Características epidemiológicas y factores asociados a la parada cardiorrespiratoria extrahospitalaria atendida por espectadores antes de la llegada del primer recurso asistencial / Epidemiological characteristics and factors associated with out-of-hospital cardiac arrest attended by bystanders before ambulance arrival

Fundamento:. Comparar las características epidemiológicas de las paradas cardiacas extrahospitalarias enfunción de si fueron o no atendidas por espectadoresantes de la llegada de la ambulancia y describir los factores asociados a la reanimación por testigos. Metodología: Estudio observacional retrospectivo sobre los casos de parada cardiorrespiratoria extrahospitalaria ocurridos en el País Vasco durante cinco años.Se determinaron diferencias epidemiológicas de los casos en función de si la reanimación cardiopulmonar fueiniciada por espectadores. La relación entre la variabledependiente no se inicia reanimación por testigos y distintos factores de exposición se analizó con regresiónlogística multivariable. Resultados: Se revisaron 3278 eventos; en el 61,9 % delos casos no se practicó reanimación por testigos o espectadores y se asoció a inexistencia de instruccionestelefónicas (OR: 6,25; IC95 %: 5,15-7,58; p < 0,001), localización del evento en el domicilio (OR: 2,94; IC95 %: 2,48-3,48; p < 0,001), evento no presenciado (OR: 1,56; IC95 %:1,28-1,89; p < 0,001), víctima con edad superior a 64 años(OR: 1,48; IC95 %: 1,26-1,74; p < 0,001) y ámbito urbano(OR: 1,29; IC95 %: 1,04-1,62; p = 0,023). Conclusiones: Existen diferencias en las paradas cardiacas en función de si han sido o no reanimadas porespectadores y estas características podrían condicionar la decisión del rescatador al respecto de iniciar lareanimación y la evolución de la misma.(AU)

Background: The aim of this study is to analyze thecharacteristics of out of hospital cardiac arrests basedon whether patients received bystander resuscitationbefore ambulance arrival, and to describe the factorsassociated with resuscitation attempts by bystanders. Methods: A retrospective observational study was performed. Clinical data from cardiac arrest patients in theBasque Country (Spain) were collected over a periodof five years. Epidemiological characteristics comparedresuscitation started by bystanders with resuscitationcarried out by ambulance caregivers. The relation between no resuscitation started by bystander and different exposure factors was explored by multiple logisticregression analysis. Results: We analyzed 3,278 cardiac arrests. Of them,61.9 % were not attended by bystanders and this wasassociated with the absence of instructions from Emergency Centre (OR: 6.25, 95 % CI: 5.15-7.58, p < 0.001),home location (OR: 2.94, 95 %CI: 2.48-3.48, p < 0.001),unwitnessed cardiac arrest (OR: 1.56, 95 %CI 1.28-1.89,p < 0.001), victims of 65 years or older (OR: 1.48, 95 %CI:1.26-1.74, p < 0.001) and suburban locations (OR: 1.29,95 %CI: 1.04-1.62, p = 0.023). Conclusion: There are differences in cardiac arrestsdepending on whether they have been resuscitated bybystanders. These characteristics may influence thebystander’s decision to initiate resuscitation maneuvers (or not) and evolution.(AU)

Epidemiological characteristics and factors associated with out-of-hospital cardiac arrest attended by bystanders before ambulance arrival.

BACKGROUND: The aim of this study is to analyze the characteristics of out-of-hospital cardiac arrests based on whether patients received bystander resuscitation before ambulance arrival, and to describe the factors associated with resuscita-tion attempts by bystanders. METHODS: A retrospective observational study was performed. Clinical data from cardiac arrest patients in the Basque Country (Spain) were collected over a period of five years. Epidemiological characteristics compared resuscitation started by bystanders with resuscitation carried out by ambulance caregivers. The relation between no resuscitation started by bystander and different exposure factors was explored by multiple logistic regression analysis. RESULTS: We analyzed 3,278 cardiac arrests. Of them, 61.9?% were not attended by bystanders and this was associated with the absence of instructions from Emergency Centre (OR: 6.25, 95%CI: 5.15-7.58, p?

The effect of early dexamethasone administration on bronchopulmonary dysplasia in preterm infants with respiratory distress syndrome.

OBJECTIVES: This study was carried to evaluate the effect of early administration of dexamethasone on the incidence of bronchopulmonary dysplasia (BPD) and/or death in surfactant-treated preterm infants with respiratory distress syndrome (RDS). STUDY DESIGN: In a multicenter, double-blind, placebo-controlled trial, 109 preterm infants with RDS and birth weights between 700 and 1600 gm, who were treated with mechanical ventilation and surfactant, were randomly assigned before 36 hours of life to receive dexamethasone (n = 55) or placebo (n = 54) for 12 days. RESULTS: There were no differences in the incidence of BPD and/or death between groups. However, fewer patients in the dexamethasone group were oxygen-dependent at 36 weeks after conception (8% vs 33%, p < 0.05). The dexamethasone group had a lower incidence of necrotizing enterocolitis (0% vs 9%, p < 0.05). The incidence of arterial hypertension, hyperglycemia, and sepsis was not affected by the treatment. Basal and poststimulation serum cortisol levels did not differ between groups. CONCLUSION: The administration of dexamethasone early in the course of RDS does not decrease the incidence of BPD and/or death in preterm infants. However, dexamethasone may reduce oxygen dependency at 36 weeks after conception.

Does continuous positive airway pressure (CPAP) during weaning from intermittent mandatory ventilation in very low birth weight infants have risks or benefits? A controlled trial.

OBJECTIVE: The purpose of this study was to evaluate three ventilator weaning strategies and to evaluate whether the use of continuous positive airway pressure (CPAP) via a nasopharyngeal or endotracheal tube would increase the likelihood of extubation failure in very low birth weight (VLBW) infants. STUDY DESIGN: We studied prospectively 87 preterm infants (mean +/- SD; birth weight: 1078 +/- 188 g; gestational age: 28.8 +/- 2.2 weeks) who were in the process of being weaned from intermittent mandatory ventilation (IMV). Infants were assigned by systematic sampling to one of the following three treatment groups: (1) direct extubation from IMV (D.EXT) (n = 30); (2) preextubation endotracheal CPAP (ET-CPAP) for 12-24 hr (n = 28); or (3) postextubation nasopharyngeal CPAP (NP-CPAP) for 12-24 hr (n = 29). Failure was defined as the need for resumption of mechanical ventilation within 72 hr of extubation due to frequent or severe apnea and/or respiratory failure (pH < 7.25, PaCO2 > 60 mm Hg, and/or requirement for oxygen FiO2 > 60%). RESULTS: There were no significant differences in failure rates among the three procedures. Failures were 2/30 (7%) in D.EXT; 4/28 (14%) in ET-CPAP; and 7/29 (24%) in the NP-CPAP. There were also no differences in FiO2, PaO2, and respiratory rates before and after discontinuation of IMV among the three groups. PaCO2 values were slightly higher in the NP-CPAP group 12-24 hr after weaning from IMV. CONCLUSION: We were unable to demonstrate a clear difference in extubation outcome by use of CPAP administered via an endotracheal or nasopharyngeal tube when compared to direct extubation from low-rate IMV in VLBW infants.