Introduction: Cardiac arrest during procedures in the Cath Lab is excessively harmful, as manual ... more Introduction: Cardiac arrest during procedures in the Cath Lab is excessively harmful, as manual chest compressions prevents the continuity of coronary angiography and coronary angioplasty and require the assistance of trained staff in cardiopulmonary resuscitation (CPR) quickly and accurately. AutoPulse® is a mechanical CPR device that consists of mechanical pneumatic band attached to a board that involves the patient’s chest and allows effective and continuous pneumatic compressions, allowing mechanical CPR simultaneously to coronary angiography and angioplasty. Hypothesis: We assessed the hypothesis that mechanical CPR may be feasible during percutaneous coronary interventions and more effective than manual CPR by the analysis of intra-coronary pressure curves. Methods: The device was used in 6 consecutive cases of cardiac arrests (ventricular fibrillation refractory to attempts of defibrillation and standard treatment) in the Cath Lab, allowing continuity of percutaneous coronar...
Background: There is controversy in the literature about the advantages of the radial vs. femoral... more Background: There is controversy in the literature about the advantages of the radial vs. femoral access route for diagnostic catheterizations. This study aimed to compare the radial and femoral access for procedural and fluoroscopy times and for contrast volume. Methods: This was an observational, retrospective study based on the records of consecutive patients undergoing cardiac catheterization from July 2012 to December 2013. Results: We evaluated 192 patients and the radial access was used in 78.1% of the cases. Mean age was 63.1 ± 11.9 years, most were male (55.7%) and 21.4% had diabetes. Procedural time was lower in the radial group: 12.0 minutes (9.0 to 17.2 minutes) vs. 18.3 minutes (12.0 to 34.5 minutes), p < 0.01. Fluoroscopy time was 270.0 seconds (180.0 to 389.5 seconds) vs. 244.0 seconds (175.3 to 705.0 seconds), and there was no difference between groups (p = 0.59). Contrast volume was lower in the radial group: 100.0 mL (75.0 to 117.5 mL) vs. 100.0 mL (80.0 to 150.0 mL), p < 0.01. Conclusions: In this laboratory, which favored the radial access for cardiac catheterization, procedural and fluoroscopy times, as well as contrast volume, were lower or comparable to the femoral access.
An initial experience using the AutoPulse ® Non-Invasive Cardiac Support Pump in a catheterisatio... more An initial experience using the AutoPulse ® Non-Invasive Cardiac Support Pump in a catheterisation laboratory is reported. The device was used for a case of cardiopulmonary arrest in the catheterisation laboratory, allowing the percutaneous procedure to continue with simultaneous cardiopulmonary resuscitation. The device provided uninterrupted and effective chest compressions and allowed a team physician to perform other functions during the procedure. There were difficulties related to the setup of the device and to the radiopacity of the electronic components, which prevented some angiographic projections from being obtained. The use of mechanical devices for chest compressions during cardiopulmonary arrest is feasible; however, there is no proof of their benefits when compared to cardiopulmonary resuscitation using manual compressions.
Background: Studies in adults suggest that good quality chest compressions have an overall greate... more Background: Studies in adults suggest that good quality chest compressions have an overall greater importance in the outcome of resuscitation than ventilation. Whilst ventilation remains important in paediatric resuscitation this does not diminish the necessity of good quality chest compressions. Aim: To assess the quality of chest compressions provided by different paediatric health care personnel. Method: 100 volunteers were assessed in 2011 (Year 1) and 74 of those returned for re-assessment in 2013 (Year 2). They were asked to perform chest compressions for 2 min at what they believed to be the correct rate and depth of compressions. A child manikin attached to a defibrillator via adhesive pads and accelerometer puck was used. Results were recorded and downloaded via code review software to a lap top for interrogation of speed and depth over the 2 min period. Volunteers were able to use a metronome if desired. Data collected included job title, clinical area and resuscitation training record: Results: In year 1 the rates of chest compressions varied between 150 and 204 per minute. Half the volunteers chose to use the metronome which made no difference. Overall in year 1 the rates were too fast and the depths of compression were less than 1/3 depth of the chest i.e. inadequate. These volunteers had 1 further training session prior to being re-tested in year 2. The results in year 2 showed that the majority were now performing chest compressions at rates between 90 and 120 per minute and achieved compression depths of > 1/3 depth of the chest. Conclusion: Analysis of depth of chest compressions as well as rate provides important feedback to paediatric health care providers and regular training will improve quality of chest compressions provided to critically ill children.
Introduction: Cardiac arrest during procedures in the Cath Lab is excessively harmful, as manual ... more Introduction: Cardiac arrest during procedures in the Cath Lab is excessively harmful, as manual chest compressions prevents the continuity of coronary angiography and coronary angioplasty and require the assistance of trained staff in cardiopulmonary resuscitation (CPR) quickly and accurately. AutoPulse® is a mechanical CPR device that consists of mechanical pneumatic band attached to a board that involves the patient’s chest and allows effective and continuous pneumatic compressions, allowing mechanical CPR simultaneously to coronary angiography and angioplasty. Hypothesis: We assessed the hypothesis that mechanical CPR may be feasible during percutaneous coronary interventions and more effective than manual CPR by the analysis of intra-coronary pressure curves. Methods: The device was used in 6 consecutive cases of cardiac arrests (ventricular fibrillation refractory to attempts of defibrillation and standard treatment) in the Cath Lab, allowing continuity of percutaneous coronar...
Background: There is controversy in the literature about the advantages of the radial vs. femoral... more Background: There is controversy in the literature about the advantages of the radial vs. femoral access route for diagnostic catheterizations. This study aimed to compare the radial and femoral access for procedural and fluoroscopy times and for contrast volume. Methods: This was an observational, retrospective study based on the records of consecutive patients undergoing cardiac catheterization from July 2012 to December 2013. Results: We evaluated 192 patients and the radial access was used in 78.1% of the cases. Mean age was 63.1 ± 11.9 years, most were male (55.7%) and 21.4% had diabetes. Procedural time was lower in the radial group: 12.0 minutes (9.0 to 17.2 minutes) vs. 18.3 minutes (12.0 to 34.5 minutes), p < 0.01. Fluoroscopy time was 270.0 seconds (180.0 to 389.5 seconds) vs. 244.0 seconds (175.3 to 705.0 seconds), and there was no difference between groups (p = 0.59). Contrast volume was lower in the radial group: 100.0 mL (75.0 to 117.5 mL) vs. 100.0 mL (80.0 to 150.0 mL), p < 0.01. Conclusions: In this laboratory, which favored the radial access for cardiac catheterization, procedural and fluoroscopy times, as well as contrast volume, were lower or comparable to the femoral access.
An initial experience using the AutoPulse ® Non-Invasive Cardiac Support Pump in a catheterisatio... more An initial experience using the AutoPulse ® Non-Invasive Cardiac Support Pump in a catheterisation laboratory is reported. The device was used for a case of cardiopulmonary arrest in the catheterisation laboratory, allowing the percutaneous procedure to continue with simultaneous cardiopulmonary resuscitation. The device provided uninterrupted and effective chest compressions and allowed a team physician to perform other functions during the procedure. There were difficulties related to the setup of the device and to the radiopacity of the electronic components, which prevented some angiographic projections from being obtained. The use of mechanical devices for chest compressions during cardiopulmonary arrest is feasible; however, there is no proof of their benefits when compared to cardiopulmonary resuscitation using manual compressions.
Background: Studies in adults suggest that good quality chest compressions have an overall greate... more Background: Studies in adults suggest that good quality chest compressions have an overall greater importance in the outcome of resuscitation than ventilation. Whilst ventilation remains important in paediatric resuscitation this does not diminish the necessity of good quality chest compressions. Aim: To assess the quality of chest compressions provided by different paediatric health care personnel. Method: 100 volunteers were assessed in 2011 (Year 1) and 74 of those returned for re-assessment in 2013 (Year 2). They were asked to perform chest compressions for 2 min at what they believed to be the correct rate and depth of compressions. A child manikin attached to a defibrillator via adhesive pads and accelerometer puck was used. Results were recorded and downloaded via code review software to a lap top for interrogation of speed and depth over the 2 min period. Volunteers were able to use a metronome if desired. Data collected included job title, clinical area and resuscitation training record: Results: In year 1 the rates of chest compressions varied between 150 and 204 per minute. Half the volunteers chose to use the metronome which made no difference. Overall in year 1 the rates were too fast and the depths of compression were less than 1/3 depth of the chest i.e. inadequate. These volunteers had 1 further training session prior to being re-tested in year 2. The results in year 2 showed that the majority were now performing chest compressions at rates between 90 and 120 per minute and achieved compression depths of > 1/3 depth of the chest. Conclusion: Analysis of depth of chest compressions as well as rate provides important feedback to paediatric health care providers and regular training will improve quality of chest compressions provided to critically ill children.
Uploads
Papers by Túlio Vargas