The objective of the present article is the approach of 2010 ECC & CPR Guidelines and their principal modifications. Guidelines are the result of scientific evidence and clinical research that support statements and new recommendations. Some important changes in 2010 present in the Chain of Survival which includes aspects of Postresuscitation Care1,2. CPR Guidelines were published and uploaded on-line (Resuscitation and Circulation publication) in October 18th, 20109,10. One of the most important training and learning strategies is the dissemination of concepts from ILCOR CPR and ECC Guidelines which had extended into ERC and AHA. This has allowed the medical personnel to treat patients victims of cardiac arrest or cardiac emergency efficiently. We are convinced that interactive methodology and clinical simulation are essential for training and learning. We cannot know cardiopulmonary resuscitation without discussion of science and performance of lively clinical scenery cases for each of the main topics in CPR and ECC / El presente artículo busca como objetivo primordial, una aproximación a las Guías 2010 y principales cambios; estamos convencidos que el entrenamiento y aprendizaje de ella se basa en los conceptos de metodología activa y simulación clínica, no podemos tener un conocimiento de la ciencia y protocolos de reanimación cardiopulmonar sin antes no haber experimentado la discusión de temas y desarrollo de casos escenarios vivenciales, para cada uno de los tópicos descritos a continuación. Una de las estrategias más importantes es la diseminación de los conceptos contenidos en las Guías ILCOR de Reanimación Cardiopulmonar que se han consensuado en la ERC y AHA. Ello ha permitido que el personal de salud trate a los pacientes victimas de paro cardiaco o emergencias cardiacas con mayor eficiencia. Las guías actuales fundamentan todos sus aspectos en investigación y recomendaciones, los cambios se iniciaron con una variación sustantiva de la cadena de supervivencia incorporando conceptos de integración de cuidados postparo1,2. Las Guías de Reanimación Cardiopulmonar fueron publicadas y puestas on-line (Resuscitation y American Heart Association) en Octubre 18, 20109,10.

Este estudo objetivou conhecer a prevalência de parada cardiorrespiratória (PCR) atendida pelo SAMU de Araras entre 2001 e 2007, caracterizar as vítimas segundo o sexo, faixa etária, antecedentes mórbidos, natureza traumática do evento; a parada ter sido presenciada, realização de ressuscitação cardiopulmonar (RCP) por familiares/acompanhantes, tempo resposta, tipo de suporte de vida recebido na cena, indicação de choque pelo Desfibrilador Externo Automático (DEA), assim como identificar as variáveis significativas para o retorno da circulação espontânea na cena. Os dados foram coletados retrospectivamente das fichas de atendimento das vítimas de PCR do SAMU de Araras após aprovação do Comitê de Ética em Pesquisa da EEUSP. Foram selecionadas 328 fichas que preencheram os critérios de inclusão. O SAMU de Araras realizou 28.924 atendimentos gerais no período estudado, dos quais em 330 foram iniciadas as manobras de ressuscitação cardiopulmonar. A taxa de PCR no período avaliado é 1,13%, com predomínio do sexo masculino 208 (64,60%) e faixa etária entre 70 e 79 anos, média de idade 63,35 anos. Os antecedentes mórbidos mais citados foram cardiopatias (29,48%), hipertensão arterial sistêmica (25,43%) e diabetes (12,14%), a maioria com citação de um único antecedente ou sem este registro. Não havia trauma associado em 302 (92,64%) vítimas. O DEA foi utilizado em 280 (85,37%) vítimas, com indicação de choque em 95 (29%). A PCR foi presenciada em 115 (35,00%) vítimas, para as quais houve maior percentual de início de RCP (p=0,004) pela família/ acompanhante e houve mais indicação de choque pelo DEA(p<0,001) em relação às vítimas que foram encontradas em PCR. Houve maior proporção do retorno da circulação espontânea nas vítimas que receberam suporte avançado de vida na cena 54(31,76%), (p=0,018) em relação às que receberam somente suporte básico de vida. O tempo resposta médio foi de 05:24 minutos. Pela análise univariada, as seguintes variáveis foram significativas (p<0,05) para o retorno da circulação espontânea: faixa etária (p=0,018), diabetes melitus (p<0,001), responsividade (p=0,041), pulso carotídeo presente na avaliação inicial (p= 0,001), compressões torácicas pelo SAMU (p=0,028), choque pelo DEA (p<0,001), suporte avançado de vida (p=0,018), intubação traqueal (p<0,001). No modelo de regressão logística múltipla apenas \"pulso carotídeo presente na abordagem inicial\" foi selecionada como preditora independente para o retorno da circulação espontânea na cena (Odds Ratio 4,03), p =0,002.Concluiu-se que o serviço oferece um tempo resposta dentro dos padrões mundialmente recomendados e que as vítimas que tiveram PCR presenciada, apesar de receberem proporcionalmente mais RCP pela família/acompanhante e terem mais indicação de choque pelo DEA, não apresentaram mais retorno da circulação espontânea na cena. As vítimas com pulso presente na avaliação inicial do SAMU, isto é, as que tiveram a PCR presenciada pela equipe, ou tempo resposta \"zero\" têm 4,03 mais chances de retorno da circulação espontânea na cena, sendo esta variável a única preditora independente. O investimento em capacitação permanente da equipe do SAMU, ensino da população a reconhecer um evento crítico, iniciar manobras de reanimação e acionar precocemente o SAMU poderão contribuir para aumentar as chances de sobrevivência de vítimas de PCR em ambiente pré-hospitalar / The objective of this study was to know the prevalence of cardiac arrest (CA) assisted by Emergency Medical Service of the City of Araras (SAMU-Araras), SP, Brazil, between 2001 and 2007, classifying victims according to the gender, age groups, morbid antecedents, traumatic nature of the event, witnessed arrest, accomplishment of cardiopulmonar ressuscitation (CPR) by bystanders, time elapsed between the call of SAMU and the arrival of the EMS team to the site (time-response), type of life support received on-scene, shock indication for AED, as well as to compare the outcome of these cases, in terms of return of the spontaneous circulation (ROSC) still on scene, according to those variables. Data were collected from the records of SAMU of Araras, after approval of the Research Ethics Board of the Nurse School of University of São Paulo (EEUSP). 328 records that fulfilled the criteria were selected. SAMU-Araras accomplished 28.924 general medical attendances in the period of the study. In 330, CPR was performed (1.13%). Man (64.60%) and age group between 70 e 79 years old were predominants, and 63,35 yo. was the average. The mentioned prior diseases were cardiopathy (29.48%), sistemic arterial hypertension (25.43%) and diabetes (12.14%), most of all with just one problem cited or even no prior diseases. There was not associated trauma in 92.64% of the cases. AED was used in 85.37% of the cases were CPR was performed, with shock indication in 95 (29%) victims. CA was witnessed in 115 (35.00%) victims. In these cases, CPR performed by relatives were more frequent (p=0.004), as well as shock was more frequently indicated (p <0.001) compared with those where CA was not witnessed. There was larger proportion (51.83%) of ROSC in the victims that received advanced life support on scene, (p=0.018) comparing to the ones that received only basic life support. The time-response average was 05:24 minutes. The following variables presented statistical association (p <0.05) for ROSC: age group (p=0.018), diabetes (p <0.001), responsivity (p=0.041), carotid pulse present at the time of initial assesment (p=0,001), thoracic compressions by the SAMU team (p=0.028), shock delivered by AED (p <0.001), advanced life support performed (p = 0.018), and use of tracheal tube (p <0.001). In the statistical model of multiple logistics regression only the variable \"carotid pulse present at the time of initial assesment\" was selected as independent predictor for the return of the spontaneous circulation on scene (Odds Ratio 4.03), p =0.002. In conclusion, the SAMU-Araras offers a time-response according to international recommendations. Victims that have had witnessed CA, although received more frequenty CPR and recommended shock, they did not have better outcomes. The victims with present pulse in the initial assessment by the SAMU team, or in other words, the ones that presented CA witnessed by the SAMU team, had 4.03 more times in terms of chances of ROSC on scene, being this an independent predictor. The investment in permanent training of the SAMU professionals, the education for the people recognize a critical event and immediately to begin CPR can contribute to increase the survival chances for victims of CA in prehospital environment

Este estudo objetivou conhecer a prevalência de parada cardiorrespiratória (PCR) atendida pelo SAMU de Araras entre 2001 e 2007, caracterizar as vítimas segundo o sexo, faixa etária, antecedentes mórbidos, natureza traumática do evento; a parada ter sido presenciada, realização de ressuscitação cardiopulmonar (RCP) por familiares/acompanhantes, tempo resposta, tipo de suporte de vida recebido na cena, indicação de choque pelo Desfibrilador Externo Automático (DEA), assim como identificar as variáveis significativas para o retorno da circulação espontânea na cena. Os dados foram coletados retrospectivamente das fichas de atendimento das vítimas de PCR do SAMU de Araras após aprovação do Comitê de Ética em Pesquisa da EEUSP. Foram selecionadas 328 fichas que preencheram os critérios de inclusão. O SAMU de Araras realizou 28.924 atendimentos gerais no período estudado, dos quais em 330 foram iniciadas as manobras de ressuscitação cardiopulmonar. A taxa de PCR no período avaliado é 1,13%, com predomínio do sexo masculino 208 (64,60%) e faixa etária entre 70 e 79 anos, média de idade 63,35 anos. Os antecedentes mórbidos mais citados foram cardiopatias (29,48%), hipertensão arterial sistêmica (25,43%) e diabetes (12,14%), a maioria com citação de um único antecedente ou sem este registro. Não havia trauma associado em 302 (92,64%) vítimas. O DEA foi utilizado em 280 (85,37%) vítimas, com indicação de choque em 95 (29%). A PCR foi presenciada em 115 (35,00%) vítimas, para as quais houve maior percentual de início de RCP (p=0,004) pela família/ acompanhante e houve mais indicação de choque pelo DEA(p<0,001) em relação às vítimas que foram encontradas em PCR. Houve maior proporção do retorno da circulação espontânea nas vítimas que receberam suporte avançado de vida na cena 54(31,76%), (p=0,018) em relação às que receberam somente suporte básico de vida. O tempo resposta médio foi de 05:24 minutos. Pela análise univariada, as seguintes variáveis foram significativas (p<0,05) para o retorno da circulação espontânea: faixa etária (p=0,018), diabetes melitus (p<0,001), responsividade (p=0,041), pulso carotídeo presente na avaliação inicial (p= 0,001), compressões torácicas pelo SAMU (p=0,028), choque pelo DEA (p<0,001), suporte avançado de vida (p=0,018), intubação traqueal (p<0,001). No modelo de regressão logística múltipla apenas \"pulso carotídeo presente na abordagem inicial\" foi selecionada como preditora independente para o retorno da circulação espontânea na cena (Odds Ratio 4,03), p =0,002.Concluiu-se que o serviço oferece um tempo resposta dentro dos padrões mundialmente recomendados e que as vítimas que tiveram PCR presenciada, apesar de receberem proporcionalmente mais RCP pela família/acompanhante e terem mais indicação de choque pelo DEA, não apresentaram mais retorno da circulação espontânea na cena. As vítimas com pulso presente na avaliação inicial do SAMU, isto é, as que tiveram a PCR presenciada pela equipe, ou tempo resposta \"zero\" têm 4,03 mais chances de retorno da circulação espontânea na cena, sendo esta variável a única preditora independente. O investimento em capacitação permanente da equipe do SAMU, ensino da população a reconhecer um evento crítico, iniciar manobras de reanimação e acionar precocemente o SAMU poderão contribuir para aumentar as chances de sobrevivência de vítimas de PCR em ambiente pré-hospitalar / The objective of this study was to know the prevalence of cardiac arrest (CA) assisted by Emergency Medical Service of the City of Araras (SAMU-Araras), SP, Brazil, between 2001 and 2007, classifying victims according to the gender, age groups, morbid antecedents, traumatic nature of the event, witnessed arrest, accomplishment of cardiopulmonar ressuscitation (CPR) by bystanders, time elapsed between the call of SAMU and the arrival of the EMS team to the site (time-response), type of life support received on-scene, shock indication for AED, as well as to compare the outcome of these cases, in terms of return of the spontaneous circulation (ROSC) still on scene, according to those variables. Data were collected from the records of SAMU of Araras, after approval of the Research Ethics Board of the Nurse School of University of São Paulo (EEUSP). 328 records that fulfilled the criteria were selected. SAMU-Araras accomplished 28.924 general medical attendances in the period of the study. In 330, CPR was performed (1.13%). Man (64.60%) and age group between 70 e 79 years old were predominants, and 63,35 yo. was the average. The mentioned prior diseases were cardiopathy (29.48%), sistemic arterial hypertension (25.43%) and diabetes (12.14%), most of all with just one problem cited or even no prior diseases. There was not associated trauma in 92.64% of the cases. AED was used in 85.37% of the cases were CPR was performed, with shock indication in 95 (29%) victims. CA was witnessed in 115 (35.00%) victims. In these cases, CPR performed by relatives were more frequent (p=0.004), as well as shock was more frequently indicated (p <0.001) compared with those where CA was not witnessed. There was larger proportion (51.83%) of ROSC in the victims that received advanced life support on scene, (p=0.018) comparing to the ones that received only basic life support. The time-response average was 05:24 minutes. The following variables presented statistical association (p <0.05) for ROSC: age group (p=0.018), diabetes (p <0.001), responsivity (p=0.041), carotid pulse present at the time of initial assesment (p=0,001), thoracic compressions by the SAMU team (p=0.028), shock delivered by AED (p <0.001), advanced life support performed (p = 0.018), and use of tracheal tube (p <0.001). In the statistical model of multiple logistics regression only the variable \"carotid pulse present at the time of initial assesment\" was selected as independent predictor for the return of the spontaneous circulation on scene (Odds Ratio 4.03), p =0.002. In conclusion, the SAMU-Araras offers a time-response according to international recommendations. Victims that have had witnessed CA, although received more frequenty CPR and recommended shock, they did not have better outcomes. The victims with present pulse in the initial assessment by the SAMU team, or in other words, the ones that presented CA witnessed by the SAMU team, had 4.03 more times in terms of chances of ROSC on scene, being this an independent predictor. The investment in permanent training of the SAMU professionals, the education for the people recognize a critical event and immediately to begin CPR can contribute to increase the survival chances for victims of CA in prehospital environment

abstract: Medical students acquire and enhance their clinical skills using various available techniques and resources. As the health care profession has move towards team-based practice, students and trainees need to practice team-based procedures that involve timely management of clinical tasks and adequate communication with other members of the team. Such team-based procedures include surgical and clinical procedures, some of which are protocol-driven. Cost and time required for individual team-based training sessions, along with other factors, contribute to making the training complex and challenging. A great deal of research has been done on medically-focused collaborative virtual reality (VR)-based training for protocol-driven procedures as a cost-effective as well as time-efficient solution. Most VR-based simulators focus on training of individual personnel. The ones which focus on providing team training provide an interactive simulation for only a few scenarios in a collaborative virtual environment (CVE). These simulators are suited for didactic training for cognitive skills development. The training sessions in the simulators require the physical presence of mentors. The problem with this kind of system is that the mentor must be present at the training location (either physically or virtually) to evaluate the performance of the team (or an individual). Another issue is that there is no efficient methodology that exists to provide feedback to the trainees during the training session itself (formative feedback). Furthermore, they lack the ability to provide training in acquisition or improvement of psychomotor skills for the tasks that require force or touch feedback such as cardiopulmonary resuscitation (CPR). To find a potential solution to overcome some of these concerns, a novel training system was designed and developed that utilizes the integration of sensors into a CVE for time-critical medical procedures. The system allows the participants to simultaneously access the CVE and receive training from geographically diverse locations. The system is also able to provide real-time feedback and is also able to store important data during each training/testing session. Finally, this study also presents a generalizable collaborative team-training system that can be used across various team-based procedures in medical as well as non-medical domains. / Dissertation/Thesis / Ph.D. Biomedical Informatics 2014