Superviviencia de la parada cardiorrespiratoria hospitalaria / Survival form in-hospital cardiac arrest

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[Trends in cardiopulmonary resuscitation]. / Tendencias en resucitación cardiopulmonar.

Less than 10% of those individuals who suffer an episode of sudden cardiac arrest are successfully resuscitated and return home to live productive lives. New approaches to cardiac resuscitation could substantially improve such dismal outcome. Four current trends that have the greatest potential for improving outcome can be recognized in cardiopulmonary resuscitation (CPR): (1) systems to prevent cardiac arrests through recognition of early warning signs and timely intervention, (2) a shift towards a flow-based resuscitation emphasizing the delivery of high-quality uninterrupted CPR limiting the role of ventilation, (3) the growing role of technology in driving resuscitation interventions, incrementally enhancing the human decision-making process, and (4) the use of hypothermia.

Tendencias en resucitación cardiopulmonar / Trends in cardiopulmonary resuscitation

Menos del 10% de las personas que sufren una parada cardíaca son resucitados con éxito y regresan a sus hogares para vivir vidas productivas. Nuevos enfoques de la resucitación podrían modificar de forma sustancial este resultado tan triste. Cuatro tendencias en resucitación cardiopulmonar (RCP) parecen tener el mayor potencial para mejorar el pronóstico: a) los sistemas para la prevención de la parada cardíaca mediante reconocimiento precoz de los signos de alarma e intervención oportuna; b) el cambio hacia una resucitación orientada hacia el flujo sanguíneo enfatizando la realización ininterrumpida de una RCP de alta calidad con un papel limitado de la ventilación; c) el papel creciente de la tecnología que guía las intervenciones en resucitación y mejora el proceso humano de toma de decisiones, y d) el empleo de hipotermia

Less than 10% of those individuals who suffer an episode of sudden cardiac arrest are successfully resuscitated and return home to live productive lives. New approaches to cardiac resuscitation could substantially improve such dismal outcome. Four current trends that have the greatest potential for improving outcome can be recognized in cardiopulmonary resuscitation (CPR): (1) systems to prevent cardiac arrests through recognition of early warning signs and timely intervention, (2) a shift towards a flow-based resuscitation emphasizing the delivery of high-quality uninterrupted CPR limiting the role of ventilation, (3) the growing role of technology in driving resuscitation interventions, incrementally enhancing the human decision-making process, and (4) the use of hypothermia

[Irritable bowel syndrome and cardiac right-to-left shunt through a patent foramen ovale]. / Síndrome del intestino irritable y cortocircuito cardíaco derecha-izquierda por foramen oval permeable.

BACKGROUND AND OBJECTIVE: Both irritable bowel syndrome (IBS) and patent foramen ovale (PFO) have a similar prevalence in the general population, affect more commonly women and are related to comorbidities such as migraine. In IBS there are alterations in the metabolism of certain substances like serotonin. In the presence of PFO with a right- to left-shunt (RLS), a percentage of venous blood bypasses the lung filter and may increase these substances in blood. PATIENTS AND METHOD: A phone interview was done to determine the presence of IBS in patients previously attended for detection of RLS with transcranial Doppler ultrasound. The presence and grade of RLS was analyzed and compared with subjects without gastrointestinal symptoms (NoGI). Rome II criteria were used to diagnose IBS or other functional gastrointestinal disorder (FGD) and Venice 1999 consensus were used for the diagnosis of RLS. RESULTS: Thirthy-three (18.3%) of 180 interviewed patients had IBS and 62 (34.4%) other FGD. RLS was found in 41% of NoGI patients, 64% of patients with IBS and 68% of patients with other FGD (odds ratio [OR] = 2.56; p < 0.05 for SII, and OR = 3.06; p < 0.01 for other FGD). RLS with a massive pattern was registered in en 27% of NoGI patients, 39% of patients with IBS and 45% of patients with other FGD (OR = 1.73; p = 1 for IBS, and OR = 2.21; p < 0.05 for other FGD). CONCLUSIONS: We found a higher prevalence of cardiac RLS through a PFO in patients with IBS and other FGD. A possible etiopathogenic relationship must be considered in future studies.

[Avoidable mortality after out-of-hospital cardiac arrest]. / Mortalidad evitable por parada cardíaca extrahospitalaria.

More than 50,000 people suffer annually in Spain an episode of out-of-hospital cardiac arrest, but less than 10% of those individuals are successfully resuscitated and return home to live productive lives. The application of the scientific evidence available in resuscitation could substantially improve such dismal outcome. However, most of the procedures that have been able to reduce mortality are not sufficiently being used in Spain. In addition to the development of really intense strategies for early defibrillation, 4 current aspects in resuscitation have the greatest potential for improving outcome: a) prevention of cardiac arrests through recognition of early warning signs and timely intervention; b) flow-based cardiopulmonary resuscitation limiting the role of ventilation; c) use of technology in driving resuscitation interventions, and d) use of hypothermia.

Mortalidad evitable por parada cardíaca extrahospitalaria / Avoidable mortality after out-of-hospital cardiac arrest

En España, cada año más de 50.000 personas presentan una parada cardíaca extrahospitalaria, pero menos de la mitad recibe tratamiento y en menos del 10% se aplican con éxito técnicas de resucitación que les permiten regresar a sus hogares para llevar una vida productiva. La aplicación de la evidencia científica disponible en resucitación podría modificar de forma sustancial este resultado tan triste. Sin embargo, la mayoría de los procedimientos que han conseguido reducir la mortalidad por parada cardíaca no se emplean suficientemente en nuestro medio. Junto con el establecimiento de estrategias realmente enérgicas para la desfibrilación precoz, otros 4 aspectos de la resucitación tienen el mayor potencial para mejorar el pronóstico: a) prevención de la parada cardíaca mediante el reconocimiento precoz de los signos de alarma e intervención oportuna; b) resucitación orientada hacia el flujo sanguíneo, con un papel limitado de la ventilación; c) aplicación de la tecnología para guiar las intervenciones en resucitación, y d) empleo de hipotermia

More than 50,000 people suffer annually in Spain an episode of out-of-hospital cardiac arrest, but less than 10% of those individuals are successfully resuscitated and return home to live productive lives. The application of the scientific evidence available in resuscitation could substantially improve such dismal outcome. However, most of the procedures that have been able to reduce mortality are not sufficiently being used in Spain. In addition to the development of really intense strategies for early defibrillation, 4 current aspects in resuscitation have the greatest potential for improving outcome: a) prevention of cardiac arrests through recognition of early warning signs and timely intervention; b) flow-based cardiopulmonary resuscitation limiting the role of ventilation; c) use of technology in driving resuscitation interventions, and d) use of hypothermia

Síndrome del intestino irritable y cortocircuito cardíaco derecha-izquierda por foramen oval permeable / Irritable bowel syndrome and cardiac right-to-left shunt through a patent foramen oval

FUNDAMENTO Y OBJETIVO: El síndrome de intestino irritable (SII) y el foramen oval permeable(FOP) tienen una prevalencia similar en la población general, afectan más a mujeres y se relacionancon otras enfermedades como la migraña. La presencia de FOP con cortocircuito (shunt) derecha izquierda (CDI) podría alterar el metabolismo de ciertas sustancias como la serotonina, muy relacionadas con el SII. Sin embargo, hasta la fecha no se ha estudiado la posibleasociación entre ambas entidades.PACIENTES Y MÉTODO: Se ha realizado una encuesta telefónica para determinar la presencia de SII enpacientes atendidos previamente para detección de CDI mediante ultrasonografía Doppler transcraneal.Se analizó la presencia y el grado de CDI y se los comparó con los de sujetos sin síntomas gastrointestinales (NoGI). Se utilizaron los criterios de Roma II para el diagnóstico de SII u otra enfermedad funcional gastrointestinal (EFGI), y el consenso de Venecia-1999 para el CDI.RESULTADOS: De 180 pacientes encuestados, 33 (18,3%) tenían SII y 62 (34,4%), otra EFGI.Tenían CDI un 41% de los NoGI, un 64% de los pacientes con SII y un 68% de los pacientes con otra EFGI (odds ratio [OR] = 2,56; p < 0,05 para SII, y OR = 3,06; p < 0,01 para otra EFGI). Los patrones masivos de CDI se registraron en el 27% de los NoGI, en el 39% de lospacientes con SII y en el 45% de los afectados por otra EFGI (OR = 1,73; p = 1 para SII, y OR = 2,21; p < 0,05 para otra EFGI).CONCLUSIONES: Se encontró mayor prevalencia de CDI cardíaco por FOP en pacientes con SII y otros trastornos funcionales digestivos. Su posible relación etiopatogénica debería considerarse en futuros estudios

BACKGROUND AND OBJECTIVE: Both irritable bowel syndrome (IBS) and patent foramen ovale (PFO) have a similar prevalence in the general population, affect more commonly women and are related to comorbidities such as migraine. In IBS there are alterations in the metabolism of certain substances like serotonin. In the presence of PFO with a right- to left-shunt (RLS), a percentageof venous blood bypasses the lung filter and may increase these substances in blood.PATIENTS AND METHOD: A phone interview was done to determine the presence of IBS in patientspreviously attended for detection of RLS with transcranial Doppler ultrasound. The presenceand grade of RLS was analyzed and compared with subjects without gastrointestinal symptoms (NoGI). Rome II criteria were used to diagnose IBS or other functional gastrointestinal disorder (FGD) and Venice 1999 consensus were used for the diagnosis of RLS.RESULTS: Thirthy-three (18.3%) of 180 interviewed patients had IBS and 62 (34.4%) other FGD. RLS was found in 41% of NoGI patients, 64% of patients with IBS and 68% of patients with other FGD (odds ratio [OR] = 2.56; p < 0.05 for SII, and OR = 3.06; p < 0.01 for otherFGD). RLS with a massive pattern was registered in en 27% of NoGI patients, 39% of patients with IBS and 45% of patients with other FGD (OR = 1.73; p = 1 for IBS, and OR = 2.21; p <0.05 for other FGD).CONCLUSIONS: We found a higher prevalence of cardiac RLS through a PFO in patients with IBS and other FGD. A possible etiopathogenic relationship must be considered in future studies

Colitis isquémica y foramen oval permeable / Ischemic colitis and patent foramen oval

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Síndrome de apnea obstructiva durante el sueño y cortocircuito derecha-izquierda / Obstructive sleep apnea syndrome and right-to-left shunt

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Causas vasculares de amnesia global transitoria / Vascular causes of transient global amnesia

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Respuesta sanitaria en desastres. Enseñanzas del atentado contra las Torres Gemelas de Nueva York / Sanitary response in disasters. Learnings from the terrorist attack against the Twin Twers of New York City

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