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

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

Elaboration of an educational video for cardiopulmonary resuscitation with chest compressions in adults / Elaboración de un video educativo para reanimación cardiopulmonar con compresiones torácicas en adultos / Elaboração de vídeo educativo para reanimação cardiopulmonar com compressões torácicas em adultos

ABSTRACT Objectives: to develop and analyze the face and content validity of a storyboard for constructing an educational video for training laypersons in cardiopulmonary resuscitation with only chest compressions in adults. Methods: a methodological study of storyboard elaboration and validity for producing an educational health video. The storyboard was submitted to analysis of 20 judges to assess its adequacy with the proposed objective. To assess the agreement between judges, the Content Validity Index was calculated. After validating the storyboard, video production took place. Results: the Content Validity Index met expectations. Its mean in each group was ≥ 0.90 (lay judges = 0.97; expert judges = 0.90; all judges = 0.94). Conclusions: the video produced is composed of scientific information, professional expertise and laypersons' perceptions, making it important evidence for health education.

RESUMEN Objetivos: elaborar y analizar la validez de apariencia y contenido de un storyboard para la construcción de un video educativo para la formación de legos en reanimación cardiopulmonar con solo compresiones torácicas en adultos. Métodos: estudio metodológico de la elaboración y validación de un storyboard para la producción de un video educativo en salud. El storyboard fue sometido al análisis de 20 jueces, para evaluar su adecuación al objetivo propuesto. Para evaluar la concordancia entre los jueces se calculó el Índice de Validez de Contenido. Después de validar el guión gráfico, se produjo el video. Resultados: el Índice de Validez de Contenido obtenido cumplió con las expectativas. Su promedio en cada grupo fue ≥ 0,90 (jueces legos = 0,97; jueces expertos = 0,90; todos los jueces = 0,94). Conclusiones: el video producido está compuesto por información científica, experiencia profesional y percepciones de los legos, lo que lo convierte en evidencia importante para la educación en salud.

RESUMO Objetivos: elaborar e analisar a validade de face e de conteúdo de um storyboard para a construção de um vídeo educativo para treinamento de leigos em reanimação cardiopulmonar somente com compressões torácicas em adultos. Métodos: estudo metodológico de elaboração e validação de um storyboard para a produção de um vídeo educativo em saúde. O storyboard foi submetido à análise de 20 juízes, para avaliação de sua adequação com objetivo proposto. Para avaliar a concordância entre os juízes, calculou-se o Índice de Validade de Conteúdo. Após a validação do storyboard, ocorreu a produção do vídeo. Resultados: o Índice de Validade de Conteúdo obtido atendeu ao esperado. A média dele em cada grupo esteve ≥ 0,90 (juízes leigos = 0,97; juízes experts = 0,90; todos os juízes = 0,94). Conclusões: o vídeo produzido é composto por informações científicas, expertise profissional e percepções de leigos, tornando-se importante evidência para a educação em saúde.

Construção e validação de tecnologia educacional para adolescentes sobre reanimação cardíaca / Elaboración y validación de tecnología educativa para adolescentes sobre reanimación cardíaca / Construction and validity of educational technology for adolescents on cardiac resuscitation

Resumo Objetivo Construir e validar uma história em quadrinhos para adolescentes sobre reanimação cardíaca. Métodos Estudo metodológico de abordagem quantitativa realizado em três fases: 1) revisão integrativa, 2) identificação das necessidades de aprendizagem (mediante inquérito transversal com 84 adolescentes) e 3) construção e validação de storyboard feito sob considerações da Teoria da Aprendizagem Significativa. A história obedeceu aos seis passos do quadrinista Mccloud, e foi validada por 23 juízes que julgaram os quadrinhos pelo Instrumento de Validação de Conteúdo Educacional em Saúde. Utilizou-se o Índice de Validade de Conteúdo e o Teste Binomial para verificar se a proporção de concordância foi, estatisticamente, igual ou superior a 80%. Resultados A revisão integrativa justificou ser necessária a construção de tecnologias educacionais sobre Suporte Básico de Vida. Os 84 adolescentes apontaram necessidade de aprendizagem sobre os três primeiros elos de atendimento a uma parada cardíaca. A tecnologia trouxe, na narrativa da personagem Dara, instruções para aplicar Suporte Básico de Vida somente com as mãos em vítimas de Parada Cardíaca. Na validação, 17 (dezessete) dos 18 (dezoito) itens avaliados receberam nota máxima, a avaliação global da tecnologia obteve o valor 0,99. Conclusão Os juízes consideraram válida a tecnologia educacional do tipo história em quadrinhos para ensinar reanimação cardiopulmonar.

Resumen Objetivo Elaborar y validar una historieta para adolescentes sobre reanimación cardíaca. Métodos Estudio metodológico de enfoque cuantitativo realizado en tres fases: 1) revisión integradora, 2) identificación de las necesidades de aprendizaje (mediante investigación transversal con 84 adolescentes) y 3) elaboración y validación del storyboard realizado de acuerdo con reflexiones sobre la teoría del aprendizaje significativo. La historia siguió los seis pasos del autor de historietas Mccloud y fue validada por 23 jueces, que evaluaron la historieta mediante el Instrumento de Validación de Contenido Educativo en Salud. Se utilizó el Índice de Validez de Contenido y la prueba binominal para verificar si la proporción de concordancia era estadísticamente igual o superior a 80 %. Resultados La revisión integradora justificó la necesidad de elaborar tecnologías educativas sobre soporte vital básico. Los 84 adolescentes señalaron la necesidad de aprender sobre los tres primeros eslabones en la atención a un paro cardíaco. La tecnología proporciona, mediante la narrativa del personaje Dara, instrucciones para aplicar el soporte vital básico solo con las manos en víctimas de paro cardíaco. En la validación, 17 (diecisiete) de los 18 (dieciocho) ítems evaluados recibieron nota máxima, la evaluación global de la tecnología obtuvo el valor de 0,99. Conclusión Los jueces consideraron válida la tecnología educativa tipo historieta para enseñar reanimación cardiopulmonar.

Abstract Objective To construct and validate a comic book for adolescents about cardiac resuscitation. Methods This is a methodological study with a quantitative approach carried out in three phases: 1) integrative review; 2) identification of learning needs (through a cross-sectional survey with 84 adolescents); and 3) construction and validity of storyboard made under considerations of the Theory of Meaningful Learning. The story obeyed the six steps of comic artist Mccloud, and was validated by 23 judges who judged the comic book using the Educational Content Validation Instrument in Health. The Content Validity Index and the binomial test were used to verify whether the proportion of agreement was statistically equal to or greater than 80%. Results The integrative review justified the need to construct educational technologies on Basic Life Support. The 84 adolescents indicated the need to learn about the first three links of care in a cardiac arrest. The technology brought, in the narrative of character Dara, instructions to apply Basic Life Support only with the hands in victims of cardiac arrest. In validity, 17 (seventeen) of the 18 (eighteen) items assessed received the maximum score, and the overall assessment of the technology obtained a value of 0.99. Conclusion The judges considered the comic book type educational technology valid for teaching cardiopulmonary resuscitation.

Desfechos após Parada Cardiorrespiratória Extra-Hospitalar de Natureza Clínica e Traumática / Outcomes after Clinical and Traumatic Out-of-Hospital Cardiac Arrest

Resumo Fundamento Dados sobre Parada Cardiorrespiratória extra-hospitalar ainda são escassos, muito variados e indicam mau prognóstico para eventos traumáticos. Objetivos Descrever a sobrevivência extra/intra-hospitalar, o tempo de sobrevivência e as condições neurológicas dos atendidos por unidades de suporte avançado à vida e submetidos a ressuscitação cardiopulmonar e comparar os resultados das paradas cardiorrespiratórias de natureza clínica e traumática. Métodos Estudo de coorte, realizado em três etapas, nas duas primeiras, os dados foram coletados em fichas do Serviço de Atendimento Móvel de Urgências e prontuários, na terceira, foi aplicada a Escala de Categoria de Performance Cerebral. A casuística foi de vítimas reanimadas com idade ≥18 anos. Os testes de Fisher e log-rank foram empregados na comparação das causas, considerando nível de significância de 5%. Resultados Foram analisados 852 pacientes, 20,66% foram hospitalizados, 4,23% sobreviveram até transferência ou alta, 58,33% apresentaram desfecho favorável um ano após parada. Houve associação entre sobrevivência pré/intra-hospitalar e natureza da ocorrência (p=0,026), porém não houve diferença entre as curvas de sobrevivência, p=0,6. Conclusões A sobrevivência à hospitalização após parada cardiorrespiratória extra-hospitalar foi baixa, porém, a maioria dos sobreviventes à alta alcançaram desfecho favorável após um ano. O tempo de sobrevivência dos hospitalizados após eventos de natureza clínica e traumática foram similares, porém a sobrevida pré-hospitalar foi maior entre os traumatizados.

Abstract Background Data on out-of-hospital cardiac arrest are still scarce, very varied, and indicate a poor prognosis for traumatic events. Objectives To describe the out-of-hospital/in-hospital survival, survival time, and neurological conditions of those treated by advanced life support units and submitted to cardiopulmonary resuscitation and compare the results of clinical and traumatic cardiac arrests. Methods This is a cohort study carried out in three stages; in the first two, data were collected from the Mobile Emergency Care Service forms and medical records; then, the Brain Performance Category Scale was applied in the third stage. The sample consisted of resuscitated victims aged ≥18 years. Fisher's and log-rank tests were used to compare the causes, considering a significance level of 5%. Results 852 patients were analyzed; 20.66% were hospitalized, 4.23% survived until transfer or discharge, and 58.33% had a favorable outcome one year after arrest. There was an association between pre/in-hospital survival and the nature of the occurrence (p=0.026), but there was no difference between the survival curves (p=0.6). Conclusions Survival of hospitalization after out-of-hospital cardiac arrest was low; however, most who survived to be discharged achieved a favorable outcome after one year. The survival time of those hospitalized after clinical and traumatic events were similar, but pre-hospital survival was higher among trauma patients.

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.

Relationship between measures of thoracic diameter and cardiopulmonary resuscitation-induced thoracoabdominal injury

SUMMARY OBJECTIVE: We investigated the relationship between thoracic diameters and chest compression-related thoracoabdominal injury in patients with non-traumatic out-of-hospital cardiac arrest who had a return of spontaneous circulation after cardiopulmonary resuscitation. METHODS: A total of 63 consecutive adult non-traumatic out-of-hospital cardiac arrest patients were enrolled in this prospective study. Computed tomography was performed on each patient and the anteroposterior diameter, skin-to-skin anteroposterior diameter, and transverse diameter of the chest were measured. Patients were divided into two groups based on the presence or absence of cardiopulmonary resuscitation-related thoracoabdominal injury. Age, sex, and duration of cardiopulmonary resuscitation, anteroposterior diameter, skin-to-skin anteroposterior diameter, and transverse diameter were compared between the groups. The primary outcome was the relationship between thoracic diameters and cardiopulmonary resuscitation-induced thoracoabdominal injuries. RESULTS: Thoracoabdominal injuries were detected in 46% (n=29) of the patients and consisted of rib fractures in 22 (34.9%) patients, pulmonary contusion in 7 (11.1%), and sternal fracture in 3 (4.8%) patients. There were no significant differences in cardiopulmonary resuscitation duration between patients with and without thoracoabdominal injuries (p=0.539). Similarly, there were no significant differences in anteroposterior diameter, skin-to-skin anteroposterior diameter, or transverse diameter between patient groups (p=0.978, p=0.730, and p=0.146, respectively) or between patients who died within the first 28 days and those who survived for longer than 28 days (p=0.488, p=0.878, and p=0.853, respectively). CONCLUSION: The iatrogenic thoracoabdominal injuries caused by cardiopulmonary resuscitation performed according to the cardiopulmonary resuscitation guidelines were independent of thoracic diameters. Therefore, the cardiac compression depth of 5-6 cm recommended by the current cardiopulmonary resuscitation guidelines is reliable for patients with different thoracic diameters.

Validity of the classification of emergency service requests related to suicidal behavior / Validez de la clasificación de las demandas por conducta suicida a un servicio de emergencias

Abstract Introduction Suicide attempts are the most predictive risk factor for suicide deaths. Most people who attempt suicide receive care from out-of-hospital Emergency Services (OES), where these requests are managed and classified. Objective Validate the Emergency Coordination Center (ECC) classification for the detection of suicidal behavior requests. Method A descriptive, cross-sectional study of requests to the ECC of Málaga (Spain) during 2013 and 2014 was conducted. To classify the requests, the authors considered the ECC categorization when answering the call and the clinical assessment of the healthcare professional when attending the person who had made the call at the scene, which was considered the reference standard. To analyze the validity of the ECC classification system, sensitivity, specificity, and positive and negative predictive values (PPV and NPV) were calculated. Results The total number of requests for medical assistance analyzed was 112,599. The validity indicators of the classification system for suicidal behavior were sensitivity = 44.78%, specificity = 99.34%, PPV = 46.91% and NPV = 99.28%. Discussion and conclusion The ECC classification system has a lower capacity to detect the presence of suicidal behavior and a higher capacity to identify its absence in the requests received. OES provide key information on suicidal behavior requests as they can be one of the first places people with this problem go to. It would therefore be extremely useful to improve the classification systems for requests related to suicidal behavior.

Resumen Introducción Los intentos de suicidio constituyen el factor de riesgo más predictivo de todos los casos de suicidio consumado. La mayoría de las personas que intentan suicidarse reciben atención en los Servicios de Urgencias Extrahospitalarios (SUE) donde se gestionan y clasifican estas demandas. Objetivo Validar la clasificación del Centro Coordinador de Urgencias y Emergencias (CCUE) para detectar las demandas relacionadas con la conducta suicida. Método Se llevó a cabo un estudio descriptivo y transversal de las demandas al CCUE de Málaga (España) realizadas durante 2013 y 2014. Para su clasificación se tuvo en cuenta la categorización en el CCUE al responder la llamada y el juicio clínico del profesional sanitario cuando atiende al demandante in situ, considerando éste como patrón de referencia. Para evaluar la validez del sistema de clasificación se calcularon la sensibilidad, la especificidad y los valores predictivos positivo (VPP) y negativo (VPN). Resultados El total de demandas sanitarias analizadas fue de 112,599. Los indicadores de validez del sistema de clasificación para las demandas por conductas de suicidio fueron una sensibilidad = 44.78%, especificidad = 99.34%, VPP = 46.91% y VPN = 99.28%. Discusión y conclusión El sistema de clasificación del CCUE presenta una capacidad más baja para detectar presencia de conducta suicida comparada con una capacidad más alta para identificar su ausencia en las demandas recibidas. Los SUE aportan información relevante sobre las demandas por conducta suicida ya que pueden ser uno de los primeros lugares a los que acuden las personas con este problema. Por ello, sería de gran utilidad mejorar los sistemas de clasificación de las demandas por conducta suicida.

Extracorporeal Cardiopulmonary Resuscitation for an Out-of-Hospital Cardiac Arrest

Extra corporeal membrane oxygenation (ECMO) for refractory out?of?hospital cardiac arrest (OHCA) has been shown to improve outcome in many Western countries. There are no reports of ECMO being used to support OHCA in India till date. We report a case of a young man who developed cardiac arrest (CA) while driving and was given bystander cardiac massage. He was brought to tertiary care center where an ECMO was utilized for refractory CA. The patient subsequently underwent emergency coronary artery stenting and was weaned off ECMO and ventilation. We discuss the case and highlight the role of bystander cardiopulmonary resuscitation.

Trends in outcomes after out-of-hospital cardiac arrest: An observational study in Jiading District Shanghai / 中华急诊医学杂志

Objective:This study aimed to investigate temporal trends in Event survival after OHCA from 2015 to 2019 in Jiading district Shanghai. And analysis the influencing factors.Methods:This was a population based observational cohort study evaluating the temporal trends in survival after OHCA, we included consecutive patients who experienced an OHCA between January 1,2015 and December 31, 2019, we included all adult patients aged ≥ 18 years who presumed medical cause and were treated by emergency medical services (EMS) in Jiading District. The Data was obtained from Dispatch software system, The emergency case registration system, paper-based treatment records, dispatcher's telephone recording and in-hospital records, This Data organized according to the Utstein template using standard data element definitions. Temporal changes were measured by chi-square trend test. we constructed a multilevel logistic regression model to identify factors independently associated with event survival arrival at hospital and survival to hospital discharge.Results:A total of 1305 patients with OHCA met study inclusion criteria during the study period. Survival to hospital admission was 4.14% increased from 1.87% in 2015 to 7.31% in 2019 for trend ( P=0.009), survival to hospital discharge was 1.23%, increased from 0.37% in 2015 to 3.32% in 2019 ( P=0.003). But there was no evidence of a temporal change in survival to hospital discharge with good neurologic function (0.37 in 2015 to1.33% in 2019, P=0.339 for trend). In the subgroup, the rate of Recognition was increased from 7.49% in 2015 to 19.27% in 2019 ( P< 0.01). The proportion of cases receiving bystander CPR was 17.39%, which increased from 9.36% in 2015 to 25.19% in 2019 ( P= 0.000). The proportion of shockable rhythm was 4.06%, there was no evidence of a temporal change in the proportion of the overall rhythm (3.00%-4.65%, P=0.323 for trend), There were no cases of bystanders using automated external defibrillators (AEDs) in patients with cardiac arrest, The EMS response time (min) were15.45±8.71, which decreased from 15.10±8.12 in 2015 to 13.41±6.47 in 2019 ( P< 0.0001). Multiple regression analysis showed that Male ( OR= 0.315, 95% CI: 0.168-0.519, P =0.000), Not Shockable rhythm ( OR= 0.096, 95% CI: 0.043-0.012, P=0.000), and public location ( OR=2.411, 95% CI: 1.302-4.463, P=0.005) were independent predictor of Factors Associated with survival at hospital admission. Male ( OR= 0.247, 95% CI: 0.070-0.866, P=0.029), Not Shockable rhythm ( OR= 0.072, 95% CI: 0.016-0.318, P=0.001), and No Epinephrine administration ( OR=5.953, 95% CI:1.222-29.012, P=0.005) were independent predictor of Factors Associated with Survival to Hospital Discharge. Conclusions:Survival after OHCA has improved over time. Several targeted initiatives established along the chain of survival of OHCA during the past 5-years may help explain the improvement in survival outcome observed in Jiading District, including improved the rate of Recognition, improved participation rates in bystander CPR and a reduction in EMS response time.In the future, more resources should be improving the quality of CPR training and expanding AEDs coverage and encouraging the public to have the courage to use them.

Impact of dispatcher-assisted cardiopulmonary resuscitation on survival after out-of-hospital cardiac arrest: A Meta-analysis / 中华急诊医学杂志

Objective:To evaluate the outcome of the patients receiving dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) delivered by first-responders who witnessed the out-of-hospital cardiac arrest (OHCA) before the Emergency Medical Service (EMS) arrived.Methods:We performed a search of the relevant literature exploring major scientific databases. We assessed the quality of the included cohort study according to the Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0. Meta-analysis was performed on three outcome indicators (recovery of spontaneous circulation survival to hospital discharge and survival with favourable neurologic outcome) using the Revman5.3 software.Results:A total of 21 studies with 349 822 patients were selected for the meta-analysis, including 182 125 patients in the DA-CPR group and 167 697 in the CPR-only group. The meta-analysis showed no significant difference between the DA-CPR and CPR-only groups in ROSC [ RR=1.10, 95% confidence interval ( CI): 0.94-1.29, P=0.24], survival to hospital discharge ( RR=1.10, 95% CI: 0.90-1.34, P=0.34) and survival with favourable neurologic outcome ( RR=1.01, 95% CI: 0.79-1.28, P=0.97) of the patients in America, Japan and Korea. However, there was a significant difference between the DA-CPR and the CPR-only groups in ROSC ( RR=2.61, 95% CI:1.53-4.46, P=0.0005), survival to hospital discharge( RR=6.08, 95% CI: 1.84-20.04, P=0.003), and survival with favourable neurologic outcome( RR=9.76, 95% CI: 1.87-51.02, P=0.007) of the patients in China. Conclusions:The overall effect of DA-CPR is significantly different for each country. In detail, DA-CPR offers a survival advantage (Return of spontaneous circulation, survival to hospital discharge and survival with favourable neurologic outcome) over CPR alone in China but no advantage in developed countries.

Retrospective analysis of extracorporeal cardiopulmonary resuscitation in 40 out-of-hospital cardiac arrest adults / 中华急诊医学杂志

Objective:To summarize the experience and effect of extracorporeal cardiopulmonary resuscitation (ECPR) in the treatment of out-of-hospital cardiac arrest (OHCA) in adults.Methods:The data of 40 adults with OHCA-ECPR in Emergency Department of the First Affiliated Hospital of Nanjing Medical University from April 2015 to April 2022 were retrospectively analyzed. The patients were grouped by discharge survival/in-hospital death, with/without bystander resuscitation, and with/without interhospital transport. Age, sex, Charlson comorbidity index, initial rhythm, no-flow time, time from cardiac arrest to extracorporeal membrane oxygenation (ECMO) initiation (CA-Pump On time), ECMO evacuation success rate, survival rate, ECMO treatment time, time-to-death, and length of hospital stay were analyzed.Results:①Among the 40 patients with OHCA-ECPR, 9 patients (22.5%) survived upon discharge, 7 (77.8%) of whom had good neurological outcomes.②The no-flow time in the survival group was significantly shorter than that in the death group, and the proportion of shockable initial rhythm was higher.③Bystander resuscitation greatly shortened the no-flow time.④The regional OHCA-ECPR interhospital transport extended the CA-Pump On time, without affecting patients’ prognosis.Conclusions:ECPR improves the prognosis of patients with OHCA. Bystander resuscitation greatly shortens the no-flow time. ECPR is significantly effective in patients with short no-flow time and shockable initial rhythm. Regional interhospital transport ECPR is recommended to benefit more patients with OHCA.

The research progress on the registration database of out-of-hospital cardiac arrest / 中华危重病急救医学

Out-of-hospital cardiac arrest (OHCA) with high mortality and disable rate is a public health problem of common concern all over the world. In order to improve the survival rate of OHCA, developed countries such as Europe and the United States have established regional and even national OHCA registration database for continuous monitoring and quality improvement of OHCA, identifying the weaknesses in each link of the survival chain, and evaluating effective measures to enhance the survival rate. At present, China still lacks of registration database that can comprehensively collect the information of OHCA and effectively reflect the treatment status and research direction of OHCA. In order to shorten the huge gap of OHCA survival rate between China and developed countries such as Europe and the United States, we should learn from the experience of foreign registration databases and establish OHCA registration database suitable for China's national conditions, so as to promote the improvement of OHCA survival rate in China. This paper presents several major OHCA registry databases of the internationally recognized, such as cardiac arrest registry to enhance survival (CARES), resuscitation outcomes consortium (ROC), European registry of cardiac arrest (EuReCa), Pan-Asian resuscitation outcomes registry (PAROS), and Australian resuscitation outcome consortium (Aus-ROC), aims to provide a reference for promoting the construction of the cardiac arrest registration database in China.

Reanimação cardiopulmonar para leigos: avaliação de vídeos sob a perspectiva do letramento digital em saúde / Cardiopulmonary resuscitation for lay people: Evaluation of videos from the perspective of digital health literacy / Reanimación cardiopulmonar para legos: evaluación de videos desde la perspectiva de la alfabetización digital en salud

Resumo Objetivo: analisar indicadores de qualidade e conteúdo técnico dos vídeos postados na plataforma YouTube, para leigos, sobre reanimação cardiopulmonar em adultos e sua produção audiovisual quanto aos princípios do letramento digital em saúde. Método: estudo descritivo, exploratório, que selecionou vídeos gravados entre dezembro de 2015 e abril de 2021. Foram analisados por indicadores da produção de material audiovisual, considerando as diretrizes da American Heart Association e os princípios do letramento digital em saúde. Foi realizada estatística descritiva e inferencial. Resultados: dos 121 vídeos analisados, 26 não atenderam qualquer indicador sobre ressuscitação cardiopulmonar; quatro atingiram 81% de conformidade; oito vídeos, 79%; nove vídeos, 69% e 74 vídeos de seis a 63%. De acordo com os princípios do letramento digital em saúde, um vídeo atendeu 85% dos indicadores; 81 vídeos atenderam de 50 a 80% e 39 vídeos, de 10 a 49%. Foi identificada correlação positiva entre letramento e ressuscitação cardiopulmonar. Conclusão: nenhum vídeo apresentou 100% de conformidade com as diretrizes da American Heart Association. A falta de mecanismos de fiscalização e controle sobre conteúdos relacionados à saúde permite a publicação de vídeos equivocados, que têm sido utilizados como aprendizado pelas pessoas e podem perder o maior objetivo que é salvar vidas.

Abstract Objective: to analyze the quality indicators and technical content of the videos for lay people posted on the YouTube platform, on cardiopulmonary resuscitation in adults and their audiovisual production regarding the principles of digital health literacy. Method: a descriptive and exploratory study, which selected videos recorded between December 2015 and April 2021. They were analyzed by indicators of the production of audiovisual material, considering the American Heart Association guidelines and the principles of digital health literacy. Descriptive and inferential statistics were performed. Results: of the 121 videos analyzed, 26 did not comply with any indicator on cardiopulmonary resuscitation, four reached 81% compliance, eight videos reached 79%, nine reached 69% and 74 videos, from 6% to 63%. According to the principles of digital health literacy, one video met 85% of the indicators, 81 met from 50% to 80% and 39, from 10% to 49%. A positive correlation was identified between literacy and cardiopulmonary resuscitation. Conclusion: no video presented 100% compliance with the American Heart Association guidelines. The absence of mechanisms for supervision and control over health-related contents allows for the posting of mistaken videos, which have been used as a learning method by people and can thus miss their greatest goal: save lives.

Resumen Objetivo: analizar los indicadores de calidad y contenido técnico de los videos publicados en la plataforma YouTube, para legos, sobre reanimación cardiopulmonar en adultos y su producción audiovisual según los principios de la alfabetización digital en salud. Método: estudio descriptivo, exploratorio, que seleccionó videos grabados entre diciembre de 2015 y abril de 2021. Fueron analizados en función de los indicadores de producción de material audiovisual, considerando las directrices de la American Heart Association y los principios de la alfabetización digital en salud. Se realizó estadística descriptiva e inferencial. Resultados: de los 121 videos analizados, 26 no cumplieron con ninguno de los indicadores de reanimación cardiopulmonar; cuatro lograron un 81% de conformidad; ocho videos, 79%; nueve videos, 69% y 74 videos de seis a 63%. De acuerdo con los principios de la alfabetización digital en salud, un video cumplió con el 85% de los indicadores; 81 videos cumplieron del 50 al 80% y 39 videos del 10 al 49%. Se identificó una correlación positiva entre la alfabetización y la reanimación cardiopulmonar. Conclusión: ningún video cumplió el 100% de las directrices de la American Heart Association. La falta de mecanismos de supervisión y control sobre los contenidos relacionados con la salud permite la publicación de videos erróneos, que han sido utilizados como experiencia de aprendizaje por las personas y es probable que no cumplan con el principal objetivo, que es salvar vidas.

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.

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.

Óbitos intra e extra-hospitalares por infarto agudo do miocárdio nas capitais brasileiras / In- and out-of-hospital deaths by acute myocardial infarction in brazilian state capitals

Resumo Fundamento: O infarto agudo do miocárdio (IAM) é a principal causa de óbito no Brasil e no mundo. Aproximadamente metade dos óbitos ocorrem fora do ambiente hospitalar. Objetivos: Analisar a distribuição, a evolução temporal e as características sociodemográficas (CSD) dos óbitos intra e extra-hospitalares por IAM nas capitais brasileiras e a sua relação com indicadores municipais de desenvolvimento (IMD). Métodos: Estudo ecológico com contagem anual dos óbitos por IAM nas 27 capitais brasileiras de 2007 a 2016, os quais foram divididos em dois grupos, intra-hospitalar (H) e extra-hospitalar (EH). Avaliou-se a evolução temporal das taxas de mortalidade em cada grupo e as diferenças das CSD. Modelos de regressão binominal negativa compararam temporalmente a contagem de óbitos em cada grupo com as seguintes variáveis: residir nas regiões Sul e Sudeste (S/SE), índice de desenvolvimento humano municipal (IDHM), índice de Gini e expectativa de anos de estudo (EAE). Considerou-se estatisticamente valores significativos de p < 0,05. Resultados: A taxa de mortalidade EH para o conjunto das capitais aumentou ao longo do tempo. Todas as CSD pesquisadas foram difententes entre os grupos (p < 0,001). No grupo EH prevaleceram os óbitos em homens, em pacientes ≥ 80 anos e em solteiros. O S/SE elevou a incidência de óbitos extra-hospitalares (IRR = 2,84; IC 95% = 1,67-4,85), enquanto o maior EAE registrou queda (IRR = 0,86; IC 95% = 0,77-0,97). Para o grupo H, o maior IDHM reduziu a incidência de óbitos (IRR = 0,44; IC 95% = 0,33-0,58), enquanto o maior EAE apresentou crescimento (IRR = 1,09; IC 95% = 1,03-1,15). Conclusão: Os óbitos intra e extra-hospitalares por IAM nas capitais apresentam diferenças sociodemográficas, incidência influenciada por IMD e progressivo aumento da ocorrência extra-hospitalar.

Abstract Background: Acute myocardial infarction (AMI) is the main cause of death in Brazil and the world. Approximately half of these deaths occur outside the hospital. Objectives: To analyze the distribution, temporal evolution, and sociodemographic characteristics (SDC) of in- and out-of-hospital deaths by AMI in Brazilian state capitals and their relationship with municipal development indicators (MDI). Methods: This is an ecological study of the number of deaths due to AMI reported annually by the 27 Brazilian state capitals from 2007 to 2016; these were divided into 2 groups: in-hospital (H) and out-of-hospital (OH). We evaluated the temporal evolution of mortality rates in each group and differences in SDC. Negative binomial regression models were used to compare the temporal evolution of the number of deaths in each group with the following variables: residing in the South/Southeast regions (S/SE), municipal human development index (MHDI), Gini coefficient, and expected years of schooling (EYS). We considered p-values<0.05 as statisticallysignificant. Results: The OH mortality rate increased with time for all state capitals. All studied SDC were different between groups (p<0.001). In the OH group, most deaths were of men and patients aged 80 years or older and not married. S/SE increased the incidence of OH deaths (incidence rate ratio [IRR]=2.84; 95% confidence interval [CI]=1.67-4.85), while higher EYS reduced it (IRR=0.86; 95% CI=0.77-0.97). In the H group, higher MHDI reduced the incidence of deaths (IRR=0.44; 95% CI=0.33-0.58), while higher EYS increased it (IRR=1.09; 95% CI=1.03-1.15). Conclusions: In- and out-of-hospital deaths due to AMI in Brazilian state capitals were influenced by MDI, presented sociodemographic differences and a progressive increase in out-of-hospital occurrences.

Simulation study on quality of CPR between manual chest compression and mechanical chest compression devices performed in ambulance

@#Background: Maintaining good quality CPR while transporting out-of-hospital cardiac arrest patients is very challenging. We aim to determine how different ambulance speed can affect the quality of chest compression performed either manually or mechanically. Methods: This was an observational manikin-based study. A total of 96 participants as well as two types of mechanical compression devices: Lucas-2 and AutoPulse, performed one minute of continuous chest compression on BT-CPEA programmed manikin while the ambulance travelled at different speeds, i.e., idle state, 30km/hr and 60km/hr. Seven outcome variables of chest compression were measured. Performance data of different groups of compressor were compared and analysed using repeated measures analysis of variance (ANOVA). Results: In manual chest compression, significant variation were noted among different speeds in term of average compression rate (p<0.001), average compression depth (p=0.007), fraction of adequate/insufficient compression depth and fraction of normal hands positioning with p=0.018, 0.022 and 0.034 respectively. Overall, AutoPulse and Lucas-2 were not affected by ambulance speed. Lucas2 showed more consistent average compression rate, higher fraction of adequate compression depth and reduced fraction of insufficient compression depth as compared to manual compression with p<0.001, 0.001 and 0.043 respectively. Conclusion: In this study we found that ambulance speed significantly affected certain aspects of manual chest compression most notably compression depth, rate and hand positioning. AutoPulse and Lucas-2 can improve these aspects by providing more consistent compression rate, depth and fraction of adequate compression depth during transport.

Effect evaluation of video teaching method based on information training platform on improving the quality of cardiopulmonary resuscitation of new nurses / 中国实用护理杂志

Objective:To study the effect of video teaching combined with offline training in cardiopulmonary resuscitation training for new nurses outside hospital.Methods:From August 2017 to August 2018, 125 new nurses from Shanghai Changzheng Hospital were selected. New nurses in August 2017 were set as control group ( n=65). In August 2018, the new nurses were set as the observation group ( n=60). The control group used the traditional offline training mode to train cardiopulmonary resuscitation outside the hospital. The observation group used information platform video teaching combined with offline theoretical training to carry out cardiopulmonary resuscitation training. After systematic training, the results of cardiopulmonary resuscitation after training and the satisfaction of teaching were compared between the two groups. Results:Before training, there was no significant difference in the assessment results of cardiopulmonary resuscitation theory and operation between the two groups ( t values were 0.12, 1.23, P>0.05). After training the scores of cardiopulmonary resuscitation theory and operation examination in the observation group were 85.41±3.20, 92.40±2.50, and 82.52±4.50, 85.0±3.60 in the control group ( t value was 1.04,4.24, all P<0.05). Encouraging and enhancing the learning interest of new nurses, cultivating mutual supervision and mutual guidance, integrating theoretical knowledge with practical operation, improving and adjusting self-motivation, overall evaluation of teaching methods and total score in the observation group were 3.61±0.34, 3.54±0.20, 3.61±0.28, 3.87±0.20, 3.32±0.21, 17.95±0.26, and 2.60±0.41, 2.41±0.16, 2.55±0.35, 2.41±0.46, 2.58±0.20,12.55±0.32 in the control group ( t value was 2.187-2.452, P<0.05). Conclusion:Video teaching combined with offline training can improve the performance of new nurses in the training of high-quality cardiopulmonary resuscitation, stimulate the learning interest of nurses, and enhance the effect of high-quality cardiopulmonary resuscitation training.