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

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

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

Combined ECG, Echocardiographic, and Biomarker Criteria for Diagnosing Acute Myocardial Infarction in Out-of-Hospital Cardiac Arrest Patients

PURPOSE: Acute coronary lesions commonly trigger out-of-hospital cardiac arrest (OHCA). However, the prevalence of coronary artery disease (CAD) in Asian patients with OHCA and whether electrocardiogram (ECG) and other findings might predict acute myocardial infarction (AMI) have not been fully elucidated. MATERIALS AND METHODS: Of 284 consecutive resuscitated OHCA patients seen between January 2006 and July 2013, we enrolled 135 patients who had undergone coronary evaluation. ECGs, echocardiography, and biomarkers were compared between patients with or without CAD. RESULTS: We included 135 consecutive patients aged 54 years (interquartile range 45-65) with sustained return of spontaneous circulation after OHCA between 2006 and 2012. Sixty six (45%) patients had CAD. The initial rhythm was shockable and non-shockable in 110 (81%) and 25 (19%) patients, respectively. ST-segment elevation predicted CAD with 42% sensitivity, 87% specificity, and 65% accuracy. ST elevation and/or regional wall motion abnormality (RWMA) showed 68% sensitivity, 52% specificity, and 70% accuracy in the prediction of CAD. Finally, a combination of ST elevation and/or RWMA and/or troponin T elevation predicted CAD with 94% sensitivity, 17% specificity, and 55% accuracy. CONCLUSION: In patients with OHCA without obvious non-cardiac causes, selection for coronary angiogram based on the combined criterion could detect 94% of CADs. However, compared with ECG only criteria, the combined criterion failed to improve diagnostic accuracy with a lower specificity.