Incidence, treatment, and factors associated with survival of out-of-hospital cardiac arrest attended by Spanish emergency services: report from the Out-of-Hospital Spanish Cardiac Arrest Registry for 2022. / Incidencia, tratamiento y factores asociados con la supervivencia de la parada cardiaca extrahospitalaria atendida por los servicios de emergencias en España: informe 2022 del registro OHSCAR.

SUMMARY: Out-of-hospital cardiac arrest is a serious public health problem worldwide. The annual incidence is estimated at around 400 000 cases in Europe and the United States, and survival rates scarcely reach 10%. However, there is considerable variation between countries and even between regions that share a similar health care system within a single country. Information recorded by the Out-of-Hospital Spanish Cardiac Arrest Registry (OHSCAR) provides information on care provided by emergency ambulance services, final health outcomes after cardiac arrest cases (including variations), the possibility of organ donation, and the impact of the COVID-19 pandemic. This paper presents the OHSCAR report for Spanish emergency services for the year 2022.

RESUMEN: La parada cardiorrespiratoria extrahospitalaria (PCREH) es un grave problema de salud pública mundial, con una incidencia anual estimada entorno a entorno a los 350.000 y 400.000 casos de PCERH en Europa y Estados Unidos, respectivamente. La supervivencia final se sitúa en porcentajes que apenas alcanzan el 10%, aunque existe una importante variabilidad entre países e incluso entre regiones del mismo país con modelos de atención similares. En España, el Registro Español de Parada Cardiaca Extrahospitalaria (acrónimo OHSCAR) ha ofrecido información sobre la asistencia a la PCRE prestada por los servicios de emergencias (SEM) y sus resultados finales en salud, así como sobre variabilidad, posibilidades de programas de donación o impacto de la pandemia COVID-19. A continuación se presenta el informe OHSCAR correspondiente a la asistencia a la PCRE por los SEM españoles durante el año 2022.

Out-of-Hospital Cardiac Arrest Following the COVID-19 Pandemic.

Importance: Out-of-hospital cardiac arrest (OHCA) health care provision may be a good indicator of the recovery of the health care system involved in OHCA care following the COVID-19 pandemic. There is a lack of data regarding outcomes capable of verifying this recovery. Objective: To determine whether return to spontaneous circulation, overall survival, and survival with good neurological outcome increased in patients with OHCA since the COVID-19 pandemic was brought under control in 2022 compared with prepandemic and pandemic levels. Design, Setting, and Participants: This observational cohort study was conducted to examine health care response and survival with good neurological outcome at hospital discharge in patients treated following OHCA. A 3-month period, including the first wave of the pandemic (February 1 to April 30, 2020), was compared with 2 periods before (April 1, 2017, to March 31, 2018) and after (January 1 to December 31, 2022) the pandemic. Data analysis was performed in July 2023. Emergency medical services (EMS) serving a population of more than 28 million inhabitants across 10 Spanish regions participated. Patients with OHCA were included if participating EMS initiated resuscitation or continued resuscitation initiated by a first responder. Exposure: The pandemic was considered to be under control following the official declaration that infection with SARS-CoV-2 was to be considered another acute respiratory infection. Main Outcome and Measures: The main outcomes were return of spontaneous circulation, overall survival, and survival at hospital discharge with good neurological outcome, expressed as unimpaired or minimally impaired cerebral performance. Results: A total of 14 732 patients (mean [SD] age, 64.2 [17.2] years; 10 451 [71.2%] male) were included, with 6372 OHCAs occurring during the prepandemic period, 1409 OHCAs during the pandemic period, and 6951 OHCAs during the postpandemic period. There was a higher incidence of OHCAs with a resuscitation attempt in the postpandemic period compared with the pandemic period (rate ratio, 4.93; 95% CI, 4.66-5.22; P < .001), with lower incidence of futile resuscitation for OHCAs (2.1 per 100 000 person-years vs 1.3 per 100 000 person-years; rate ratio, 0.81; 95% CI, 0.71-0.92; P < .001). Recovery of spontaneous circulation at hospital admission increased from 20.5% in the pandemic period to 30.5% in the postpandemic period (relative risk [RR], 1.08; 95% CI, 1.06-1.10; P < .001). In the same way, overall survival at discharge increased from 7.6% to 11.2% (RR, 1.45; 95% CI, 1.21-1.75; P < .001), with 6.6% of patients being discharged with good neurological status (Cerebral Performance Category Scale categories 1-2) in the pandemic period compared with 9.6% of patients in the postpandemic period (RR, 1.07; 95% CI, 1.04-1.10; P < .001). Conclusions and Relevance: In this cohort study, survival with good neurological outcome at hospital discharge following OHCA increased significantly after the COVID-19 pandemic.

Effect of the COVID-19 pandemic on advanced life support units' prehospital management of the stroke code in four Spanish regions: an observational study.

INTRODUCTION: Stroke is the most common time-dependent pathology that pre-hospital emergency medical services (EMS) are confronted with. Prioritisation of ambulance dispatch, initial actions and early pre-notification have a major impact on mortality and disability. The COVID-19 pandemic has led to disruptions in the operation of EMS due to the implementation of self-protection measures and increased demand for care. It is crucial to evaluate what has happened to draw the necessary conclusions and propose changes to improve the system's strength for the future. The study aims to compare prehospital time and neuroprotective care metrics for acute stroke patients during the first wave of COVID-19 and the same periods in the years before and after. METHODS: Analytical, observational, multicentre study conducted in the autonomous communities of Andalusia, Catalonia, Galicia, and Madrid in the pre-COVID-19 (2019), "first wave" of COVID-19 (2020) and post-COVID-19 (2021) periods. Consecutive non-randomized sampling. Descriptive statistical analysis and hypothesis testing to compare the three time periods, with two by two post-hoc comparisons, and multivariate analysis. RESULTS: A total of 1,709 patients were analysed. During 2020 there was a significant increase in attendance time of 1.8 min compared to 2019, which was not recovered in 2021. The time of symptom onset was recorded in 82.8% of cases, and 83.3% of patients were referred to specialized stroke centres. Neuroprotective measures (airway, blood glucose, temperature, and blood pressure) were performed in 43.6% of patients. CONCLUSION: During the first wave of COVID-19, the on-scene times of pre-hospital emergency teams increased while keeping the same levels of neuroprotection measures as in the previous and subsequent years. It shows the resilience of EMS under challenging circumstances such as those experienced during the pandemic.

Brecha de género persistente en la parada cardiaca extrahospitalaria en España durante el periodo 2013-2018 / Persistent gender gaps in out-of-hospital cardiac arrest in Spain from 2013 through 2018

Objetivos. Examinar las diferencias de género en las características de la parada cardiaca extrahospitalaria (PCRE), los tratamientos, la supervivencia, y los cambios evolutivos en España. Método. Datos de dos series temporales (2013/2014 y 2017/2018) del registro prospectivo de PCRE (OHSCAR). Se incluyeron todos los casos consecutivos en los que intervino un equipo de emergencias. Las variables dependientes fueron las variables de atención de la PCRE, la llegada al hospital con pulso espontáneo, la supervivencia global al alta, y con buenos resultados neurológicos. El sexo fue la variable independiente. Resultados. Las mujeres fueron significativamente mayores, menos propensas a presentar una PCRE en lugar público, recibir desfibrilación externa automática, tener un ritmo inicial desfibrilable y ser atendidas por una ambulancia en menos de 15 minutos. Además, menos mujeres recibieron intervención coronaria percutánea o hipotermia al ingreso hospitalario. Tanto en 2013/2014 como en 2017/2018 las mujeres tuvieron menos probabilidades de supervivencia al ingreso hospitalario (OR = 0,52; p < 0,001; OR = 0,61; p = 0,009 respectivamente), y al alta hospitalaria (OR = 0,69; p = 0,001; OR = 0,72; p = 0,001, respectivamente) y con buenos resultados neurológicos (OR = 0,50; p < 0,001; OR = 0,63; p <0,001, respectivamente). Conclusiones. En ambos periodos las mujeres tuvieron menos probabilidades de sobrevivir y de hacerlo en buenas condiciones neurológicas. Estos resultados indican la necesidad de adoptar nuevos enfoques para abordar las diferencias de género en la PCRE. (AU)

Objective. To examine gender-related differences in the management and survival of out-of-hospital cardiac arrest (OHCA) in Spain during 2 time series. Methods. Analysis of data recorded in the prospective Spanish OHCA registry (OHSCAR in its Spanish acronym) for 2 time series (2013-2014 and 2017-2018). We included all 11036 consecutive cases in which an emergency team intervened. The dependent variables were arrival at the hospital after return of spontaneous circulation, overall survival to discharge, and overall survival with good neurological outcomes. Sex was the independent variable. We report descriptive statistics, patient group comparisons, and changes over time. Results.Women were significantly older and less likely to experience an OHCA in a public place, receive automatic external defibrillation, have a shockable heart rhythm, and be attended by an ambulance team within 15 minutes. In addition, fewer women underwent percutaneous coronary interventions or received treatment for hypothermia on admission to the hospital. In 2013-2014 and 2017-2018, respectively, the likelihood of survival was lower for women than men on admission (odds ratio [OR], 0.52 vs OR, 0.61; P < .001 and P = .009 in the 2 time series) and at discharge (OR, 0.69 vs 0.72 for men; P = .001 in both time series). Survival with good neurological outcomes was also less likely in women (OR, 0.50 vs 0.63; P < .001 in both series). Conclusions. The odds for survival and survival with good neurological outcomes were lower for women in nearly all patient groups in both time series. These findings suggest the need to adopt new approaches to address gender differences in OHCA. (AU)

Persistent gender gaps in out-of-hospital cardiac arrest in Spain from 2013 through 2018. / Brecha de género persistente en la parada cardiaca extrahospitalaria en España durante el periodo 2013-2018.

OBJECTIVES: To examine gender-related differences in the management and survival of out-of-hospital cardiac arrest (OHCA) in Spain during 2 time series. MATERIAL AND METHODS: Analysis of data recorded in the prospective Spanish OHCA registry (OHSCAR in its Spanish acronym) for 2 time series (2013-2014 and 2017-2018). We included all 11 036 consecutive cases in which an emergency team intervened. The dependent variables were arrival at the hospital after return of spontaneous circulation, overall survival to discharge, and overall survival with good neurological outcomes. Sex was the independent variable. We report descriptive statistics, patient group comparisons, and changes over time. RESULTS: Women were significantly older and less likely to experience an OHCA in a public place, receive automatic external defibrillation, have a shockable heart rhythm, and be attended by an ambulance team within 15 minutes. In addition, fewer women underwent percutaneous coronary interventions or received treatment for hypothermia on admission to the hospital. In 2013-2014 and 2017-2018, respectively, the likelihood of survival was lower for women than men on admission (odds ratio [OR], 0.52 vs OR, 0.61; P .001 and P = .009 in the 2 time series) and at discharge (OR, 0.69 vs 0.72 for men; P = .001 in both time series). Survival with good neurological outcomes was also less likely in women (OR, 0.50 vs 0.63; P .001 in both series). CONCLUSION: The odds for survival and survival with good neurological outcomes were lower for women in nearly all patient groups in both time series. These findings suggest the need to adopt new approaches to address gender differences in OHCA.

OBJETIVO: Examinar las diferencias de género en las características de la parada cardiaca extrahospitalaria (PCRE), los tratamientos, la supervivencia, y los cambios evolutivos en España. METODO: Datos de dos series temporales (2013/2014 y 2017/2018) del registro prospectivo de PCRE (OHSCAR). Se incluyeron todos los casos consecutivos en los que intervino un equipo de emergencias. Las variables dependientes fueron las variables de atención de la PCRE, la llegada al hospital con pulso espontáneo, la supervivencia global al alta, y con buenos resultados neurológicos. El sexo fue la variable independiente. RESULTADOS: Las mujeres fueron significativamente mayores, menos propensas a presentar una PCRE en lugar público, recibir desfibrilación externa automática, tener un ritmo inicial desfibrilable y ser atendidas por una ambulancia en menos de 15 minutos. Además, menos mujeres recibieron intervención coronaria percutánea o hipotermia al ingreso hospitalario. Tanto en 2013/2014 como en 2017/2018 las mujeres tuvieron menos probabilidades de supervivencia al ingreso hospitalario (OR = 0,52; p 0,001; OR = 0,61; p = 0,009 respectivamente), y al alta hospitalaria (OR = 0,69; p = 0,001; OR = 0,72; p = 0,001, respectivamente) y con buenos resultados neurológicos (OR = 0,50; p 0,001; OR = 0,63; p 0,001, respectivamente). CONCLUSIONES: En ambos periodos las mujeres tuvieron menos probabilidades de sobrevivir y de hacerlo en buenas condiciones neurológicas. Estos resultados indican la necesidad de adoptar nuevos enfoques para abordar las diferencias de género en la PCRE.

Variabilidad regional en incidencia, características generales y resultados finales de la parada cardiaca extrahospitalaria en España: Registro OHSCAR / Regional variation in the incidence, general characteristics, and outcomes of prehospital cardiac arrest in Spain: the Out-of-Hospital Spanish Cardiac Arrest Registry

OBJETIVOS: Existe gran variabilidad internacional en la incidencia y los resultados en la atención a la parada cardiaca extrahospitalaria (PCRE). El objetivo es conocer si existe variabilidad en la incidencia, características y resultados en supervivencia en la atención a la PCRE por los servicios extrahospitalarios de emergencias (SEM) de España. MÉTODO: Análisis descriptivo, retrospectivo de los datos del registro OHSCAR correspondientes al periodo octubre2013-octubre 2014, que incluye pacientes atendidos por 19 SEM de España con intento de reanimación. Se recogieron los casos atendidos y variables clave sobre la asistencia a una PCRE: incidencia, características del paciente, del evento, de la actuación previa a los equipos de emergencias (EE), de la reanimación realizada, y de los principales tratamientos hospitalarios. Se comparó la situación neurológica al alta hospitalaria de los casos con ingreso hospitalario. RESULTADOS: La incidencia de casos con intento de reanimación y todas las características generales, salvo la distribución por sexo, presentaron diferencias estadísticamente significativas entre los SEM participantes (p < 0,001). Hubo diferencias significativas en los tratamientos hospitalarios recibidos y en los resultados finales, tanto en la proporción de pacientes que llegaron con pulso espontáneo al hospital, 30,5%, rango entre 21,3% y 56,1% (p < 0,001), como en el porcentaje de altas hospitalaria con categoría 1 o 2 de la clasificación Cerebral Perfomance Categories (CPC), sobre el total de ingresados, 31,8%, rango entre 17,2% y 58,3% (p < 0,001). CONCLUSIONES: Existe una importante variabilidad entre los SEM españoles en la incidencia de casos con intento de reanimación, en todas las variables clave y en la supervivencia al alta hospitalaria de la atención a la PCRE

BACKGROUND AND OBJECTIVE: The incidence and outcomes of care for out-of-hospital cardiac arrest (OHCA) vary greatly from country to country. We aimed to study variation in the incidence, characteristics, and outcomes of care for OHCAs given by Spanish prehospital emergency services. METHODS: Descriptive retrospective analysis of data from the Out-of-Hospital Spanish Cardiac Arrest Registry (OHSCAR) from October 2013 to October 2014. Attempts by 19 Spanish emergency services to resuscitate patients were studied. All OHCA cases were reviewed to obtain the following data: incidence, patient and event characteristics, prior emergencies, resuscitation attempts, and the main treatments provided in the hospital. If a patient was admitted, we compared the neurologic status on hospital discharge. RESULTS: Statistically significant differences were detected between emergency services (P< .0001) in the incidence of attempted resuscitation and all general characteristics except sex. Hospital treatments and outcomes also differed significantly: pulse had been restored on arrival of 30.5% of patients (range 21.3% to 56.1%, P< .001), and 31.8% of admitted patients were discharged in cerebral performance categories 1 or 2 (range 17.2% to58.3%,P< .001). CONCLUSION: Differences in the incidence of resuscitation attempts, key variables, and survival at discharge from the hospital are present in OHCA cases attended by prehospital emergency services in different regions of Spain

Regional variation in the incidence, general characteristics, and outcomes of prehospital cardiac arrest in Spain: the Out-of-Hospital Spanish Cardiac Arrest Registry. / Variabilidad regional en incidencia, características generales y resultados finales de la parada cardiaca extrahospitalaria en España: Registro OHSCAR.

OBJECTIVES: The incidence and outcomes of care for out-of-hospital cardiac arrest (OHCA) vary greatly from country to country. We aimed to study variation in the incidence, characteristics, and outcomes of care for OHCAs given by Spanish prehospital emergency services. MATERIAL AND METHODS: Descriptive retrospective analysis of data from the Out-of-Hospital Spanish Cardiac Arrest Registry (OHSCAR) from October 2013 to October 2014. Attempts by 19 Spanish emergency services to resuscitate patients were studied. All OHCA cases were reviewed to obtain the following data: incidence, patient and event characteristics, prior emergencies, resuscitation attempts, and the main treatments provided in the hospital. If a patient was admitted, we compared the neurologic status on hospital discharge. RESULTS: Statistically significant differences were detected between emergency services (P .0001) in the incidence of attempted resuscitation and all general characteristics except sex. Hospital treatments and outcomes also differed significantly: pulse had been restored on arrival of 30.5% of patients (range 21.3% to 56.1%, P .001), and 31.8% of admitted patients were discharged in cerebral performance categories 1 or 2 (range 17.2% to 58.3%, P .001). CONCLUSION: Differences in the incidence of resuscitation attempts, key variables, and survival at discharge from the hospital are present in OHCA cases attended by prehospital emergency services in different regions of Spain.

OBJETIVO: Existe gran variabilidad internacional en la incidencia y los resultados en la atención a la parada cardiaca extrahospitalaria (PCRE). El objetivo es conocer si existe variabilidad en la incidencia, características y resultados en supervivencia en la atención a la PCRE por los servicios extrahospitalarios de emergencias (SEM) de España. METODO: Análisis descriptivo, retrospectivo de los datos del registro OHSCAR correspondientes al periodo octubre 2013-octubre 2014, que incluye pacientes atendidos por 19 SEM de España con intento de reanimación. Se recogieron los casos atendidos y variables clave sobre la asistencia a una PCRE: incidencia, características del paciente, del evento, de la actuación previa a los equipos de emergencias (EE), de la reanimación realizada, y de los principales tratamientos hospitalarios. Se comparó la situación neurológica al alta hospitalaria de los casos con ingreso hospitalario. RESULTADOS: La incidencia de casos con intento de reanimación y todas las características generales, salvo la distribución por sexo, presentaron diferencias estadísticamente significativas entre los SEM participantes (p 0,001). Hubo diferencias significativas en los tratamientos hospitalarios recibidos y en los resultados finales, tanto en la proporción de pacientes que llegaron con pulso espontáneo al hospital, 30,5%, rango entre 21,3% y 56,1% (p 0,001), como en el porcentaje de altas hospitalaria con categoría 1 o 2 de la clasificación Cerebral Perfomance Categories (CPC), sobre el total de ingresados, 31,8%, rango entre 17,2% y 58,3% (p 0,001). CONCLUSIONES: Existe una importante variabilidad entre los SEM españoles en la incidencia de casos con intento de reanimación, en todas las variables clave y en la supervivencia al alta hospitalaria de la atención a la PCRE.

Efectividad de la consulta de enfermería en una central de coordinación de urgencias sanitarias / Efficacy of nurse consultants in a health emergency coordination center

Objetivo: Describir la actividad del enfermero de consulta (EC) en la Central de Coordinación de Urgencias Sanitarias de Galicia-061 (CCUSG-061), en términos de capacidad de resolución de problemas y adecuación de decisiones. Método: Estudio retrospectivo, observacional y descriptivo que incluyó todas las llamadas telefónicas atendidas por los EC entre julio de 2013 y 2014. Se consideró como resolución efectiva cualquier demanda que tras ser resuelta sin movilizar recursos no originase una nueva llamada telefónica, ingreso hospitalario o fallecimiento del paciente en las 24 horas siguientes. Resultados: Los EC atendieron 37.553 llamadas, 92% resueltas sin necesidad de movilizar recursos o pacientes. De ellas, el 97% no fue objeto de rellamada, ni de complicaciones en las 24 horas siguientes. Conclusiones: Los EC resuelven de forma segura la mayoría de las necesidades asistenciales de los pacientes, sin movilizar pacientes o recursos sanitarios (AU)

Objective: To describe nurse consultants’ work at the Health Emergency Coordination Center of Galicia (CCUSG-061) in terms of their ability to resolve problems and the appropriateness of their decisions. Methods: Retrospective, observational, descriptive study that included all telephone calls attended by nurses between July 2013 and 2014. The results of a consultation were considered successful if a request for help was resolved without mobilization of resources and did not lead to a new call to the emergency service, a hospital admission, or a death in the next 24 hours. Results: The nurses attended 37 553 calls, resolving 92% without mobilizing resources or patients. Ninety-seven percent of the calls resolved did not generate new calls or complications in the next 24 hours. Conclusions: Nurses resolve most patients’ emergency care requirements safely without moving patients or mobilizing health resources (AU)

[Efficacy of nurse consultants in a health emergency coordination center]. / Efectividad de la consulta de enfermería en una central de coordinación de urgencias sanitarias.

OBJECTIVES: To describe nurse consultants' work at the Health Emergency Coordination Center of Galicia (CCUSG-061) in terms of their ability to resolve problems and the appropriateness of their decisions. MATERIAL AND METHODS: Retrospective, observational, descriptive study that included all telephone calls attended by nurses between July 2013 and 2014. The results of a consultation were considered successful if a request for help was resolved without mobilization of resources and did not lead to a new call to the emergency service, a hospital admission, or a death in the next 24 hours. RESULTS: The nurses attended 37 553 calls, resolving 92% without mobilizing resources or patients. Ninety-seven percent of the calls resolved did not generate new calls or complications in the next 24 hours. CONCLUSION: Nurses resolve most patients' emergency care requirements safely without moving patients or mobilizing health resources.

OBJETIVO: Describir la actividad del enfermero de consulta (EC) en la Central de Coordinación de Urgencias Sanitarias de Galicia-061 (CCUSG-061), en términos de capacidad de resolución de problemas y adecuación de decisiones. METODO: Estudio retrospectivo, observacional y descriptivo que incluyó todas las llamadas telefónicas atendidas por los EC entre julio de 2013 y 2014. Se consideró como resolución efectiva cualquier demanda que tras ser resuelta sin movilizar recursos no originase una nueva llamada telefónica, ingreso hospitalario o fallecimiento del paciente en las 24 horas siguientes. RESULTADOS: Los EC atendieron 37.553 llamadas, 92% resueltas sin necesidad de movilizar recursos o pacientes. De ellas, el 97% no fue objeto de rellamada, ni de complicaciones en las 24 horas siguientes. CONCLUSIONES: Los EC resuelven de forma segura la mayoría de las necesidades asistenciales de los pacientes, sin movilizar pacientes o recursos sanitarios.

Factores pronóstico de supervivencia en la parada cardiaca extrahospitalaria atendida con desfibriladores externos semiautomáticos en Galicia / Factors predicting survival of out-of-hospital cardiac arrest managed with semiautomatic external defibrillators in Galicia

Objetivos: Determinar los factores pronóstico de las paradas cardiacas extrahospitalarias (PCE) atendidas por el servicio de emergencias médicas (SEM) en Galicia en las que se utilizó un desfibrilador externo semiautomático (DESA). Método: Estudio descriptivo retrospectivo de las PCE atendidas con DESA durante un periodo de 5 años, con recogida de datos según el estilo Utstein. Las variables analizadas fueron: sexo, edad, fecha y hora del suceso, asistencia en medio rural o urbano, localización, PCE presenciada, inicio maniobras por testigos, primer ritmo cardiaco monitorizado, intubación orotraqueal (IOT), y tiempos de alerta y asistenciales. Resultados: Se analizaron 2.005 casos (0,14/1.000 habitantes-año), 68,2% varones, 70,8% atendidos en medio rural y 61% con localización en el domicilio. Se logró la reanimación cardiaca extrahospitalaria (RCE) in situ en el 10,9% de los pacientes (29,9% en los casos encontrados en ritmos desfibrilables y 3,3% en aquellos en asistolia). Se realizó IOT en el15,7% de los casos, de los que lograron RCE el 24,8%. La disminución del tiempo medio entre la alerta y la asistencia (12:26 minutos en los que se logró la RCE y de 16:16 minutos en los fallecidos) resulta significativo para el aumento de la RCE (p < 0,001), así como los ritmos desfibrilables (p = 0,001). Contrariamente los ritmos asistolia disminuyen las posibilidades de supervivencia (p < 0,005). Conclusiones: La presencia de ritmos desfibrilables y los tiempos asistenciales breves son los factores significativamente relacionados con la supervivencia de la PCE atendida con DESA en Galicia (AU)

Objectives: To determine prognostic factors in out-of-hospital cardiac arrests managed with semiautomatic external defibrillators (SAEDs) by emergency health service responders in Galicia, Spain. Method: Retrospective descriptive study of out-of-hospital cardiac arrests treated with SAEDs over a period of 5 years. We collected Utstein outcome data from the database and analyzed the following variables: sex, age, date and time of cardiac event, rural vs urban setting, type of location, witnessed or not, bystander resuscitation attempts or not, time first heart rhythm was detected, use of orotracheal intubation or not, time of call for help, and time to arrival of emergency responders. Results: We analyzed 2005 cases (0.14/1000 person-years; 68.2% male, 70.8% in rural locations, 61% at home). Return of spontaneous circulation (ROSC) was achieved in situ in 10.9% (in 29.9% of patients with shockable rhythms and in 3.3% of those in asystole). Intubation was necessary in 15.7%; ROSC was achieved in 24.8% of the intubated patients. ROSC was achieved in significantly more patients when responders arrived soon after the call for help (mean: 12 minutes, 26 seconds) than when arrival was delayed (mean: 16 minutes, 16 seconds when ROSC was not achieved; P <001 ). The presence of a shockable rhythm was also significantly more frequent when response time was faster (P<001 ). Asystole, on the other hand, reduced the likelihood of survival (P< 005). Conclusion: Prognostic factors related to survival of SAED-managed out-of-hospital cardiac arrest in Galicia were the presence of a shockable rhythm, shorter response time, continuation of basic life support measures including advanced airway management, bystander life-support maneuvers, an urban location, and night timing of the arres (AU)

[Factors predicting survival of out-of-hospital cardiac arrest managed with semiautomatic external defibrillators in Galicia]. / Factores pronóstico de supervivencia en la parada cardiaca extrahospitalaria atendida con desfibriladores externos semiautomáticos en Galicia.

OBJECTIVES: To determine prognostic factors in out-of-hospital cardiac arrests managed with semiautomatic external defibrillators (SAEDs) by emergency health service responders in Galicia, Spain. MATERIAL AND METHODS: Retrospective descriptive study of out-of-hospital cardiac arrests treated with SAEDs over a period of 5 years. We collected Utstein outcome data from the database and analyzed the following variables: sex, age, date and time of cardiac event, rural vs urban setting, type of location, witnessed or not, bystander resuscitation attempts or not, time first heart rhythm was detected, use of orotracheal intubation or not, time of call for help, and time to arrival of emergency responders. RESULTS: We analyzed 2005 cases (0.14/1000 person-years; 68.2% male, 70.8% in rural locations, 61% at home). Return of spontaneous circulation (ROSC) was achieved in situ in 10.9% (in 29.9% of patients with shockable rhythms and in 3.3% of those in asystole). Intubation was necessary in 15.7%; ROSC was achieved in 24.8% of the intubated patients. ROSC was achieved in significantly more patients when responders arrived soon after the call for help (mean: 12 minutes, 26 seconds) than when arrival was delayed (mean: 16 minutes, 16 seconds when ROSC was not achieved; P<.001). The presence of a shockable rhythm was also significantly more frequent when response time was faster (P<.001). Asystole, on the other hand, reduced the likelihood of survival (P<.005). CONCLUSION: Prognostic factors related to survival of SAED-managed out-of-hospital cardiac arrest in Galicia were the presence of a shockable rhythm, shorter response time, continuation of basic life support measures including advanced airway management, bystander life-support maneuvers, an urban location, and night timing of the arrest.

OBJETIVO: Determinar los factores pronóstico de las paradas cardiacas extrahospitalarias (PCE) atendidas por el servicio de emergencias médicas (SEM) en Galicia en las que se utilizó un desfibrilador externo semiautomático (DESA). METODO: Estudio descriptivo retrospectivo de las PCE atendidas con DESA durante un periodo de 5 años, con recogida de datos según el estilo Utstein. Las variables analizadas fueron: sexo, edad, fecha y hora del suceso, asistencia en medio rural o urbano, localización, PCE presenciada, inicio maniobras por testigos, primer ritmo cardiaco monitorizado, intubación orotraqueal (IOT), y tiempos de alerta y asistenciales. RESULTADOS: Se analizaron 2.005 casos (0,14/1.000 habitantes-año), 68,2% varones, 70,8% atendidos en medio rural y 61% con localización en el domicilio. Se logró la reanimación cardiaca extrahospitalaria (RCE) in situ en el 10,9% de los pacientes (29,9% en los casos encontrados en ritmos desfibrilables y 3,3% en aquellos en asistolia). Se realizó IOT en el 15,7% de los casos, de los que lograron RCE el 24,8%. La disminución del tiempo medio entre la alerta y la asistencia (12:26 minutos en los que se logró la RCE y de 16:16 minutos en los fallecidos) resulta significativo para el aumento de la RCE (p < 0,001), así como los ritmos desfibrilables (p = 0,001). Contrariamente los ritmos asistolia disminuyen las posibilidades de supervivencia (p < 0,005). CONCLUSIONES: La presencia de ritmos desfibrilables y los tiempos asistenciales breves son los factores significativamente relacionados con la supervivencia de la PCE atendida con DESA en Galicia.

Study design for the "effect of METOprolol in CARDioproteCtioN during an acute myocardial InfarCtion" (METOCARD-CNIC): a randomized, controlled parallel-group, observer-blinded clinical trial of early pre-reperfusion metoprolol administration in ST-segment elevation myocardial infarction.

BACKGROUND: Infarct size predicts post-infarction mortality. Oral ß-blockade within 24 hours of a ST-segment elevation acute myocardial infarction (STEMI) is a class-IA indication, however early intravenous (IV) ß-blockers initiation is not encouraged. In recent magnetic resonance imaging (MRI)-based experimental studies, the ß(1)-blocker metoprolol has been shown to reduce infarct size only when administered before coronary reperfusion. To date, there is not a single trial comparing the pre- vs. post-reperfusion ß-blocker initiation in STEMI. OBJECTIVE: The METOCARD-CNIC trial is testing whether the early initiation of IV metoprolol before primary percutaneous coronary intervention (pPCI) could reduce infarct size and improve outcomes when compared to oral post-pPCI metoprolol initiation. DESIGN: The METOCARD-CNIC trial is a randomized parallel-group single-blind (to outcome evaluators) clinical effectiveness trial conducted in 5 Counties across Spain that will enroll 220 participants. Eligible are 18- to 80-year-old patients with anterior STEMI revascularized by pPCI ≤6 hours from symptom onset. Exclusion criteria are Killip-class ≥III, atrioventricular block or active treatment with ß-blockers/bronchodilators. Primary end point is infarct size evaluated by MRI 5 to 7 days post-STEMI. Prespecified major secondary end points are salvage-index, left ventricular ejection fraction recovery (day 5-7 to 6 months), the composite of (death/malignant ventricular arrhythmias/reinfarction/admission due to heart failure), and myocardial perfusion. CONCLUSIONS: The METOCARD-CNIC trial is testing the hypothesis that the early initiation of IV metoprolol pre-reperfusion reduces infarct size in comparison to initiation of oral metoprolol post-reperfusion. Given the implications of infarct size reduction in STEMI, if positive, this trial might evidence that a refined use of an approved inexpensive drug can improve outcomes of patients with STEMI.

Plan de desfibrilación externa semiautomática en Galicia. Resultados finales de su implantación / Semiautomatic external defibrillation plan for Galicia: results of implementation

Objetivo: Conocer los resultados del plan de implantación de un programa de desfibriladores semiautomáticos (DESA) en Galicia y valorar su eficacia. Método: Se estudian las paradas cardiorrespiratorias (PCR) atendidas por las ambulancias de la red de transporte sanitario urgente (RTSU) con DESA durante los años 2001,2002 y 2003, la recuperación de constantes en el punto de la atención inicial por los sistémicas médicos de emergencias (SEM), los factores que influyen en la supervivencia y la eficacia del DESA. Se analizó la hoja de registro DESA de los técnicos en transporte sanitario (TTS) de las ambulancias de la RTSU y la hoja DESA informatizada de la Central de Coordinación de Urgencias Sanitarias-061 (CCUS-061).Resultados: 958 PCR atendidas con DESA (26,6 PCR/mes). El 25,1% se encontraban en un ritmo desfibrilable. Se recuperaron el 11,3% del total. El 50,4% de las PCR fueron presenciadas y se inició resucitación cardiopulmonar (RCP) por testigo en el 18,9%.Los intervalos temporales desde la PCR hasta la recepción de la llamada, primer intento de RCP, retorno de circulación y primera desfibrilación en general han tendido a disminuir con los años, aunque el descenso sólo resultó significativo para el intervalo desde la PCR hasta la recepción de la llamada en la CCUS-061.Conclusiones: El programa de implantación del DESA, desarrollado y puesto en marcha por la Fundación Pública Urxencias Sanitarias de Galicia (FPUS-061), ha demostrado estar adaptado a las necesidades de nuestra comunidad. Aunque se ha observado una mejoría en los últimos años, aún deben acortarse más los tiempos de alerta, respuesta y desfibrilación, así como aumentar la tasa de RCP por testigos. (AU)

Objective: To evaluate the effectiveness of a plan for implementing the use of semiautomatic external defibrillators in Galicia. Methods: Cardiorespiratory arrests treated by ambulance attendants with semiautomatic external defibrillators in 2001,2002 and 2003 were studied. Recovery of vital constants at the point of initial emergency service care was noted, and factors affecting survival and the efficacy of defibrillation were analyzed. Data were extracted from the ambulance attendants’ defibrillation records and the computer records of the ambulance service dispatch center. Results: Nine hundred fifty-eight cardio respiratory arrests were treated with semiautomatic external defibrillators (26.61arrests/month). Ambulance attendants found a shock able rhythm in 25.15%; ventricular fibrillation was restored in11.27%. Arrests were witnessed in 50.41% of the cases, and cardiopulmonary resuscitation (CPR) was initiated by a bystander in 18.95%. Times between the arrest and reception of a call to the emergency service, first attempt at resuscitation, restoration of circulation, and first shock decreased from year to year. Conclusions: To improve the results of cardiopulmonary resuscitation in Galicia, it is necessary to shorten the time between the arrest and the call to the emergency service, the ambulance response time, and time until the first shock. The frequency of bystander CPR is low, but has tended to rise in recent years. Basic CPR training in the general population should be improved. The plan for use of semiautomatic external defibrillators that was developed and put into practice by the ambulance service has been shown to meet the needs of our community. To improve outcomes in emergency cases, ambulance response times should be shortened (AU)

Cost-efficiency assessment of Advanced Life Support (ALS) courses based on the comparison of advanced simulators with conventional manikins.

BACKGROUND: Simulation is an essential tool in modern medical education. The object of this study was to assess, in cost-effective measures, the introduction of new generation simulators in an adult life support (ALS) education program. METHODS: Two hundred fifty primary care physicians and nurses were admitted to ten ALS courses (25 students per course). Students were distributed at random in two groups (125 each). Group A candidates were trained and tested with standard ALS manikins and Group B ones with new generation emergency and life support integrated simulator systems. RESULTS: In group A, 98 (78%) candidates passed the course, compared with 110 (88%) in group B (p < 0.01). The total cost of conventional courses was euro 7689 per course and the cost of the advanced simulator courses was euro 29034 per course (p < 0.001). Cost per passed student was euro 392 in group A and euro 1320 in group B (p < 0.001). CONCLUSION: Although ALS advanced simulator systems may slightly increase the rate of students who pass the course, the cost-effectiveness of ALS courses with standard manikins is clearly superior.

Paediatric out-of-hospital resuscitation in an area with scattered population (Galicia-Spain).

BACKGROUND: Cardiorespiratory arrest (CRA) is a rare event in childhood. Our objective was to determine the characteristics of paediatric CRA and the immediate results of cardiopulmonary resuscitation (CPR) in Galicia, a community with a very scattered population. METHODS: All children (aged from newborn to 16 years old) who suffered an out-of-hospital CRA in Galicia and were assisted by the Public Foundation Medical Emergencies of Galicia-061 staff, from June 2002 to February 2005, were included in the study. Data were prospectively recorded following the Utstein's style guidelines. RESULTS: Thirty-one cases were analyzed (3.4 CRA annual cases per 100,000 paediatric population). The arrest was respiratory in 16.1% and cardiac in 83.9% of cases. CRA occurred at home in 58.1% of instances. Time CRA to initiation of CPR was shorter than 10 minutes in 32.2% and longer than 20 minutes in 29.0% of cases. 22.6% of children received bystander CPR. The first recorded rhythm was asystole in 67.7% of cases. Bag-mask ventilation was used in 67.7% and in 83.8% oro-tracheal intubation was done. A peripheral venous access was achieved in 67.7% and intraosseous access was used in 16.1% of patients. 93.5% of children were treated with adrenaline. After initial CPR, sustained restoration of spontaneous circulation was achieved in 38.7% of cases. Six children (19.4%) survived until hospital discharge. Four of 5 children with respiratory arrest survived, whereas only 2 of 26 children with cardiac arrest survived until hospital discharge. CONCLUSION: Despite the handicap of a highly disseminated population, paediatric CRA characteristics and CPR results in Galicia are comparable to references from other communities. Programs to increase bystander CPR, equip laypeople with basic CPR skills and to update life support knowledge of health staff are needed to improve outcomes.

Manual de soporte vital avanzado en urgencias prehospitalarias

Contiene: soporte vital básico y desfibrilación externa semiautomática, soporte vital avanzado, control de la vía aérea y ventilación en soporte vital avanzado, vía de administración y fármacos, arritmias, tratamiento eléctrico de las arritmias extrahospitalarias, reanimación cardipulmonar pediátrica y neonatal, RCP en situaciones especiales, asistencia prehospitalaria al paciente politraumatizado en situación crítica, síndroma postparada, transporte sanitario, atención inicial al síndrome coronario agudo, ética y resucitación.

Manual de reanimación cardiopulmonar básica en niños

Manual cuya finalidad es difundir las técnicas de reanimación cardiopulmonar básica ante una parada cardiorespiratoria. Está dirigido entre otros colectivos a personal sanitario, especialmente aquellos que atienden niños enfermos de cualquier edad o especialidad. Incluye: conceptos generales, reanimación cardiopulmonar básica, obstrucción de vía aérea por cuerpo extraño, resúmen de RCP básica, prevención de parada cardiorespiratoria.