Luis Sánchez-Santos

A randomized comparison of the GlideScope videolaryngoscope to the standard laryngoscopy for intubation by pediatric residents in simulated easy and difficult infant airway scenarios.

Background: Videolaryngoscopy has been developed mainly to assist difficult airway intubation. However, there is a lack of studies demonstrating the real efficacy of its use in children. In this study, we tested the hypothesis that GlideScope (Verathon Inc, Bothell, Wash) videolaryngoscope improves tracheal intubation when used by pediatric residents in an advanced patient simulation model. Methods: Pediatric residents who passed a pediatric advanced life support course were eligible for the study. An advanced infant simulator was used, and 4 scenarios were proposed: normal airway (NA), tongue edema (TE), tongue edema and oropharyngeal edema, and cervical collar. No participant had prior experience with any videolaryngoscope. After a brief instruction in GlideScope technique, each participant performed the 4 scenarios using both the standard Miller and GlideScope laryngoscopes, in a random sequence. Results: Sixteen residents were included. The number of failed intubations was higher with GlideScope in NA and TE scenarios (3 vs 0, in both cases). Mean (SD) time to successful intubation was significantly longer with GlideScope in the NA scenario (GlideScope, 38 [SD, 13] vs Miller, 26 [SD, 16] seconds; P = 0.043). The number of maneuvers was significantly higher with GlideScope in the tongue edema and oropharyngeal edema scenario (2.3 [SD, 1.5] vs 1.5 [SD, 1]; P = 0.04). Upper jaw injury index was significantly lower with GlideScope in NA (2.0 [SD, 1] vs 2.6 [SD, 0.8]; P = 0.008) and cervical collar (2.1 [SD, 1.0] vs 2.8 [SD, 0.5]; P = 0.011) scenarios. Participants considered GlideScope technique more difficult than standard Miller in NA (5 [SD, 2.0] vs 3 [SD, 1.3]; P = 0.04) and TE (5.9 [SD, 2.5] vs 3.9 [SD, 1.7]; P = 0.02) scenarios. Conclusions: In simulated scenarios of infant NA and difficult airway, when used by pediatric residents, GlideScope did not improve intubation performance when compared with the standard laryngoscope. Nevertheless, GlideScope may be safer for upper jaw injury and could have advantages in the management of complicated airway. Further studies are needed to assess if specific training will improve GlideScope intubation performance and whether the in simulator results translate into clinical practice.

Cost-efficiency assessment of Advanced Life Support (ALS) courses based on the comparison of advanced simulators with conventional manikins

BackgroundSimulation is an essential tool in modern medical education. The object of this study was to assess, in cost-effective measures, the introduction of new generation simulators in an adult life support (ALS) education program.MethodsTwo hundred fifty primary care physicians and nurses were admitted to ten ALS courses (25 students per course). Students were distributed at random in two groups (125 each). Group A candidates were trained and tested with standard ALS manikins and Group B ones with new generation emergency and life support integrated simulator systems.ResultsIn group A, 98 (78%) candidates passed the course, compared with 110 (88%) in group B (p < 0.01). The total cost of conventional courses was €7689 per course and the cost of the advanced simulator courses was €29034 per course (p < 0.001). Cost per passed student was €392 in group A and €1320 in group B (p < 0.001).ConclusionAlthough ALS advanced simulator systems may slightly increase the rate of students who pass the course, the cost-effectiveness of ALS courses with standard manikins is clearly superior.

Paediatric out-of-hospital resuscitation in an area with scattered population (Galicia-Spain)

BackgroundCardiorespiratory arrest (CRA) is a rare event in childhood. Our objective was to determine the characteristics of paediatric CRA and the immediate results of cardiopulmonary resuscitation (CPR) in Galicia, a community with a very scattered population.MethodsAll children (aged from newborn to 16 years old) who suffered an out-of-hospital CRA in Galicia and were assisted by the Public Foundation Medical Emergencies of Galicia-061 staff, from June 2002 to February 2005, were included in the study. Data were prospectively recorded following the Utsteins style guidelines.ResultsThirty-one cases were analyzed (3.4 CRA annual cases per 100.000 paediatric population). The arrest was respiratory in 16.1% and cardiac in 83.9% of cases. CRA occurred at home in 58.1% of instances. Time CRA to initiation of CPR was shorter than 10 minutes in 32.2% and longer than 20 minutes in 29.0% of cases. 22.6% of children received bystander CPR. The first recorded rhythm was asystole in 67.7% of cases. Bag-mask ventilation was used in 67.7% and in 83.8% oro-tracheal intubation was done. A peripheral venous access was achieved in 67.7% and intraosseous access was used in 16.1% of patients. 93.5% of children were treated with adrenaline. After initial CPR, sustained restoration of spontaneous circulation was achieved in 38.7% of cases. Six children (19.4%) survived until hospital discharge. Four of 5 children with respiratory arrest survived, whereas only 2 of 26 children with cardiac arrest survived until hospital discharge.ConclusionDespite the handicap of a highly disseminated population, paediatric CRA characteristics and CPR results in Galicia are comparable to references from other communities. Programs to increase bystander CPR, equip laypeople with basic CPR skills and to update life support knowledge of health staff are needed to improve outcomes.

Recomendaciones para el soporte telefónico a la reanimación por testigos desde los centros de coordinación de urgencias y emergencias

Dispatch-assisted bystander cardiopulmonary resuscitation in out-of-hospital cardiac arrest has been shown as an effective measure to improve the survival of this process. The development of a unified protocol for all dispatch centers of the different emergency medical services can be a first step towards this goal in our environment. The process of developing a recommendations document and the realization of posters of dispatch-assisted cardiopulmonary resuscitation, agreed by different actors and promoted by the Spanish Resuscitation Council, is presented.

Out-of-hospital cardiac arrest (OHCA) attended by mobile emergency teams with a physician on board. Results of the Spanish OHCA Registry (OSHCAR)

Most survival outcomes in out-of-hospital cardiac arrest (OHCA) are provided by emergency medical services (EMS) without a doctor on board. Our objective was to determine such outcomes in a whole country with public physician-led EMS.nnnMETHODSnWe analyzed data from a nationwide prospective registry of OHCA cases attended by 19 public EMS in Spain, covering the period from 1-October 2013 to 30-October 2014.nnnRESULTSnAdvanced life support (ALS) was initiated in 9347 cases (incidence 18.6 cases/105 inhabitants per year). Resuscitation was considered futile in 558 cases (5.9%), and ALS was continued in 8789 cases (94.1%); mean age 63.5±17 years, 72.1% men. Initial rhythm was shockable in 22.1% of cases. Basic life support (BLS) was provided by bystanders in 1602 (24%) cases (635 of them with telephone assistance from the dispatch center). Of 8789 patients receiving ALS, 72.1% men, 2669 (30.4%) patients had return of spontaneous circulation on hospital arrival, 50.6% when the initial rhythm was shockable. Hospital discharge with good neurological status (CPC1-2) was found in 11.1% of the study population and in 27.6% when considering the Utstein comparator group of patients. A total of 216 (2.5%) patients arrived at the hospital with ongoing resuscitation, of whom only one survived with CPC1-2, and 165 (1.9%) patients were included in non-heart-beating donation programs.nnnCONCLUSIONSnIn Spain with physician-led EMS, OHCA survival with CPC1-2 reached a reasonable percentage despite only a modest contribution of bystander BLS. Ongoing resuscitation strategy seems to be futile except when considering non-heart beating donation programs.

Out-of-hospital pediatric cardiorespiratory arrest in Galicia: impact of the 2005 resuscitation guidelines.

Introduction: Pediatric out-of-hospital cardiorespiratory arrest (CRA) is a rare event but has a high mortality and morbidity among survivors. In 2005, an international consensus on science and treatment recommendations has been released, with the aim of improving the assistance of patients who had and, eventually, increasing survival without neurologic sequelae. Our objective was to assess the impact of the 2005 guidelines on the initial prehospital assistance of children with out-of-hospital CRA in a community with scattered population. Methods: This is a prospective observational study following the Utstein-style guidelines of pediatric CRA in 2 periods: group 1 (pre-2005), from July 2002 to February 2005 (32 months); and group 2 (post-2005), from January 2007 to December 2008 (24 months). Patients aged from 0 months to 16 years who had an out-of-hospital respiratory or cardiac arrest were included in the study. Results: There were 31 patients (84% cardiac) who had CRA in group 1 and 21 patients (62% cardiac) who had CRA in group 2 (P = 0.073). Both groups were comparable in age, sex, CRA cause, place of CRA incident, management of airway, fluid administrations, and defibrillation attempts. A significant increment in the number of bystander cardiopulmonary resuscitation (CPR) was observed in group 2 (13 [62%] vs 7 [29%], P = 0.004). The intraosseous access was more frequently used in the post-2005 group (8 [38%] vs 5 [16%], P = 0.021). In group 2, a higher percentage of patients received more than 1 adrenaline dose (95% vs 61%, P = 0.006), were treated with bicarbonate (7 [33%] vs 3 [10%], P = 0.045), and were not treated with atropine (5 [24%] vs 17 [55%], P = 0.020). Survival to hospital admission, sustained return of spontaneous circulation, and survival to hospital discharge were comparable in both groups. Conclusions: In cases of pediatric out-of-hospital CRA in a community with scattered population, after the introduction of the 2005 international CPR recommendations, there was an increase in bystander CPR and changes in immediate treatment were detected. However, these changes did not result in a significant outcome improvement.

Un primer paso en la enseñanza del soporte vital básico en las escuelas: la formación de los profesores

INTRODUCTIONnTeachers may have an essential role in basic life support (BLS) training in schoolchildren. However, few data are available about their BLS learning abilities.nnnAIMnTo quantitatively assess the quality of BLS when performed by school teachers after a brief and simple training program.nnnMATERIALS AND METHODSnA quasi-experimental study with no control group, and involving primary and secondary education teachers from four privately managed and public funded schools was conducted in 3 stages: 1st. A knowledge test, 2nd: BLS training, and 3rd: Performance test. Training included a 40minutes lecture and 80minutes hands-on session with the help feedback on the quality of the chest compressions.nnnRESULTSnA total of 81 teachers were included, of which 60.5% were women. After training, the percentage of subjects able to perform the BLS sequence rose from 1.2% to 46% (P<.001). Chest compression quality also improved significantly in terms of: correct hands position (97.6 vs. 72.3%; P<.001), mean depth (48.1 vs. 38.8mm; P<.001), percentage that reached recommended depth (46.5 vs. 21.5%; P<.001), percentage of adequate decompression (78.7 vs. 61.2%; P<.05), and percentage of compressions delivered at recommended rate (64.2 vs. 26.9%; P<.001).nnnCONCLUSIONSnAfter and brief and simple training program, teachers of privately managed public funded schools were able to perform the BLS sequence and to produce chest compressions with a quality similar to that obtained by staff with a duty to assist cardiac arrest victims. The ability of schoolteachers to deliver good-quality BLS is a pre-requisite to be engaged in BLS training for schoolchildren.

Clinical assessment of long-term infusion of vecuronium in pediatric intensive care

Objective: To assess clinically the efficacy of vecuronium in providing prolonged muscle relaxation in children and to study the mean effective dose and its relation to patient age and duration of infusion. Design: Prospective, observational study. Setting: Pediatric intensive care unit (PICU) of a university tertiary care center. Patients: All pediatric patients consecutively admitted to our PICU between September 1998 and June 1999 requiring neuromuscular blockade for a period longer than 24 hours were included. Those with impairment of renal, liver and/or neuromuscular function were excluded from the study. Vecuronium infusion was adjusted according to clinically effective neuromuscular degree of blockade assessed by means of peripheral nerve stimulation in train-of-four (TOF) modality. Measurements and main results: Twenty patients were studied. Initial infusion rate was 0.09±0.01 mg/kg/hour. Duration of infusion ranged between 1 and 24 days. Mean infusion rate was 0.11±0.03 mg/kg/hour. Mean infusion ...