes for cardiac arrest were collected. Patient characteristics and clinical data during the period from January 2015 to December 2016 were obtained. The sensitivity and positive predictive value (PPV) of each code for identifying OHCA were calculated and an optimal algorithm using diagnostic and procedure codes to detect OHCA patients was selected. The kappa coefficient was calculated to examine the agreement between algorithm-detected cases and true OHCA patients. RESULTS: A total of 397 patients were included in this study. The single use of ICD-10 codes was an insensitive method for identifying OHCA patients. Combination of diagnostic codes and procedure codes showed a good sensitivity (98.6%) and PPV (94.8%) for identifying OHCA patients. The agreement between the optimal algorithm and true OHCA was excellent (κ=0.970). CONCLUSION: Using ICD-10 codes for identifying OHCA patients is an insensitive method. The combination of ICD-10 codes and procedure codes can be an alternative search method.

Comparison of outcome of cardiopulmonary resuscitation with AutoPulse and LUCAS in out-of-hospital cardiac arrest patient

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.

High Incidence and Mortality of Out-of-Hospital Cardiac Arrest on Traditional Holiday in South Korea

BACKGROUND AND OBJECTIVES: This study aimed to confirm the effects of traditional holidays on the incidence and outcomes of out-of-hospital cardiac arrest (OHCA) in South Korea. METHODS: We studied 95,066 OHCAs of cardiac cause from a nationwide, prospective study from the Korea OHCA Registry from January 2012 to December 2016. We compared the incidence of OHCA, in-hospital mortality, and neurologic outcomes between traditional holidays, Seollal (Lunar New Year's Day) and Chuseok (Korean Thanksgiving Day), and other day types (weekday, weekend, and public holiday). RESULTS: OHCA occurred more frequently on traditional holidays than on the other days. The median OHCA incidence were 51.0 (interquartile range [IQR], 44.0–58.0), 53.0 (IQR, 46.0–60.5), 52.5 (IQR, 45.3–59.8), and 60.0 (IQR, 52.0–69.0) cases/day on weekday, weekend, public holiday, and traditional holiday, respectively (p<0.001). The OHCA occurred more often at home rather than in public place, lesser bystander cardiopulmonary resuscitation (CPR) was performed, and the rate of cessation of CPR within 20 minutes without recovery of spontaneous circulation was higher on traditional holiday. After multivariable adjustment, traditional holiday was associated with higher in-hospital mortality (adjusted hazard ratio [HR], 1.339; 95% confidence interval [CI], 1.058–1.704; p=0.016) but better neurologic outcomes (adjusted HR, 0.503; 95% CI, 0.281–0.894; p=0.020) than weekdays. CONCLUSIONS: The incidence of OHCAs was associated with day types in a year. It occurred more frequently on traditional holidays than on other day types. It was associated with higher in-hospital mortality and favorable neurologic outcomes than weekday.

The Effect of Transport Time Interval on Neurological Recovery after Out-of-Hospital Cardiac Arrest in Patients without a Prehospital Return of Spontaneous Circulation

BACKGROUND: Longer transport adversely affects outcomes in out-of-hospital cardiac arrest (OHCA) patients who do not return to spontaneous circulation (ROSC). The aim of this study was to determine the association between the transport time interval (TTI) and neurological outcomes in OHCA patients without ROSC. METHODS: We analyzed adult OHCA patients with presumed cardiac etiology and without prehospital ROSC from 2012 to 2015. The study population was divided into 2 groups according to STI (short STI [1–5 minutes] and long STI [≥ 6 minutes]). The primary exposure was TTI, which was categorized as short (1–5 minutes), intermediate (6–10 minutes), or long (≥ 11 minutes). The primary outcome was a good neurological recovery at discharge. Multiple logistic regression analysis was used in each STI group. RESULTS: Among 57,822 patients, 23,043 (40%), 20,985 (36%), and 13,794 (24%) were classified as short, intermediate, and long TTI group. A good neurological recovery occurred in 1.0%, 0.6%, and 0.3% of the patients in the short, intermediate and long TTI group, respectively. Among 12,652 patients with short STI, a good neurological recovery occurred in 2.2%, 1.0%, and 0.4% of the patients in the short, intermediate and long TTI group, respectively. Among 45,570 patients with long STI, a good neurological recovery occurred in 0.7%, 0.5%, and 0.3% of the patients in the short, intermediate and long TTI group, respectively. When short TTI was used as a reference, the adjusted odds ratios (AOR) of TTI for good neurological recovery was different between short STI group and long STI group (AOR [95% confidence interval, 0.46 [0.32–0.67] vs. 0.72 [0.59–0.89], respectively, for intermediate TTI and 0.31 [0.17–0.55] vs. 0.49 [0.37–0.65], respectively, for long TTI). CONCLUSION: A longer TTI adversely affected the likelihood of a good neurological recovery in OHCA patients without prehospital ROSC. This negative effect was more prominent in short STI group.