ABSTRACT
AIM: To analyze differences in ventilatory parameters and outcome with different ventilatory methods during CPR. METHODS: Pragmatic prospective quasi-experimental study in out-of-hospital urban environment. Patients over 18 years of age in non-traumatic cardiac arrest, attended by an emergency medical service between April 2021 and September 2022, were included. Two groups were compared according to the ventilatory method: mechanical ventilator (IPPV, tidal volume 7 ml/kg, frequency 10-12 bpm) or manual resuscitator bag. The main variables of interest are those of gasometry performed 15 minutes after intubation or when spontaneous circulation is recovered and final outcome. Patients were followed up to hospital discharge. RESULTS: Of the 359 patients attended, 150 were included (71 in IPPV and 79 with a bag). In patients with arterial blood gases, pCO2 was 67.8 ± 21.1 in the IPPV group vs 95.9 ± 39.0 mmHg in the bag group (p = 0.006) and pH was 7.00 ± 0.18 vs 6.92 ± 0.18 (p = 0.18). With a venous sample, the pCO2 was 68.1 ± 18.9 vs 89.5 ± 26.5 mmHg (p < 0.001) and the pH was 7.03 ± 0.15 vs 6.94 ± 0.17 (p = 0.005), respectively. Survival with CPC 1-2 to hospital discharge was 15.6% with IPPV and 11.3% with bag (p = 0.44). CONCLUSION: The use of a mechanical ventilator in IPPV was associated with a better ventilatory status during CPR compared to the use of the bag, without conclusive data regarding its clinical repercussion with the sample collected.
Subject(s)
Cardiopulmonary Resuscitation , Emergency Medical Services , Out-of-Hospital Cardiac Arrest , Humans , Adolescent , Adult , Out-of-Hospital Cardiac Arrest/therapy , Prospective Studies , Cardiopulmonary Resuscitation/methods , Emergency Medical Services/methods , Ventilators, MechanicalABSTRACT
BACKGROUND: The humanitarian response to a cholera outbreak in a complex international crisis requires guaranteeing minimum conditions so that normalcy can be restored. Basic responses to a cholera outbreak include water and sanitation. The general objective of this systematic review was the analysis of the current evidence that addresses the effectiveness of different WASH measures to control cholera. METHODS: A review and analysis of the literature available in the main databases (PubMed, WoS and Scopus) and in a specific meta-search engine for humanitarian aid was carried out (reliefweb.int). Based on the establishment of the PICO research question "Can beneficiaries of humanitarian aid benefit from water, hygiene and sanitation interventions for cholera reduction?", the identification of keywords and databases to carry out the searches, as well as a selection process based on the established eligibility criteria: being studies in both English and Spanish where the WASH intervention was clearly defined, studies where health outcomes of cholera were presented, or data related to the function and use of the WASH intervention, was established. RESULTS: The initial search provided 17,185 documents susceptible of analysis that were screened using the search criteria, up to 22 references that were read in full text and the 11 that were finally analyzed. These were coded based on the measures set out in their protocols, on the interventions carried out in the improvement of water and its supply, the improvement of sanitation, the measures aimed at better hygiene and those that evaluated the complete WASH intervention. CONCLUSIONS: All the measures offered positive results, their effectiveness was conditioned by the education of the beneficiaries, the simplicity of the activities and the involvement of local actors.
OBJETIVO: La respuesta humanitaria ante un brote de cólera en una crisis compleja de carácter internacional requiere garantizar unas condiciones mínimas para que se pueda recuperar la normalidad. Entre las respuestas básicas a un brote de cólera están las correspondientes al agua y el saneamiento. El objetivo general de esta revisión narrativa fue el análisis de la evidencia actual que aborda la efectividad de las diferentes medidas WASH para controlar el cólera. METODOS: Se realizó una revisión y análisis de la literatura disponible en las bases de datos principales (PubMed, WoS y Scopus) y en un metabuscador específico de ayuda humanitaria (reliefweb.int). Basada en el establecimiento de la pregunta de investigación PICO: "¿Los beneficiarios de la ayuda humanitaria se pueden beneficiar de las intervenciones en agua, higiene y saneamiento para la disminución del cólera?" la identificación de las palabras clave y bases de datos para realizar las búsquedas, además de un proceso de selección basado en los criterios de elegibilidad establecidos; siendo estudios tanto en inglés como español donde la intervención WASH fue claramente definida, estudios donde se presentaran resultados de salud del cólera, o datos relacionados con la función y el uso de la intervención WASH. RESULTADOS: La búsqueda inicial proporcionó 17.185 documentos susceptibles de análisis que fueron cribados mediante los criterios de búsqueda hasta las 22 referencias que fueron leídas a texto completo y las 11 que fueron analizadas finalmente. Estas fueron codificadas en base a las medidas expuestas en sus protocolos, a las intervenciones realizadas en la mejora del agua y su suministro, la mejora del saneamiento, las medidas destinadas a una mejor higiene y aquellas que evaluaban la intervención WASH completa. CONCLUSIONES: Todas las medidas ofrecieron resultados positivos, su eficacia estuvo condicionada por la educación de los beneficiarios, la simplicidad de las actividades y la implicación de los actores locales.
