viernes, 4 de febrero de 2011
Estudian si una vacuna de la gripe A provoca narcolepsia
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La prevención cerca al cáncer
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Seguridad y eficacia de la carga del desfibrilador mientras se mantienen las compresiones torácicas
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Artículo nº 1597. Vol 11 nº 2, febrero 2011.
Autor: José Luis Pérez Vela
Autor: José Luis Pérez Vela
Seguridad y eficacia de la carga del desfibrilador mientras se mantienen las compresiones torácicas
Artículo original: Safety and efficacy of defibrillator charging during ongoing chest compressions: a multi-center study. Edelson DP, Robertson-Dick BJ, Yuen TC, Eilevstjonn J, Walsh D, Bareis CJ, Vanden Hoek TL, Abella BS. Resuscitation 2010; 81(11): 1521-1526. [Resumen] [Artículos relacionados]
Introducción: A pesar que ya desde el año 2005 la AHA, y el ERC en las actuales recomendaciones de 2010, recomiendan que los reanimadores sigan haciendo compresiones torácicas mientras se carga el desfibrilador y se enfatiza la importancia de disminuir las interrupciones en las compresiones torácicas, en la práctica clínica se producen pausas frecuentes y prolongadas. Estas pausas se asocian a un peor pronóstico tanto en estudios experimentales como clínicos.
Resumen: Estudio retrospectivo en tres centros de USA que analiza la duración de la pausa peri-choque y la seguridad de realizar la carga del desfibrilador mientras se hacen compresiones torácicas, valorando choques no advertidos a los reanimadores y choques inapropiados a los pacientes. Los datos se obtuvieron de registros de los monitores desfibriladores. Se analizan un total de 680 ciclos de carga, en 244 episodios de parada cardiaca intra-hospitalaria. El desfibrilador se cargó durante la realización de compresiones torácicas en 448 (65.9%) ocasiones, destacando una amplia variabilidad entre los tres centros. La carga del desfibrilador durante las compresiones se correlacionó con una disminución en la pausa pre-choque (2,6 frente a 13,3 segundos; P < 0,001) y en el tiempo sin compresiones en los 30 segundos previos a la desfibrilación (10,3 frente a 14,8 segundos; P < 0,001). La mejoría en los tiempos fue más marcada cuando los reanimadores iniciaban la carga del desfibrilador tras el ciclo de compresiones, antes de analizar el ritmo, “anticipándose” a la necesidad de realizar (o no) una descarga. No encontraron diferencias en cuanto a choques inapropiados cuando se realizaba la carga durante las compresiones y solo en un caso se produjo la administración de un choque inadvertido por el reanimador durante las compresiones.
Comentario: En las actuales guías del ERC en resucitación se enfatiza la minimización en las interrupciones en las compresiones torácicas y la disminución de lo que podríamos denominar la pausa pre-choque [1]. El estudio analizado, si bien tiene algunas limitaciones, al ser retrospectivo, observacional y realizado en tres centros con alta formación y desarrollo en RCP, demuestra cómo en la práctica clínica la realización de la carga del desfibrilador mientras se continúa el masaje cardiaco disminuye los tiempos sin compresiones y la pausa prechoque, con mínimo riesgo para paciente y reanimadores. Apoya por tanto, una práctica clínica que, aunque ya recomendada, todavía es poco aplicada.
Introducción: A pesar que ya desde el año 2005 la AHA, y el ERC en las actuales recomendaciones de 2010, recomiendan que los reanimadores sigan haciendo compresiones torácicas mientras se carga el desfibrilador y se enfatiza la importancia de disminuir las interrupciones en las compresiones torácicas, en la práctica clínica se producen pausas frecuentes y prolongadas. Estas pausas se asocian a un peor pronóstico tanto en estudios experimentales como clínicos.
Resumen: Estudio retrospectivo en tres centros de USA que analiza la duración de la pausa peri-choque y la seguridad de realizar la carga del desfibrilador mientras se hacen compresiones torácicas, valorando choques no advertidos a los reanimadores y choques inapropiados a los pacientes. Los datos se obtuvieron de registros de los monitores desfibriladores. Se analizan un total de 680 ciclos de carga, en 244 episodios de parada cardiaca intra-hospitalaria. El desfibrilador se cargó durante la realización de compresiones torácicas en 448 (65.9%) ocasiones, destacando una amplia variabilidad entre los tres centros. La carga del desfibrilador durante las compresiones se correlacionó con una disminución en la pausa pre-choque (2,6 frente a 13,3 segundos; P < 0,001) y en el tiempo sin compresiones en los 30 segundos previos a la desfibrilación (10,3 frente a 14,8 segundos; P < 0,001). La mejoría en los tiempos fue más marcada cuando los reanimadores iniciaban la carga del desfibrilador tras el ciclo de compresiones, antes de analizar el ritmo, “anticipándose” a la necesidad de realizar (o no) una descarga. No encontraron diferencias en cuanto a choques inapropiados cuando se realizaba la carga durante las compresiones y solo en un caso se produjo la administración de un choque inadvertido por el reanimador durante las compresiones.
Comentario: En las actuales guías del ERC en resucitación se enfatiza la minimización en las interrupciones en las compresiones torácicas y la disminución de lo que podríamos denominar la pausa pre-choque [1]. El estudio analizado, si bien tiene algunas limitaciones, al ser retrospectivo, observacional y realizado en tres centros con alta formación y desarrollo en RCP, demuestra cómo en la práctica clínica la realización de la carga del desfibrilador mientras se continúa el masaje cardiaco disminuye los tiempos sin compresiones y la pausa prechoque, con mínimo riesgo para paciente y reanimadores. Apoya por tanto, una práctica clínica que, aunque ya recomendada, todavía es poco aplicada.
José Luis Pérez Vela.
Servicio de Medicina Intensiva. Hospital Universitario “12 de Octubre”. Madrid.
Comité Directivo PNRCP. SEMICYUC.
©REMI, http://remi.uninet.edu. Febrero 2011.
Enlaces:
Servicio de Medicina Intensiva. Hospital Universitario “12 de Octubre”. Madrid.
Comité Directivo PNRCP. SEMICYUC.
©REMI, http://remi.uninet.edu. Febrero 2011.
Enlaces:
- European Resuscitation Council Guidelines for Resuscitation 2010 Section 1. Executive summary. Nolan JP, Soar J, Zideman DA, Biarent D, Bossaert LL, Deakin C, Koster RW, Wyllie J, Böttiger B; ERC Guidelines Writing Group.Resuscitation 2010; 81(10): 1219-1276. [PubMed]
Búsqueda en PubMed:
- Enunciado: Seguridad de la desfibrilación durante el paro cardiaco
- Sintaxis: heart arrest[mh] AND "electric countershock"[mh] AND safety[mh]
- [Resultados]
Palabras clave: Paro cardiaco, Resucitación cardiopulmonar, Compresiones torácicas, Desfibrilación, Seguridad.
Crackdown in Egypt Widens but Officials Offer Concessions
Crackdown in Egypt Widens but Officials Offer Concessions
Ed Ou for The New York Times
By ANTHONY SHADID
Published: February 3, 2011
CAIRO — The Egyptian government on Thursday broadened its crackdown on a 10-day uprising that has shaken its rule, arresting journalists and human rights advocates across an edgy city, while offering more concessions in a bid to win support from a population growing frustrated with a devastated economy and scenes of chaos in the streets.
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Times Topics: Egypt News— The Protests | Hosni Mubarak
Related in Opinion
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Editorial: Egypt’s Agonies(February 4, 2011)
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The campaign was a startling blend of the oldest tactics of an authoritarian government — stoking fears of foreigners — with the air of sincerity of a repentant order. Trying to seize the initiative from a revolt that has marked one of the most decisive moments in modern Egyptian history, the government promised that neither President Hosni Mubarak nor his son Gamal, long seen as a contender for power, would run for president and offered dialogue with the banned Muslim Brotherhood, gestures almost unthinkable weeks ago.
As protesters battled crowds rallied by the government for a second day, organizers sought to rally even bigger demonstrations for Friday — dubbed the “Friday of departure” — in hopes of keeping the momentum behind a popular uprising that has demanded that Mr. Mubarak step down after three decades in power.
Voiced often in the tumultuous scenes of defiance and determination in Tahrir Square was a fear that if they lost, the protesters and their organizers would bear the brunt of a withering crackdown.
“If we can’t bring this to an end, we’re going to all be in the slammer by June,” said Murad Mohsen, a doctor treating the wounded at a makeshift clinic near barricades, where thousands fought off droves of government supporters with rocks and firebombs.
Dr. Mohsen’s comments illustrated the changing dynamic of an uprising that has captivated the Arab world, reverberating through Jordan, Sudan and Yemen, where there were peaceful protests on Thursday. New calls for protests went out in Algeria, Bahrain and Libya.
From festive scenes of just days ago, the revolt has become more martial, as exhausted men defend what they describe as the perimeter of a free Egypt around Tahrir Square. Their demands have grown more forceful and the uprising more radical. After pitched clashes of two days that left at least seven dead and hundreds wounded, banners in Tahrir Square declared Mr. Mubarak “a war criminal,” and several in the crowd said that the president should be executed. Major television networks were largely unable to broadcast from the square on Thursday.
The United States joined a chorus of criticism, with Secretary of State Hillary Rodham Clinton saying, “We condemn in the strongest terms attacks on peaceful demonstrators, human rights activists, foreigners and diplomats.”
The government’s strategy seems motivated at turning broader opinion in the country against the protests and perhaps wearing down the demonstrators themselves, some of whom seemed exhausted by the clashes. Vice President Omar Suleiman, appointed Saturday to a position that Mr. Mubarak had until then refused to fill, appealed to Egypt’s sense of decency in allowing Mr. Mubarak to serve out his term, and he chronicled the mounting losses that, he said, the uprising had inflicted on a crippled Egyptian economy.
“End your sit-in,” he said. “Your demands have been answered.”
Mr. Mubarak said in an interview with ABC that he was eager to step down but if he did, “Egypt would sink into chaos.”
In interviews and statements, the government has increasingly spread an image that foreigners were inciting the uprising, a refrain echoed in the streets. The suggestions are part of a days-long Egyptian media campaign that has portrayed the protesters as troublemakers and ignored the scope of an uprising with diffuse goals and leadership.
“Millions turn out to support Mubarak,” read the banner headline on Thursday on the front page of Al Ahram, the leading government newspaper.
The propaganda has been so pronounced that an announcer on Nile Television, Shahira Amin, quit. “I cleared my conscience and walked out,” she said.
The Committee to Protect Journalists said it had 100 reports of attacks on journalists. Al Jazeera, the influential Arabic channel, said government supporters stormed the Hilton Hotel in Cairo, searching for journalists, and two of its reporters were attacked. A Greek journalist was stabbed with a screwdriver and others were beaten and harassed.
Police also raided the Hisham Mubarak Law Center, a headquarters for many of the international human rights organizations working in Egypt. The human rights workers were told to lie on the floor and the chips were removed from the telephones, someone present in the building said, speaking on condition of anonymity for fear of retribution.
As the day wore on, tension descended across parts of the city, which is still guarded by popular committees that banded together after the police withdrew Saturday. Government supporters roamed parts of the downtown, itching for a fight, and looters set fire to a shopping mall along the Nile that was already looted and burned Friday.
The menace was a counterpoint to Tahrir Square, where the literati and well-off demonstrators mixed with the poorest of rough-and-tumble neighborhoods in scenes of camaraderie and determination that have made the square an emblem of the revolt. Protesters flashed V-for-victory signs at dawn, celebrating their success in holding the square and even pushing the barricades forward in clashes that dragged through the night.
Related
The Lede Blog: Latest Updates on Day 10 of Egypt Protests(February 3, 2011)
White House, Egypt Discuss Plan for Mubarak’s Exit (February 4, 2011)
Gangs Hunt Journalists and Rights Workers (February 4, 2011)
Some Fear a Street Movement’s Leaderless Status May Become a Liability (February 4, 2011)
In Yemen, Protesters Face Off in Peace (February 4, 2011)
King Moves to Widen Outreach in Jordan (February 4, 2011)
As Islamist Group Rises, Its Intentions Are Unclear(February 4, 2011)
Times Topics: Egypt News— The Protests | Hosni Mubarak
Related in Opinion
Nicholas D. Kristof: We Are All Egyptians (February 4, 2011)
Roger Cohen: Hosni Mubarak Agonistes (February 4, 2011)
Timothy Egan: Bonfire of American Vanities (February 3, 2011)
Editorial: Egypt’s Agonies(February 4, 2011)
Op-Ed Contributor: An Exit Plan for Mubarak (February 4, 2011)
A version of this article appeared in print on February 4, 2011, on page A1 of the New York edition .
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