[Early statin therapy in acute myocardial infarction]. / Tratamiento precoz con estatinas en el infarto agudo de miocardio.

OBJECTIVES: To evaluate the effects of the early administration of statins during acute myocardial infarction (MI). DESIGN: A retrospective cohort study was carried out. SETTING: National (Spain). PATIENTS OR PARTICIPANTS: Patients included in the ARIAM registry from January 1999 to December 2008 with a diagnosis of MI. INTERVENTIONS: None. MAIN VARIABLES: We used logistic regression analysis and propensity scoring to determine whether the administration of statins during the first 24h of MI acts as a protective factor against: 1) mortality, 2) the incidence of lethal arrhythmias, or 3) cardiogenic shock. RESULTS: A total of 36 842 patients were included in the study. Statins were administered early in 50.2% of the patients. Statin administration was associated with younger patients with known previous dyslipidemia, obesity, a history of ischemic heart disease, heart failure, presence of sinus tachycardia, use of beta-blockers, angiotensin-converting enzyme inhibitors, thrombolysis and percutaneous coronary intervention. Mortality was 8.2% (13.2% without statin versus 3% with statin, P<.001). Multivariate analysis demonstrated that statin administration acted as a protective factor against mortality (adjusted OR 0.518, 95%CI 0.447 to 0.601). Continued use of statins was associated with a reduction in mortality (adjusted OR 0.597, 95%CI 0.449 to 0.798), and the start of treatment was a protective factor against mortality (adjusted OR 0.642, 95%CI 0.544 -0.757). Statin therapy also exerted a protective effect against the incidence of lethal arrhythmias and cardiogenic shock. CONCLUSIONS: These results suggest that early treatment with statins in patients with MI is associated with reduced mortality.

Evaluación del contenido y funcionamiento de los carros de reanimación cardiopulmonar de un hospital / Evaluation of the content and functioning of cardiopulmonary resuscitation trolleys in a hospital

Fundamento. En la atención a la parada cardiorrespiratoria hospitalaria se utilizan carros de paro cardíaco ubicados en las diferentes áreas del centro. No obstante, ni su contenido ni su revisión suelen depender de la unidad responsable de la atención en estas situaciones de emergencia, y su mantenimiento puede no estar bien definido. Objetivo. Evaluar si el contenido y el funcionamiento de los equipos de los carros de paro cardíaco de nuestro centro aseguran la ejecución eficaz de los protocolos de soporte vital avanzado cardiológico. Métodos. Un grupo de expertos elaboró un listado de material necesario y se evaluó la adecuación del contenido de los carros con las recomendaciones del grupo de expertos. Resultados. Un 40 por ciento de los carros evaluados presentaban deficiencias que podían comprometer o dificultar la eficacia de la reanimación. Sólo un 20 por ciento no presentaba deficiencias. Conclusiones. Debe establecerse un circuito que asegure el óptimo equipamiento de los carros, y esta coordinación debe recaer en la unidad responsable de la asistencia a estas situaciones emergentes (AU)

Thrombolysis with recombinant tissue plasminogen activator during cardiopulmonary resuscitation in fulminant pulmonary embolism. A case series.

OBJECTIVE: To describe our outcomes using thrombolysis during the cardiopulmonary resuscitation (CPR) of patients in cardiorespiratory arrest (CA) caused by fulminant pulmonary embolism (FPE). DESIGN: A case series. SETTING: Intensive care units of a district hospital and a referral centre. PATIENTS: Six patients that suffered CA secondary to an FPE. INTERVENTIONS: Administration of recombinant tissue plasminogen activator during usual CPR manoeuvres when there was a strong suspicion of FPE. Permission for the thrombolytic therapy was sought from family members in all cases. RESULTS: Four out of the six patients survived and remain symptom-free. The thrombolysis was not associated with any fatal complications. CONCLUSIONS: Early thrombolysis during CPR manoeuvres for CA apparently caused by an FPE may reduce the mortality rate among these patients.

Efficacy of thrombolysis in patients with acute myocardial infarction requiring cardiopulmonary resuscitation.

OBJECTIVE: To evaluate the efficacy and safety of systemic thrombolysis administered to resuscitated patients after cardiac arrest (CA) due to an acute myocardial infarction (AMI), through a study of their mortality and haemorrhagic complications. DESIGN: We studied a retrospective cohort of patients with ischaemic heart disease gathered from the database of the Spanish multi-centre project "Analysis of Delay in AMI" (ARIAM). SETTING: Intensive care (ICU) and coronary care (CCU) units of 77 Spanish hospitals. PATIENTS AND PARTICIPANTS: The study period was from 1 January 1995 to 1 January 2000, when 22,922 patients were included in the ARIAM database register; 13,704 were diagnosed with AMI and we studied 303 of these AMI patients admitted after resuscitation for CA. MEASUREMENTS AND RESULTS: Of the 303 patients studied, 228 were male (75.25%); the mean age was 64.57 +/- 12.48 years. Systemic thrombolysis was administered to 67 patients (group I) and the remaining 236 patients were managed without this treatment (group II). The ICU/CCU mortality rate of the series was 39.93 % (121 patients); that of group I was 17.91% (12 patients) and that of group II 46.18% (109 patients) (P < 0.00001). Group I required less mechanical ventilation (group I, 42.85% vs group II, 80.76 %; P < 0.00001) and fewer cardiopulmonary resuscitation attempts (33.34% vs 60.98%, P < 0.0001). Group I also showed a lower incidence of cardiogenic shock (14.28% vs 39.01%, P < 0.0001) and anoxic encephalopathy (8.62% vs 39.89% P = 0.006). There were no fatal haemorrhagic complications in either group. Logistic regression analysis showed the administration of thrombolysis to be an independent variable that protected against mortality. CONCLUSIONS: The administration of thrombolysis to patients with AMI who require resuscitation may be efficacious in reducing mortality and is safe, with no increase in haemorrhagic complications.

Peripartum cardiomyopathy: a case series.

OBJECTIVES: We describe our experience with peripartum cardiomyopathy. DESIGN AND SETTING: A case series in intensive care units (ICU) of a district hospital and a referral center. PATIENTS: Six patients who required admission to an ICU after the onset of peripartum cardiomyopathy. RESULTS: Five of the six patients survived, with total recovery of ventricular function. After 1 year of follow-up all five survivors were symptom free with a normal ventricular function. CONCLUSIONS: There is a low rate of ICU admissions for peripartum cardiomyopathy, which has a potentially fatal prognosis. However, this disease can be detected by echocardiography among patients without the semiology.

Miniexamen neurológico en el traumatismo craneoencefálico grave / Neurologic mini-examination in severe cranio-encephalic trauma

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