Paro cardiaco / Cardiac arrest

Noviembre 5, 2017. No. 2893

Epinefrina en el paro cardíaco fuera del hospital: ¿Útil o perjudicial? Epinephrine in Out-of-hospital Cardiac Arrest: Helpful or Harmful? Shao H1, Li CS1. Author information Chin Med J (Engl). 2017 Sep 5;130(17):2112-2116. doi: 10.4103/0366-6999.213429. Abstract OBJECTIVE: Epinephrine is the primary drug administered during cardiopulmonary resuscitation (CPR) to reverse cardiac arrest. The evidence for the use of adrenaline in out-of-hospital cardiac arrest (OHCA) and in-hospital resuscitation is inconclusive. We conducted a systematic review on the clinical efficacy of adrenaline in adult OHCA patients to evaluate whether epinephrine provides any overall benefit for patients. DATA SOURCES: The EMBASE and PubMed databases were searched with the key words "epinephrine," "cardiac arrest," and variations of these terms. STUDY SELECTION: Data from clinical randomized trials, meta-analyses, guidelines, and recent reviews were selected for review. RESULTS: Sudden cardiac arrest causes 544,000 deaths in China each year, with survival occurring in <1% of cases (compared with 12% in the United States). The American Heart Association recommends the use of epinephrine in patients with cardiac arrest, as part of advanced cardiac life support. There is a clear evidence of an association between epinephrine and increased return of spontaneous circulation (ROSC). However, there are conflicting results regarding long-term survival and functional recovery, particularly neurological outcome, after CPR. There is currently insufficient evidence to support or reject epinephrine administration during resuscitation. We believe that epinephrine may have a role in resuscitation, as administration of epinephrine during CPR increases the probability of restoring cardiac activity with pulses, which is an essential intermediate step toward long-term survival. CONCLUSIONS: The administration of adrenaline was associated with improved short-term survival (ROSC). However, it appears that the use of adrenaline is associated with no benefit on survival to hospital discharge or survival with favorable neurological outcome after OHCA, and it may have a harmful effect. Larger placebo-controlled, double-blind, randomized control trials are required to definitively establish the effect of epinephrine. PDF El papel del centro de despacho en la reanimación. The role of dispatch in resuscitation. Ng YY1, Leong SH2, Ong ME3,4. Author information Singapore Med J. 2017 Jul;58(7):449-452. doi: 10.11622/smedj.2017059. Abstract The role of the dispatch centre has increasingly become a focus of attention in cardiac arrest resuscitation. The dispatch centre is part of the first link in the chain of survival because without the initiation of early access, the rest of the chain is irrelevant. The influence of dispatch can also extend to the initiation of bystander cardiopulmonary resuscitation, early defibrillation and the rapid dispatch of emergency ambulances. The new International Liaison Committee on Resuscitation, the American Heart Association and, especially, the European ResuscitationCouncil 2015 guidelines have been increasing their emphasis on dispatch as the key to improving out-of-hospital cardiac arrest survival. KEYWORDS: cardiopulmonary resuscitation; dispatcher-assisted CPR; primary safety access point; public access defibrillation; telephone CPR PDF LI Congreso Mexicano de Anestesiología Mérida Yucatán, Noviembre 21-25, 2017 Información / Information

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org

Paro cardiaco y embarazo / Cardiac arrest and pregnancy

Octubre 12, 2017. No. 2839

Fundamentos en el paro cardíaco durante la cesárea Essentials in cardiac arrest during cesarean section. van Liempt SW, Stoecklein K, Tjiong MY, Schwarte LA, de Groot CJ, Teunissen PW. Author information Clin Pract. 2015 Feb 17;5(1):668. doi: 10.4081/cp.2015.668. eCollection 2015 Jan 28. Abstract Cardiac arrest during cesarean section is very rare. Obstetrical teams have low exposure to these critical situations necessitating frequent rehearsal and knowledge of its differential diagnosis and treatment. A 40-year-old woman pregnant with triplets underwent cesarean sections because of vaginal bleeding due to a placenta previa at 35.2 weeks of gestation. Spinal anesthesia was performed. Asystole occurred during uterotomy. Immediate resuscitation and delivery of the neonates eventually resulted in good maternal and neonatal outcomes. The differential diagnosis is essential and should include obstetric and non-obstetric causes. We describe the consideration of Bezold Jarisch reflex and amniotic fluid embolism as most appropriate in this case. KEYWORDS: Bezold Jarisch reflex; cardiac arrest; cesarean section PDF Colapso materno: Desafiando la regla de cuatro minutos. Maternal collapse: Challenging the four-minute rule. Benson MD1, Padovano A2, Bourjeily G3, Zhou Y4. Author information EBioMedicine. 2016 Apr;6:253-257. doi: 10.1016/j.ebiom.2016.02.042. Epub 2016 Mar 2. Abstract INTRODUCTION: The current approach to, cardiopulmonary resuscitation of pregnant women in the third trimester has been to adhere to the "four-minute rule": If pulses have not returned within 4min of the start of resuscitation, perform a cesarean birth so that birth occurs in the next minute. This investigation sought to re-examine the evidence for the four-minute rule. METHODS: A literature review focused on perimortem cesarean birth was performed using the same key words that were used in formulating the "four-minute rule." Maternal and neonatal injury free survival rates as a function of arrest to birth intervals were determined, as well as actual incision to birth intervals. RESULTS: Both maternal and neonatal injury free survival rates diminished steadily as the time interval from maternal arrest to birth increased. There was no evidence for any specific survival threshold at 4min. Skin incision to birth intervals of 1min occurred in only 10% of women. CONCLUSION: Once a decision to deliver is made, care providers should proceed directly to Cesarean birth during maternal cardiac arrest in the third trimester rather than waiting for 4min for restoration of the maternal pulse. Birth within 1min from the start of the incision is uncommon in these circumstances. KEYWORDS: Cardiopulmonary resuscitation in pregnancy; Maternal cardiac arrest; Maternal mortality; Perimortem cesarean section; Postmortem cesarean section PDF Paro Cardíaco en el embarazo Dr. Manuel Eduardo Sáenz Madrigal, Dr. Carlos Adrián Vindas Morera Rev. Costarr. Cardiol. 2013 Julio-Diciembre, Volumen 15, N.º 2 Resumen El paro cardíaco en el embarazo presenta un escenario único en el que están incluidos dos pacientes: la madre y el feto. El manejo de este escenario requiere de un equipo multidisciplinario incluyendo especialistas en anestesia, obstetricia, neonatología, cardiología y en ocasiones cirugía cardíaca. Los protocolos de soporte vital básico y soporte cardíaco avanzado deben ser implementados, sin embargo, dados los cambios anatómicos y fisiológicos que ocurren en el embarazo, algunas modificaciones en los algoritmos son fundamentales. La evidencia existente acerca del manejo del paro cardíaco en el embarazo es relativamente insuficiente, sin estudios randomizados, por lo tanto las recomendaciones son basadas en pequeños estudios de cohorte y reportes de casos, además de la opinión de los expertos. En esta revisión hablaremos del paro cardíaco en el embarazo, sus implicaciones y el manejo adecuado por parte del equipo multidisciplinario, además del tiempo en el que se debe realizar la cesárea en caso de no retorno de circulación espontánea. Palabras clave: paro, cardíaco, reanimación, cardiopulmonar y embarazo. PDF XXVII Congreso Peruano de Anestesiología Lima, Noviembre 2-4, 2017 Informes / Information

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org