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Introduction: Every year, five million people around the world experience an out-of-hospital cardiac arrest (OHCA) and less than 40 % receive any assistance before the arrival of the Emergency Medical Services (EMS). Ambulance operators (AO) take care of people experiencing an OHCA, stabilize and then transfer them. In Medellín, Colombia, there is a public AO and several private providers, but the information about an OHCA and the operational characteristics during the response to the event are limited. Objective: To estimate the incidence of OHCA and to explore the factors associated with survival after the event in Medellín city. Methods: Retrospective, population-based cohort study. All the medical records of patients experiencing an OHCA who were assessed and treated by ambulance operators, (AO) of the Emergency Medical Services (EMS) and private agencies in Medellin city were reviewed. Descriptive statistics were used for data analysis and the annual incidence of the event standardized for the general population was estimated. Potential survival-associated factors reported as OR with their corresponding 95% CI were explored. Results: A total of 1,447 patient records with OHCA between 2018 and 2019 were analyzed. The event incidence rate for the number of cases assessed was 28.1 (95 % CI 26.0-30.3) and 26.9 (95 % CI 24.9- 29.1) cases per 100,000 inhabitants/year for 2018 and 2019, respectively; the incidence rate of treated OHCA was 2.6 (95 % CI 2.0-3.3) and 3.2 (95 % CI 2.5-4.0) per 100,000 inhabitants/year, for 2018 and 2019. Survival on arrival at hospitals of treated cases was 14.2 % (95 % CI 5.5-22.8) and 15.5 % (95 % CI 7.4-23.5) for 2018 and 2019, respectively. Conclusions: This study portrays the operating and care characteristics of the population experiencing OHCA in Medellín city. The incidence rate of the event and the survival were lower than those reported in the literature. [ABSTRACT FROM AUTHOR]

Adult In-hospital Cardiac Arrest (IHCA) is defined as the loss of circulation of an in-patient. Following high-quality cardiopulmonary resuscitation (CPR), if the return of spontaneous circulation (ROSC) is achieved, the post-cardiac arrest syndrome develops (PCAS). This review is intended to discuss the current diagnosis and treatment of PCAS. To approach this topic, a bibliography search was conducted through direct digital access to the scientific literature published in English and Spanish between 2014 and 2020, in MedLine, SciELO, Embase and Cochrane. This search resulted in 248 articles from which original articles, systematic reviews, meta-analyses and clinical practice guidelines were selected for a total of 56 documents. The etiologies may be divided into 56% of in-hospital cardiac, and 44% of non-cardiac arrests. The incidence of this physiological collapse is up to 1.6 cases/1,000 patients admitted, and its frequency is higher in the intensive care units (ICU), with an overall survival rate of 13% at one year. The primary components of PCAS are brain injury, myocardial dysfunction and the persistence of the precipitating pathology. The mainstays for managing PCAS are the prevention of cardiac arrest, ventilation support, control of peri-cardiac arrest arrythmias, and interventions to optimize neurologic recovery. A knowledgeable healthcare staff in PCAS results in improved patient survival and future quality of life. Finally, there is clear need to do further research in the Latin American Population. [ABSTRACT FROM AUTHOR]

Introduction: In-hospital cardiac arrest is a rare but life-threatening event. However, the epidemiology of this event in intensive care units is not clear. Objective: To determine the clinical characteristics of cardiac arrest in adult patients hospitalized in several intensive care units (ICU) of the Metropolitan Area of the Aburrá Valley, Colombia, over a period of one year. Methods: Observational study for a limited period of one year for adult patients with cardiac arrest in the ICU of the hospitals of the Metropolitan Area of the Aburrá Valley, Colombia: San Vicente Foundation University Hospital, IPS University, and Manuel Uribe Ángel Hospital. Results: Of 3710 eligible patients who were treated in 91 beds, 646 cardiac arrest events occurred during this period, of which 151 were candidates for resuscitation maneuvers. The overall incidence of cardiac arrest in the ICU was 17.1%, without differences between the three hospitals included and the incidence of resuscitable cardiac arrest was 39.9 cases per 1000 admissions to the ICU. The most common cardiac arrest rhythm was asystole 54.3% and the overall survival at hospital discharge was 3.3%. Conclusion: In the analyzed ICU, cardiac arrest was an infrequent event, but it presents a high mortality at discharge from the ICU and hospital. However, the few patients who survive have a good neurological prognosis. [ABSTRACT FROM AUTHOR]

Perioperative anaphylaxis represents a complex diagnosis due to the varying intensity of the symptoms which are also shared with other pathologies. This article discusses a case of a patient that sustained 2 probable anaphylactic reactions during consecutive cranial surgeries under general anesthesia; the causal agent could not be confirmed. Investigating these reactions is essential for identifying the causal agents and preventing increasingly severe reactions in future exposures. [ABSTRACT FROM AUTHOR]

Mentioning microcirculation and endothelial dysfunction to explain the pathophysiology of diseases whose relationship was not well understood is a recent phenomenon. Microcirculation is not only compromised by disease but can be altered by conditions that the anesthesiologist faces (agents and anesthetic techniques). There is significant and increasing evidence that anesthetic agents may alter it. The importance? In a state of hypoperfusion, it can be worsened by other factors (mechanical ventilation, vasoactive medications, sedatives, opioids). In shock's late stage, the support to tissue perfusion given by peripheral circulation is weak and disappears. Therefore, is it beneficial to direct targeted therapies only toward macrovascular goals? Methods for identifying early alteration and direct therapies for restoration are important. The clinical evaluation is rapid and reproducible, and measuring body temperature determines alteration indirectly. There are other methods to determine microcirculation objectively: nowadays, optical evaluation techniques using polarized orthogonal spectral light and sidestream dark-field is the best approach. In hemorrhagic shock the degree of organ dysfunction is determined by microvasculature's alteration. Compensatory mechanisms exist for this purpose, making its measurement and use in perioperative period important. Strategies have been studied to improve tissue perfusion (recruitment of microcirculation). The recentness of the study of microcirculation calls its usefulness into question. It is necessary to determine the clinical impact through controlled clinical trials with protocols on resuscitation strategy, which can complement the current perioperative anesthetic practice. [ABSTRACT FROM AUTHOR]