Características clínicas de reanimações cardiopulmonares intra-hospitalares registradas em prontuário: estudo transversal / Clinical characteristics of in-hospital cardiopulmonary resuscitations recorded in medical records: a cross-sectional study / Características clínicas de las reanimaciones cardiopulmonares intrahospitalarias registradas en las historias clínicas: estudio transversal

Objetivo: identificar características clínicas das paradas cardiopulmonares e reanimações cardiopulmonares ocorridas em ambiente intra-hospitalar. Método: estudo quantitativo, prospectivo e observacional, a partir de informações de prontuários de pacientes submetidos a manobras de reanimação devido à parada cardiopulmonar entre janeiro e dezembro de 2021. Utilizou-se um instrumento baseado nas variáveis do modelo de registro Utstein. Resultados: em 12 meses foram registradas 37 paradas cardiopulmonares. A maioria ocorreu na unidade de terapia intensiva respiratória, com causa clínica mais prevalente hipóxia. 65% dos pacientes foram intubados no atendimento e 57% apresentaram ritmo atividade elétrica sem pulso. A duração da reanimação variou entre menos de cinco a mais de 20 minutos. Como desfecho imediato, 57% sobreviveram. Conclusão: dentre os registros analisados, a maior ocorrência de paradas cardiopulmonares foi na unidade de terapia intensiva respiratória, relacionada à Covid-19. Foram encontrados registros incompletos e ausência de padronização nas condutas.

Objective: identify the clinical characteristics of cardiopulmonary arrests and cardiopulmonary resuscitations in the in-hospital environment. Method: this is a quantitative, prospective and observational study based on information from the medical records of patients who underwent resuscitation maneuvers due to cardiopulmonary arrest between January and December 2021. An instrument based on the variables of the Utstein registration protocol was used. Results: thirty-seven cardiopulmonary arrests were recorded in 12 months. The majority occurred in a respiratory intensive care unit, with hypoxia being the most prevalent clinical cause. Sixty-five percent of the patients were intubated and 57% had pulseless electrical activity. The duration of resuscitation ranged from less than five to more than 20 min. As for the immediate outcome, 57% survived. Conclusion: among the records analyzed, the highest occurrence of cardiopulmonary arrests was in respiratory intensive care units, and they were related to Covid-19. Moreover, incomplete records and a lack of standardization in cardiopulmonary resuscitation procedures were found.

Objetivo: Identificar las características clínicas de paros cardiopulmonares y reanimaciones cardiopulmonares que ocurren en un ambiente hospitalario. Método: estudio cuantitativo, prospectivo y observacional, realizado a partir de información presente en historias clínicas de pacientes sometidos a maniobras de reanimación por paro cardiorrespiratorio entre enero y diciembre de 2021. Se utilizó un instrumento basado en las variables del modelo de registro Utstein. Resultados: en 12 meses se registraron 37 paros cardiopulmonares. La mayoría ocurrió en la unidad de cuidados intensivos respiratorios, la causa clínica más prevalente fue la hipoxia. El 65% de los pacientes fue intubado durante la atención y el 57% presentaba un ritmo de actividad eléctrica sin pulso. La duración de la reanimación varió entre menos de cinco y más de 20 minutos. Como resultado inmediato, el 57% sobrevivió. Conclusión: entre los registros analizados, la mayor cantidad de paros cardiopulmonares se dio en la unidad de cuidados intensivos respiratorios, relacionada con Covid-19. Se encontraron registros incompletos y falta de estandarización en el procedimiento.

Mechanism of the effect of Xuebijing injection on neurological function and survival of rats after cardiac arrest/cardiopulmonary resuscitation / 中国药房

OBJECTIVE To explore the potential mechanism of the effect of Xuebijing injection （XBJ） on neurological function and survival of rats after cardiac arrest （CA）/cardiopulmonary resuscitation （CPR） based on the S-nitrosoglutathione reductase （GSNOR）/S-nitrosoglutathione （GSNO） pathway. METHODS The CA/CPR rat model was established by ventricular fibrillation. Using a sham operation group as control， high-throughput sequencing was employed to analyze and mine the differentially expressed genes （DEGs）. Enzyme-linked immunosorbent assay was used to determine the contents of GSNOR and GSNO in the hippocampus； the active components of XBJ were screened and subjected to molecular docking analysis with GSNOR. The rats successfully modeled using the same method were divided into model group （n＝30）， inhibitor （GSNOR inhibitor） group （n＝30）， XBJ group （n＝30） and XBJ+inhibitor group （n＝30）， and a sham operation group （n＝30） was set up. Neurological function was evaluated and survival status was recorded at 3 hours， 24 hours and 3 days after the first 89） drug intervention. The contents of GSNOR and GSNO in the hippocampus of rats were determined in each group at the 0191） above time points， and the relationship of the contents of GSNOR and GSNO with modified neurologic severity scale （mNSS） score was analyzed. RESULTS GSNOR coding gene was differentially expressed between the model group and the sham operation group. Compared with the sham operation group， GSNOR content increased significantly in the hippocampus of rats in model group， while GSNO content decreased significantly （P＜0.05）. The active components of XBJ， such as 4- methylenemiltirone and salviolone， could be bound to GSNOR protein， with the binding energy lower than －6 kcal/mol， mainly connected by hydrogen bonds. Animal experiments revealed that mNSS score and GSNOR levels in the hippocampus of rats in the model group were significantly higher than those in the sham operation group （P＜0.05）， while GSNO levels and survival rate were significantly lower than those in the sham operation group （P＜0.05）. The above indexes of rats were improved significantly in administration groups， the mNSS score in the XBJ group was significantly lower than that in the inhibitor group， the content changes of GSNOR and GSNO in the inhibitor group were more obvious than those in the XBJ group， and the various indicators in the XBJ+inhibitor group were significantly better than the XBJ group and the inhibitor group （P＜0.05）. GSNOR content was positively correlated with the mNSS score， and GSNO content was negatively correlated with the mNSS score （P＜0.05）. CONCLUSIONS XBJ can improve the neurological function of rats and enhance their survival rates after CA/CPR， the mechanism of which may be associated with the down-regulation of GSNOR and the up-regulation of GSNO.

Development validation and evaluation of the knowledge test on cardiopulmonary resuscitation and correct use of the automated external defibrillator in Asunción 2023

Introduction: in out-of-hospital cardiac arrest, early and efficient intervention through cardiopulmonary resuscitation (CPR) maneuvers and the use of the automated external defibrillator (AED) are the cornerstone for survival. Instruments that improve education would increase the responsiveness of lay personnel. Objectives: to develop, validate and evaluate a knowledge test on cardiopulmonary resuscitation and correct use of the automated external defibrillator in Asunción during 2023. Methodology: observational cross-sectional study, non-probabilistic sample for convenience of lay personnel users of mass attendance centers in Asunción. An exclusive questionnaire was developed on knowledge in cardiopulmonary resuscitation and the use of the automated external defibrillator (KOR-AED) based on the chain of survival in out-of-hospital cardiac arrest. Content, construct, and internal consistency were validated using expert opinion, factor analysis and Cronbach's alpha. Results: a total of 200 lay people participated, mostly shopping mall customers, with a predominance of men (63.5 %) (127), between 25-29 years old 28.5% (57). 61.5 % (123) had a university education, 75.5 % (151) had not related to health, 52 % (104) had prior knowledge of CPR, but 81.5 % (163) did not. The test showed reliability and suitability for factor analysis (Cronbach's alpha 0.75, Kaiser-Meyers-Olkin; 0.78, Bartlett p<0.05). The questions covered the first three links in the chain of survival, with items of medium to high difficulty. Women performed significantly better (p=0.04). Conclusion: the KOR-AED test is a valid and reliable instrument to improve the education of the layperson in CPR and use of the AED based on the chain of survival.

Introducción: en la parada cardíaca extrahospitalaria la actuación precoz y eficiente mediante maniobras de reanimación cardiopulmonar (RCP) y uso del desfibrilador externo automático (DEA) constituyen la piedra angular para la supervivencia. Instrumentos que mejoren la educación aumentarían la respuesta del personal lego. Objetivos: desarrollar, validar y evaluar una prueba de conocimientos sobre reanimación cardiopulmonar y uso correcto del desfibrilador externo automático en Asunción durante el 2023. Metodología: estudio observacional corte transversal, muestro no probabilístico por conveniencia de personal lego usuarios de centros de concurrencia masiva de Asunción. Se desarrolló un cuestionario exclusivo sobre conocimientos en reanimación cardiopulmonar y uso del desfibrilador externo automático (COR-DEA) basado en la cadena de supervivencia en parada cardíaca extrahospitalaria. Se validó el contenido, el constructo y la consistencia interna mediante la opinión de experto, análisis de factores y el alfa de Cronbach. Resultados: participaron 200 legos mayormente clientes de shoppings, predominando hombres 63,5 % (127) entre 25-29 años 28,5 % (57). Con educación universitaria 61,5 % (123), no relacionados con la salud 75,5 % (151), con conocimientos previos en RCP 52 % (104), pero no en DEA 81,5 % (163). El test mostró fiabilidad y adecuación para análisis factorial (Alfa de Cronbach 0.75, Kaiser-Meyers-Olkin; 0.78, Bartlett p<0.05). Las preguntas abarcarón los tres primeros eslabones de la cadena de supervivencia, con ítems de dificultad media a alta. Las mujeres tuvieron significativamente mejor desempeñó (p=0.04). Conclusión: la prueba COR-DEA es un instrumento válido y fiable para mejorar la educación del lego en RCP y uso del DEA basado en la cadena de supervivencia.

Development validation and evaluation of the knowledge test on cardiopulmonary resuscitation and correct use of the automated external defibrillator in Asunción 2023 / Desarrollo validación y evaluación de la prueba de conocimientos sobre reanimación cardiopulmonar y uso correcto del desfibrilador externo automático en Asunción 2023

Introduction: in out-of-hospital cardiac arrest, early and efficient intervention through cardiopulmonary resuscitation (CPR) maneuvers and the use of the automated external defibrillator (AED) are the cornerstone for survival. Instruments that improve education would increase the responsiveness of lay personnel. Objectives: to develop, validate and evaluate a knowledge test on cardiopulmonary resuscitation and correct use of the automated external defibrillator in Asunción during 2023. Methodology: observational cross-sectional study, non-probabilistic sample for convenience of lay personnel users of mass attendance centers in Asunción. An exclusive questionnaire was developed on knowledge in cardiopulmonary resuscitation and the use of the automated external defibrillator (KOR-AED) based on the chain of survival in out-of-hospital cardiac arrest. Content, construct, and internal consistency were validated using expert opinion, factor analysis and Cronbach's alpha. Results: a total of 200 lay people participated, mostly shopping mall customers, with a predominance of men (63.5 %) (127), between 25-29 years old 28.5% (57). 61.5 % (123) had a university education, 75.5 % (151) had not related to health, 52 % (104) had prior knowledge of CPR, but 81.5 % (163) did not. The test showed reliability and suitability for factor analysis (Cronbach's alpha 0.75, Kaiser-Meyers-Olkin; 0.78, Bartlett p<0.05). The questions covered the first three links in the chain of survival, with items of medium to high difficulty. Women performed significantly better (p=0.04). Conclusion: the KOR-AED test is a valid and reliable instrument to improve the education of the layperson in CPR and use of the AED based on the chain of survival.

Introducción: en la parada cardíaca extrahospitalaria la actuación precoz y eficiente mediante maniobras de reanimación cardiopulmonar (RCP) y uso del desfibrilador externo automático (DEA) constituyen la piedra angular para la supervivencia. Instrumentos que mejoren la educación aumentarían la respuesta del personal lego. Objetivos: desarrollar, validar y evaluar una prueba de conocimientos sobre reanimación cardiopulmonar y uso correcto del desfibrilador externo automático en Asunción durante el 2023. Metodología: estudio observacional corte transversal, muestro no probabilístico por conveniencia de personal lego usuarios de centros de concurrencia masiva de Asunción. Se desarrolló un cuestionario exclusivo sobre conocimientos en reanimación cardiopulmonar y uso del desfibrilador externo automático (COR-DEA) basado en la cadena de supervivencia en parada cardíaca extrahospitalaria. Se validó el contenido, el constructo y la consistencia interna mediante la opinión de experto, análisis de factores y el alfa de Cronbach. Resultados: participaron 200 legos mayormente clientes de shoppings, predominando hombres 63,5 % (127) entre 25-29 años 28,5 % (57). Con educación universitaria 61,5 % (123), no relacionados con la salud 75,5 % (151), con conocimientos previos en RCP 52 % (104), pero no en DEA 81,5 % (163). El test mostró fiabilidad y adecuación para análisis factorial (Alfa de Cronbach 0.75, Kaiser-Meyers-Olkin; 0.78, Bartlett p<0.05). Las preguntas abarcarón los tres primeros eslabones de la cadena de supervivencia, con ítems de dificultad media a alta. Las mujeres tuvieron significativamente mejor desempeñó (p=0.04). Conclusión: la prueba COR-DEA es un instrumento válido y fiable para mejorar la educación del lego en RCP y uso del DEA basado en la cadena de supervivencia.

Determinación del riesgo de muerte por afecciones vasculares en hipertensos de la población peruana 2021-2022

Objetivo: determinar el riesgo de muerte inmediata por eventos vasculares en hipertensos de la población peruana en el periodo 2021-2022 Metodología: estudio observacional, de casos y controles basado en datos del sistema nacional de defunciones del instituto nacional de estadística e informática del Perú entre enero de 2021 a agosto de 2022. Fueron incluidos todos los pacientes, hipertensos y no hipertensos, que fallecieron por alguna de las afecciones vasculares seleccionadas en las variables las cuales fueron, además de la presencia de hipertensión: paro cardiaco, accidente cerebrovascular isquémico y hemorrágico, choque cardiogénico, Se realizó la prueba de Chi-cuadrado de Pearson y la razón de probabilidades para la estimación del riesgo. Resultados: de 5385 muertes por infarto de miocardio, 54,80% tuvieron hipertensión arterial; de 1425 muertes por choque cardiogénico, 45,12% fueron hipertensos; de 434 fallecidos por accidente cerebrovascular isquémico, 52,76% padecieron hipertensión arterial; de los 746 fallecidos por accidente cerebrovascular hemorrágico, 56,97% fueron hipertensos; de los 4401 fallecidos por paro cardiaco, 25,61% también tuvieron hipertensión arterial. Se encontró que los hipertensos tuvieron un riesgo 7,52 veces mayor de morir por infarto agudo de miocardio, 3,39 veces por choque cardiogénico, 5,75 veces por accidente cerebrovascular isquémico, 10,27 accidente cerebrovascular hemorrágico y 1,94 veces por paro cardiaco. Conclusiones: las afecciones vasculares de mayor a menor riesgo de provocar la muerte en hipertensos son el accidente cerebrovascular, el infarto de miocardio, el accidente cerebrovascular isquémico, el choque cardiogénico y el paro cardiaco.

Objective: To determine the risk of immediate death due to vascular events in hypertensive patients in the Peruvian population in the period 2021-2022. Methodology: Observational, case-control study based on data from the national death system of the National Institute of Statistics and Informatics of Peru between January 2021 and August 2022. All patients, hypertensive and non-hypertensive, who died from any of the vascular affections selected in the variables which were, in addition to the presence of hypertension: cardiac arrest, ischemic and hemorrhagic cerebrovascular accident, cardiogenic shock. The Pearson's Chi-square test and the odds ratio were performed for the estimation of the risk. Results: Of 5385 deaths due to myocardial infarction, 54.80% had arterial hypertension; of 1425 deaths due to cardiogenic shock, 45.12% were hypertensive; of 434 deaths from ischemic stroke, 52.76% suffered arterial hypertension; of the 746 who died from hemorrhagic stroke, 56.97% were hypertensive; of the 4,401 deaths from cardiac arrest, 25.61% also had arterial hypertension. It was found that hypertensive patients had a 7.52 times higher risk of dying from acute myocardial infarction, 3.39 times from cardiogenic shock, 5.75 times from ischemic stroke, 10.27 times from hemorrhagic stroke and 1.94 times from heart attack. Conclusions: Vascular conditions from highest to lowest risk of causing death in hypertensives are cerebrovascular accident, myocardial infarction, ischemic cerebrovascular accident, cardiogenic shock and cardiac arrest.

Intraoperative Cardiac Arrest due to Allergic Acute Coronary Syndrome (Kounis syndrome) Triggered by Cephalosporin

An acute coronary syndrome due to mast?cell activation in the presence of an allergen is known as Kounis Syndrome (KS). This relatively new entity of KS is being increasingly recognized among allergists, cardiologists, and emergency physicians; however, it is not well?known among anesthesiologists. We report here, a case of type 2 KS due to antibiotic administration causing sudden perioperative cardiac arrest.

Cardioverter-defibrillator reduces mortality risk in eligible ischemic and non-ischemic cardiomyopathy patients: Sub-analysis of the multi-center Improve SCA study

Background & Objective: Despite the burden of sudden cardiac arrest (SCA) worldwide, implantable cardioverter-defibrillators (ICDs) are underutilized, particularly in Asia, Latin America, Eastern Europe, the Middle East, and Africa. The Improve SCA trial demonstrated that primary prevention (PP) patients in these regions benefit from an ICD or a cardiac resynchronization therapy defibrillator (CRT-D). We aimed to compare the rate of device therapy and mortality among ischemic and non-ischemic cardiomyopathy (ICM and NICM) PP patients who met guideline indications for ICD therapy and had an ICD/CRT-D implanted. Methods: Improve SCA was a prospective, non-randomized, non-blinded multicenter trial that enrolled patients from the above-mentioned regions. All-cause mortality and device therapy were examined by cardiomyopathy (ICM vs NICM) and implantation status. Cox proportional hazards methods were used, adjusting for factors affecting mortality risk. Results: Of 1848 PP NICM patients, 1007 (54.5%) received ICD/CRT-D, while 303 of 581 (52.1%) PP ICM patients received an ICD/CRT-D. The all-cause mortality rate at 3 years for NICM patients with and without an ICD/CRT-D was 13.1% and 18.3%, respectively (HR 0.51, 95% CI 0.38e0.68, p < 0.001). Similarly, all-cause mortality at 3 years in ICM patients was 13.8% in those with a device and 19.9% in those without an ICD/CRT-D (HR 0.54, 95% CI 0.33e.0.88, p ¼ 0.011). The time to first device therapy, time to first shock, and time to first antitachycardia pacing (ATP) therapy were not significantly different between groups (p 0.263). Conclusions: In this large data set of patients with a guideline-based PP ICD indication, defibrillator device implantation conferred a significant mortality benefit in both NICM and ICM patients. The rate of appropriate device therapy was also similar in both groups.

Simulação in situ de parada cardíaca em fibrilação ventricular para o treinamento de profissionais de enfermagem / In-situ simulation of cardiac arrest in ventricular fibrillation for professional nursing training

Objetivo: Relatar a experiência e a percepção dos profissionais de enfermagem com a utilização de simulação in situnão anunciada de parada cardiorrespiratória (PCR) em ritmo de fibrilação ventricular no ambiente intra-hospitalar. Métodos: Manequim (Laerdal®) de alta fidelidade foi colocado no leito de isolamento de uma Unidade Coronariana que dispõe de central de monitoramento, sem o conhecimento dos profissionais de enfermagem que estavam assumindo o plantão. Um técnico de enfermagem do turno anterior de trabalho passou o caso como um paciente fictício recém-admitido com infarto agudo do miocárdio. Após a passagem do plantão, modificou-se o ritmo cardíaco do manequim de ritmo sinusal para fibrilação ventricular. Registrou-se o tempo (em minutos e segundos) desde a modificação do ritmo até algum profissional da enfermagem desencadear uma ação efetiva relacionada ao fato. Após o profissional perceber que se tratava de um manequim, ele foi orientado a desencadear as intervenções adequadas como se fosse um paciente real. Após o final da simulação, um questionário para avaliação da percepção desses profissionais em relação à atividade foi aplicado. Resultado: Quinze profissionais participaram da simulação in situ. O tempo para reação foi 28 segundos no turno diurno, dois minutos e seis segundos no turno vespertino e quatro minutos e três segundos no período noturno. Todos profissionais (100%) reconheceram a importância do treinamento, todos (100%) acharam que este treinamento aumenta a segurança do profissional e do paciente, a maioria (90%) achou que pode melhorar a comunicação entre a equipe, e todos (100%) acharam que atividades como esta deveriam ser repetidas. Conclusão: A simulação in situ parece ser uma alternativa viável para o treinamento dos profissionais de enfermagem no atendimento inicial da PCR em um hospital de emergência brasileiro. Esta atividade foi avaliada positivamente pelos participantes (AU).

Objective: Report the experience and perception of nursing professionals with an unannounced in-situ simulation of cardiopulmonary arrest (CPA) in ventricular fibrillation in an in-hospital environment. Methods: A high-fidelity mannequin (Laerdal®) was placed on the isolation bed of a Coronary Care Unit with a monitoring center without the knowledge of the nursing professionals taking over the shift. A nurse technician from the previous shift was told to report the case as a fictitious newly admitted patient with acute myocardial infarction. After the care transition, the cardiac rhythm was changed from sinus rhythm to ventricular fibrillation. The time was recorded (in minutes and seconds) from the onset of ventricular fibrillation until a nursing professional triggered an effective action. After the professionals realized it was a mannequin, they were instructed to initiate the appropriate interventions as if the mannequin were an actual patient. After the end of the simulation, a questionnaire was used to assess the professionals' perception of the activity. Results: Fifteen professionals participated in this in-situ simulation. The reaction time was 28 seconds on the morning shift, two minutes and six seconds on the afternoon shift, and four minutes and three seconds on the night shift. All professionals (100%) recognized the importance of this training, and all thought it increased professional and patient safety. Most participants (90%) thought it could improve communication among the team. All professionals (100%) felt that such activities should be repeated. Conclusion: In-situ simulation is a feasible alternative to train nursing professionals in the initial CPA management in a Brazilian emergency hospital. Participants positively evaluated this activity (AU).

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

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

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

Multiparameters Associated to Successful Weaning from VA ECMO in Adult Patients with Cardiogenic Shock or Cardiac Arrest: Systematic Review and Meta?Analysis

Venoarterial extracorporeal membrane oxygenation (VA ECMO) is a form of temporary mechanical circulatory support and simultaneous extracorporeal gas exchange for acute cardiorespiratory failure, including refractory cardiogenic shock (CS) and cardiac arrest (CA). Few studies have assessed predictors of successful weaning (SW) from VA ECMO. This systematic review and meta-analysis aimed to identify a multiparameter strategy associated with SW from VA ECMO. PubMed and the Cochrane Library and the International Clinical Trials Registry Platform were searched. Studies reporting adult patients with CS or CA treated with VA ECMO published from the year 2000 onwards were included. Primary outcomes were hemodynamic, laboratory, and echocardiography parameters associated with a VA ECMO SW. A total of 11 studies (n=653) were included in this review. Pooled VA ECMO SW was 45% (95%CI: 39�%, I2 7%) and in?hospital mortality rate was 46.6% (95%CI: 33�%; I2 36%). In the SW group, pulse pressure [MD 12.7 (95%CI: 7.3�) I2 = 0%] and mean blood pressure [MD 20.15 (95%CI: 13.8�.4 I2 = 0) were higher. They also had lower values of creatinine [MD �59 (95%CI: �9 to �2) I2 = 7%], lactate [MD �1 (95%CI: �4 to �7) I2 = 89%], and creatine kinase [�79.5 (95%CI: �87 to �1) I2 = 38%]. And higher left and right ventricular ejection fraction, MD 17.9% (95%CI: �2�.2) I2 = 91%, and MD 15.9% (95%CI 11.9�) I2 = 0%, respectively. Different hemodynamic, laboratory, and echocardiographic parameters were associated with successful device removal. This systematic review demonstrated the relationship of multiparametric assessment on VA ECMO SW.

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.

Reduced mobility is associated with adverse outcomes after in-hospital cardiac arrest

SUMMARY OBJECTIVE: In-hospital cardiac arrest is a critical medical emergency. Knowledge of prognostic factors could assist in cardiopulmonary resuscitation decision-making. Frailty and functional status are emerging risk factors and may play a role in prognostication. The objective was to evaluate the association between reduced mobility and in-hospital cardiac arrest outcomes. METHODS: This retrospective cohort study included patients over 18 years of age with in-hospital cardiac arrest in Botucatu, Brazil, from April 2018 to December 2021. Exclusion criteria were patients with a do-not-resuscitate order or patients with recurrent in-hospital cardiac arrest. Reduced mobility was defined as the need for a bed bath 48 h before in-hospital cardiac arrest. The outcomes of no return of spontaneous circulation and in-hospital mortality were evaluated. RESULTS: A total of 387 patients were included in the analysis. The mean age was 65.4±14.8 years; 53.7% were males and 75.4% had reduced mobility. Among the evaluated outcomes, the no return of spontaneous circulation rate was 57.1%, and in-hospital mortality was 94.3%. In multivariate analysis, reduced mobility was associated with no return of spontaneous circulation when adjusted by age, gender, initial shockable rhythm, duration of cardiopulmonary resuscitation, and epinephrine administration. However, in multiple logistic regression, there was no association between reduced mobility and in-hospital mortality. CONCLUSION: In patients with in-hospital cardiac arrest, reduced mobility is associated with no return of spontaneous circulation. However, there is no relation to in-hospital mortality.

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

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

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

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

The Role of Shunt Occlusion During Extracorporeal Life Support

ABSTRACT Introduction: The current recommendation for systemic to pulmonary artery shunt (SPS) patients requiring extracorporeal life support (ECLS) is to keep the shunt open, maintaining a higher pump flow. The practice in our center is to totally occlude the shunt while on ECLS, and we are presenting the outcome of this strategy. Methods: This is a retrospective analysis of patients who underwent SPS for cyanotic congenital heart disease with decreased pulmonary blood flow and required postoperative ECLS between January 2016 and December 2020. ECLS indication was excessive pulmonary blood flow, leading to either refractory low cardiac output syndrome (LCOS) or cardiac arrest. All patients had their shunts totally occluded soon after ECLS establishment. Results: Of the 27 SPS patients who needed postoperative ECLS (13 refractory LCOS, 14 extracorporeal cardiopulmonary resuscitation), wherein the strategy of occluding the shunt on ECLS initiation was followed, 16 (59.3 %) survived ECLS weaning and eight (29.6%) survived to discharge. Conclusion: Increased flow to maintain systemic circulation for a SPS patient while on ECLS is an accepted strategy, but it should not be applied universally. A large subset of SPS patients, who require ECLS either due to cardiac arrest or refractory LCOS due to excessive pulmonary flow, might benefit from complete occlusion of the shunt soon after commencement of ECLS, especially in cases with frank pulmonary edema or haemorrhage in the pre-ECLS period. A prospective randomized trial could be ethically justified for the subset of patients receiving ECLS for the indication of excessive pulmonary blood flow.

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

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

Factors associated with the clinical outcomes of adult cardiac and non-cardiac origin cardiac arrest in emergency departments: a nationwide retrospective cohort study from China / 世界急诊医学杂志（英文）

@#Cardiac arrest (CA) is one of the most common causes of death.[1-3] Despite extensive studies on the management of CA, the global survival rate in adults is only approximately 7%, and 30-day survival is even less than 2% in China.[4] Some studies have shown that CA patients of cardiac and non-cardiac origin may differ in underlying diseases, clinical manifestations, and prognosis, which leads to differences in terms of the pathophysiological mechanism and treatment measure.[5,6] However, little is known about the risk factors in relation to the prognosis of CA across arrest etiologies.

Effect of post-rewarming fever after targeted temperature management in cardiac arrest patients: a systematic review and meta-analysis / 世界急诊医学杂志（英文）

@#BACKGROUND: Targeted temperature management (TTM), as a therapeutic temperature control strategy for cardiac arrest (CA), is recommended by guidelines. However, the relationship between post-rewarming fever (PRF) and the prognosis of CA patients is unclear. Therefore, we aim to summarize the studies regarding the influence of PRF on patients with CA. METHODS: EMBASE, PubMed, and Cochrane Central databases were searched from inception to March 13, 2022. Randomized clinical trials (RCTs) and cohort studies on PRF in CA patients were included. According to the heterogeneity, the meta-analysis was performed using a random effects model or fixed effects model to calculate the pooled odds ratios (ORs) and corresponding 95% confidence intervals (CIs). The outcome data were unfavorable neurological outcome and mortality. RESULTS: The meta-analysis included 11 observational studies involving 3,246 patients. The results of the meta-analysis show that PRF (body temperature >38.0 °C) has no effect on the neurological outcome of CA patients (OR 0.71, 95% CI 0.43-1.17, I2 82%) and has a significant relationship with lower mortality (OR 0.63; 95% CI 0.49-0.80, I2 39%). However, PRF with a stricter definition (body temperature >38.5 °C ) was associated with worse neurological outcome (OR 1.44, 95% CI 1.08-1.92, I2 45%) and higher mortality (OR 1.71, 95% CI 1.25-2.35, I2 47%). CONCLUSION: This study suggests that PRF >38.0 °C may not affect the neurological outcome and have a lower mortality in CA patients who completed TTM. However, PRF >38.5 °C is a potential prognostic factor for worse outcomes in CA patients.

The neuro-prognostic value of the ion shift index in cardiac arrest patients following extracorporeal cardiopulmonary resuscitation / 世界急诊医学杂志（英文）

@#BACKGROUND: The ion shift index (ISI) as a prognostic indicator that can show the severity of hypoxic-ischemic injury. We aimed to evaluate the performance of the ISI in predicting unfavorable neurological outcomes at hospital discharge in cardiac arrest (CA) patients following extracorporeal cardiopulmonary resuscitation (ECPR) and to compare its performance to other prognostic predictors. METHODS: This was a retrospective observational study including adult CA patients treated with ECPR between January 2018 and December 2022 in a tertiary hospital. Data regarding clinical characteristics and laboratory parameters were collected from medical records. The ISI was determined based on the first available serum electrolyte levels after ECPR. The primary outcome was unfavorable neurological status at hospital discharge, defined as Cerebral Performance Categories 3-5. Comparisons of the characteristics between the two groups were made using the χ2 test for categorical variables and the t-test or non-parametric Mann-Whitney U-test for continuous variables, as appropriate. Correlation analysis was performed using Spearman’s rank correlation coefficient. A two-tailed P-value <0.05 was considered statistically significant. RESULTS: Among the 122 patients involved, 46 (37.7%) had out-of-hospital CA, and 88 had unfavorable neurological outcomes. The ISI was significantly higher in the unfavorable outcome group than in the favorable outcome group (3.74 [3.15-4.57] vs. 2.69 [2.51-3.07], P<0.001). A higher ISI level was independently related to unfavorable outcome (odds ratio=6.529, 95% confidence interval 2.239-19.044, P=0.001). An ISI level >3.12 predicted unfavorable outcomes with a sensitivity and specificity of 74.6% and 85.2%, respectively (P<0.001). The prognostic performance of ISI (area under the curve [AUC]=0.887) was similar to that of other predictors, such as gray-to-white matter ratio (AUC=0.850, P=0.433) and neuron-specific enolase (AUC=0.925, P=0.394). CONCLUSION: ISI may be used as a prognostic biomarker to predict neurological outcomes in CA patients following ECPR.