RESSUSCITAÇÃO CARDIORRESPIRATÓRIA

A ressuscitação cardiorrespiratória inclui todos os procedimentos que devem ser adotados para manejar uma situação de parada cardiorrespiratória, incluindo o suporte básico e avançado de vida. O suporte básico de vida inclui o ABCD primário (A - avaliar consciência, ativar sistema de emergência e avaliar respiração; B - realizar duas ventilações lentas; C - avaliar circulação e iniciar compressões torácicas; D - desfibrilação). O suporte avançado de vida inclui o ABCD secundário, que consta de: A - colocar dispositivo de via aérea; B - ventilar com pressão positiva e oxigenar adequadamente; C - garantir circulação: acesso venoso, drogas vasopressoras, considerar antiarrítmicos, tampões, marca-passo; D - diagnóstico do tipo de parada cardiorrespiratória e diagnóstico diferencial, procurando e tratando causas reversíveis de paradacardiorrespiratória. O acesso rápido ao sistema médico de emergências, a ressuscitação cardiorrespiratória e a desfibrilação rápidas (que integram o suporte básico de vida) e o suporte avançado de vida formam a “cadeia de sobrevida”, cujos quatro elos ilustram a interdependência entre os elementos de uma resposta de emergência para conseguir uma sobrevivência ótima das vítimas de parada cardíaca intra e extra-hospitalar. Unitermos: Parada cardiorrespiratória; ressuscitação cardiorrespiratória; suporte básico de vida; suporte avançado de vid

Cardiorespiratory resuscitation

A ressuscitação cardiorrespiratória inclui todos os procedimentos que devem ser adotados para manejar uma situação de parada cardiorrespiratória, incluindo o suporte básico e avançado de vida. O suporte básico de vida inclui o ABCD primário (A - avaliar consciência, ativar sistema de emergência e avaliar respiração; B - realizar duas ventilações lentas; C - avaliar circulação e iniciar compressões torácicas; D - desfibrilação). O suporte avançado de vida inclui o ABCD secundário, que consta de: A - colocar dispositivo de via aérea; B - ventilar com pressão positiva e oxigenar adequadamente; C - garantir circulação: acesso venoso, drogas vasopressoras, considerar antiarrítmicos, tampões, marca-passo; D - diagnóstico do tipo de parada cardiorrespiratória e diagnóstico diferencial, procurando e tratando causas reversíveis de parada cardiorrespiratória. O acesso rápido ao sistema médico de emergências, a ressuscitação cardiorrespiratória e a desfibrilação rápidas (que integram o suporte básico de vida) e o suporte avançado de vida formam a “cadeia de sobrevida”, cujos quatro elos ilustram a interdependência entre os elementos de uma resposta de emergência para conseguir uma sobrevivência ótima das vítimas de parada cardíaca intra e extra-hospitalar.Cardiorespiratory resuscitation includes basic and advanced life support used to assist cardiorespiratory arrest. Basic life support includes primary ABCD: A - assess responsiveness, activate emergency medical system, airway and breathing evaluation; B - perform two slow breaths; C - assess signals of circulation and provide chest compressions; D - defibrillation. Advanced life support includes secondary ABCD: A - place airway device; B - confirm effective ventilation and oxygenation; C - establish intravenous access, administer vasopressor drugs, consider antiarrhythmics, buffers and pacemaker; D - establish cardiorespiratory arrest rhythm and differential diagnosis (search for and treat reversible causes). Fast emergency medical system, cardiorespiratory resuscitation and defibrillation (basic life support) and advanced life support are the four links from the “chain of survival”. A good emergency response to achieve an optimal survival in-hospital and out-of-hospital cardiac arrest depends on a good relation between these four elements

The role of serum lactate in post-cardiac arrest syndrome

Cardiopulmonary arrest is a medical emergency with significant mortality. The success of resuscitation led to the emergence of post-cardiac arrest syndrome (PCAS), which originates from ischemia-reperfusion injury and its consequent increase in serum lactate. Despite the robust evidence correlating hyperlactatemia as a prognostic marker in critically ill patients, there is insufficient evidence about the role of serum lactate in the outcome of PCAS. Thus, the purpose of this review is to check the current evidence on the role of lactate in predicting mortality in PCAS.Keywords: Cardiac arrest; cardiopulmonary resuscitation; lactic acid

Serum neuron-specific enolase as early predictor of outcome after in-hospital cardiac arrest: a cohort study

INTRODUCTION: Outcome after cardiac arrest is mostly determined by the degree of hypoxic brain damage. Patients recovering from cardiopulmonary resuscitation are at great risk of subsequent death or severe neurological damage, including persistent vegetative state. The early definition of prognosis for these patients has ethical and economic implications. The main purpose of this study was to investigate the prognostic value of serum neuron-specific enolase (NSE) in predicting outcomes in patients early after in-hospital cardiac arrest. METHODS: Forty-five patients resuscitated from in-hospital cardiac arrest were prospectively studied from June 2003 to January 2005. Blood samples were collected, at any time between 12 and 36 hours after the arrest, for NSE measurement. Outcome was evaluated 6 months later with the Glasgow outcome scale (GOS). Patients were divided into two groups: group 1 (unfavorable outcome) included GOS 1 and 2 patients; group 2 (favorable outcome) included GOS 3, 4 and 5 patients. The Mann–Whitney U test, Student's t test and Fisher's exact test were used to compare the groups. RESULTS: The Glasgow coma scale scores were 6.1 ± 3 in group 1 and 12.1 ± 3 in group 2 (means ± SD; p < 0.001). The mean time to NSE sampling was 20.2 ± 8.3 hours in group 1 and 28.4 ± 8.7 hours in group 2 (p = 0.013). Two patients were excluded from the analysis because of sample hemolysis. At 6 months, favorable outcome was observed in nine patients (19.6%). Thirty patients (69.8%) died and four (9.3%) remained in a persistent vegetative state. The 34 patients (81.4%) in group 1 had significantly higher NSE levels (median 44.24 ng/ml, range 8.1 to 370) than those in group 2 (25.26 ng/ml, range 9.28 to 55.41; p = 0.034). CONCLUSION: Early determination of serum NSE levels is a valuable ancillary method for assessing outcome after in-hospital cardiac arrest

Echocardiographic evaluation during weaning from mechanical ventilation

INTRODUCTION: Echocardiographic, electrocardiographic and other cardiorespiratory variables can change during weaning from mechanical ventilation. OBJECTIVES: To analyze changes in cardiac function, using Doppler echocardiogram, in critical patients during weaning from mechanical ventilation, using two different weaning methods: pressure support ventilation and T-tube; and comparing patient subgroups: success vs. failure in weaning. METHODS: Randomized crossover clinical trial including patients under mechanical ventilation for more than 48 h and considered ready for weaning. Cardiorespiratory variables, oxygenation, electrocardiogram and Doppler echocardiogram findings were analyzed at baseline and after 30 min in pressure support ventilation and T-tube. Pressure support ventilation vs. T-tube and weaning success vs. failure were compared using ANOVA and Student's t-test. The level of significance was p<0.05. RESULTS: Twenty-four adult patients were evaluated. Seven patients failed at the first weaning attempt. No echocardiographic or electrocardiographic differences were observed between pressure support ventilation and T-tube. Weaning failure patients presented increases in left atrium, intraventricular septum thickness, posterior wall thickness and diameter of left ventricle and shorter isovolumetric relaxation time. Successfully weaned patients had higher levels of oxygenation. CONCLUSION: No differences were observed between Doppler echocardiographic variables and electrocardiographic and other cardiorespiratory variables during pressure support ventilation and T-tube. However cardiac structures were smaller, isovolumetric relaxation time was larger, and oxygenation level was greater in successfully weaned patient

Mechanical ventilation in patients in the intensive care unit of a general university hospital in southern Brazil: an epidemiological study

OBJECTIVES: To determine the characteristics, the frequency and the mortality rates of patients needing mechanical ventilation and to identify the risk factors associated with mortality in the intensive care unit (ICU) of a general university hospital in southern Brazil. METHOD: Prospective cohort study in patients admitted to the ICU who needed mechanical ventilation for at least 24 hours between March 2004 and April 2007. RESULTS: A total of 1,115 patients admitted to the ICU needed mechanical ventilation. The mortality rate was 51%. The mean age (± standard deviation) was 57±18 years, and the mean Acute Physiology and Chronic Health Evaluation II (APACHE II) score was 22.6±8.3. The variables independently associated with mortality were (i) conditions present at the beginning of mechanical ventilation, age (hazard ratio: 1.01;