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Duración de los esfuerzos de reanimación prehospitalaria después de un paro cardíaco extrahospitalario

Ken Nagao1, Hiroshi Nonogi2, Naohiro Yonemoto2

  • 1From Cardiovascular Center (K.N., S.F., S.T.), Nihon University Hospital, Tokyo, Japan; Department of Cardiology, Shizuoka General Hospital, Shizuoka, Japan (H.N.); Department of Epidemiology and Biostatistics, National Center of Neurology and Psychiatry, Tokyo, Japan (N.Y.); Department of Emergency Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA (D.F.G.); Department of Cardiology, Kawasaki Saiwai Hospital, Japan (N.I.); Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan (M.T.); Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan (S.S.); Department of Cardiology, Kyoto University, Japan (T.K.); and Department of Cardiology, Fukuoka University of School of Medicine, Japan (K.S.). nagao.ken@nihon-c.ac.jp.

Circulation
|February 28, 2016
PubMed
Resumen

Para el paro cardíaco fuera del hospital, la reanimación continua antes del hospital durante al menos 40 minutos puede maximizar las vidas salvadas. Esta duración se aplica a todos los casos de testigos adultos, independientemente del ritmo inicial o la RCP de los espectadores.

Palabras clave:
reanimación cardiopulmonarParamiento del corazónParos cardíacos fuera del hospitalla reanimación

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Área de la Ciencia:

  • Medicina de emergencia
  • Cardiología
  • Salud pública

Sus antecedentes:

  • La determinación de la duración óptima para la reanimación prehospitalaria en el paro cardíaco extrahospitalario (OHCA) es crucial para mejorar las tasas de supervivencia.
  • Las directrices actuales carecen de plazos específicos para poner fin a los esfuerzos de reanimación, lo que lleva a la variabilidad en la práctica.

Objetivo del estudio:

  • Determinar la duración mínima de la reanimación prehospitalaria requerida para lograr un resultado neurológico favorable en pacientes adultos con OHCA.
  • Analizar cómo la duración de la reanimación impacta los resultados neurológicos en diferentes ritmos iniciales de paro cardíaco y estado de RCP del espectador.

Principales métodos:

  • Análisis de 282,183 casos de OACS presenciados por personas adultas del Registro Utstein de todo Japón (2005-2012).
  • Cálculo de la duración de la reanimación prehospitalaria y su asociación con el resultado neurológico favorable de 30 días.
  • Estratificación en cuatro grupos basados en el ritmo inicial (shockable / no shockable) y la reanimación de espectadores (presente / ausente).

Principales resultados:

  • La duración mínima de la reanimación prehospitalaria para lograr una sensibilidad ≥99% para un resultado neurológico favorable osciló entre 1 y 60 minutos.
  • Una mayor duración de la reanimación se asoció con una menor probabilidad de resultados neurológicos favorables (aOR 0,84).
  • Las duraciones mínimas variaron ligeramente: 40 minutos (resistencia cardíaca con descargas eléctricas/sin espectadores), 40 minutos (resistencia cardíaca con descargas eléctricas/sin espectadores), 44 minutos (resistencia cardíaca sin descargas eléctricas/sin espectadores) y 45 minutos (resistencia cardíaca sin descargas eléctricas/sin espectadores).

Conclusiones:

  • Los esfuerzos de reanimación pre-hospitalaria deben continuarse durante al menos 40 minutos en el OHCA presenciado por un adulto.
  • Esta recomendación se basa en los hallazgos de los grupos de detención por choque y tiene como objetivo optimizar la supervivencia y los resultados neurológicos.