Cardiopulmonary Resuscitation

IJCS

Original Article

Prospective Longitudinal Study on Mortality and Quality of Care for Ward Patients Following Rapid Response Team Implementation in Brazil

Fernanda Aburesi Salvadori et al. Renata Kobayasi Maria Beatriz Perondi Edison Ferreira de Paiva

Abstract

Background:

A Rapid Response Team (RRT) is a multidisciplinary team trained to assist hospitalized patients experiencing cardiac arrest (CA) or sudden clinical deterioration. Its effectiveness, however, remains debatable.

Objectives:

This study aimed to characterize the changes that occurred in a quaternary, highly complex hospital following the adoption of the RRT and to ascertain whether its implementation was associated with a decline in the mortality rates of patients admitted to wards.

Methods:

This was a prospective observational study conducted from April 1^st, 2014, to December 31, 2019. The study compared patient mortality and clinical outcomes after the implementation of the RRT, focusing on the frequency and outcomes of “code blue” (CA) and “code yellow” (other types of clinical deterioration) calls. Pearson’s chi-squared test (χ²) was employed to compare categorical variables, while the Student’s t-test was utilized to compare continuous variables for independent samples. P-values < 0.05 were considered statistically significant.

Results:

The team responded to a total of 2,194 inpatient calls, 495 for code blue and 1,699 for code yellow. In the years following the team’s implementation, the number of deaths and code blue calls decreased, while the number of code yellow and total RRT calls increased. When comparing the first and second three-year terms, there were no significant differences regarding code blue mortality (276/293 [94.2%] vs. 184/200 [92%], p = 0.338). Still, survival rates for patients assisted during code yellow calls increased (348/609 [57.1%] vs. 648/1,005 [64.5%], p = 0.003). This improvement in code yellow outcomes was associated with a reduction in the overall ward mortality rate (1,078/96,866 [1.1%] vs. 788/85,019 [0.9%], p < 0.001).

Conclusion:

The implementation of the RRT was associated with a decrease in the number of in-hospital CA and unexpected deaths over six years, as well as an increase in the number of code yellow and overall RRT calls. Overall ward mortality also declined.

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IJCS

Editorial

Rescuing Lives: Reflecting on the Future of Cardiopulmonary Arrest Care

Sergio Timerman

Current Overview

Between 2018 and 2022, data from 2,154 cases attended by a mobile emergency service were analyzed. This analysis not only reinforced the severity of CPA, with mortality rates still alarmingly high, but also emphasized the impact of early interventions. Bystander-initiated cardiopulmonary resuscitation (CPR), the use of automated external defibrillators (AEDs), and ongoing training of emergency teams are critical pillars for changing this scenario.^,

However, the effectiveness of care is still heavily reliant on one critical factor: time. Every minute of delay drastically reduces survival chances, reinforcing the importance of robust and quick response systems, both in urban and rural settings.^,

[…]

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IJCS

Original Article

Cardiopulmonary Resuscitation-Induced Consciousness (CPRIC): Occurrence and Perception of Health Professionals and Firemen

Matheus Sousa Arci et al. Lívia Maria Coura de Sá Lucas Alves Oliveira Giulia Bortoloni Agria … Christian Morinaga Ricardo Toshio Enohi

Abstract

Background:

Cardiopulmonary Resuscitation-Induced Consciousness (CPRIC) is rare and poorly understood, impacting the effectiveness of Cardiopulmonary Resuscitation (CPR). In Brazil, investigating the prevalence and characteristics of CPRIC is essential in order to improve protocols and properly train health professionals and firefighters.

Objectives:

To investigate the occurrence of CPRIC and to verify the knowledge and experience of health professionals and firefighters concerning this phenomenon.

Methods:

This work was a cross-sectional observational study conducted with 507 professionals from different regions of Brazil who work directly with resuscitation maneuvers. An online questionnaire, containing 19 questions about professional profile, experience in cardiopulmonary arrest (CPA), and knowledge and recognition of CPRIC, was used. Data were analyzed using descriptive and inferential statistical techniques, including unpaired Student’s t-test and chi-square test, along with logistic regression to calculate the odds ratio (OR). The level of statistical significance was p<0.05.

Results:

The CPRIC presence rate was 0.22%, with 57.2% of the professionals reporting prior knowledge of the phenomenon. Inferential analysis showed that profession, number of CPAs witnessed in the last year, and specialization were significantly associated with CPRIC knowledge.

Conclusion:

Limited understanding and variability in exposure highlight the need to update CPRIC management guidelines, incorporating specific guidance on CPRIC.

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IJCS

Original Article

Retrospective Analysis of 2.154 Cardiopulmonary Arrest Assistance Provided by a Mobile Emergency Service From 2018-2022

Roseana Boek Carvalho et al. Rodrigo Pereira de Almeida Bruna Marmett Liliane Appratto de Souza … Fabiano Barrionuevo Fernanda Donner Alves

Abstract

Background

It is estimated that 1 in 10 patients will survive a cardiopulmonary arrest (CPA), with half of them occurring in an out-of-hospital setting. Mobile pre-hospital care services aim to reduce morbidity and mortality resulting from CPA.

Objective

To analyze five years of data regarding response time for assistance, mortality, and characteristics of victims of out-of-hospital CPA cases treated by a public mobile emergency service in Southern Brazil.

Methods

Data collected between 2018 and 2022 included the number of CPA cases, victim profile (age and sex), and details of each incident (day of the week, month, shift, city area, time elapsed before initiating basic life support [BLS], and mortality prior to arrival at the referral hospital). Pearson’s Chi-square and Mann-Whitney U tests were used with a significance level of 5%.

Results

The victims’ profile was mostly elderly (60%) and men (55.9%). The mortality rate from CPA was 87.3%, with over half of the cases (51.11%) requiring more than 15 minutes to initiate assistance. A longer response time was significantly associated with higher CPA mortality rates (p < 0.05).

Conclusion

The data showed a profile of victims that was mostly male and elderly. In more than half of the cases, BLS initiation took over 15 minutes, a delay that was linked to the high mortality rate of CPA, highlighting the association between mortality and time to assistance.

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IJCS

Case Report

Cardiopulmonary Resuscitation Induced Consciousness: Case Report

Daniela Aparecida Morais et al. Anselmo Dornas Moura Daniel Claus Fruk Guelfi Cintia Maria Guedes de Moraes Guilherme Augusto Cruz Machado

Introduction

High-quality cardiopulmonary resuscitation (CPR) can generate cerebral blood flow capable of inducing different levels of consciousness in patients. This process, called CPR-induced consciousness (CPRIC), has been reported in the literature.^–

The prevalence of CPRIC has been estimated at 0.3% to 0.9%. However, this low prevalence could be attributed to study design or sample size.

[…]

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IJCS

Case Report

Cardiac Arrest Due to Hypocalcemia

Fernanda Aburesi Salvadori et al. Eduardo Martelli Moreira Murilo Bacchini Dias Amaro Nunes Duarte-Neto Edison Ferreira de Paiva

Discussion

Long QT syndrome (LQTS) can be congenital or acquired. The causes of acquired LQTS include hypocalcemia, due to prolongation of the phase 2 of the action potential (AP), medications (amiodarone, antidepressants and neuroleptics), hypokalemia, hypomagnesemia and severe bradycardia.^– LQTS is associated with a specific polymorphic ventricular tachycardia (VT), named as torsades de pointes (TdP), because of the characteristic shift in the QRS axis that gives the impression of a “torsion”.

The QT interval is a marker of the AP duration. In LQTS patients, the AP is prolonged unevenly across the myocardium, so as to cause high dispersion of repolarization. The AP prolongation favors the formation of early afterdepolarization (EAD), which are deformities in the plateau and rapid repolarization phases (2 and 3) capable of inducing ventricular extrasystoles. EADs in the unevenly repolarized myocardium are the cause of TdP. Tachycardia is sustained due to focal electric activity and/or a reentrant mechanism. It may either cease spontaneously or degenerate into ventricular fibrillation and cardiac arrest ^, .

[…]

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IJCS

Original Article

Medical Behavior in Cardiorespiratory Arrest before and After Simulation Based on Advanced Cardiac Life Support (ACLS) Course

Douglas Marostica Catolino et al. José Knofholz

Abstract

Background:

The Advanced Cardiac Life Support (ACLS) course is designed to teach cardiovascular emergency, aiming to promote a harmonious and synchronized work of the entire hospital team, making the multidisciplinary job more effective in the execution of cardiopulmonary resuscitation (CPR).

Objective:

To compare the effectiveness of CPR performed between physicians trained on ACLS and non-trained physicians.

Methods:

A questionnaire was applied to physicians working at the emergency room of hospitals in Curitiba, state of Paraná, whose resolution required theoretical and practical knowledge about CPR. For analysis, descriptive statistics and Fisher’s association analysis were used, and the medians of the groups were evaluated by Mann-Whitney/Kruskal-Wallis with significance of 5%.

Results:

Thirty-four physicians were volunteers, of whom 20 had taken the ACLS course (Group A) and 14 had not (Group B). The trained physicians obtained the highest median (4.00 vs. 3.00, p = 0.06) of correct answers. Group A scored at least 3 of the 5 questions in the questionnaire, showing better performance than Group B (OR = 6.75, 95% CI, 1.1 < OR < 41.0, p = 0.04). The year of the course did not significantly change the performance in the questionnaire.

Conclusion:

It is suggested that the ACLS course was effective in qualifying physicians to handle situations of cardiorespiratory arrest properly, which was reproduced by the better performance in the resolution of the questionnaire. It is believed that when the sample of volunteers is increased, the trends found materialize the other hypotheses proposed.

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ABC

Original Article

Impact of cerebral cardiopulmonary resuscitation maneuvers in a general hospital: prognostic factors and outcomes

Eduardo Bartholomay et al. Fernando Suparregui Dias Fábio Alves Torres Pedro Jacobson … Afonso Mariante Rodrigo Wainstein Renato Silva Luiz Carlos Bodanese

OBJECTIVE: To assess survival of patients undergoing cerebral cardiopulmonary resuscitation maneuvers and to identify prognostic factors for short-term survival. METHODS: Prospective study with patients undergoing cardiopulmonary resuscitation maneuvers. RESULTS: The study included 150 patients. Spontaneous circulation was re-established in 88 (58%) patients, and 42 (28%) were discharged from the hospital. The necessary number of patients treated to save 1 life in 12 months was 3.4. The presence of ventricular fibrillation or tachycardia (VF/VT) as the initial rhythm, shorter times of cardiopulmonary resuscitation maneuvers and cardiopulmonary arrest, and greater values of mean blood pressure (BP) prior to cardiopulmonary arrest were independent variables for re-establishment of spontaneous circulation and hospital discharge. The odds ratios for hospital discharge were as follows: 6.1 (95% confidence interval [CI] = 2.7-13.6), when the initial rhythm was VF/VT; 9.4 (95% CI = 4.1-21.3), when the time of cerebral cardiopulmonary resuscitation was < 15 min; 9.2 (95% CI = 3.9-21.3), when the time of cardiopulmonary arrest was 70 mmHg. CONCLUSION: The presence of VF/VT as the initial rhythm, shorter times of cerebral cardiopulmonary resuscitation and of cardiopulmonary arrest, and a greater value of BP prior to cardiopulmonary arrest were independent variables of better prognosis.

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ABC

Original Article

Retrospective Study of the Survival of Patients who Underwent Cardiopulmonary Resuscitation in an Intensive Care Unit

Daniel Martins Moreira et al. Guilherme Mariante Neto Marcelo Wierzynski Oliveira Letícia Biscaino Alves … Luís Carlos Chorazje Adamatti Eliana de Andrade Trotta Sílvia Regina Rios Vieira

OBJECTIVE: To evaluate clinical and evolutive characteristics of patients admitted in an intensive care unit after cardiopulmonary resuscitation, identifying prognostic survival factors.METHODS: A retrospective study of 136 patients admitted between 1995 and 1999 to an intensive care unit, evaluating clinical conditions, mechanisms and causes of cardiopulmonary arrest, and their relation to hospital mortality.RESULTS: A 76% mortality rate independent of age and sex was observed. Asystole was the most frequent mechanism of death, and seen in isolation pulmonary arrest was the least frequent. Cardiac failure, need for mechanical ventilation, cirrhosis and previous stroke were clinically significant (p<0.01) death factors.CONCLUSION: Prognostic factors supplement the doctor's decision as to whether or not a patient will benefit from cardiopulmonary resuscitation.

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