Integration of basic life support training into exercise-based cardiac rehabilitation programs

Bystander cardiopulmonary resuscitation (CPR) and early defibrillation are well-recognised factors leading to better prognosis of out-of-hospital cardiac arrest (OHCA). Efforts to reinforce the local chain of survival, with great emphasis in promoting laypeople training in basic life support (BLS), have translated into enhanced outcomes and survival from OHCA. Targeted BLS training for high-risk groups such as cardiac patients and their families has been recommended, but the optimal method has not been defined. The principal aim of this thesis is to assess the feasibility and effectiveness of a novel BLS training strategy for cardiac patients at risk and their families, merged in an exercise-based cardiac rehabilitation (CR) program. Results display poor baseline BLS skills and confidence of patients and their relatives, which were enhanced after a brief BLS instruction. Additionally, a CPR retraining strategy integrated in the supervised exercise training of patients in a CR program served to prevent their skills deterioration and increase their confidence to act in case of OHCA. This formula also showed a positive effect on skill retention in the family environment. This may suggest the feasibility of this formula to effectively train cardiac patients and their relatives in BLS taking advantage of CR programs, enhancing awareness on the role of bystanders to provide early assistance to OHCA and contributing to increase the number of trained citizens in BLS

A Randomized Trial to Evaluate the Impact of Exercise-Based Cardiac Rehabilitation for the Prevention of Chemotherapy-Induced Cardiotoxicity in Patients With Breast Cancer: ONCORE Study Protocol

[Abstract] Background. Anthracyclines and monoclonal antibodies against human epidermal growth factor receptor-2 (HER2) are frequently used to treat breast cancer but they are associated with risk of developing cardiotoxicity. Implementation of cardioprotective strategies as part of breast cancer treatment are needed. To date, a limited number of studies have examined the effectiveness of cardiac rehabilitation programs or exercise programs in the prevention of cardiotoxicity through an integral assessment of cardiac function. The ONCORE study proposes an exercise-based cardiac rehabilitation program as a non-pharmacological tool for the management of chemotherapy-induced cardiotoxicity. Methods. The study protocol describes a prospective, randomized controlled trial aimed to determine whether an intervention through an exercise-based CR program can effectively prevent cardiotoxicity induced by anthracyclines and/or anti-HER2 antibodies in women with breast cancer. Three hundred and forty women with breast cancer at early stages scheduled to receive cardiotoxic chemotherapy will be randomly assigned (1:1) to participation in an exercise-based CR program (intervention group) or to usual care and physical activity recommendation (control group). Primary outcomes include changes in left ventricular ejection fraction and global longitudinal strain as markers of cardiac dysfunction assessed by transthoracic echocardiography. Secondary outcomes comprise levels of cardiovascular biomarkers and cardiopulmonary function through peak oxygen uptake determination, physical performance and psychosocial status. Supervised exercise program-related outcomes including safety, adherence/compliance, expectations and physical exercise in- and out-of-hospital are studied as exploratory outcomes. Transthoracic echocardiography, clinical test and questionnaires will be performed at the beginning and two weeks after completion of chemotherapy. Discussion. The growing incidence of breast cancer and the risk of cardiotoxicity derived from cancer treatments demand adjuvant cardioprotective strategies. The proposed study may determine if an exercise-based CR program is effective in minimizing chemotherapy-induced cardiotoxicity in this population of women with early-stage breast cancer. The proposed research question is concrete, with relevant clinical implications, transferable to clinical practice and achievable with low risk.Instituto de Salud Carlos III; PI17/0168

Thirty-Second Sit-To-Stand Test as an Alternative for Estimating Peak Oxygen Uptake and 6-Min Walking Distance in Women With Breast Cancer: A Cross-Sectional Study

[Abstract] Purpose: To determine whether the 30-s sit-to-stand (30STS) test can be a valid tool for estimating and stratifying peak oxygen uptake (VO2peak) and 6-min walking distance (6MWD) in women with breast cancer. Methods: This cross-sectional study uses data from the ONCORE randomized controlled trial, including 120 women aged 18-70 years with early-stage breast cancer under treatment with anthracycline and/or anti-HER2 antibodies. Participant characteristics were collected at baseline and pooled data from functional assessment (30STS test, relative and absolute VO2peak, and 6MWD) were collected at baseline and post-intervention (comprehensive cardio-oncology rehabilitation program vs. usual care). Bivariate correlations and multivariate linear regression analyses were performed to study the relationship between functional test variables. Results: The number of repetitions in the 30STS test showed (i) a moderate correlation with relative VO2peak (ml/kg/min) (r = 0.419; p < 0.001; n = 126), (ii) a weak correlation with absolute VO2peak (ml/min) (r = 0.241; p = 0.008; n = 120), and (iii) a moderate correlation with the 6MWD (r = 0.440; p < 0.001; n = 85). The ONCORE equations obtained from the multivariate regression models allowed the estimation of VO2peak and 6MWD (r2 = 0.390; r2 = 0.261, respectively) based on the 30STS test, and its stratification into tertiles (low, moderate, and high). Conclusion: The 30STS test was found to be a useful tool to estimate VO2peak and/or 6MWD in women with early-stage breast cancer. Its use may facilitate the assessment and stratification of functional capacity in this population for the implementation of therapeutic exercise programs if cardiopulmonary exercise testing (CPET) or 6MWT are not available.Open Access funding provided thanks to the CRUE-CSIC agreement with Springer Nature. This work was supported by a competitive grant from the Asociación Española Contra el Cáncer (AECC) Scientific Foundation — PRDLC21480DÍAZ — and by a competitive grant of the Spanish Health Research Fund of the Carlos III Health Institute (ISCIII) — PI17/01687, co-funded FEDER, through Strategic Action in Healthcare, 2017. The ISCIII is the national and international reference in biomedical research and public health in Spain. The AECC Scientific Foundation and the ISCIII had no role in study design, data collection, data analysis, data interpretation, or writing of the report. Funding for open access charge will be supported by Universidade da Coruña/CISUGFundación Científica Asociación Española Contra el Cáncer; PRDLC21480DÍA

Criteria for admitting elderly patients with acute coronary syndrome to critical care units from Spanish hospital emergency departments: a LONGEVO-SCA cohort study

Objetivo: la información sobre los condicionantes de ingreso en unidades de críticos (UC) de pacientes ancianos con síndrome coronario agudo (SCA) es escasa. El objetivo de este estudio fue describir los factores asociados al ingreso en UC en una serie de ancianos no seleccionados con SCA en España. Métodos: el registro LONGEVO-SCA incluyó prospectivamente pacientes 80 años con SCA sin elevación del segmento ST (SCASEST), realizándose una valoración geriátrica intrahospitalaria y analizándose la evolución clínica a los 6 meses. Se analizaron los condicionantes de ingreso en UC mediante regresión logística binaria. Resultados: de un total de 508 pacientes (edad media 84,3 años), 150 (29,5%) fueron ingresados en UC. Los pacientes ingresados en UC presentaban menor edad, mayor proporción de insuficiencia cardíaca aguda, troponina positiva y peor función ventricular izquierda, así como puntuaciones superiores en las escalas de riesgo GRACE y ACTION-ICU. Estos pacientes presentaban, asimismo, una mejor situación funcional y una menor prevalencia de fragilidad, y fueron sometidos a coronariografía con mayor frecuencia (p < 0,001). No se apreciaron diferencias en mortalidad hospitalaria ni evolución a los 6 meses entre ambos grupos. Los predictores independientes de ingreso en UC fueron la ausencia de insuficiencia cardíaca previa, troponina positiva al ingreso, disfunción ventricular izquierda, valores elevados en la escala GRACE y en el índice de Charlson, y ausencia de fragilidad. Conclusiones: alrededor de un tercio de los ancianos con SCASEST son ingresados en UC. Los pacientes ingresados en UC presentan mayor perfil de riesgo al ingreso y menor prevalencia de síndromes geriátricos

Acute muscle fatigue and CPR quality assisted by visual feedback devices: a randomized-crossover simulation trial

Objective: To analyse the acute muscular fatigue (AMF) in triceps brachii and rectus abdominis during compression-only and standard cardiopulmonary resuscitation (CPR) performed by certified basic life support providers. Methods: Twenty-six subjects were initially recruited and randomly allocated to two study groups according to the muscles analysed; eighteen finally met the inclusion criteria (nine in each group). Both groups carried out two CPR tests (compression-only and standard CPR) of 10 min divided into five 2-min intermittent periods. The ventilation method was freely chosen by each participant (mouth-to-mouth, pocket-mask or bag-valve-mask). CPR feedback was provided all the time. AMF was measured by tensiomyography at baseline and after each 2-min period of the CPR test, in triceps brachii or rectus abdominis according to the study group. Results: Rectus abdominis’ contraction time increased significantly during the fifth CPR period (p = 0.020). Triceps brachii’s radial muscle belly displacement (p = 0.047) and contraction velocity (p = 0.018) were lower during compression-only CPR than during standard CPR. Participants who had trained previously with feedback devices achieved better CPR quality results in both protocols. Half of participants chose bag-valve-mask to perform ventilations but attained lower significant ventilation quality than the other subjects. Conclusions: Compression-only CPR induces higher AMF than standard CPR. Significantly higher fatigue levels were found during the fifth CPR test period, regardless of the method. Adequate rescuer’s strength seems to be a requisite to take advantage of CPR quality feedback devices. Training should put more emphasis on the quality of ventilation during CPR.Sociedad para el Desarrollo de Cantabria (SODERCAN) | Ref. RH16-XX-02