Prognostic value of venous blood analysis at the start of CPR in non-traumatic out-of-hospital cardiac arrest: association with ROSC and the neurological outcome.

BACKGROUND: The knowledge of new prognostic factors in out-of-hospital cardiac arrest (OHCA) that can be evaluated since the beginning of cardiopulmonary resuscitation (CPR) manoeuvres could be helpful in the decision-making process of prehospital care. We aim to identify metabolic variables at the start of advanced CPR at the scene that may be associated with two main outcomes of CPR (recovery of spontaneous circulation (ROSC) and neurological outcome). METHODS: Prospective observational study of all non-traumatic OHCA in patients older than 17 years assisted by emergency medical services (EMS), with doctor and nurse on board, between January 2012 and December 2017. Venous blood gases were sampled upon initially obtaining venous access to determine the initial values of pH, pCO2, HCO3-, base excess (BE), Na+, K+, Ca2+ and lactate. ROSC upon arrival at the hospital and neurological status 30 days later (Cerebral Performance Categories (CPC) scale) were recorded. RESULTS: We included 1552 patients with OHCA with blood test data in a 6-year period. ROSC was achieved in 906 cases (58.4%), and good neurological recovery at 30 days (CPC I-II) occurred in 383 cases (24.68%). In multivariate analysis, we found a significant relationship between non-recovery of spontaneous circulation (no-ROSC) and low pH levels (adjusted odds ratio (OR) 0.03 (0.002-0.59), p = 0.020), high pCO2 levels (adjusted OR 1.03 [1.01-1.05], p = 0.008) and high potassium levels (adjusted OR 2.28 [1.43-3.61], p = 0.008). Poor neurological outcomes were associated with low pH levels (adjusted OR 0.06 [0.02-0.18], p < 0.001), high pCO2 (adjusted OR 1.05 [1.03-1.08], p < 0.001), low HCO3- (adjusted OR 0.97 [0.94-0.999], p = 0.044), low BE (adjusted OR 0.96 [0.93-0.98], p < 0.001) and high potassium levels (adjusted OR 1.37 [1.16-1.60], p < 0.001). CONCLUSION: There is a significant relationship between severe alterations of venous blood-gas variables and potassium at the start of CPR of non-traumatic OHCA and low-ROSC rate and neurological prognosis.

[Incidence of acute agitation and variation in acute agitation management by emergency services]. / Incidencia y variabilidad de manejo de la agitación aguda en los servicios de emergencias médicas.

OBJECTIVES: To describe the management of acute agitation by Spanish emergency medical services (EMS) and assess the incidence of acute agitation. MATERIAL AND METHODS: Observational descriptive study based on aggregate data from unpublished internal EMS reports. RESULTS: Seven participating emergency services received 4 306 213 emergency calls in 2013; 111 599 (2.6%, or 6.2 calls per 1000 population) were categorized as psychiatric emergencies. A total of 84 933 interventions (4.2%, or 4 per 1000 population) were required; 37 951 of the calls concerned agitated patients (1.9%, or 2 cases per 1000 population). Only 3 EMS mandated a specific procedure for their responders to use in such cases. CONCLUSION: The agitated patient is a common problem for EMS responders. Few teams apply specific procedures for managing these patients.

OBJETIVO: Evaluar la incidencia y el manejo de la agitación aguda por los servicios de emergencias médicas (SEM) en España. METODO: Estudio observacional descriptivo que utiliza datos agregados de las memorias de actividad o datos internos no publicados de los SEM. RESULTADOS: Durante el año 2013, los 7 SEM participantes recibieron 4.306.213 llamadas, de las cuales 111.599 (2,6%; 6,2 llamadas/1.000 habitantes) fueron categorizadas como psiquiátricas. Las actuaciones requeridas por motivos psiquiátricos fueron 84.933 (4,2% del total de actuaciones; 4,0 actuaciones/1.000 habitantes) y, de estas, 37.951 fueron por pacientes agitados (1,9% del total de actuaciones; 2,0 actuaciones/1.000 habitantes). Solo 3 SEM disponían de un procedimiento específico para los equipos asistenciales de atención al paciente psiquiátrico y al paciente agitado. CONCLUSIONES: El paciente agitado es un problema común en los equipos asistenciales de los SEM. Pocos de estos equipos cuentan con procedimientos específicos de actuación ante estos casos.

Incidencia y variabilidad de manejo de la agitación aguda en los servicios de emergencias médicas / Incidence of acute agitation and variation in acute agitation management by emergency services

Objetivo. Evaluar la incidencia y el manejo de la agitación aguda por los servicios de emergencias médicas (SEM) en España. Método. Estudio observacional descriptivo que utiliza datos agregados de las memorias de actividad o datos internos no publicados de los SEM. Resultados. Durante el año 2013, los 7 SEM participantes recibieron 4.306.213 llamadas, de las cuales 111.599 (2,6%; 6,2 llamadas/1.000 habitantes) fueron categorizadas como psiquiátricas. Las actuaciones requeridas por motivos psiquiátricos fueron 84.933 (4,2% del total de actuaciones; 4,0 actuaciones/1.000 habitantes) y, de estas, 37.951 fueron por pacientes agitados (1,9% del total de actuaciones; 2,0 actuaciones/1.000 habitantes). Solo 3 SEM disponían de un procedimiento específico para los equipos asistenciales de atención al paciente psiquiátrico y al paciente agitado. Conclusiones. El paciente agitado es un problema común en los equipos asistenciales de los SEM. Pocos de estos equipos cuentan con procedimientos específicos de actuación ante estos casos (AU)

Objective. To describe the management of acute agitation by Spanish emergency medical services (EMS) and assess the incidence of acute agitation. Methods. Observational descriptive study based on aggregate data from unpublished internal EMS reports. Results. Seven participating emergency services received 4 306 213 emergency calls in 2013; 111 599 (2.6%, or 6.2 calls per 1000 population) were categorized as psychiatric emergencies. A total of 84 933 interventions (4.2%, or 4 per 1000 population) were required; 37 951 of the calls concerned agitated patients (1.9%, or 2 cases per 1000 population). Only 3 EMS mandated a specific procedure for their responders to use in such cases. Conclusions. The agitated patient is a common problem for EMS responders. Few teams apply specific procedures for managing these patients (AU)

Código 100: un estudio sobre la conducta suicida en lugares públicos / Code 100: a study on suicidal behavior in public places

Los servicios de urgencias de nuestro país reciben diariamente una gran cantidad de pacientes que han realizado un intento de suicidio o refieren ideación suicida. Desafortunadamente, estos pacientes son a menudo reticentes a mantener un seguimiento en salud mental. En este estudio describimos un programa pionero para favorecer la evaluación y el tratamiento de los pacientes suicidas y en particular de aquellos que son atendidos por los servicios de emergencia fuera de sus domicilios. Resumiremos la aplicación del programa y compararemos los resultados de un seguimiento específico entre los pacientes suicidas atendidos por los equipos de emergencia en lugares públicos frente al resto de pacientes con riesgo suicida evaluados en el servicio de urgencias de un hospital terciario

Every day, the emergency departments in our country receive a large number of patients that have thought about or attempted suicide. Unfortunately, these patients are very often reluctant to maintain a regular follow-up in mental health services. In this study we describe an original program to encourage assessment and treatment of suicidal patients, particularly when they receive medical treatment in public places. We summarize the application of the program and compare the results of a specific follow-up between two groups of patients: suicidal patients assessed by emergency services in public places and all other suicidal patients assessed in the emergency department of a tertiary hospital

Code 100: a study on suicidal behavior in public places.

Every day, the emergency departments in our country receive a large number of patients that have thought about or attempted suicide. Unfortunately, these patients are very often reluctant to maintain a regular follow-up in mental health services. In this study we describe an original program to encourage assessment and treatment of suicidal patients, particularly when they receive medical treatment in public places. We summarize the application of the program and compare the results of a specific follow-up between two groups of patients: suicidal patients assessed by emergency services in public places and all other suicidal patients assessed in the emergency department of a tertiary hospital.