Resuscitation highlights in 2015
2016; Elsevier BV; Volume: 100; Linguagem: Inglês
10.1016/j.resuscitation.2016.01.002
ISSN1873-1570
AutoresJerry P. Nolan, J.P. Ornato, Michael Parr, Gavin D. Perkins, Jasmeet Soar,
Tópico(s)Disaster Response and Management
ResumoThe 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations (CoSTR) and the 2015 European Resuscitation Council (ERC) Guidelines were just some of the landmark publications in Resuscitation last year.1Nolan J.P. Hazinski M.F. Aicken R. et al.Part I. Executive summary international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations.Resuscitation. 2015; 95: e1-e32Abstract Full Text Full Text PDF PubMed Google Scholar, 2Monsieurs K. Nolan J.P. Bossaert L.L. et al.European Resuscitation Council Guidelines for Resuscitation 2015 Section 1 Executive Summary.Resuscitation. 2015; 95: 1-80Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar The editors have highlighted some of the other key papers that helped to further resuscitation science in 2015. The Utstein-style template for reporting outcomes from out-of-hospital cardiac arrest (OHCA) has been revised and updated.3Perkins G.D. Jacobs I.G. Nadkarni V.M. et al.Cardiac Arrest and Cardiopulmonary Resuscitation Outcome Reports: Update of the Utstein Resuscitation Registry Templates for Out-of-Hospital Cardiac Arrest: A Statement for Healthcare Professionals From a Task Force of the International Liaison Committee on Resuscitation (American Heart Association, European Resuscitation Council, Australian and New Zealand Council on Resuscitation, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Southern Africa, Resuscitation Council of Asia); and the American Heart Association Emergency Cardiovascular Care Committee and the Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation.Resuscitation. 2015; 96: 328-340Abstract Full Text Full Text PDF PubMed Google Scholar This template facilitates reporting of the bystander-witnessed, shockable rhythm as a measure of emergency medical services (EMS) system efficacy and all EMS system-treated arrests as a measure of system effectiveness. Several additional important subgroups are identified that enable an estimate of the specific contribution of rhythm and bystander actions that are key determinants of outcome. Several recent studies have indicated that survival rates for OHCA are slowly increasing. An analysis of the Resuscitation Outcomes Consortium study sites showed that unadjusted survival rates for 47,148 EMS-treated OHCA cases increased from 8.2% in 2006 to 10.4% in 2010.4Daya M.R. Schmicker R.H. Zive D.M. et al.Out-of-hospital cardiac arrest survival improving over time: results from the Resuscitation Outcomes Consortium (ROC).Resuscitation. 2015; 91: 108-115Abstract Full Text Full Text PDF PubMed Scopus (16) Google Scholar In a sub-analysis of 111 U.S. and Canadian hospitals participating in the ROC-PRIMED study during 2007–2009, greater survival and favourable neurological status at discharge were associated with greater adherence to recommended hospital based post-resuscitative care guidelines.5Stub D. Schmicker R.H. Anderson M.L. et al.Association between hospital post-resuscitative performance and clinical outcomes after out-of-hospital cardiac arrest.Resuscitation. 2015; 92: 45-52Abstract Full Text Full Text PDF PubMed Google Scholar Four studies published in 2015 focussed on outcomes after cardiac arrest in the elderly.6Beesems S.G. Blom M.T. van der Pas M.H. et al.Comorbidity and favorable neurologic outcome after out-of-hospital cardiac arrest in patients of 70 years and older.Resuscitation. 2015; 94: 33-39Abstract Full Text Full Text PDF PubMed Google Scholar, 7Terman S.W. Shields T.A. Hume B. Silbergleit R. The influence of age and chronic medical conditions on neurological outcomes in out of hospital cardiac arrest.Resuscitation. 2015; 89: 169-176Abstract Full Text Full Text PDF PubMed Google Scholar, 8Winther-Jensen M. Pellis T. Kuiper M. et al.Mortality and neurological outcome in the elderly after target temperature management for out-of-hospital cardiac arrest.Resuscitation. 2015; 91: 92-98Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar, 9Libungan B. Lindqvist J. Stromsoe A. et al.Out-of-hospital cardiac arrest in the elderly: a large-scale population-based study.Resuscitation. 2015; 94: 28-32Abstract Full Text Full Text PDF PubMed Google Scholar Two studies documented an association between age and neurological outcome7Terman S.W. Shields T.A. Hume B. Silbergleit R. The influence of age and chronic medical conditions on neurological outcomes in out of hospital cardiac arrest.Resuscitation. 2015; 89: 169-176Abstract Full Text Full Text PDF PubMed Google Scholar, 8Winther-Jensen M. Pellis T. Kuiper M. et al.Mortality and neurological outcome in the elderly after target temperature management for out-of-hospital cardiac arrest.Resuscitation. 2015; 91: 92-98Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar but two others found no such association.6Beesems S.G. Blom M.T. van der Pas M.H. et al.Comorbidity and favorable neurologic outcome after out-of-hospital cardiac arrest in patients of 70 years and older.Resuscitation. 2015; 94: 33-39Abstract Full Text Full Text PDF PubMed Google Scholar, 9Libungan B. Lindqvist J. Stromsoe A. et al.Out-of-hospital cardiac arrest in the elderly: a large-scale population-based study.Resuscitation. 2015; 94: 28-32Abstract Full Text Full Text PDF PubMed Google Scholar In a study of seven North American cities, Pittsburgh had the highest crude rate of cardiac arrest deaths in patients 18–64 years of age, particularly in neighbourhoods with lower socioeconomic status (SES).10Uray T. Mayr F.B. Fitzgibbon J. et al.Socioeconomic factors associated with outcome after cardiac arrest in patients under the age of 65.Resuscitation. 2015; 93: 14-19Abstract Full Text Full Text PDF PubMed Google Scholar The authors retrospectively identified 415 patients aged 18–64 years treated for OHCA and in-hospital cardiac arrest (IHCA) at two Pittsburgh hospitals between January 2010 and July 2012. Socioeconomic factors strongly influenced the type, severity, and outcome of patients with OHCA but not those with IHCA. The prognostic value of pregnancy in women receiving CPR in the emergency department was evaluated in a population-based, matched cohort study using the Nationwide Emergency Department Sample (NEDS) from 2006 to 2010.11Lavecchia M. Abenhaim H.A. Cardiopulmonary resuscitation of pregnant women in the emergency department.Resuscitation. 2015; 91: 104-107Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar The authors identified 157 pregnant women among 8162 women requiring CPR in the emergency department. Pregnancy was associated with better overall survival of 36.9% compared to 25.9% in non-pregnant women (OR 1.89 [1.32–2.70], p < 0.01). Traumatic injury was identified as a significant predictor of outcome in pregnancy. In non-trauma patients, pregnant women had significantly better odds of surviving CPR than non-pregnant women (OR 2.10 [1.41–3.13], p < 0.01). In cases of trauma, no significant difference was observed between groups. Nehme and co-authors used data from the Victorian Ambulance Cardiac Arrest Registry to compare epidemiology, survival to hospital discharge and 12-month functional recovery in 8648 adult OHCAs occurring before and after paramedic arrival.12Nehme Z. Andrew E. Bernard S. Smith K. Comparison of out-of-hospital cardiac arrest occurring before and after paramedic arrival: epidemiology, survival to hospital discharge and 12-month functional recovery.Resuscitation. 2015; 89: 50-57Abstract Full Text Full Text PDF PubMed Google Scholar When compared to OHCA cases occurring before EMS arrival, EMS-witnessed arrests were associated with significantly higher survival to hospital discharge rates and favourable neurological recovery at 12-month post-arrest. In a summary of nine studies included in a systematic review of OHCA in schools, it was confirmed that OHCA in children and adolescents is rare, with a minority of cases occurring at school.13Smith C.M. Colquhoun M.C. Out-of-hospital cardiac arrest in schools: a systematic review.Resuscitation. 2015; 96: 296-302Abstract Full Text Full Text PDF PubMed Google Scholar However, when cardiac arrests occur on school property, it is more likely to affect an adult than a student. Outcomes are better than for arrests occurring at other out-of-hospital locations, probably due to the high proportion of witnessed arrests and high rates of bystander CPR. Does the number of EMS personnel on scene affect cardiac arrest outcome? In a retrospective review of 16,122 EMS-treated OHCAs from Canada and the United States, the presence of 5 or 6, 7 or 8 EMS personnel on-scene was associated with a higher rate of survival to hospital discharge compared with fewer personnel on-scene (adjusted odds ratio 1.35 [95% CI: 1.05, 1.73]).14Warren S.A. Prince D.K. Huszti E. et al.Volume versus outcome: more emergency medical services personnel on-scene and increased survival after out-of-hospital cardiac arrest.Resuscitation. 2015; 94: 40-48Abstract Full Text Full Text PDF PubMed Google Scholar The authors concluded that more EMS personnel on-scene within 15 min of a 911 call is associated with improved survival from OHCA. The publication of advanced life support (ALS) treatment recommendations in the 2015 CoSTR and 2015 guidelines by the ERC included continuing emphasis on the need for rapid response systems (RRS) of care to identify the deteriorating patient and prevent IHCA.15Soar J. Callaway C.W. Aibiki M. et al.Part 4: advanced life support: 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations.Resuscitation. 2015; 95: e71-e122Abstract Full Text Full Text PDF PubMed Scopus (0) Google Scholar, 16Soar J. Nolan J.P. Bottiger B.W. et al.European Resuscitation Council Guidelines for Resuscitation 2015 Section 3 Adult Advanced Life Support.Resuscitation. 2015; 95: 99-146Abstract Full Text Full Text PDF Google Scholar Resuscitation continues to publish important studies that aim to improve our understanding of RRS. Jarvis and colleagues assessed the Royal College of Physicians of London (RCPL) National Early Warning Score (NEWS) system and compared workloads generated by the RCPL's escalation protocol with those for aggregate NEWS values alone.17Jarvis S. Kovacs C. Briggs J. et al.Aggregate National Early Warning Score (NEWS) values are more important than high scores for a single vital signs parameter for discriminating the risk of adverse outcomes.Resuscitation. 2015; 87: 75-80Abstract Full Text Full Text PDF PubMed Google Scholar The recommended NEWS escalation protocol produced additional work for the bedside nurse and responding doctor, disproportionate to the benefit in increased detection of adverse outcomes. Efficient staff resource allocation and avoiding alarm fatigue will be increasingly important to optimise RRS in evolution. The performance of the NEWS in identifying 48 h and 30 day mortality, intensive care unit (ICU) admission, and a combined endpoint of 48 h mortality or ICU admission was evaluated in unselected prehospital patients.18Silcock D.J. Corfield A.R. Gowens P.A. Rooney K.D. Validation of the National Early Warning Score in the prehospital setting.Resuscitation. 2015; 89: 31-35Abstract Full Text Full Text PDF PubMed Google Scholar All the endpoints were associated with higher NEWS scores and they concluded that calculation of prehospital NEWS may facilitate earlier recognition of deteriorating patients, and the early involvement of senior emergency department staff. Abbott and colleagues conducted a prospective observational cohort study of all adult general medical patients admitted to a single hospital over a 20-day period.19Abbott T.E. Vaid N. Ip D. et al.A single-centre observational cohort study of admission National Early Warning Score (NEWS).Resuscitation. 2015; 92: 89-93Abstract Full Text Full Text PDF PubMed Google Scholar They aimed to compare the newly introduced NEWS to the early warning score currently used – the Patient at Risk Score (PARS). Physiological data and early warning scores recorded in bedside charts were collected on admission and a NEWS score was retrospectively calculated. The primary outcome was a composite of critical care admission or death within 2 days of admission. The secondary outcome was hospital length of stay. NEWS was more strongly associated with the primary outcome than PARS, and a NEWS of 3 or more was associated with the primary outcome (odds ratio 7.03, p = 0.003). Neither score was correlated with hospital length of stay. They suggested that current guidelines advocating a threshold of 5 for triggering a clinical review should be reviewed since a score of 3 or more was associated with a poor outcome. Both scores were poor predictors of hospital length of stay. To add weight to this suggestion a further study evaluated the weightings and calculations used for early warning scores (EWS) where calculation errors may potentially impact on hospital efficiency and patient care.20Jarvis S. Kovacs C. Briggs J. et al.Can binary early warning scores perform as well as standard early warning scores for discriminating a patient's risk of cardiac arrest, death or unanticipated intensive care unit admission.Resuscitation. 2015; 93: 46-52Abstract Full Text Full Text PDF PubMed Google Scholar They truncated 36 published 'standard' EWSs so that, for each component, only two scores were possible: 0 when the standard EWS scored 0 and 1 when the standard EWS scored greater than 0. They found that binary EWSs had lower Area under the Receiver Operating Characteristics (AUROCs) than the standard EWSs in most cases, although for some the difference was not significant. The binary form of the NEWS, had significantly better discrimination than all standard EWSs, except for NEWS. Overall, Binary NEWS at a trigger value of 3 would detect as many adverse outcomes as are detected by NEWS using a trigger of 5, but would require a 15% higher triggering rate. The balance between fewer errors and a potentially greater workload needs further investigation. Capan and colleagues studied optimal patient-centred rapid response team (RRT) activation rules using electronic medical records (EMR)-derived Markovian models.21Capan M. Ivy J.S. Rohleder T. Hickman J. Huddleston J.M. Individualizing and optimizing the use of early warning scores in acute medical care for deteriorating hospitalized patients.Resuscitation. 2015; 93: 107-112Abstract Full Text Full Text PDF PubMed Google Scholar NEWS was used and statistical tests identified 12 statistically significant subpopulations which differed clinically, as measured by length of stay and time to re-admission. They suggest the full potential of EWS for personalising acute care delivery is yet to be realised. Delivering high-quality CPR to all victims of cardiac arrest remains a key priority identified by the ILCOR review of science and treatment recommendations22Perkins G.D. Travers A.H. Considine J. et al.Part 3: adult basic life support and automated external defibrillation: 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations.Resuscitation. 2015; 95: e43-e70Abstract Full Text Full Text PDF PubMed Google Scholar and ERC Guidelines23Perkins G.D. Handley A.J. Koster K.W. et al.European Resuscitation Council Guidelines for Resuscitation 2015 Section 2 Adult basic life support and automated external defibrillation.Resuscitation. 2015; 95: 81-98Abstract Full Text Full Text PDF PubMed Scopus (0) Google Scholar Despite clear evidence of benefit from bystander CPR,24Hasselqvist-Ax I. Riva G. Herlitz J. et al.Early cardiopulmonary resuscitation in out-of-hospital cardiac arrest.N Engl J Med. 2015; 372: 2307-2315Crossref PubMed Scopus (17) Google Scholar the rates of bystander CPR remain sub-optimal in many communities. In 2015 the World Health Organization endorsed the "Kids save lives" campaign which promotes CPR in schools.25Bottiger B.W. Van Aken H. Kids save lives: training school children in cardiopulmonary resuscitation worldwide is now endorsed by the World Health Organization (WHO).Resuscitation. 2015; 94: A5-A7Abstract Full Text Full Text PDF PubMed Google Scholar This strategy is logical as school children are a captive audience, training is more efficient,26Baldi E. Bertaia D. Contri E. School children learn BLS better and in less time than adults.Resuscitation. 2015; 88: e15-e16Abstract Full Text Full Text PDF PubMed Google Scholar eager to learn and the future generation of adults. The timing of what to teach and when in the school curriculum is assisted by the findings from a systematic review by De Buck et al.27De Buck E. Van Remoortel H. Dieltjens T. et al.Evidence-based educational pathway for the integration of first aid training in school curricula.Resuscitation. 2015; 94: 8-22Abstract Full Text Full Text PDF PubMed Google Scholar Evidence from 30 studies showed that children as young as 5 can learn some skills and those over 11 are likely to help in an emergency. An evidence-based educational pathway for CPR and first aid for different age groups is presented. The issue of whether it is safe to defibrillate when properly-gloved rescuer hands are touching the patient sparked considerable interest and discussion in 2015.28Deakin C.D. Thomsen J.E. Lofgren B. Petley G.W. Achieving safe hands-on defibrillation using electrical safety gloves—a clinical evaluation.Resuscitation. 2015; 90: 163-167Abstract Full Text Full Text PDF PubMed Google Scholar, 29Kerber R.E. Hands-on defibrillation: "gloves as sweet as damask roses" (William Shakespeare: The winter's tale).Resuscitation. 2015; 90: A6-A7Abstract Full Text Full Text PDF PubMed Google Scholar, 30Kulstad E. Garrett M. Naiman M. Garrett F. Overestimated electrical exposure risk associated with hands-on defibrillation?.Resuscitation. 2015; 92: e15Abstract Full Text Full Text PDF PubMed Google Scholar, 31Lemkin D.L. Bond M.C. Witting M.D. Lemkin M.A. Reply to Letter: overestimated electrical exposure risk associated with hands-on defibrillation?.Resuscitation. 2015; 92: e17-e18Abstract Full Text Full Text PDF PubMed Google Scholar The ability of electrical insulating gloves to protect the rescuer during hands-on defibrillation was tested using a 'worst case' electrical scenario.28Deakin C.D. Thomsen J.E. Lofgren B. Petley G.W. Achieving safe hands-on defibrillation using electrical safety gloves—a clinical evaluation.Resuscitation. 2015; 90: 163-167Abstract Full Text Full Text PDF PubMed Google Scholar Data from 61 shocks applied to 43 different patients were recorded. Rescuer leakage current was significantly below the 1 mA safe threshold, enabling the authors to conclude that hands-on defibrillation is safe if the rescuer makes only one other point of contact with the patient and uses Class 1 electrical insulating gloves. Public access defibrillation (PAD) deployment rates remain low: 1% in Asia,32Ong M.E. Shin S.D. De Souza N.N. et al.Outcomes for out-of-hospital cardiac arrests across 7 countries in Asia: The Pan Asian Resuscitation Outcomes Study (PAROS).Resuscitation. 2015; 96: 100-108Abstract Full Text Full Text PDF PubMed Google Scholar 3.8% in Copenhagen,33Agerskov M. Nielsen A.M. Hansen C.M. et al.Public Access Defibrillation: great benefit and potential but infrequently used.Resuscitation. 2015; 96: 53-58Abstract Full Text Full Text PDF PubMed Google Scholar and 16% in Stockholm.34Ringh M. Jonsson M. Nordberg P. et al.Survival after Public Access Defibrillation in Stockholm, Sweden – a striking success.Resuscitation. 2015; 91: 1-7Abstract Full Text Full Text PDF PubMed Google Scholar An analysis of the cost effectiveness of PAD programmes and other studies suggests cost effectiveness would be improved by identifying locations with the highest incidence of OHCA and investing in interventions to increase AED utilisation.35Moran P.S. Teljeur C. Masterson S. O'Neill M. Harrington P. Ryan M. Cost-effectiveness of a national public access defibrillation programme.Resuscitation. 2015; 91: 48-55Abstract Full Text Full Text PDF PubMed Google Scholar, 36Moon S. Vadeboncoeur T.F. Kortuem W. et al.Analysis of out-of-hospital cardiac arrest location and public access defibrillator placement in Metropolitan Phoenix, Arizona.Resuscitation. 2015; 89: 43-49Abstract Full Text Full Text PDF PubMed Google Scholar, 37Gonzalez M. Leary M. Blewer A.L. et al.Public knowledge of automatic external defibrillators in a large U.S. urban community.Resuscitation. 2015; 92: 101-106Abstract Full Text Full Text PDF PubMed Google Scholar For example, there is a volunteer-based automated external defibrillator (AED) network in Copenhagen which provided a unique opportunity to assess AED use. Investigators found that an AED was applied before ambulance arrival in only 3.8% of all OHCA cases even though 15.1% of all events occurred within 100 m of an accessible AED. In contrast, in a retrospective analysis of OHCAs from 2006-12 in Stockholm, one-month survival was 31% (n = 101) for cases defibrillated by the EMS, 42% (n = 22) when defibrillated by first responders, and 70% (n = 52) when defibrillated by a public AED.34Ringh M. Jonsson M. Nordberg P. et al.Survival after Public Access Defibrillation in Stockholm, Sweden – a striking success.Resuscitation. 2015; 91: 1-7Abstract Full Text Full Text PDF PubMed Google Scholar AEDs within the PAD programme constituted 2.6% of all public AEDs and were used in 28% (n = 21) of cases when a public AED was used. A critical determinant of whether PAD programmes are successful hinges on matching deployed AED location with where cardiac arrests are likely to occur in the community. The location of 654 OHCAs were compared with 1704 non-medically placed AEDs in metropolitan Phoenix, Arizona during 2010–12.36Moon S. Vadeboncoeur T.F. Kortuem W. et al.Analysis of out-of-hospital cardiac arrest location and public access defibrillator placement in Metropolitan Phoenix, Arizona.Resuscitation. 2015; 89: 43-49Abstract Full Text Full Text PDF PubMed Google Scholar Events occurred most frequently at locations categorised as 'In Cars/Roads/Parking lots' (190/654, 29.1%) and there were no identified AEDs for these areas. AEDs were placed most frequently in 'Public business/office/workplace' locations and cardiac arrests occurred with the second highest frequency in this location type. The authors found only a weak correlation between events and deployed AEDs even though it was possible to identify areas where OHCAs occurred frequently. Public use of AEDs also depends on their knowledge of the devices and willingness to use them. A survey of 514 bystanders in two high-volume train stations in Philadelphia, Pennsylvania found that 66% were able to correctly identify an AED and its purpose, and 58% reported willingness to use an AED in an emergency.37Gonzalez M. Leary M. Blewer A.L. et al.Public knowledge of automatic external defibrillators in a large U.S. urban community.Resuscitation. 2015; 92: 101-106Abstract Full Text Full Text PDF PubMed Google Scholar However, less than 10% of respondents presented with a hypothetical cardiac arrest scenario spontaneously mentioned using an AED when asked what actions they would take. Mobile phone technology can link incident location, nearest PAD and a nearby first responder. One system, Pulsepoint, has been deployed to over 600 communities in the US. A user survey found 63% (n = 813) had received a notification of a nearby suspected cardiac arrest, of whom 189 (23%) had responded. Of those who did respond, one third did not make it to the scene of the incident. 44 (32%) found a victim who was unconscious and not breathing normally and CPR was provided in 11 cases.38Brooks S.C. Simmons G. Worthington H. Bobrow B.J. Morrison L.J. The PulsePoint Respond mobile device application to crowdsource basic life support for patients with out-of-hospital cardiac arrest: challenges for optimal implementation.Resuscitation. 2015; 98: 20-26Abstract Full Text Full Text PDF PubMed Google Scholar Many rescuers have wondered why resuscitation guidelines recommend resuming chest compressions for 2 min after defibrillation before checking for a pulse or analysing the rhythm. An analysis of 372 defibrillation attempts in 176 patients in the Resuscitation Outcomes Consortium (ROC) database documented 182 episodes of post-shock asystole.39Pierce A.E. Roppolo L.P. Owens P.C. Pepe P.E. Idris A.H. The need to resume chest compressions immediately after defibrillation attempts: an analysis of post-shock rhythms and duration of pulselessness following out-of-hospital cardiac arrest.Resuscitation. 2015; 89: 162-168Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar The mean interval of asystole after defibrillation was 69 ± 136 s (median 20 s; IQR 36) and the mean interval for return of an organised rhythm was 64 ± 157 s (median 7 s; IQR 26). The mean time to return of spontaneous circulation (ROSC) was 280 ± 320 s (median 136 s; IQR 445). The authors concluded that the majority of patients remain pulseless for over 2 min after defibrillation and the duration of asystole before return of pulses is longer than 120 s beyond the shock gap in as many as 25%. Their data support the recommendation to resume chest compressions for 2 min immediately following attempted defibrillation. A stepwise approach to airway management during CPR and after ROSC that is based on patient factors, the stage in the resuscitation process (during CPR or after ROSC) and the skills of the rescuer was recommended by the European Resuscitation Council in 2015 based on the ILCOR CoSTR.15Soar J. Callaway C.W. Aibiki M. et al.Part 4: advanced life support: 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations.Resuscitation. 2015; 95: e71-e122Abstract Full Text Full Text PDF PubMed Scopus (0) Google Scholar, 16Soar J. Nolan J.P. Bottiger B.W. et al.European Resuscitation Council Guidelines for Resuscitation 2015 Section 3 Adult Advanced Life Support.Resuscitation. 2015; 95: 99-146Abstract Full Text Full Text PDF Google Scholar The ILCOR ALS CoSTR systematic review comparing tracheal intubation and supraglottic airways (SGAs) did not include a meta-analysis based on the identified studies. The ERC 2015 guidelines recommend that in the absence of personnel skilled in tracheal intubation, a SGA (e.g. laryngeal mask airway, laryngeal tube or i-gel) is an acceptable alternative. However, a systematic review that included a meta-analysis of studies comparing tracheal intubation and SGAs identified 10 observational studies with 34,533 intubated patients and 41,116 SGA patients.40Benoit J.L. Gerecht R.B. Steuerwald M.T. McMullan J.T. Endotracheal intubation versus supraglottic airway placement in out-of-hospital cardiac arrest: a meta-analysis.Resuscitation. 2015; 93: 20-26Abstract Full Text Full Text PDF PubMed Google Scholar Tracheal intubation was associated with higher odds of ROSC (odds ratio [OR] 1.28, 95% confidence interval [CI] 1.05–1.55), survival to hospital admission (OR 1.34, CI 1.03–1.75), and neurologically intact survival (OR 1.33, CI 1.09–1.61). Although the numbers are impressive, as the authors state, meta-analyses cannot overcome the inherent limitations of observational studies. A conceptual model identifies potential mechanisms linking advanced airway management with OHCA outcomes.41Benoit J.L. Prince D.K. Wang H.E. Mechanisms linking advanced airway management and cardiac arrest outcomes.Resuscitation. 2015; 93: 124-127Abstract Full Text Full Text PDF PubMed Google Scholar Hopefully the results from two large RCTs [AIRWAY 2 [ISRCTN 08256118] and PART [NCT02419573]) will help answer the question of which advanced airway technique is best during CPR. Videolaryngoscopy can help improve the view of the larynx at intubation. An observational study of IHCAs compared videolaryngoscopy in 121 patients (52.8%) with direct laryngoscopy in 108 patients (47.2%).42Lee D.H. Han M. An J.Y. et al.Video laryngoscopy versus direct laryngoscopy for tracheal intubation during in-hospital cardiopulmonary resuscitation.Resuscitation. 2015; 89: 195-199Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar First attempt success was higher with videolaryngoscopy (71.9%; 87/121) than with direct laryngoscopy (52.8%; 57/108; p = 0.003). Another study of tracheal intubation by novice emergency physicians of OHCA patients arriving in the emergency department described first attempt success rate after a phase when direct laryngoscopy was used and compared this with a phase when video laryngoscopy was used.43Park S.O. Kim J.W. Na J.H. et al.Video laryngoscopy improves the first-attempt success in endotracheal intubation during cardiopulmonary resuscitation among novice physicians.Resuscitation. 2015; 89: 188-194Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar First attempt success (n = 49) was higher with video laryngoscopy compared with direct laryngoscopy (n = 34, 91.8% vs. 55.9%; p < 0.001), time for insertion was shorter (37 [29–55] vs. 62 [56–110] s; p < 0.001), oesophageal intubation occurred only with direct laryngoscopy (n = 6, 17.6%), and the median duration of chest compression interruption was shorter (0 [0–0] vs. 7 [3–6] s). The use of videolaryngoscopes is increasing despite the lack of RCTs. Waveform capnography should be used to confirm tracheal tube position in all patients who are intubated, including during CPR.16Soar J. Nolan J.P. Bottiger B.W. et al.European Resuscitation Council Guidelines for Resuscitation 2015 Section 3 Adult Advanced Life Support.Resuscitation. 2015; 95: 99-146Abstract Full
Referência(s)