Out of hospital Cardio-pulmonary arrest - Is there a role for the primary healthcare teams?

Abstract

Out of hospital cardiac arrest (OHCA) remains a major cause of morbidity and mortality. The survival rates are poor and even more frustrating are the rates of neurologically favorable outcomes at hospital discharge. In a recent IJHPR article, Einav et al. concluded that many primary care clinics are underequipped and the physicians underprepared to initiate life-saving services.The chance of having an OHCA in a primary care clinic is very low. But although the impact is small, primary care teams as well as other out-of-hospital healthcare personal should be familiar with the telephone number for summoning emergency medical services (EMS), be aware of the location of the defibrillator in their clinic, and know how to use it.The literature about effective ways to keep long-standing competencies in cardiopulmonary resuscitation among medical personnel outside the hospital is scarce. It is very difficult to evaluate the actual effectiveness of interventions on better outcome; the events are rare and unique in their nature and it hard to generalize the conclusions.The “chain of survival” concept involves a series of steps that should be taken at the scene in the community: early recognition of symptoms and activation of an emergency response system; early bystander cardiopulmonary resuscitation; rapid defibrillation, if needed; early advanced cardiac life support and integrated post-resuscitation care. In this “chain” there is an important role for healthcare personal in the community via improving their own skills and performance and via a deeper involvement in the education of the public.We should take all the needed steps so that community clinic personnel can be role models for effective and successful out of hospital cardiac resuscitation (OHCR).

Influence of the Type of Physician on Survival from Emergency-Medical-Service-Witnessed Cardiac Arrest: An Observational Study

“…[ 32 ] This disturbing fact is probably related to multiple factors such as a lack of exposure, training problems, and ALS protocols being too complicated, but above all, it might be indicative of a greater problem: Primary healthcare systems are already overwhelmed. Attending the emergency personnel causes physicians to abandon their patients in surgery and return later to deal with an increased number of waiting patients [ 32 ]. This stressful situation might weaken not only resuscitation attempts but also consultancy work.…”

Basic cardiopulmonary life support (BCLS) for cardiopulmonary resuscitation by trained paramedics and medics outside the hospital

“…The outcomes, especially neurological, are poor in victims of cardiac arrest outside the hospital. [ 1 ] Immediate cardiac compression by bystander can help buy time till medical help reaches and can improve the outcomes. [ 2 3 ] For India, availability of a larger number of CPR-trained laypersons is the need of the hour, as medical help may take time to reach the site of cardiopulmonary arrest.…”

Suporte Básico De Vida Na Atenção Primária À Saúde: Revisão Integrativa Da Literatura

“…Brasil 21,22,25,26,27,28 , dois (14,3%) na Espanha 20,24 , um (7,1%) na Turquia 19 , um (7,1%) em Cuba 15 , um (7,1%) na Finlândia 16 , um (7,1%) em Singapura 18 e dois (14,4%) não envolveram pesquisa em campo. 17,23 Em relação aos estudos desenvolvidos no Brasil, as regiões foram: três (50%) em São Paulo 22,25,26 , dois (33%) em Minas Gerais 21,27 e um (17%) na Bahia. 28 Em relação ao idioma, seis (43%) foram publicados em português 21,22,25,26,27,28 , seis (43%) em inglês 16,27,18,19,20,23 e dois (14%) em espanhol.…”

“…17,23 Em relação aos estudos desenvolvidos no Brasil, as regiões foram: três (50%) em São Paulo 22,25,26 , dois (33%) em Minas Gerais 21,27 e um (17%) na Bahia. 28 Em relação ao idioma, seis (43%) foram publicados em português 21,22,25,26,27,28 , seis (43%) em inglês 16,27,18,19,20,23 e dois (14%) em espanhol. 15,20 Quanto ao método, onze (78,6%) estudos são de nível de evidência 6, dois (14,3%) com nível de evidência 7 e um (7,1%) com nível de evidência 4.…”

“…Dos estudos com nível de evidência 6, dez (90,9%) são de abordagem quantitativa 15,16,19,21,22,24,25,26,27,28 e um (9,1%) de validação de instrumento de medida. 20 Os estudos com nível de evidência 7 referem-se à opinião de autoridade 23 e relatório de comitê de especialista. 17 22,28,25 Contatou-se escasso conhecimento dos profissionais quanto ao manuseio do DEA e cuidados a serem implementados ao se utilizar o desfibrilador no paciente em PCR.…”