Patients with cardiac arrest after fulminant pulmonary embolism (PE) have a very poor prognosis. Conventional cardiopulmonary resuscitation (CPR) is frequently unsuccessful because it does not treat ...the underlying condition. Although thrombolysis is an effective therapeutic option for patients with acute PE, this treatment has traditionally been withheld during CPR because of the anticipated risk of severe hemorrhagic complications associated with chest compressions. This chapter focuses on the mechanisms of action of thrombolytic therapy during CPR after acute PE on the basis of experimental and clinical data. In fact, most data suggest a significant improvement of overall and neurological outcome in patients receiving thrombolysis during CPR after massive PE. Although the use of thrombolytics is indeed associated with an increased incidence of hemorrhagic complications in this setting, critical bleeding complications are rare and do not seem to outweigh the potential benefits of this therapeutic option. Therefore, thrombolytic therapy should not be withheld in patients suffering cardiac arrest after massive PE, particularly if conventional CPR has failed to show immediate success and other treatment options (e.g., surgical embolectomy) are not available.
Sudden out-of-hospital cardiac arrest is the third leading cause of death in industrialized nations. Many of these lives could be saved if bystander cardiopulmonary resuscitation rates were better. ..."All citizens of the world can save a life-CHECK-CALL-COMPRESS." With these words, the International Liaison Committee on Resuscitation launched the 2019 global "World Restart a Heart" initiative to increase public awareness and improve the rates of bystander cardiopulmonary resuscitation and overall survival for millions of victims of cardiac arrest globally. All participating organizations were asked to train and to report the numbers of people trained and reached. Overall, social media impact and awareness reached up to 206 million people, and >5.4 million people were trained in cardiopulmonary resuscitation worldwide in 2019. Tool kits and information packs were circulated to 194 countries worldwide. Our simple and unified global message, "CHECK-CALL-COMPRESS," will save hundreds of thousands of lives worldwide and will further enable many policy makers around the world to take immediate and sustainable action in this most important healthcare issue and initiative.
Revisión por pares
Thrombolysis during CPR in patients after massive PE may be an adequate therapeutic option to improve overall and neurological outcome of this group of patients with a very poor prognosis. ...Thrombolytic drugs appear to have beneficial effects by both direct action on pulmonary emboli and improvement of microcirculatory perfusion. Clinical studies provide increasing evidence that thrombolytic therapy during CPR can contribute to a stabilization in patients with cardiac arrest caused by acute MI or massive PE. In addition, an improvement in the microcirculatory perfusion caused by thrombolytic treatment of patients with cardiac arrest may be a major reason for an improved neurological outcome.
Thrombolysis during CPR may increase the incidence of bleeding events, but currently available data suggest that these potential risks probably do not outweigh the benefits provided by thrombolysis during cardiac arrest. Regarding the poor prognosis of cardiac arrest and the urgent need for causal treatment options, it is now necessary to assess the effects and potential risks of this promising treatment in a large, randomized clinical trial.
At the 2013 Academic Emergency Medicine global health consensus conference, a breakout session on a resuscitation research agenda was held. Two articles focusing on cardiac arrest and trauma ...resuscitation are the result of that discussion. This article describes the burden of disease and outcomes, issues in resuscitation research, and global trends in resuscitation research funding priorities. Globally, cardiovascular disease and trauma cause a high burden of disease that receives a disproportionately smaller research investment. International resuscitation research faces unique ethical challenges. It needs reliable baseline statistics regarding quality of care and outcomes; data linkages between providers; reliable and comparable national databases; and an effective, efficient, and sustainable resuscitation research infrastructure to advance the field. Research in resuscitation in low‐ and middle‐income countries is needed to understand the epidemiology, infrastructure and systems context, level of training needed, and potential for cost‐effective care to improve outcomes. Research is needed on low‐cost models of population‐based research, ways to disseminate information to the developing world, and finding the most cost‐effective strategies to improve outcomes.
Resumen
En la Conferencia de Consenso de la Academic Emergency Medicine de 2013, tuvo lugar una sesión de grupo titulada “Un programa de investigación en reanimación”. El resultado de ese debate son dos artículos centrados en la parada cardiaca y la reanimación del paciente politraumatizado. Este artículo describe la carga de enfermedad y los resultados, los temas de la investigación en reanimación y las tendencias globales en las prioridades de financiación de la investigación en reanimación. De forma global, la enfermedad cardiovascular y el traumatismo causan una alta carga de enfermedad que recibe una cantidad desproporcionadamente menor de la inversión en investigación. La investigación en reanimación internacional se enfrenta a retos éticos únicos. Se necesitan estadísticas de referencia fiables sobre la calidad de la atención y los resultados, datos conectados entre proveedores, bases de datos nacionales comparables y fiables y una infraestructura de investigación en reanimación efectiva, eficiente y sostenible con el fin de avanzar en este campo. Se necesita investigar en reanimación en los países de recursos medios y bajos para comprender la epidemiología, el contexto de la infraestructura y los sistemas, el nivel de aprendizaje necesario y su potencial cost‐efectividad para mejorar los resultados. Se necesita también investigación en modelos de bajo coste para la investigación basada en la población, las vías para difundir la información al mundo en desarrollo y encontrar las estrategias más cost‐efectivas para mejorar los resultados.
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