The Use of the Borg Rating of Perceived Exertion Scale in Cardiopulmonary Resuscitation. / O Uso da Escala de Borg na Percepção do Esforço em Manobras de Reanimação Cardiopulmonar.

BACKGROUND: A cardiopulmonary arrest is a critical event whose survival rate is related to the quality of resuscitation maneuvers combined with the use of technology. It is important to understand the perception of fatigue during this procedure, aiming to improve the effectiveness of compressions to increase the chances of survival. OBJECTIVES: To apply the Borg rating of perceived exertion scale (Borg scale) to analyze the exertion perceived by nurses during cardiopulmonary resuscitation maneuvers using a feedback device. METHODS: Experimental study with a randomized distribution of nurses in a teaching hospital. Perceived exertion during simulated cardiopulmonary resuscitation with/without a feedback device was assessed using the Borg scale. The statistical significance level of 5% was adopted. RESULTS: 69 nurses working in critical and non-critical adult care units were included. Perceived exertion and heart rate were lower in the intervention group (p<0.001), influenced by the feedback device, with no significant difference between critical and non-critical units. CONCLUSIONS: The Borg scale proved to be adequate for the proposed objectives. The feedback device contributed to lower exertion and heart rate reduction during resuscitation maneuvers. The low cost and ease of application favor its use during training and real-time resuscitation attempts to assess performance using a feedback device to reduce exertion and perception of fatigue. It allows reflection on the intervening factors and resources that can influence the quality of resuscitation attempts and the chances of survival.

FUNDAMENTO: A parada cardiorrespiratória é um evento crítico cuja taxa de sobrevivência é relacionada à qualidade das manobras de reanimação, aliada à tecnologia. É importante compreender a percepção do cansaço durante esse procedimento visando a efetividade das compressões e o aumento das chances na sobrevida. OBJETIVO: Aplicar a Escala de Borg para analisar o esforço percebido por enfermeiros durante as manobras de reanimação cardiopulmonar com dispositivo de feedback. MÉTODO: Estudo experimental com distribuição randomizada de enfermeiros em hospital de ensino, simulando parada cardiorrespiratória, para avaliação da percepção do esforço utilizando a escala de Borg durante a reanimação cardiopulmonar com/sem dispositivo de feedback. Foi adotado nível de significância estatística 5%. RESULTADOS: Foram incluídos 69 enfermeiros atuantes em unidades críticas e não críticas de atendimento ao adulto. A percepção de esforço e a frequência cardíaca foi menor no grupo intervenção (p<0,001), influenciadas pelo dispositivo de feedback, sem diferença significativa quanto às unidades de atuação. CONCLUSÃO: A escala de Borg mostrou-se adequada para os objetivos propostos. O dispositivo de feedback contribuiu no menor esforço e redução da frequência cardíaca durante as manobras de reanimação. O baixo custo e a facilidade de aplicação favorecem o uso em treinamentos e atendimentos em tempo real para avaliar o desempenho durante a reanimação, utilizando dispositivo de feedback por reduzir os esforços e a percepção do cansaço. Também permite a reflexão sobre os fatores intervenientes e recursos que podem influenciar na qualidade da assistência e nas chances de sobrevivência.

O Uso da Escala de Borg na Percepção do Esforço em Manobras de Reanimação Cardiopulmonar / The Use of the Borg Rating of Perceived Exertion Scale in Cardiopulmonary Resuscitation

Resumo Fundamento A parada cardiorrespiratória é um evento crítico cuja taxa de sobrevivência é relacionada à qualidade das manobras de reanimação, aliada à tecnologia. É importante compreender a percepção do cansaço durante esse procedimento visando a efetividade das compressões e o aumento das chances na sobrevida. Objetivo Aplicar a Escala de Borg para analisar o esforço percebido por enfermeiros durante as manobras de reanimação cardiopulmonar com dispositivo de feedback. Método Estudo experimental com distribuição randomizada de enfermeiros em hospital de ensino, simulando parada cardiorrespiratória, para avaliação da percepção do esforço utilizando a escala de Borg durante a reanimação cardiopulmonar com/sem dispositivo de feedback. Foi adotado nível de significância estatística 5%. Resultados Foram incluídos 69 enfermeiros atuantes em unidades críticas e não críticas de atendimento ao adulto. A percepção de esforço e a frequência cardíaca foi menor no grupo intervenção (p<0,001), influenciadas pelo dispositivo de feedback, sem diferença significativa quanto às unidades de atuação. Conclusão A escala de Borg mostrou-se adequada para os objetivos propostos. O dispositivo de feedback contribuiu no menor esforço e redução da frequência cardíaca durante as manobras de reanimação. O baixo custo e a facilidade de aplicação favorecem o uso em treinamentos e atendimentos em tempo real para avaliar o desempenho durante a reanimação, utilizando dispositivo de feedback por reduzir os esforços e a percepção do cansaço. Também permite a reflexão sobre os fatores intervenientes e recursos que podem influenciar na qualidade da assistência e nas chances de sobrevivência.

Abstract Background A cardiopulmonary arrest is a critical event whose survival rate is related to the quality of resuscitation maneuvers combined with the use of technology. It is important to understand the perception of fatigue during this procedure, aiming to improve the effectiveness of compressions to increase the chances of survival. Objectives To apply the Borg rating of perceived exertion scale (Borg scale) to analyze the exertion perceived by nurses during cardiopulmonary resuscitation maneuvers using a feedback device. Methods Experimental study with a randomized distribution of nurses in a teaching hospital. Perceived exertion during simulated cardiopulmonary resuscitation with/without a feedback device was assessed using the Borg scale. The statistical significance level of 5% was adopted. Results 69 nurses working in critical and non-critical adult care units were included. Perceived exertion and heart rate were lower in the intervention group (p<0.001), influenced by the feedback device, with no significant difference between critical and non-critical units. Conclusions The Borg scale proved to be adequate for the proposed objectives. The feedback device contributed to lower exertion and heart rate reduction during resuscitation maneuvers. The low cost and ease of application favor its use during training and real-time resuscitation attempts to assess performance using a feedback device to reduce exertion and perception of fatigue. It allows reflection on the intervening factors and resources that can influence the quality of resuscitation attempts and the chances of survival.

Effectiveness of cardiopulmonary resuscitation training in the teaching of family members of cardiac patients.

OBJECTIVE: To evaluate the effectiveness of a cardiopulmonary resuscitation training in the skill acquisition of family members of heart disease patients. METHOD: A quasi-experimental study, conducted in a hospital in São Paulo, Brazil. The study participants were one or more relatives of patients with heart disease that were hospitalized at the institution. In the first phase, the participant's skills and theoretical knowledge on cardiopulmonary resuscitation were evaluated before and immediately after the training. The second phase took place one month after the training, in which the same evaluations were applied. The McNemar's and Stuart-Maxwell tests were adopted (5% significance level). RESULTS: The theoretical knowledge of family members before and after training increased and a great retention of this knowledge after 30 days of training was observed. Immediately after training, the family members showed significant improvement of skills in the 15 analyzed actions and, after one month of training, they maintained most of the acquired practices on cardiopulmonary resuscitation, except for chest compressions frequency and the time between turning on the defibrillator and delivering the shock. CONCLUSION: Cardiopulmonary resuscitation training was effective in the acquisition of theoretical and practical knowledge of the family members.

Effectiveness of cardiopulmonary resuscitation training in the teaching of family members of cardiac patients / Efectividad del entrenamiento sobre resucitación cardiopulmonar en el aprendizaje de familiares de pacientes cardíacos / Efetividade de treinamento sobre ressuscitação cardiopulmonar na aprendizagem de familiares de pacientes cardiopatas

ABSTRACT Objective: To evaluate the effectiveness of a cardiopulmonary resuscitation training in the skill acquisition of family members of heart disease patients. Method: A quasi-experimental study, conducted in a hospital in São Paulo, Brazil. The study participants were one or more relatives of patients with heart disease that were hospitalized at the institution. In the first phase, the participant's skills and theoretical knowledge on cardiopulmonary resuscitation were evaluated before and immediately after the training. The second phase took place one month after the training, in which the same evaluations were applied. The McNemar's and Stuart-Maxwell tests were adopted (5% significance level). Results: The theoretical knowledge of family members before and after training increased and a great retention of this knowledge after 30 days of training was observed. Immediately after training, the family members showed significant improvement of skills in the 15 analyzed actions and, after one month of training, they maintained most of the acquired practices on cardiopulmonary resuscitation, except for chest compressions frequency and the time between turning on the defibrillator and delivering the shock. Conclusion: Cardiopulmonary resuscitation training was effective in the acquisition of theoretical and practical knowledge of the family members.

RESUMEN Objetivo: Evaluar la efectividad del entrenamiento sobre resucitación cardiopulmonar en el aprendizaje de familiares de pacientes cardíacos. Método: Estudio cuasiexperimental, realizado en un hospital de São Paulo, Brasil. Participaron de la investigación uno o más familiares de pacientes cardíacos, hospitalizados en la institución. La primera fase evaluó los conocimientos teóricos y habilidades de los participantes sobre resucitación cardiopulmonar antes e inmediatamente después del entrenamiento. La segunda fase se realizó un mes después del entrenamiento, con la aplicación de las mismas evaluaciones. Se adoptaron las pruebas de McNemar y Stuart-Maxwell (nivel de significación del 5%). Resultados: Los familiares incrementaron sus conocimientos teóricos antes y después del entrenamiento, los cuales persistieron después de 30 días de la capacitación. Después del entrenamiento, los familiares mejoraron significativamente las habilidades en las 15 acciones analizadas y, después de un mes de capacitación, mantuvieron la mayoría de las prácticas asimiladas sobre reanimación cardiopulmonar, excepto la frecuencia de las compresiones torácicas y el tiempo entre encender el desfibrilador y aplicar la descarga. Conclusión: El entrenamiento de resucitación cardiopulmonar fue efectivo en el aprendizaje teórico y práctico de los familiares.

RESUMO Objetivo: Avaliar a efetividade de um treinamento sobre ressuscitação cardiopulmonar na aprendizagem de familiares de pacientes cardiopatas. Método: Estudo quase experimental, realizado em hospital de São Paulo, Brasil. Participaram da pesquisa um ou mais familiares de pacientes cardiopatas internados na instituição. Na primeira fase foram avaliados o conhecimento teórico e as habilidades dos participantes sobre a ressuscitação cardiopulmonar antes e imediatamente após o treinamento. A segunda fase aconteceu um mês após o treinamento, com a aplicação das mesmas avaliações. Os testes McNemar e Stuart-Maxwell foram adotados (nível de significância de 5%). Resultados: Houve aumento do conhecimento teórico dos familiares antes e após o treinamento e elevada retenção desse conhecimento após 30 dias da capacitação. Os familiares apresentaram, após o treinamento, melhora significativa das habilidades nas 15 ações analisadas e, após um mês da capacitação, mantiveram a maioria das práticas assimiladas sobre ressuscitação cardiopulmonar, com exceção da frequência das compressões torácicas e do tempo entre ligar o desfibrilador e aplicar o choque. Conclusão: O treinamento sobre ressuscitação cardiopulmonar foi efetivo na aprendizagem teórica e prática dos familiares.

Do automated real-time feedback devices improve CPR quality? A systematic review of literature.

AIM: Automated real-time feedback devices have been considered a potential tool to improve the quality of cardiopulmonary resuscitation (CPR). Despite previous studies supporting the usefulness of such devices during training, others have conflicting conclusions regarding its efficacy during real-life CPR. This systematic review aimed to assess the effectiveness of automated real-time feedback devices for improving CPR performance during training, simulation and real-life resuscitation attempts in the adult and paediatric population. METHODS: Articles published between January 2010 and November 2020 were searched from BVS, Cinahl, Cochrane, PubMed and Web of Science, and reviewed according to a pre-defined set of eligibility criteria which included healthcare providers and randomised controlled trial studies. CPR quality was assessed based on guideline compliance for chest compression rate, chest compression depth and residual leaning. RESULTS: The selection strategy led to 19 eligible studies, 16 in training/simulation and three in real-life CPR. Feedback devices during training and/or simulation resulted in improved acquisition of skills and enhanced performance in 15 studies. One study resulted in no significant improvement. During real resuscitation attempts, three studies demonstrated significant improvement with the use of feedback devices in comparison with standard CPR (without feedback device). CONCLUSION: The use of automated real-time feedback devices enhances skill acquisition and CPR performance during training of healthcare professionals. Further research is needed to better understand the role of feedback devices in clinical setting.

Cooling as an Adjunctive Therapy to Percutaneous Intervention in Acute Myocardial Infarction: COOL-MI InCor Trial.

Endovascular Therapeutic hypothermia (ETH) reduces the damage caused by postischemia reperfusion injury syndrome in cardiopulmonary arrest and has already established its role in patients with sudden death; however, its role in ST-segment elevation myocardial infarction (STEMI) remains controversial. The objectives of this study were to investigate the safety, feasibility, and 30-day efficacy of rapid induction of therapeutic hypothermia as adjunctive therapy to percutaneous coronary intervention (PCI) in patients with anterior and inferior STEMIs. This was a prospective, controlled, randomized, two-arm, prospective, interventional study of patients admitted to the emergency department within 6 hours of angina onset, with anterior or inferior STEMI eligible for PCI. Subjects were randomized to the hypothermia group (primary PCI+ETH) or to the control group (primary PCI) at a 4:1 ratio. The ETH was induced by 1 L cold saline (1-4°C) associated with the Proteus™ System, by cooling for at least 18 minutes before coronary reperfusion with a target temperature of 32°C ± 1°C. Maintenance of ETH was conducted for 1-3 hours, and active reheating was done at a rate of 1°C/h for 4 hours. Primary safety outcomes were the feasibility of ETH in the absence of (1) door-to-balloon (DTB) delay; (2) major adverse cardiac events (MACE) within 30 days after randomization. The primary outcomes of effectiveness were infarct size (IS) and left ventricular ejection fraction (LVEF) at 30 days. An as-treated statistical analysis was performed. Fifty patients were included: 35 (70%) randomized to the hypothermia group and 15 (30%) to the control group. The mean age was 58 ± 12 years; 78% were men; and associated diseases were 60% hypertension, 42% diabetes, and 72% dyslipidemia. The compromised myocardial wall was anterior in 38% and inferior in 62%, and the culprit vessels were left anterior descending artery (LAD) (40%), right coronary artery (38%), and left circumflex (18%). All 35 patients who attempted ETH (100%) had successful cooling, with a mean endovascular coronary reperfusion temperature of 33.1°C ± 0.9°C. The mean ischemic time was 375 ± 89.4 minutes in the hypothermia group and 359.5 ± 99.4 minutes in the control group. The mean DTB was 92.1 ± 20.5 minutes in the hypothermia group and 87 ± 24.4 minutes in the control group. The absolute difference of 5.1 minutes was not statistically significant (p = 0.509). The MACE rates were similar between both groups (21.7% vs. 20% respectively, p = 0.237). In the comparison between the hypothermia and control groups, no statistically significant differences were observed at 30 days between mean IS (13.9% ± 8% vs. 13.8% ± 10.8%, respectively, p = 0.801) and mean final LVEF (43.3% ± 11.2% vs. 48.3 ± 10.9%, respectively; p = 0.194). Hypothermia as an adjunctive therapy to primary PCI in STEMI is feasible and can be implemented without delay in coronary reperfusion. Hypothermia was safe regarding the incidence of MACE at 30 days. However, there was a higher incidence of arrhythmia and in-hospital infection in the hypothermia group, with no increase in mortality. Regarding efficacy, there was no difference in IS or LVEF at 30 days that would suggest additional myocardial protection with ETH. ClinicalTrials.gov: NCT02664194.

Recommendations for Cardiopulmonary Resuscitation (CPR) of patients with suspected or confirmed COVID-19.

The care for patients suffering from cardiopulmonary arrest in a context of a COVID-19 pandemic has particularities that should be highlighted. The following recommendations from the Brazilian Association of Emergency Medicine (ABRAMEDE), the Brazilian Society of Cardiology (SBC) and the Brazilian Association of Intensive Medicine (AMIB) and the Brazilian Society of Anesthesiology (SBA), associations and societies official representatives of specialties affiliated to the Brazilian Medical Association (AMB), aim to guide the various assistant teams, in a context of little solid evidence, maximizing the protection of teams and patients. It is essential to wear full Personal Protective Equipment (PPE) for aerosols during the care of Cardiopulmonary Resuscitation (CPR) and it is imperative to consider and treat the potential causes in these patients, especially hypoxia and arrhythmias caused by changes in the QT interval or myocarditis. The installation of an advanced invasive airway must be obtained early and the use of High Efficiency Particulate Arrestance (HEPA) filters at the interface with the valve bag is mandatory; situations of occurrence of CPR during mechanical ventilation and in a prone position demand peculiarities that are different from the conventional CPR pattern. Faced with the care of a patient diagnosed or suspected of COVID-19, the care follows the national and international protocols and guidelines 2015 ILCOR (International Alliance of Resuscitation Committees), AHA 2019 Guidelines (American Heart Association) and the Update of the Cardiopulmonary Resuscitation and Emergency Care Directive of the Brazilian Society of Cardiology 2019.

A atenção ao paciente vítima de parada cardiorrespiratória em um contexto de pandemia de COVID-19 possui particularidades que devem ser ressaltadas. As seguintes recomendações da Associação Brasileira de Medicina de Emergência (ABRAMEDE), Sociedade Brasileira de Cardiologia (SBC), Associação de Medicina Intensiva Brasileira (AMIB) e Sociedade Brasileira de Anestesiologia (SBA), associações e sociedades representantes oficiais de especialidades afiliadas a Associação Medica Brasileira (AMB), têm por objetivo orientar as diversas equipes assistentes, em um contexto de poucas evidências sólidas, maximizando a proteção das equipes e dos pacientes.É fundamental a paramentação completa com Equipamentos de Proteção Individual (EPIs) para aerossóis durante o atendimento de Parada Cardiorrespiratória (PCR), e imperativo que se considerem e tratem os potenciais causas nesses pacientes, principalmente hipóxia e arritmias causadas por alterações no intervalo QT ou miocardites. A instalação de via aérea invasiva avançada deve ser obtida precocemente e o uso de filtros High Efficiency Particulate Arrestance (HEPA) na interface com a bolsa-válvula é obrigatório; situações de ocorrência de PCR durante a ventilação mecânica e em posição pronada demandam peculiaridades distintas do padrão convencional de PCR. Frente ao atendimento de um paciente com diagnóstico ou suspeito de COVID-19, o atendimento segue em acordo com os protocolos e diretrizes nacionais e internacionais 2015 ILCOR (Aliança Internacional dos Comitês de Ressuscitação), Diretrizes AHA 2019 (American Heart Association) e a Atualização da Diretriz de Ressuscitação Cardiopulmonar e Cuidados de Emergência da Sociedade Brasileira de Cardiologia 2019.

Position Statement: Cardiopulmonary Resuscitation of Patients with Confirmed or Suspected COVID-19 - 2020. / Posicionamento para Ressuscitação Cardiopulmonar de Pacientes com Diagnóstico ou Suspeita de COVID-19 ­ 2020.

Care for patients with cardiac arrest in the context of the coronavirus disease 2019 (COVID-19) pandemic has several unique aspects that warrant particular attention. This joint position statement by the Brazilian Association of Emergency Medicine (ABRAMEDE), Brazilian Society of Cardiology (SBC), Brazilian Association of Intensive Care Medicine (AMIB), and Brazilian Society of Anesthesiology (SBA), all official societies representing the corresponding medical specialties affiliated with the Brazilian Medical Association (AMB), provides recommendations to guide health care workers in the current context of limited robust evidence, aiming to maximize the protection of staff and patients alike. It is essential that full aerosol precautions, which include wearing appropriate personal protective equipment, be followed during resuscitation. It is also imperative that potential causes of cardiac arrest of particular interest in this patient population, especially hypoxia, cardiac arrhythmias associated with QT prolongation, and myocarditis, be considered and addressed. An advanced invasive airway device should be placed early. Use of HEPA filters at the bag-valve interface is mandatory. Management of cardiac arrest occurring during mechanical ventilation or during prone positioning demands particular ventilator settings and rescuer positioning for chest compressions which deviate from standard cardiopulmonary resuscitation techniques. Apart from these logistical issues, care should otherwise follow national and international protocols and guidelines, namely the 2015 International Liaison Committee on Resuscitation (ILCOR) and 2019 American Heart Association (AHA) guidelines and the 2019 Update to the Brazilian Society of Cardiology Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Guideline.

Instructional design in the development of an online course on Basic Life Support.

OBJECTIVE: To develop and evaluate an online course on Basic Life Support. METHOD: Technological production research of online course guided by the ADDIE (Analysis, Design, Development, Implementation, Evaluation) instructional design model based on Andragogy and the Meaningful Learning Theory. The online course was constructed in the platform Moodle, previously assessed by a group of experts, and then presented to the students of the Nursing School of the University of São Paulo, who assessed it at the end of the course. RESULTS: The course was evaluated by the experts and obtained a mean score of 0.92 (SD 0.15), considered as good quality (between 0.90-0.94), and by the students, with a mean score of 0.95 (SD 0.03), considered as high quality (0.95-1.00). CONCLUSION: The instructional design used was found to be appropriate to the development of the online course. As an active educational strategy, it contributed to the learning on Basic Life Support during cardiac arrest-related procedures in adults. In view of the need for technological innovations in education and systematization of care in cardiopulmonary resuscitation, the online course allows the establishment of continuous improvement processes in the quality of resuscitation in the care provided by students and professionals.

Basic life support: evaluation of learning using simulation and immediate feedback devices1.

OBJECTIVE: to evaluate students' learning in an online course on basic life support with immediate feedback devices, during a simulation of care during cardiorespiratory arrest. METHOD: a quasi-experimental study, using a before-and-after design. An online course on basic life support was developed and administered to participants, as an educational intervention. Theoretical learning was evaluated by means of a pre- and post-test and, to verify the practice, simulation with immediate feedback devices was used. RESULTS: there were 62 participants, 87% female, 90% in the first and second year of college, with a mean age of 21.47 (standard deviation 2.39). With a 95% confidence level, the mean scores in the pre-test were 6.4 (standard deviation 1.61), and 9.3 in the post-test (standard deviation 0.82, p <0.001); in practice, 9.1 (standard deviation 0.95) with performance equivalent to basic cardiopulmonary resuscitation, according to the feedback device; 43.7 (standard deviation 26.86) mean duration of the compression cycle by second of 20.5 (standard deviation 9.47); number of compressions 167.2 (standard deviation 57.06); depth of compressions of 48.1 millimeter (standard deviation 10.49); volume of ventilation 742.7 (standard deviation 301.12); flow fraction percentage of 40.3 (standard deviation 10.03). CONCLUSION: the online course contributed to learning of basic life support. In view of the need for technological innovations in teaching and systematization of cardiopulmonary resuscitation, simulation and feedback devices are resources that favor learning and performance awareness in performing the maneuvers.

Instructional design in the development of an online course on Basic Life Support / El diseño instruccional en el desarrollo del curso en línea acerca del Soporte Básico de Vida / O design instrucional no desenvolvimento do curso on-line sobre Suporte Básico de Vida

ABSTRACT Objective To develop and evaluate an online course on Basic Life Support. Method Technological production research of online course guided by the ADDIE (Analysis, Design, Development, Implementation, Evaluation) instructional design model based on Andragogy and the Meaningful Learning Theory. The online course was constructed in the platform Moodle, previously assessed by a group of experts, and then presented to the students of the Nursing School of the University of São Paulo, who assessed it at the end of the course. Results The course was evaluated by the experts and obtained a mean score of 0.92 (SD 0.15), considered as good quality (between 0.90-0.94), and by the students, with a mean score of 0.95 (SD 0.03), considered as high quality (0.95-1.00). Conclusion The instructional design used was found to be appropriate to the development of the online course. As an active educational strategy, it contributed to the learning on Basic Life Support during cardiac arrest-related procedures in adults. In view of the need for technological innovations in education and systematization of care in cardiopulmonary resuscitation, the online course allows the establishment of continuous improvement processes in the quality of resuscitation in the care provided by students and professionals.

RESUMEN Objetivo Desarrollar y evaluar el curso en línea acerca del Soporte Básico de Vida. Método Investigación de producción tecnológica de curso en línea, orientada por el modelo de diseño instruccional ADDIE (Analysis, Design, Development, Implementation, Evaluation), fundamentada en la Andragogía y la Teoría del Aprendizaje Significativo. El modelo fue construido en la plataforma Moodle, evaluado previamente por un grupo de especialistas, y luego presentado a los estudiantes en la Escuela de Enfermería de la Universidad de São Paulo, siendo evaluado por estos al término del curso. Resultados El curso fue evaluado por los expertos y obtuvo promedio 0,92 (DE 0,15), considerado de buena calidad (entre 0,90-0,94), y por los estudiantes, con promedio 0,95 (DE 0,03), considerado de alta calidad (0,95-1,00). Conclusión El diseño instruccional utilizado se mostró adecuado al desarrollo del curso en línea. Como estrategia educativa activa, contribuyó al aprendizaje acerca del Soporte Básico de Vida, durante las maniobras en el paro cardiorrespiratorio del adulto. Frente a la necesidad de innovaciones tecnológicas en la enseñanza y de sistematización de la atención en la reanimación cardiopulmonar, el curso en línea permite establecer procesos de mejora continua de la calidad de reanimación en atenciones prestadas por estudiantes y profesionales.

RESUMO Objetivo Desenvolver e avaliar o curso on-line sobre Suporte Básico de Vida. Método Pesquisa de produção tecnológica de curso on-line, orientada pelo modelo de design instrucional ADDIE (Analysis, Design, Development, Implementation, Evaluation), fundamentada na Andragogia e na Teoria da Aprendizagem Significativa. O modelo foi construído na plataforma Moodle, avaliado previamente por um grupo de especialistas, e então apresentado aos estudantes na Escola de Enfermagem da Universidade de São Paulo, sendo avaliado por estes ao término do curso. Resultados O curso foi avaliado pelos especialistas e obteve média 0,92 (DP 0,15), considerado de boa qualidade (entre 0,90-0,94), e pelos estudantes, com média 0,95 (DP 0,03), considerado de alta qualidade (0,95-1,00). Conclusão O design instrucional utilizado mostrou-se adequado ao desenvolvimento do curso on-line. Como estratégia educacional ativa, contribuiu para o aprendizado sobre Suporte Básico de Vida, durante as manobras na parada cardiorrespiratória do adulto. Frente à necessidade de inovações tecnológicas no ensino e de sistematização do atendimento na reanimação cardiopulmonar, o curso on-line permite estabelecer processos de melhoria contínua da qualidade de reanimação, em atendimentos prestados por estudantes e profissionais.

Basic life support: evaluation of learning using simulation and immediate feedback devices / Suporte básico de vida: avaliação da aprendizagem com uso de simulação e dispositivos de feedback imediato / Soporte vital básico: evaluación del aprendizaje con uso de simulación y dispositivos de retroalimentación inmediata

ABSTRACT Objective: to evaluate students' learning in an online course on basic life support with immediate feedback devices, during a simulation of care during cardiorespiratory arrest. Method: a quasi-experimental study, using a before-and-after design. An online course on basic life support was developed and administered to participants, as an educational intervention. Theoretical learning was evaluated by means of a pre- and post-test and, to verify the practice, simulation with immediate feedback devices was used. Results: there were 62 participants, 87% female, 90% in the first and second year of college, with a mean age of 21.47 (standard deviation 2.39). With a 95% confidence level, the mean scores in the pre-test were 6.4 (standard deviation 1.61), and 9.3 in the post-test (standard deviation 0.82, p <0.001); in practice, 9.1 (standard deviation 0.95) with performance equivalent to basic cardiopulmonary resuscitation, according to the feedback device; 43.7 (standard deviation 26.86) mean duration of the compression cycle by second of 20.5 (standard deviation 9.47); number of compressions 167.2 (standard deviation 57.06); depth of compressions of 48.1 millimeter (standard deviation 10.49); volume of ventilation 742.7 (standard deviation 301.12); flow fraction percentage of 40.3 (standard deviation 10.03). Conclusion: the online course contributed to learning of basic life support. In view of the need for technological innovations in teaching and systematization of cardiopulmonary resuscitation, simulation and feedback devices are resources that favor learning and performance awareness in performing the maneuvers.

RESUMO Objetivo: avaliar o aprendizado de estudantes no curso online sobre suporte básico de vida com dispositivos de retroalimentação imediata, em simulação de atendimento em parada cardiorrespiratória. Método: pesquisa quase-experimental, do tipo antes-depois. Foi desenvolvido curso online sobre suporte básico e aplicado aos participantes, como intervenção educacional. O aprendizado teórico foi avaliado por meio de pré e pós-teste e, para verificar a prática, utilizou-se simulação com dispositivos de retroalimentação imediata. Resultados: 62 concluintes, sendo 87% mulheres, 90% do primeiro e segundo ano de faculdade, idade média de 21,47 (desvio-padrão 2,39). Com índice de confiabilidade de 95%, a média das notas no pré-teste foi 6,4 (desvio-padrão 1,61) e, no pós-teste, 9,3 (desvio-padrão 0,82), p<0,001; na prática, 9,1 (desvio-padrão 0,95) e, de acordo com o dispositivo de feedback com desempenho equivalente à reanimação cardiopulmonar básica, 43,7 (desvio-padrão 26,86), médias de duração do ciclo de compressões por segundo de 20,5 (desvio-padrão 9,47), número de compressões de 167,2 (desvio-padrão 57,06), profundidade de compressões por milímetro de 48,1 (desvio-padrão 10,49), volume de ventilação de 742,7 (desvio-padrão 301,12), percentual de fração de fluxo de 40,3 (desvio-padrão 10,03). Conclusão: com o curso online houve contribuição para o aprendizado do suporte básico de vida. Em face da necessidade de inovações tecnológicas no ensino e na sistematização da reanimação cardiopulmonar, simulação e dispositivos de retroalimentação são recursos que favorecem o aprendizado e a consciência da performance na realização das manobras.

RESUMEN Objetivo: evaluar el aprendizaje de estudiantes en curso online sobre soporte vital básico de vida con dispositivos de retroalimentación inmediata, en simulación de asistencia en paro cardiorrespiratorio. Método: investigación casi-experimental, del tipo antes-después. Se desarrolló un curso online sobre soporte básico y aplicado a los participantes, como intervención educacional. El aprendizaje teórico fue evaluado por medio de pre y pos-test y, para verificar la práctica, se utilizó una simulación con dispositivos de retroalimentación inmediata. Resultados: 62 graduados, el 87% mujeres, el 90% del primero y segundo año de facultad, edad media de 21.47 (desviación estándar 2.39). Con índice de confiabilidad del 95%, la media de las notas en pre-test fue de 6.4 (desviación estándar1.61) y, en pos-test, 9.3 (desviación estándar 0.82), p<0.001; en la práctica, 9.1 (desviación estándar 0.95) y, de acuerdo con el dispositivo de retroalimentación con desempeño equivalente a la reanimación cardiopulmonar básica, 43.7 (desviación estándar 26.86), medias de duración del ciclo de compresiones por segundo de 20.5 (desviación estándar 9.47), número de compresiones de 1672 (desviación estándar 57.06), profundidad de compresiones por milímetro de 48.1 (desviación estándar 10.49), volumen de ventilación de 742.7 (desviación estándar 301.12), porcentual de fracción de flujo de 40.3 (desviación estándar 10.03). Conclusión: con el curso online hubo contribución al aprendizaje del soporte vital básico. En vista de la necesidad de innovaciones tecnológicas en la enseñanza y en la sistematización de la reanimación cardiopulmonar, simulación y dispositivos de retroalimentación son recursos que favorecen el aprendizaje y la consciencia del desempeño en la realización de las maniobras.

I guideline for cardiopulmonary resuscitation and emergency cardiovascular care -- Brazilian Society of Cardiology: executive summary.

Despite advances related to the prevention and treatment in the past few years, many lives are lost to cardiac arrest and cardiovascular events in general in Brazil every year. Basic Life Support involves cardiovascular emergency treatment mainly in the pre-hospital environment, with emphasis on the early recognition and delivery of cardiopulmonary resuscitation maneuvers focused on high-quality thoracic compressions and rapid defibrillation by means of the implementation of public access-to-defibrillation programs. These aspects are of the utmost importance and may make the difference on the patient's outcomes, such as on hospital survival with no permanent neurological damage. Early initiation of the Advanced Cardiology Life Support also plays an essential role by keeping the quality of thoracic compressions; adequate airway management; specific treatment for the different arrest rhythms; defibrillation; and assessment and treatment of the possible causes during all the assistance. More recently, emphasis has been given to post-resuscitation care, with the purpose of reducing mortality by means of early recognition and treatment of the post-cardiac arrest syndrome. Therapeutic hypothermia has provided significant improvement of neurological damage and should be performed in comatose individuals post-cardiac arrest. For physicians working in the emergency department or intensive care unit, it is extremely important to improve the treatment given to these patients by means of specific training, thus giving them the chance of higher success and of better survival rates.

I diretriz de ressuscitação cardiopulmonar e cuidados cardiovasculares de emergência da Sociedade Brasileira de Cardiologia: resumo executivo / I guideline for cardiopulmonary resuscitation and emergency cardiovascular care - Brazilian Society of Cardiology: executive summary

Apesar de avanços nos últimos anos relacionados à prevenção e a tratamento, muitas são as vidas perdidas anualmente no Brasil relacionado à parada cardíaca e a eventos cardiovasculares em geral. O Suporte Básico de Vida envolve o atendimento às emergências cardiovasculares principalmente em ambiente pré-hospitalar, enfatizando reconhecimento e realização precoces das manobras de ressuscitação cardiopulmonar com foco na realização de compressões torácicas de boa qualidade, assim como na rápida desfibrilação, por meio da implementação dos programas de acesso público à desfibrilação. Esses aspectos são de fundamental importância e podem fazer diferença no desfecho dos casos como sobrevida hospitalar sem sequelas neurológicas. O início precoce do Suporte Avançado de Vida em Cardiologia também possui papel essencial, mantendo, durante todo o atendimento, a qualidade das compressões torácicas, adequado manejo da via aérea, tratamento específico dos diferentes ritmos de parada, desfibrilação, avaliação e tratamento das possíveis causas. Mais recentemente dá-se ênfase a cuidados pós-ressuscitação, visando reduzir a mortalidade por meio do reconhecimento precoce e tratamento da síndrome pós-parada cardíaca. A hipotermia terapêutica tem demonstrado melhora significativa da lesão neurológica e deve ser realizada em indivíduos comatosos pós-parada cardíaca. Para os médicos que trabalham na emergência ou unidade de terapia intensiva é de grande importância o aperfeiçoamento no tratamento desses pacientes por meio de treinamentos específicos, possibilitando maiores chances de sucesso e maior sobrevida.

Despite advances related to the prevention and treatment in the past few years, many lives are lost to cardiac arrest and cardiovascular events in general in Brazil every year. Basic Life Support involves cardiovascular emergency treatment mainly in the pre-hospital environment, with emphasis on the early recognition and delivery of cardiopulmonary resuscitation maneuvers focused on high-quality thoracic compressions and rapid defibrillation by means of the implementation of public access-to-defibrillation programs. These aspects are of the utmost importance and may make the difference on the patient's outcomes, such as on hospital survival with no permanent neurological damage. Early initiation of the Advanced Cardiology Life Support also plays an essential role by keeping the quality of thoracic compressions; adequate airway management; specific treatment for the different arrest rhythms; defibrillation; and assessment and treatment of the possible causes during all the assistance. More recently, emphasis has been given to post-resuscitation care, with the purpose of reducing mortality by means of early recognition and treatment of the post-cardiac arrest syndrome. Therapeutic hypothermia has provided significant improvement of neurological damage and should be performed in comatose individuals post-cardiac arrest. For physicians working in the emergency department or intensive care unit, it is extremely important to improve the treatment given to these patients by means of specific training, thus giving them the chance of higher success and of better survival rates.