Por cada minuto de retraso en realizar la desfibrilación disminuye la supervivencia un 10-12%. Mejor hacer compresiones torácicas que nada. La RCP previa a la desfibrilación disminuye la mortalidad de un 10-12% a un 3-4%.
Hay que optimizar la cadena de supervivencia(Estudios realizados en Japón disminuía la mortalidad del 15 al 30%)? Disminuir los tiempos de respuesta a todos los niveles.
Cerca del 40% de los paros con respiración agónica no se reconoce como normal y el reconocimiento de los jadeos aumenta la supervivencia.
SOS-KANTO Background Mouth-to-mouth ventilation is a barrier to bystanders doing cardiopulmonary resuscitation (CPR), but few clinical studies have investigated the efficacy of bystander resuscitation by chest compressions without mouth-to-mouth ventilation (cardiac-only resuscitation). Methods We did a prospective, multicentre, observational study of patients who had out-of-hospital cardiac arrest. On arrival at the scene, paramedics assessed the technique of bystander resuscitation. The primary endpoint was favourable neurological outcome 30 days after cardiac arrest. Findings 4068 adult patients who had out-of-hospital cardiac arrest witnessed by bystanders were included; 439 (11%) received cardiac-only resuscitation from bystanders, 712 (18%) conventional CPR, and 2917 (72%) received no bystander CPR. Any resuscitation attempt was associated with a higher proportion having favourable neurological outcomes than no resuscitation (5·0% vs 2·2%, p<0·0001). Cardiac-only resuscitation resulted in a higher proportion of patients with favourable neurological outcomes than conventional CPR in patients with apnoea (6·2% vs 3·1%; p=0·0195), with shockable rhythm (19·4% vs 11·2%, p=0·041), and with resuscitation that started within 4 min of arrest (10·1% vs 5·1%, p=0·0221). However, there was no evidence for any benefit from the addition of mouth-to-mouth ventilation in any subgroup. The adjusted odds ratio for a favourable neurological outcome after cardiac-only resuscitation was 2·2 (95% CI 1·2—4·2) in patients who received any resuscitation from bystanders. Interpretation Cardiac-only resuscitation by bystanders is the preferable approach to resuscitation for adult patients with witnessed out-of-hospital cardiac arrest, especially those with apnoea, shockable rhythm, or short periods of untreated arrest.
Methods From January 1, 2005, through December 31, 2007, we conducted a prospective, population-based, observational study involving consecutive patients across Japan who had an out-of-hospital cardiac arrest and in whom resuscitation was attempted by emergency responders. We evaluated the effect of nationwide dissemination of public-access AEDs on the rate of survival after an out-of-hospital cardiac arrest. The primary outcome measure was the 1-month rate of survival with minimal neurologic impairment. A multivariate logistic-regression analysis was performed to assess factors associated with a good neurologic outcome. Full Text of Methods... Results A total of 312,319 adults who had an out-of-hospital cardiac arrest were included in the study; 12,631 of these patients had ventricular fibrillation and had an arrest that was of cardiac origin and that was witnessed by bystanders. In 462 of these patients (3.7%), shocks were administered by laypersons with the use of public-access AEDs, and the proportion increased, from 1.2% to 6.2%, as the number of public-access AEDs increased (P<0.001 for trend). Among all patients who had a bystander-witnessed arrest of cardiac origin and who had ventricular fibrillation, 14.4% were alive at 1 month with minimal neurologic impairment; among patients who received shocks from public-access AEDs, 31.6% were alive at 1 month with minimal neurologic impairment. Early defibrillation, regardless of the type of provider (bystander or emergency-medical-services personnel), was associated with a good neurologic outcome after a cardiac arrest with ventricular fibrillation (adjusted odds ratio per 1-minute increase in the time to administration of shock, 0.91; 95% confidence interval, 0.89 to 0.92; P<0.001). The mean time to shock was reduced from 3.7 to 2.2 minutes, and the annual number of patients per 10 million population who survived with minimal neurologic impairment increased from 2.4 to 8.9 as the number of public-access AEDs increased from fewer than 1 per square kilometer of inhabited area to 4 or more. Full Text of Results... Conclusions Nationwide dissemination of public-access AEDs in Japan resulted in earlier administration of shocks by laypersons and in an increase in the 1-month rate of survival with minimal neurologic impairment after an out-of-hospital cardiac arrest.
Focused echocardiographic evaluation in life support and peri-resuscitation of emergency patients: a prospective trial. Breitkreutz R , Price S , Steiger HV , Seeger FH , Ilper H , Ackermann H , Rudolph M , Uddin S , Weigand MA , Müller E , Walcher F ; Emergency Ultrasound Working Group of the Johann Wolfgang Goethe-University Hospital, Frankfurt am Main . Department of Anaesthesiology, Intensive Care and Pain Therapy University of the Saarland, Medical Faculty, D-66421 Homburg (Saar), Germany. email@example.com Abstract PURPOSE OF THE STUDY: Focused ultrasound is increasingly used in the emergency setting, with an ALS-compliant focused echocardiography algorithm proposed as an adjunct in peri-resuscitation care (FEEL). The purpose of this study was to evaluate the feasibility of FEEL in pre-hospital resuscitation, the incidence of potentially treatable conditions detected, and the influence on patient management. PATIENTS, MATERIALS AND METHODS: A prospective observational study in a pre-hospital emergency setting in patients actively undergoing cardio-pulmonary resuscitation or in a shock state. The FEEL protocol was applied by trained emergency doctors, following which a standardised report sheet was completed, including echo findings and any echo-directed change in management. These reports were then analysed independently. RESULTS: A total of 230 patients were included, with 204 undergoing a FEEL examination during ongoing cardiac arrest (100) and in a shock state (104). Images of diagnostic quality were obtained in 96%. In 35% of those with an ECG diagnosis of asystole, and 58% of those with PEA, coordinated cardiac motion was detected, and associated with increased survival. Echocardiographic findings altered management in 78% of cases. CONCLUSIONS: Application of ALS-compliant echocardiography in pre-hospital care is feasible, and alters diagnosis and management in a significant number of patients. Further research into its effect on patient outcomes is warranted
NUEVAS RECOMENDACIONES RCP 2010 Ignacio Cubián González Servicio de Urgencias Hospital San Pedro
Buscar movimientos similares a convulsiones o respiración agónica. Se insiste en identificar estos movimientos o respiraciones jadeantes como parte del paro, y se insta a iniciar la RCP en estos casos. Soporte Vital Básico
Se ha eliminado “ VER, OIR y SENTIR” la respiración Soporte Vital Básico
RCP“solo con las manos” para reanimadores legos (Operadores telefónicos) Soporte Vital Básico
SOS-KANTO study group. Cardiopulmonary resuscitation by bystanders with chest compression only (SOS-KANTO): an observational study. Lancet 2007;369:920-6 [ Reference ]. (Editorial Ewy GA. Lancet 2007;369:882-4 [ Reference ]).
Sayre M, Berg R, Cave D et al. Hands-only (compression-only) cardiopulmonary resuscitation: A call to action for bystander response to adults who experience out-of-hospital sudden cardiac arrest. Circulation 2008;117:2162-67. [ Reference ] Original Article
CPR with Chest Compression Alone or with Rescue Breathing
Thomas D. Rea, M.D., Carol Fahrenbruch, M.S.P.H., Linda Culley, B.A., Rachael T. Donohoe, Ph.D., Cindy Hambly, E.M.T., Jennifer Innes, B.A., Megan Bloomingdale, E.M.T., Cleo Subido, Steven Romines, M.S.P.H., and Mickey S. Eisenberg, M.D., Ph.D.N Engl J Med 2010; 363:423-433 July 29, 2010
Outcomes of chest compression only CPR versus conventional CPR conducted by lay people in patients with out of hospital cardiopulmonary arrest witnessed by bystanders: nationwide population based observational study BMJ 2011; 2011; 342:c7106 Mejor RCP convencional sobre todo en los pacientes más jovenes,con mayor retraso en iniciarse la RCP y en aquellas de causa no cardiaca.
El profesional de la salud no debe perder más de diez segundos en comprobar el pulso Soporte Vital Básico
Soporte Vital Básico Cambio en la recomendación de “aproximadamente 100 compresiones por minuto” a “ por lo menos 100 compresiones por minuto”
Soporte Vital Básico Las compresiones deben tener una profundidad, por lo menos, de 5 cm (4 cm en lactantes). La recomendación anterior era de entre 4 y 5 cm.
Soporte Vital Básico Se enfatiza en la necesidad de reducir el tiempo de interrupción de las compresiones, ya sea para realizar una descarga o para realizar ventilaciones
Tetsuhisa Kitamura, M.D., Taku Iwami, M.D., Takashi Kawamura, M.D., Ken Nagao, M.D., Hideharu Tanaka, M.D., and Atsushi Hiraide, M.D. for the Implementation Working Group for the All-Japan Utstein Registry of the Fire and Disaster Management Agency
N Engl J Med 2010; 362:994-1004
Estudio prospectivo observacional en Japón
Supervivencia PCEH tras implementación de un programa de acceso público a DF.
Cualquier ciudadano estaba legalmente autorizado a utilizarlo.
Usar la ecografía para descartar causas potencialmente tratables de PCR .
Resuscitation. 2010 Nov;81(11):1527-33. Focused echocardiographic evaluation in life support and peri-resuscitation of emergency patients: a prospective trial. Breitkreutz R , Price S , Steiger HV , Seeger FH , Ilper H , Ackermann H , Rudolph M , Uddin S , Weigand MA , Müller E , Walcher F ; Emergency Ultrasound Working Group of the Johann Wolfgang Goethe-University Hospital, Frankfurt am Main A total of 230 patients were included, with 204 undergoing a FEEL examination during ongoing cardiac arrest (100) and in a shock state (104). Images of diagnostic quality were obtained in 96%. In 35% of those with an ECG diagnosis of asystole, and 58% of those with PEA, coordinated cardiac motion was detected, and associated with increased survival. Echocardiographic findings altered management in 78% of cases.
Lancet. 2011 Jan 22;377(9762):301-11. Standard cardiopulmonary resuscitation versus active compression-decompression cardiopulmonary resuscitation with augmentation of negative intrathoracic pressure for out-of-hospital cardiac arrest: a randomised trial. Aufderheide TP , Frascone RJ , Wayne MA , Mahoney BD , Swor RA , Domeier RM , Olinger ML , Holcomb RG , Tupper DE , Yannopoulos D , Lurie KG . Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI 53226, USA. firstname.lastname@example.org